|
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
|
|
|
HC PRO APPLY FOREARM CAST
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
9832907501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$242.06
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$234.65
|
| Rate for Payer: Beech Street Commercial |
$394.25
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$239.59
|
| Rate for Payer: Cigna of WY Commercial |
$242.06
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: First Choice Health Commercial |
$222.30
|
| Rate for Payer: First Choice Health Commercial |
$373.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$234.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: HealthUtah PPO |
$247.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$239.59
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: One Health Plan of WY PPO |
$242.06
|
| Rate for Payer: PacificSource Commercial |
$222.30
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$394.25
|
| Rate for Payer: PHCS PPO |
$234.65
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: Three Rivers PPO |
$185.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$214.89
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: WINHealth Partners Commercial |
$352.75
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
|
|
HC PRO APPLY FOREARM SPLINT,STATIC
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
9832912501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$39.18
|
| Rate for Payer: Aetna of WY Medicare |
$39.18
|
| Rate for Payer: Beech Street Commercial |
$181.45
|
| Rate for Payer: Beech Street Commercial |
$346.75
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: First Choice Health Commercial |
$171.90
|
| Rate for Payer: First Choice Health Commercial |
$328.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.18
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$33.30
|
| Rate for Payer: Multiplan Medicare/VA |
$33.30
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$346.75
|
| Rate for Payer: PHCS PPO |
$181.45
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.18
|
| Rate for Payer: TriWest Veterans Administration |
$39.18
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$39.18
|
| Rate for Payer: United Healthcare Medicare |
$39.18
|
| Rate for Payer: WINHealth Partners Commercial |
$310.25
|
| Rate for Payer: WINHealth Partners Commercial |
$162.35
|
|
|
HC PRO APPLY FOREARM SPLINT,STATIC
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 29125 NONPBBPAYER
|
| Hospital Charge Code |
9832912501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$39.18
|
| Rate for Payer: Beech Street Commercial |
$227.05
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: First Choice Health Commercial |
$215.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.18
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$33.30
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$227.05
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.18
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$39.18
|
| Rate for Payer: WINHealth Partners Commercial |
$203.15
|
|
|
HC PRO APPLY LONG ARM CAST
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 29065 NONPBBPAYER
|
| Hospital Charge Code |
9832906501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.12
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Beech Street Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.68
|
| Rate for Payer: Cigna of WY Commercial |
$337.12
|
| Rate for Payer: First Choice Health Commercial |
$309.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.68
|
| Rate for Payer: Multiplan Medicare/VA |
$56.10
|
| Rate for Payer: One Health Plan of WY PPO |
$337.12
|
| Rate for Payer: PacificSource Commercial |
$309.60
|
| Rate for Payer: PHCS PPO |
$326.80
|
| Rate for Payer: Three Rivers PPO |
$258.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$299.28
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$292.40
|
|
|
HC PRO APPLY LONG ARM CAST
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
9832906501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$369.46
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Beech Street Commercial |
$358.15
|
| Rate for Payer: Beech Street Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$365.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Cigna of WY Commercial |
$369.46
|
| Rate for Payer: First Choice Health Commercial |
$339.30
|
| Rate for Payer: First Choice Health Commercial |
$247.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$358.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: HealthUtah PPO |
$377.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$365.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$56.10
|
| Rate for Payer: Multiplan Medicare/VA |
$56.10
|
| Rate for Payer: One Health Plan of WY PPO |
$369.46
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PacificSource Commercial |
$339.30
|
| Rate for Payer: PHCS PPO |
$261.25
|
| Rate for Payer: PHCS PPO |
$358.15
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: Three Rivers PPO |
$282.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$327.99
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$233.75
|
| Rate for Payer: WINHealth Partners Commercial |
$320.45
|
|
|
HC PRO APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 29105 50,NONPBBPAYER
|
| Hospital Charge Code |
9832910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$570.36
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$552.90
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$564.54
|
| Rate for Payer: Cigna of WY Commercial |
$570.36
|
| Rate for Payer: First Choice Health Commercial |
$523.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$552.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: HealthUtah PPO |
$582.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$564.54
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: One Health Plan of WY PPO |
$570.36
|
| Rate for Payer: PacificSource Commercial |
$523.80
|
| Rate for Payer: PHCS PPO |
$552.90
|
| Rate for Payer: Three Rivers PPO |
$436.50
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: United Healthcare Commercial |
$506.34
|
| Rate for Payer: United Healthcare Medicare |
$39.56
|
| Rate for Payer: WINHealth Partners Commercial |
$494.70
|
|
|
HC PRO APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
9832910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$367.65
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: First Choice Health Commercial |
$348.30
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: PHCS PPO |
$367.65
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: United Healthcare Commercial |
$336.69
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$39.56
|
| Rate for Payer: United Healthcare Medicare |
$39.56
|
| Rate for Payer: WINHealth Partners Commercial |
$198.05
|
| Rate for Payer: WINHealth Partners Commercial |
$328.95
|
|
|
HC PRO APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 29105 NONPBBPAYER
|
| Hospital Charge Code |
9832910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$285.18
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$276.45
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$282.27
|
| Rate for Payer: Cigna of WY Commercial |
$285.18
|
| Rate for Payer: First Choice Health Commercial |
$261.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$276.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$282.27
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: One Health Plan of WY PPO |
$285.18
|
| Rate for Payer: PacificSource Commercial |
$261.90
|
| Rate for Payer: PHCS PPO |
$276.45
|
| Rate for Payer: Three Rivers PPO |
$218.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: United Healthcare Commercial |
$253.17
|
| Rate for Payer: United Healthcare Medicare |
$39.56
|
| Rate for Payer: WINHealth Partners Commercial |
$247.35
|
|
|
HC PRO APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 29105 50
|
| Hospital Charge Code |
9832910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$466.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$456.68
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$442.70
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.02
|
| Rate for Payer: Cigna of WY Commercial |
$456.68
|
| Rate for Payer: First Choice Health Commercial |
$419.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$442.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: HealthUtah PPO |
$466.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.02
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: One Health Plan of WY PPO |
$456.68
|
| Rate for Payer: PacificSource Commercial |
$419.40
|
| Rate for Payer: PHCS PPO |
$442.70
|
| Rate for Payer: Three Rivers PPO |
$349.50
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: United Healthcare Commercial |
$405.42
|
| Rate for Payer: United Healthcare Medicare |
$39.56
|
| Rate for Payer: WINHealth Partners Commercial |
$396.10
|
|
|
HC PRO APPLY LOWER LEG SPLINT
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 29515 50,NONPBBPAYER
|
| Hospital Charge Code |
9832951501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$48.18
|
| Rate for Payer: Beech Street Commercial |
$484.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: First Choice Health Commercial |
$459.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.18
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$40.95
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$484.50
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.18
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$48.18
|
| Rate for Payer: WINHealth Partners Commercial |
$433.50
|
|
|
HC PRO APPLY LOWER LEG SPLINT
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 29515 50
|
| Hospital Charge Code |
9832951501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$399.84
|
| Rate for Payer: Aetna of WY Medicare |
$48.18
|
| Rate for Payer: Beech Street Commercial |
$387.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$395.76
|
| Rate for Payer: Cigna of WY Commercial |
$399.84
|
| Rate for Payer: First Choice Health Commercial |
$367.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$387.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.18
|
| Rate for Payer: HealthUtah PPO |
$408.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$395.76
|
| Rate for Payer: Multiplan Medicare/VA |
$40.95
|
| Rate for Payer: One Health Plan of WY PPO |
$399.84
|
| Rate for Payer: PacificSource Commercial |
$367.20
|
| Rate for Payer: PHCS PPO |
$387.60
|
| Rate for Payer: Three Rivers PPO |
$306.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.18
|
| Rate for Payer: United Healthcare Commercial |
$354.96
|
| Rate for Payer: United Healthcare Medicare |
$48.18
|
| Rate for Payer: WINHealth Partners Commercial |
$346.80
|
|
|
HC PRO APPLY LOWER LEG SPLINT
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 29515 NONPBBPAYER
|
| Hospital Charge Code |
9832951501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$48.18
|
| Rate for Payer: Beech Street Commercial |
$242.25
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: First Choice Health Commercial |
$229.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.18
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$40.95
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$242.25
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.18
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$48.18
|
| Rate for Payer: WINHealth Partners Commercial |
$216.75
|
|
|
HC PRO APPLY LOWER LEG SPLINT
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
9832951501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$440.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Aetna of WY Medicare |
$48.18
|
| Rate for Payer: Aetna of WY Medicare |
$48.18
|
| Rate for Payer: Beech Street Commercial |
$193.80
|
| Rate for Payer: Beech Street Commercial |
$426.55
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$435.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: Cigna of WY Commercial |
$440.02
|
| Rate for Payer: First Choice Health Commercial |
$183.60
|
| Rate for Payer: First Choice Health Commercial |
$404.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.18
|
| Rate for Payer: HealthUtah PPO |
$449.00
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$435.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$40.95
|
| Rate for Payer: Multiplan Medicare/VA |
$40.95
|
| Rate for Payer: One Health Plan of WY PPO |
$440.02
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PacificSource Commercial |
$404.10
|
| Rate for Payer: PHCS PPO |
$426.55
|
| Rate for Payer: PHCS PPO |
$193.80
|
| Rate for Payer: Three Rivers PPO |
$336.75
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.18
|
| Rate for Payer: TriWest Veterans Administration |
$48.18
|
| Rate for Payer: United Healthcare Commercial |
$177.48
|
| Rate for Payer: United Healthcare Commercial |
$390.63
|
| Rate for Payer: United Healthcare Medicare |
$48.18
|
| Rate for Payer: United Healthcare Medicare |
$48.18
|
| Rate for Payer: WINHealth Partners Commercial |
$381.65
|
| Rate for Payer: WINHealth Partners Commercial |
$173.40
|
|
|
HC PRO ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
9832263301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,718.56
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,718.56
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1,460.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,718.56
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,718.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
HC PRO ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
9832684101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$646.11 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,657.76
|
| Rate for Payer: Aetna of WY Medicare |
$760.13
|
| Rate for Payer: Beech Street Commercial |
$2,576.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,630.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,657.76
|
| Rate for Payer: First Choice Health Commercial |
$2,440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,576.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$760.13
|
| Rate for Payer: HealthUtah PPO |
$2,712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,630.64
|
| Rate for Payer: Multiplan Medicare/VA |
$646.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,657.76
|
| Rate for Payer: PacificSource Commercial |
$2,440.80
|
| Rate for Payer: PHCS PPO |
$2,576.40
|
| Rate for Payer: Three Rivers PPO |
$2,034.00
|
| Rate for Payer: TriWest Veterans Administration |
$760.13
|
| Rate for Payer: United Healthcare Commercial |
$2,359.44
|
| Rate for Payer: United Healthcare Medicare |
$760.13
|
| Rate for Payer: WINHealth Partners Commercial |
$2,305.20
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 20605 NONPBBPAYER
|
| Hospital Charge Code |
9832060501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$149.60
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 20605 50,NONPBBPAYER
|
| Hospital Charge Code |
9832060501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$344.96
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$334.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$341.44
|
| Rate for Payer: Cigna of WY Commercial |
$344.96
|
| Rate for Payer: First Choice Health Commercial |
$316.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$341.44
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$344.96
|
| Rate for Payer: PacificSource Commercial |
$316.80
|
| Rate for Payer: PHCS PPO |
$334.40
|
| Rate for Payer: Three Rivers PPO |
$264.00
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$306.24
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$299.20
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
9832060501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.18
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$133.95
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.77
|
| Rate for Payer: Cigna of WY Commercial |
$138.18
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: First Choice Health Commercial |
$126.90
|
| Rate for Payer: First Choice Health Commercial |
$308.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: HealthUtah PPO |
$141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.77
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.18
|
| Rate for Payer: PacificSource Commercial |
$126.90
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: PHCS PPO |
$133.95
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: Three Rivers PPO |
$105.75
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$122.67
|
| Rate for Payer: United Healthcare Commercial |
$298.41
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$291.55
|
| Rate for Payer: WINHealth Partners Commercial |
$119.85
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Hospital Charge Code |
9832060501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$267.90
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: First Choice Health Commercial |
$253.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$267.90
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$245.34
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$239.70
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 20610 50,NONPBBPAYER
|
| Hospital Charge Code |
9832061001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$454.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$444.92
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$431.30
|
| Rate for Payer: Cash Price |
$317.80
|
| Rate for Payer: Cash Price |
$317.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$440.38
|
| Rate for Payer: Cigna of WY Commercial |
$444.92
|
| Rate for Payer: First Choice Health Commercial |
$408.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$431.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$454.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$440.38
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$444.92
|
| Rate for Payer: PacificSource Commercial |
$408.60
|
| Rate for Payer: PHCS PPO |
$431.30
|
| Rate for Payer: Three Rivers PPO |
$340.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$394.98
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$385.90
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
9832061001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$172.90
|
| Rate for Payer: Beech Street Commercial |
$399.00
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: First Choice Health Commercial |
$163.80
|
| Rate for Payer: First Choice Health Commercial |
$378.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$399.00
|
| Rate for Payer: PHCS PPO |
$172.90
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$357.00
|
| Rate for Payer: WINHealth Partners Commercial |
$154.70
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 20610 50
|
| Hospital Charge Code |
9832061001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$345.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: First Choice Health Commercial |
$327.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$345.80
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$316.68
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$309.40
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 20610 NONPBBPAYER
|
| Hospital Charge Code |
9832061001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.46
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$215.65
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.19
|
| Rate for Payer: Cigna of WY Commercial |
$222.46
|
| Rate for Payer: First Choice Health Commercial |
$204.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.19
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$222.46
|
| Rate for Payer: PacificSource Commercial |
$204.30
|
| Rate for Payer: PHCS PPO |
$215.65
|
| Rate for Payer: Three Rivers PPO |
$170.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$197.49
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$192.95
|
|
|
HC PRO ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
9832061101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$56.35
|
| Rate for Payer: Beech Street Commercial |
$349.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: First Choice Health Commercial |
$331.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.35
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$47.90
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$349.60
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.35
|
| Rate for Payer: United Healthcare Commercial |
$320.16
|
| Rate for Payer: United Healthcare Medicare |
$56.35
|
| Rate for Payer: WINHealth Partners Commercial |
$312.80
|
|
