|
HC PRO CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
9826464201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$102.02
|
| Rate for Payer: Beech Street Commercial |
$522.50
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: First Choice Health Commercial |
$495.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.02
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$86.72
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$522.50
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$102.02
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$102.02
|
| Rate for Payer: WINHealth Partners Commercial |
$467.50
|
|
|
HC PRO CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 64615 NONPBBPAYER
|
| Hospital Charge Code |
9836461501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$115.77
|
| Rate for Payer: Beech Street Commercial |
$597.55
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: First Choice Health Commercial |
$566.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.77
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$98.40
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$597.55
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$115.77
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Medicare |
$115.77
|
| Rate for Payer: WINHealth Partners Commercial |
$534.65
|
|
|
HC PRO CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
9836461201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Medicare |
$115.32
|
| Rate for Payer: Beech Street Commercial |
$640.30
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: First Choice Health Commercial |
$606.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.32
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Multiplan Medicare/VA |
$98.02
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$640.30
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.32
|
| Rate for Payer: United Healthcare Commercial |
$586.38
|
| Rate for Payer: United Healthcare Medicare |
$115.32
|
| Rate for Payer: WINHealth Partners Commercial |
$572.90
|
|
|
HC PRO CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 64612 50
|
| Hospital Charge Code |
9836461201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,321.04
|
| Rate for Payer: Aetna of WY Medicare |
$115.32
|
| Rate for Payer: Beech Street Commercial |
$1,280.60
|
| Rate for Payer: Cash Price |
$943.60
|
| Rate for Payer: Cash Price |
$943.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,307.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,321.04
|
| Rate for Payer: First Choice Health Commercial |
$1,213.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,280.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.32
|
| Rate for Payer: HealthUtah PPO |
$1,348.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,307.56
|
| Rate for Payer: Multiplan Medicare/VA |
$98.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,321.04
|
| Rate for Payer: PacificSource Commercial |
$1,213.20
|
| Rate for Payer: PHCS PPO |
$1,280.60
|
| Rate for Payer: Three Rivers PPO |
$1,011.00
|
| Rate for Payer: TriWest Veterans Administration |
$115.32
|
| Rate for Payer: United Healthcare Commercial |
$1,172.76
|
| Rate for Payer: United Healthcare Medicare |
$115.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.80
|
|
|
HC PRO CHOLECYSTECTOMY
|
Professional
|
Both
|
$5,541.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
9834760001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$5,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,430.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,016.29
|
| Rate for Payer: Beech Street Commercial |
$5,263.95
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,374.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,430.18
|
| Rate for Payer: First Choice Health Commercial |
$4,986.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,016.29
|
| Rate for Payer: HealthUtah PPO |
$5,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,374.77
|
| Rate for Payer: Multiplan Medicare/VA |
$863.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5,430.18
|
| Rate for Payer: PacificSource Commercial |
$4,986.90
|
| Rate for Payer: PHCS PPO |
$5,263.95
|
| Rate for Payer: Three Rivers PPO |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,016.29
|
| Rate for Payer: United Healthcare Commercial |
$4,820.67
|
| Rate for Payer: United Healthcare Medicare |
$1,016.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.85
|
|
|
HC PRO CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,815.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
9754760501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$908.98 |
| Max. Negotiated Rate |
$3,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,738.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.39
|
| Rate for Payer: Beech Street Commercial |
$3,624.25
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,700.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,738.70
|
| Rate for Payer: First Choice Health Commercial |
$3,433.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,624.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.39
|
| Rate for Payer: HealthUtah PPO |
$3,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,700.55
|
| Rate for Payer: Multiplan Medicare/VA |
$908.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,738.70
|
| Rate for Payer: PacificSource Commercial |
$3,433.50
|
| Rate for Payer: PHCS PPO |
$3,624.25
|
| Rate for Payer: Three Rivers PPO |
$2,861.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.39
|
| Rate for Payer: United Healthcare Commercial |
$3,319.05
|
| Rate for Payer: United Healthcare Medicare |
$1,069.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,242.75
|
|
|
HC PRO CHROMOTUBATION OVIDUCT W/MATERIALS
|
Professional
|
Both
|
$2,209.00
|
|
|
Service Code
|
HCPCS 58350
|
| Hospital Charge Code |
9755835001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$2,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,164.82
|
| Rate for Payer: Aetna of WY Medicare |
$92.76
|
| Rate for Payer: Beech Street Commercial |
$2,098.55
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,142.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,164.82
|
| Rate for Payer: First Choice Health Commercial |
$1,988.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,098.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.76
|
| Rate for Payer: HealthUtah PPO |
$2,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,142.73
|
| Rate for Payer: Multiplan Medicare/VA |
$78.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,164.82
|
| Rate for Payer: PacificSource Commercial |
$1,988.10
|
| Rate for Payer: PHCS PPO |
$2,098.55
|
| Rate for Payer: Three Rivers PPO |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration |
$92.76
|
| Rate for Payer: United Healthcare Commercial |
$1,921.83
|
| Rate for Payer: United Healthcare Medicare |
$92.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,877.65
|
|
|
HC PRO CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99490
|
| Hospital Charge Code |
9839949001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.54
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$119.31
|
| Rate for Payer: Cigna of WY Commercial |
$120.54
|
| Rate for Payer: First Choice Health Commercial |
$110.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$123.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$119.31
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$120.54
|
| Rate for Payer: PacificSource Commercial |
$110.70
|
| Rate for Payer: PHCS PPO |
$116.85
|
| Rate for Payer: Three Rivers PPO |
$92.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$107.01
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$116.85
|
|
|
HC PRO CIRCUMCISION AGE 28 DAYS OR OLDER
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 54161 NONPBBPAYER
|
| Hospital Charge Code |
9835416101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$161.87 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$970.20
|
| Rate for Payer: Aetna of WY Medicare |
$190.43
|
| Rate for Payer: Beech Street Commercial |
$940.50
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$960.30
|
| Rate for Payer: Cigna of WY Commercial |
$970.20
|
| Rate for Payer: First Choice Health Commercial |
$891.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.43
|
| Rate for Payer: HealthUtah PPO |
$990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$960.30
|
| Rate for Payer: Multiplan Medicare/VA |
$161.87
|
| Rate for Payer: One Health Plan of WY PPO |
$970.20
|
| Rate for Payer: PacificSource Commercial |
$891.00
|
| Rate for Payer: PHCS PPO |
$940.50
|
| Rate for Payer: Three Rivers PPO |
$742.50
|
| Rate for Payer: TriWest Veterans Administration |
$190.43
|
| Rate for Payer: United Healthcare Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare |
$190.43
|
| Rate for Payer: WINHealth Partners Commercial |
$841.50
|
|
|
HC PRO CIRCUMCISION AGE 28 DAYS OR OLDER
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
9835416101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$161.87 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$776.16
|
| Rate for Payer: Aetna of WY Medicare |
$190.43
|
| Rate for Payer: Beech Street Commercial |
$752.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$768.24
|
| Rate for Payer: Cigna of WY Commercial |
$776.16
|
| Rate for Payer: First Choice Health Commercial |
$712.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$752.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.43
|
| Rate for Payer: HealthUtah PPO |
$792.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$768.24
|
| Rate for Payer: Multiplan Medicare/VA |
$161.87
|
| Rate for Payer: One Health Plan of WY PPO |
$776.16
|
| Rate for Payer: PacificSource Commercial |
$712.80
|
| Rate for Payer: PHCS PPO |
$752.40
|
| Rate for Payer: Three Rivers PPO |
$594.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.43
|
| Rate for Payer: United Healthcare Commercial |
$689.04
|
| Rate for Payer: United Healthcare Medicare |
$190.43
|
| Rate for Payer: WINHealth Partners Commercial |
$673.20
|
|
|
HC PRO CIRCUMCISION NEONATE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 54160 NONPBBPAYER
|
| Hospital Charge Code |
9835416001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$769.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$753.62
|
| Rate for Payer: Aetna of WY Medicare |
$140.12
|
| Rate for Payer: Beech Street Commercial |
$730.55
|
| Rate for Payer: Cash Price |
$538.30
|
| Rate for Payer: Cash Price |
$538.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$745.93
|
| Rate for Payer: Cigna of WY Commercial |
$753.62
|
| Rate for Payer: First Choice Health Commercial |
$692.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$730.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.12
|
| Rate for Payer: HealthUtah PPO |
$769.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$745.93
|
| Rate for Payer: Multiplan Medicare/VA |
$119.10
|
| Rate for Payer: One Health Plan of WY PPO |
$753.62
|
| Rate for Payer: PacificSource Commercial |
$692.10
|
| Rate for Payer: PHCS PPO |
$730.55
|
| Rate for Payer: Three Rivers PPO |
$576.75
|
| Rate for Payer: TriWest Veterans Administration |
$140.12
|
| Rate for Payer: United Healthcare Commercial |
$669.03
|
| Rate for Payer: United Healthcare Medicare |
$140.12
|
| Rate for Payer: WINHealth Partners Commercial |
$653.65
|
|
|
HC PRO CIRCUMCISION NEONATE
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
9835416001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$602.70
|
| Rate for Payer: Aetna of WY Medicare |
$140.12
|
| Rate for Payer: Beech Street Commercial |
$584.25
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$596.55
|
| Rate for Payer: Cigna of WY Commercial |
$602.70
|
| Rate for Payer: First Choice Health Commercial |
$553.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.12
|
| Rate for Payer: HealthUtah PPO |
$615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$596.55
|
| Rate for Payer: Multiplan Medicare/VA |
$119.10
|
| Rate for Payer: One Health Plan of WY PPO |
$602.70
|
| Rate for Payer: PacificSource Commercial |
$553.50
|
| Rate for Payer: PHCS PPO |
$584.25
|
| Rate for Payer: Three Rivers PPO |
$461.25
|
| Rate for Payer: TriWest Veterans Administration |
$140.12
|
| Rate for Payer: United Healthcare Commercial |
$535.05
|
| Rate for Payer: United Healthcare Medicare |
$140.12
|
| Rate for Payer: WINHealth Partners Commercial |
$522.75
|
|
|
HC PRO CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 54150 NONPBBPAYER
|
| Hospital Charge Code |
9835415001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
HC PRO CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
9835415001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$308.25 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Beech Street Commercial |
$390.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: First Choice Health Commercial |
$369.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: HealthUtah PPO |
$411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$390.45
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: WINHealth Partners Commercial |
$349.35
|
|
|
HC PRO CLOSED FX REDUC TX FEMORAL DISTAL W/O MA
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27508 NONPBBPAYER
|
| Hospital Charge Code |
9832750801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,508.80
|
| Rate for Payer: Aetna of WY Medicare |
$491.29
|
| Rate for Payer: Beech Street Commercial |
$2,432.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,483.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,508.80
|
| Rate for Payer: First Choice Health Commercial |
$2,304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,432.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.29
|
| Rate for Payer: HealthUtah PPO |
$2,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,483.20
|
| Rate for Payer: Multiplan Medicare/VA |
$417.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,508.80
|
| Rate for Payer: PacificSource Commercial |
$2,304.00
|
| Rate for Payer: PHCS PPO |
$2,432.00
|
| Rate for Payer: Three Rivers PPO |
$1,920.00
|
| Rate for Payer: TriWest Veterans Administration |
$491.29
|
| Rate for Payer: United Healthcare Commercial |
$2,227.20
|
| Rate for Payer: United Healthcare Medicare |
$491.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,176.00
|
|
|
HC PRO CLOSED FX REDUC TX FEMORAL DISTAL W/O MA
|
Professional
|
Both
|
$2,048.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
9832750801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$2,048.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,007.04
|
| Rate for Payer: Aetna of WY Medicare |
$491.29
|
| Rate for Payer: Beech Street Commercial |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,986.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,007.04
|
| Rate for Payer: First Choice Health Commercial |
$1,843.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,945.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.29
|
| Rate for Payer: HealthUtah PPO |
$2,048.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,986.56
|
| Rate for Payer: Multiplan Medicare/VA |
$417.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,007.04
|
| Rate for Payer: PacificSource Commercial |
$1,843.20
|
| Rate for Payer: PHCS PPO |
$1,945.60
|
| Rate for Payer: Three Rivers PPO |
$1,536.00
|
| Rate for Payer: TriWest Veterans Administration |
$491.29
|
| Rate for Payer: United Healthcare Commercial |
$1,781.76
|
| Rate for Payer: United Healthcare Medicare |
$491.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,740.80
|
|
|
HC PRO CLOSED RX MT-PHAL TOE DISLOCATION
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
9832863001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.83 |
| Max. Negotiated Rate |
$844.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$827.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$448.84
|
| Rate for Payer: Aetna of WY Medicare |
$108.04
|
| Rate for Payer: Aetna of WY Medicare |
$108.04
|
| Rate for Payer: Beech Street Commercial |
$435.10
|
| Rate for Payer: Beech Street Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$320.60
|
| Rate for Payer: Cash Price |
$320.60
|
| Rate for Payer: Cash Price |
$590.80
|
| Rate for Payer: Cash Price |
$590.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$818.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.26
|
| Rate for Payer: Cigna of WY Commercial |
$448.84
|
| Rate for Payer: Cigna of WY Commercial |
$827.12
|
| Rate for Payer: First Choice Health Commercial |
$412.20
|
| Rate for Payer: First Choice Health Commercial |
$759.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$801.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.04
|
| Rate for Payer: HealthUtah PPO |
$844.00
|
| Rate for Payer: HealthUtah PPO |
$458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$818.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.26
|
| Rate for Payer: Multiplan Medicare/VA |
$91.83
|
| Rate for Payer: Multiplan Medicare/VA |
$91.83
|
| Rate for Payer: One Health Plan of WY PPO |
$827.12
|
| Rate for Payer: One Health Plan of WY PPO |
$448.84
|
| Rate for Payer: PacificSource Commercial |
$412.20
|
| Rate for Payer: PacificSource Commercial |
$759.60
|
| Rate for Payer: PHCS PPO |
$801.80
|
| Rate for Payer: PHCS PPO |
$435.10
|
| Rate for Payer: Three Rivers PPO |
$633.00
|
| Rate for Payer: Three Rivers PPO |
$343.50
|
| Rate for Payer: TriWest Veterans Administration |
$108.04
|
| Rate for Payer: TriWest Veterans Administration |
$108.04
|
| Rate for Payer: United Healthcare Commercial |
$398.46
|
| Rate for Payer: United Healthcare Commercial |
$734.28
|
| Rate for Payer: United Healthcare Medicare |
$108.04
|
| Rate for Payer: United Healthcare Medicare |
$108.04
|
| Rate for Payer: WINHealth Partners Commercial |
$717.40
|
| Rate for Payer: WINHealth Partners Commercial |
$389.30
|
|
|
HC PRO CLOSED RX MT-PHAL TOE DISLOCATION
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 28630 NONPBBPAYER
|
| Hospital Charge Code |
9832863001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.83 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$561.54
|
| Rate for Payer: Aetna of WY Medicare |
$108.04
|
| Rate for Payer: Beech Street Commercial |
$544.35
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.81
|
| Rate for Payer: Cigna of WY Commercial |
$561.54
|
| Rate for Payer: First Choice Health Commercial |
$515.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$544.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.04
|
| Rate for Payer: HealthUtah PPO |
$573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.81
|
| Rate for Payer: Multiplan Medicare/VA |
$91.83
|
| Rate for Payer: One Health Plan of WY PPO |
$561.54
|
| Rate for Payer: PacificSource Commercial |
$515.70
|
| Rate for Payer: PHCS PPO |
$544.35
|
| Rate for Payer: Three Rivers PPO |
$429.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.04
|
| Rate for Payer: United Healthcare Commercial |
$498.51
|
| Rate for Payer: United Healthcare Medicare |
$108.04
|
| Rate for Payer: WINHealth Partners Commercial |
$487.05
|
|
|
HC PRO CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$3,696.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
9832722201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$804.11 |
| Max. Negotiated Rate |
$3,696.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,622.08
|
| Rate for Payer: Aetna of WY Medicare |
$946.01
|
| Rate for Payer: Beech Street Commercial |
$3,511.20
|
| Rate for Payer: Cash Price |
$2,587.20
|
| Rate for Payer: Cash Price |
$2,587.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,585.12
|
| Rate for Payer: Cigna of WY Commercial |
$3,622.08
|
| Rate for Payer: First Choice Health Commercial |
$3,326.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,511.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.01
|
| Rate for Payer: HealthUtah PPO |
$3,696.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,585.12
|
| Rate for Payer: Multiplan Medicare/VA |
$804.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,622.08
|
| Rate for Payer: PacificSource Commercial |
$3,326.40
|
| Rate for Payer: PHCS PPO |
$3,511.20
|
| Rate for Payer: Three Rivers PPO |
$2,772.00
|
| Rate for Payer: TriWest Veterans Administration |
$946.01
|
| Rate for Payer: United Healthcare Commercial |
$3,215.52
|
| Rate for Payer: United Healthcare Medicare |
$946.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,141.60
|
|
|
HC PRO CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$4,620.00
|
|
|
Service Code
|
HCPCS 27222 NONPBBPAYER
|
| Hospital Charge Code |
9832722201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$804.11 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,527.60
|
| Rate for Payer: Aetna of WY Medicare |
$946.01
|
| Rate for Payer: Beech Street Commercial |
$4,389.00
|
| Rate for Payer: Cash Price |
$3,234.00
|
| Rate for Payer: Cash Price |
$3,234.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,481.40
|
| Rate for Payer: Cigna of WY Commercial |
$4,527.60
|
| Rate for Payer: First Choice Health Commercial |
$4,158.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,389.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.01
|
| Rate for Payer: HealthUtah PPO |
$4,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,481.40
|
| Rate for Payer: Multiplan Medicare/VA |
$804.11
|
| Rate for Payer: One Health Plan of WY PPO |
$4,527.60
|
| Rate for Payer: PacificSource Commercial |
$4,158.00
|
| Rate for Payer: PHCS PPO |
$4,389.00
|
| Rate for Payer: Three Rivers PPO |
$3,465.00
|
| Rate for Payer: TriWest Veterans Administration |
$946.01
|
| Rate for Payer: United Healthcare Commercial |
$4,019.40
|
| Rate for Payer: United Healthcare Medicare |
$946.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,927.00
|
|
|
HC PRO CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
HCPCS 27842 NONPBBPAYER
|
| Hospital Charge Code |
9832784201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.54 |
| Max. Negotiated Rate |
$2,537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.26
|
| Rate for Payer: Aetna of WY Medicare |
$484.17
|
| Rate for Payer: Beech Street Commercial |
$2,410.15
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,460.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.26
|
| Rate for Payer: First Choice Health Commercial |
$2,283.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.17
|
| Rate for Payer: HealthUtah PPO |
$2,537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Medicare/VA |
$411.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.26
|
| Rate for Payer: PacificSource Commercial |
$2,283.30
|
| Rate for Payer: PHCS PPO |
$2,410.15
|
| Rate for Payer: Three Rivers PPO |
$1,902.75
|
| Rate for Payer: TriWest Veterans Administration |
$484.17
|
| Rate for Payer: United Healthcare Commercial |
$2,207.19
|
| Rate for Payer: United Healthcare Medicare |
$484.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,156.45
|
|
|
HC PRO CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
9832784201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.54 |
| 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 |
$484.17
|
| 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 |
$484.17
|
| Rate for Payer: HealthUtah PPO |
$2,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,969.10
|
| Rate for Payer: Multiplan Medicare/VA |
$411.54
|
| 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 |
$484.17
|
| Rate for Payer: United Healthcare Commercial |
$1,766.10
|
| Rate for Payer: United Healthcare Medicare |
$484.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,725.50
|
|
|
HC PRO CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$2,932.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
9832784001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$326.94 |
| Max. Negotiated Rate |
$2,932.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,873.36
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,520.96
|
| Rate for Payer: Aetna of WY Medicare |
$384.64
|
| Rate for Payer: Aetna of WY Medicare |
$384.64
|
| Rate for Payer: Beech Street Commercial |
$1,474.40
|
| Rate for Payer: Beech Street Commercial |
$2,785.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$2,052.40
|
| Rate for Payer: Cash Price |
$2,052.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,844.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,505.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,520.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,873.36
|
| Rate for Payer: First Choice Health Commercial |
$1,396.80
|
| Rate for Payer: First Choice Health Commercial |
$2,638.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,785.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,474.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.64
|
| Rate for Payer: HealthUtah PPO |
$2,932.00
|
| Rate for Payer: HealthUtah PPO |
$1,552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,844.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,505.44
|
| Rate for Payer: Multiplan Medicare/VA |
$326.94
|
| Rate for Payer: Multiplan Medicare/VA |
$326.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,873.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,520.96
|
| Rate for Payer: PacificSource Commercial |
$1,396.80
|
| Rate for Payer: PacificSource Commercial |
$2,638.80
|
| Rate for Payer: PHCS PPO |
$2,785.40
|
| Rate for Payer: PHCS PPO |
$1,474.40
|
| Rate for Payer: Three Rivers PPO |
$2,199.00
|
| Rate for Payer: Three Rivers PPO |
$1,164.00
|
| Rate for Payer: TriWest Veterans Administration |
$384.64
|
| Rate for Payer: TriWest Veterans Administration |
$384.64
|
| Rate for Payer: United Healthcare Commercial |
$1,350.24
|
| Rate for Payer: United Healthcare Commercial |
$2,550.84
|
| Rate for Payer: United Healthcare Medicare |
$384.64
|
| Rate for Payer: United Healthcare Medicare |
$384.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,492.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,319.20
|
|
|
HC PRO CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 27840 NONPBBPAYER
|
| Hospital Charge Code |
9832784001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$326.94 |
| Max. Negotiated Rate |
$1,940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,901.20
|
| Rate for Payer: Aetna of WY Medicare |
$384.64
|
| Rate for Payer: Beech Street Commercial |
$1,843.00
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,881.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,901.20
|
| Rate for Payer: First Choice Health Commercial |
$1,746.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,843.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.64
|
| Rate for Payer: HealthUtah PPO |
$1,940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,881.80
|
| Rate for Payer: Multiplan Medicare/VA |
$326.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,901.20
|
| Rate for Payer: PacificSource Commercial |
$1,746.00
|
| Rate for Payer: PHCS PPO |
$1,843.00
|
| Rate for Payer: Three Rivers PPO |
$1,455.00
|
| Rate for Payer: TriWest Veterans Administration |
$384.64
|
| Rate for Payer: United Healthcare Commercial |
$1,687.80
|
| Rate for Payer: United Healthcare Medicare |
$384.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,649.00
|
|
|
HC PRO CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Professional
|
Both
|
$2,183.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
9832781001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$361.34 |
| Max. Negotiated Rate |
$2,183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,139.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,115.82
|
| Rate for Payer: Aetna of WY Medicare |
$425.11
|
| Rate for Payer: Aetna of WY Medicare |
$425.11
|
| Rate for Payer: Beech Street Commercial |
$2,051.05
|
| Rate for Payer: Beech Street Commercial |
$2,073.85
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: Cash Price |
$1,528.10
|
| Rate for Payer: Cash Price |
$1,528.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,117.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,094.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,115.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,139.34
|
| Rate for Payer: First Choice Health Commercial |
$1,943.10
|
| Rate for Payer: First Choice Health Commercial |
$1,964.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,073.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,051.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.11
|
| Rate for Payer: HealthUtah PPO |
$2,183.00
|
| Rate for Payer: HealthUtah PPO |
$2,159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,117.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,094.23
|
| Rate for Payer: Multiplan Medicare/VA |
$361.34
|
| Rate for Payer: Multiplan Medicare/VA |
$361.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,139.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,115.82
|
| Rate for Payer: PacificSource Commercial |
$1,943.10
|
| Rate for Payer: PacificSource Commercial |
$1,964.70
|
| Rate for Payer: PHCS PPO |
$2,073.85
|
| Rate for Payer: PHCS PPO |
$2,051.05
|
| Rate for Payer: Three Rivers PPO |
$1,637.25
|
| Rate for Payer: Three Rivers PPO |
$1,619.25
|
| Rate for Payer: TriWest Veterans Administration |
$425.11
|
| Rate for Payer: TriWest Veterans Administration |
$425.11
|
| Rate for Payer: United Healthcare Commercial |
$1,878.33
|
| Rate for Payer: United Healthcare Commercial |
$1,899.21
|
| Rate for Payer: United Healthcare Medicare |
$425.11
|
| Rate for Payer: United Healthcare Medicare |
$425.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,855.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,835.15
|
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