|
HC PRO CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
9832840001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$196.38 |
| Max. Negotiated Rate |
$1,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,153.46
|
| Rate for Payer: Aetna of WY Medicare |
$231.04
|
| Rate for Payer: Beech Street Commercial |
$1,118.15
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,141.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,153.46
|
| Rate for Payer: First Choice Health Commercial |
$1,059.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,118.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.04
|
| Rate for Payer: HealthUtah PPO |
$1,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,141.69
|
| Rate for Payer: Multiplan Medicare/VA |
$196.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,153.46
|
| Rate for Payer: PacificSource Commercial |
$1,059.30
|
| Rate for Payer: PHCS PPO |
$1,118.15
|
| Rate for Payer: Three Rivers PPO |
$882.75
|
| Rate for Payer: TriWest Veterans Administration |
$231.04
|
| Rate for Payer: United Healthcare Commercial |
$1,023.99
|
| Rate for Payer: United Healthcare Medicare |
$231.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,000.45
|
|
|
HC PRO CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 25630 NONPBBPAYER
|
| Hospital Charge Code |
9832563001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$243.77 |
| Max. Negotiated Rate |
$1,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
| Rate for Payer: Aetna of WY Medicare |
$286.79
|
| Rate for Payer: Beech Street Commercial |
$1,384.15
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
| Rate for Payer: First Choice Health Commercial |
$1,311.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$286.79
|
| Rate for Payer: HealthUtah PPO |
$1,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
| Rate for Payer: Multiplan Medicare/VA |
$243.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
| Rate for Payer: PacificSource Commercial |
$1,311.30
|
| Rate for Payer: PHCS PPO |
$1,384.15
|
| Rate for Payer: Three Rivers PPO |
$1,092.75
|
| Rate for Payer: TriWest Veterans Administration |
$286.79
|
| Rate for Payer: United Healthcare Commercial |
$1,267.59
|
| Rate for Payer: United Healthcare Medicare |
$286.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|
|
HC PRO CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
9832563001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$243.77 |
| Max. Negotiated Rate |
$1,933.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,894.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,142.68
|
| Rate for Payer: Aetna of WY Medicare |
$286.79
|
| Rate for Payer: Aetna of WY Medicare |
$286.79
|
| Rate for Payer: Beech Street Commercial |
$1,107.70
|
| Rate for Payer: Beech Street Commercial |
$1,836.35
|
| Rate for Payer: Cash Price |
$816.20
|
| Rate for Payer: Cash Price |
$816.20
|
| Rate for Payer: Cash Price |
$1,353.10
|
| Rate for Payer: Cash Price |
$1,353.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,875.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,131.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,142.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,894.34
|
| Rate for Payer: First Choice Health Commercial |
$1,049.40
|
| Rate for Payer: First Choice Health Commercial |
$1,739.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,836.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,107.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$286.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$286.79
|
| Rate for Payer: HealthUtah PPO |
$1,933.00
|
| Rate for Payer: HealthUtah PPO |
$1,166.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,875.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,131.02
|
| Rate for Payer: Multiplan Medicare/VA |
$243.77
|
| Rate for Payer: Multiplan Medicare/VA |
$243.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,894.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,142.68
|
| Rate for Payer: PacificSource Commercial |
$1,049.40
|
| Rate for Payer: PacificSource Commercial |
$1,739.70
|
| Rate for Payer: PHCS PPO |
$1,836.35
|
| Rate for Payer: PHCS PPO |
$1,107.70
|
| Rate for Payer: Three Rivers PPO |
$1,449.75
|
| Rate for Payer: Three Rivers PPO |
$874.50
|
| Rate for Payer: TriWest Veterans Administration |
$286.79
|
| Rate for Payer: TriWest Veterans Administration |
$286.79
|
| Rate for Payer: United Healthcare Commercial |
$1,014.42
|
| Rate for Payer: United Healthcare Commercial |
$1,681.71
|
| Rate for Payer: United Healthcare Medicare |
$286.79
|
| Rate for Payer: United Healthcare Medicare |
$286.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,643.05
|
| Rate for Payer: WINHealth Partners Commercial |
$991.10
|
|
|
HC PRO CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 25624
|
| Hospital Charge Code |
9832562401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$378.56 |
| Max. Negotiated Rate |
$1,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,480.78
|
| Rate for Payer: Aetna of WY Medicare |
$445.37
|
| Rate for Payer: Beech Street Commercial |
$1,435.45
|
| Rate for Payer: Cash Price |
$1,057.70
|
| Rate for Payer: Cash Price |
$1,057.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,465.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,480.78
|
| Rate for Payer: First Choice Health Commercial |
$1,359.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,435.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.37
|
| Rate for Payer: HealthUtah PPO |
$1,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,465.67
|
| Rate for Payer: Multiplan Medicare/VA |
$378.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,480.78
|
| Rate for Payer: PacificSource Commercial |
$1,359.90
|
| Rate for Payer: PHCS PPO |
$1,435.45
|
| Rate for Payer: Three Rivers PPO |
$1,133.25
|
| Rate for Payer: TriWest Veterans Administration |
$445.37
|
| Rate for Payer: United Healthcare Commercial |
$1,314.57
|
| Rate for Payer: United Healthcare Medicare |
$445.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,284.35
|
|
|
HC PRO CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,447.00
|
|
|
Service Code
|
HCPCS 25622 NONPBBPAYER
|
| Hospital Charge Code |
9832562201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$244.42 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,418.06
|
| Rate for Payer: Aetna of WY Medicare |
$287.55
|
| Rate for Payer: Beech Street Commercial |
$1,374.65
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,403.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,418.06
|
| Rate for Payer: First Choice Health Commercial |
$1,302.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,374.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.55
|
| Rate for Payer: HealthUtah PPO |
$1,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,403.59
|
| Rate for Payer: Multiplan Medicare/VA |
$244.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,418.06
|
| Rate for Payer: PacificSource Commercial |
$1,302.30
|
| Rate for Payer: PHCS PPO |
$1,374.65
|
| Rate for Payer: Three Rivers PPO |
$1,085.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.55
|
| Rate for Payer: United Healthcare Commercial |
$1,258.89
|
| Rate for Payer: United Healthcare Medicare |
$287.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,229.95
|
|
|
HC PRO CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
9832562201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$244.42 |
| Max. Negotiated Rate |
$1,925.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,886.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,134.84
|
| Rate for Payer: Aetna of WY Medicare |
$287.55
|
| Rate for Payer: Aetna of WY Medicare |
$287.55
|
| Rate for Payer: Beech Street Commercial |
$1,100.10
|
| Rate for Payer: Beech Street Commercial |
$1,828.75
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,867.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,123.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,134.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,886.50
|
| Rate for Payer: First Choice Health Commercial |
$1,042.20
|
| Rate for Payer: First Choice Health Commercial |
$1,732.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,828.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,100.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.55
|
| Rate for Payer: HealthUtah PPO |
$1,925.00
|
| Rate for Payer: HealthUtah PPO |
$1,158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,867.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,123.26
|
| Rate for Payer: Multiplan Medicare/VA |
$244.42
|
| Rate for Payer: Multiplan Medicare/VA |
$244.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,886.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,134.84
|
| Rate for Payer: PacificSource Commercial |
$1,042.20
|
| Rate for Payer: PacificSource Commercial |
$1,732.50
|
| Rate for Payer: PHCS PPO |
$1,828.75
|
| Rate for Payer: PHCS PPO |
$1,100.10
|
| Rate for Payer: Three Rivers PPO |
$1,443.75
|
| Rate for Payer: Three Rivers PPO |
$868.50
|
| Rate for Payer: TriWest Veterans Administration |
$287.55
|
| Rate for Payer: TriWest Veterans Administration |
$287.55
|
| Rate for Payer: United Healthcare Commercial |
$1,007.46
|
| Rate for Payer: United Healthcare Commercial |
$1,674.75
|
| Rate for Payer: United Healthcare Medicare |
$287.55
|
| Rate for Payer: United Healthcare Medicare |
$287.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,636.25
|
| Rate for Payer: WINHealth Partners Commercial |
$984.30
|
|
|
HC PRO CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
9832354501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.56 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,210.30
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$680.12
|
| Rate for Payer: Aetna of WY Medicare |
$325.37
|
| Rate for Payer: Aetna of WY Medicare |
$325.37
|
| Rate for Payer: Beech Street Commercial |
$659.30
|
| Rate for Payer: Beech Street Commercial |
$1,173.25
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$673.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,197.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,210.30
|
| Rate for Payer: Cigna of WY Commercial |
$680.12
|
| Rate for Payer: First Choice Health Commercial |
$624.60
|
| Rate for Payer: First Choice Health Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,173.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$659.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.37
|
| Rate for Payer: HealthUtah PPO |
$1,235.00
|
| Rate for Payer: HealthUtah PPO |
$694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$673.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,197.95
|
| Rate for Payer: Multiplan Medicare/VA |
$276.56
|
| Rate for Payer: Multiplan Medicare/VA |
$276.56
|
| Rate for Payer: One Health Plan of WY PPO |
$680.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,210.30
|
| Rate for Payer: PacificSource Commercial |
$1,111.50
|
| Rate for Payer: PacificSource Commercial |
$624.60
|
| Rate for Payer: PHCS PPO |
$1,173.25
|
| Rate for Payer: PHCS PPO |
$659.30
|
| Rate for Payer: Three Rivers PPO |
$926.25
|
| Rate for Payer: Three Rivers PPO |
$520.50
|
| Rate for Payer: TriWest Veterans Administration |
$325.37
|
| Rate for Payer: TriWest Veterans Administration |
$325.37
|
| Rate for Payer: United Healthcare Commercial |
$603.78
|
| Rate for Payer: United Healthcare Commercial |
$1,074.45
|
| Rate for Payer: United Healthcare Medicare |
$325.37
|
| Rate for Payer: United Healthcare Medicare |
$325.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.75
|
| Rate for Payer: WINHealth Partners Commercial |
$589.90
|
|
|
HC PRO CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
HCPCS 23545 NONPBBPAYER
|
| Hospital Charge Code |
9832354501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.56 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,513.12
|
| Rate for Payer: Aetna of WY Medicare |
$325.37
|
| Rate for Payer: Beech Street Commercial |
$1,466.80
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,497.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,513.12
|
| Rate for Payer: First Choice Health Commercial |
$1,389.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,466.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.37
|
| Rate for Payer: HealthUtah PPO |
$1,544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,497.68
|
| Rate for Payer: Multiplan Medicare/VA |
$276.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,513.12
|
| Rate for Payer: PacificSource Commercial |
$1,389.60
|
| Rate for Payer: PHCS PPO |
$1,466.80
|
| Rate for Payer: Three Rivers PPO |
$1,158.00
|
| Rate for Payer: TriWest Veterans Administration |
$325.37
|
| Rate for Payer: United Healthcare Commercial |
$1,343.28
|
| Rate for Payer: United Healthcare Medicare |
$325.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,312.40
|
|
|
HC PRO CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
9832350001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$1,542.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,511.16
|
| Rate for Payer: Aetna of WY Medicare |
$231.34
|
| Rate for Payer: Beech Street Commercial |
$1,464.90
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: Cash Price |
$1,079.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,495.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,511.16
|
| Rate for Payer: First Choice Health Commercial |
$1,387.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,464.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.34
|
| Rate for Payer: HealthUtah PPO |
$1,542.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,495.74
|
| Rate for Payer: Multiplan Medicare/VA |
$196.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,511.16
|
| Rate for Payer: PacificSource Commercial |
$1,387.80
|
| Rate for Payer: PHCS PPO |
$1,464.90
|
| Rate for Payer: Three Rivers PPO |
$1,156.50
|
| Rate for Payer: TriWest Veterans Administration |
$231.34
|
| Rate for Payer: United Healthcare Commercial |
$1,341.54
|
| Rate for Payer: United Healthcare Medicare |
$231.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,310.70
|
|
|
HC PRO CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 25675 NONPBBPAYER
|
| Hospital Charge Code |
9832567501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,077.60
|
| Rate for Payer: Aetna of WY Medicare |
$411.96
|
| Rate for Payer: Beech Street Commercial |
$2,014.00
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,056.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,077.60
|
| Rate for Payer: First Choice Health Commercial |
$1,908.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.96
|
| Rate for Payer: HealthUtah PPO |
$2,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,056.40
|
| Rate for Payer: Multiplan Medicare/VA |
$350.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,077.60
|
| Rate for Payer: PacificSource Commercial |
$1,908.00
|
| Rate for Payer: PHCS PPO |
$2,014.00
|
| Rate for Payer: Three Rivers PPO |
$1,590.00
|
| Rate for Payer: TriWest Veterans Administration |
$411.96
|
| Rate for Payer: United Healthcare Commercial |
$1,844.40
|
| Rate for Payer: United Healthcare Medicare |
$411.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,802.00
|
|
|
HC PRO CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
9832567501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$1,696.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,662.08
|
| Rate for Payer: Aetna of WY Medicare |
$411.96
|
| Rate for Payer: Beech Street Commercial |
$1,611.20
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,645.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,662.08
|
| Rate for Payer: First Choice Health Commercial |
$1,526.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,611.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.96
|
| Rate for Payer: HealthUtah PPO |
$1,696.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,645.12
|
| Rate for Payer: Multiplan Medicare/VA |
$350.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,662.08
|
| Rate for Payer: PacificSource Commercial |
$1,526.40
|
| Rate for Payer: PHCS PPO |
$1,611.20
|
| Rate for Payer: Three Rivers PPO |
$1,272.00
|
| Rate for Payer: TriWest Veterans Administration |
$411.96
|
| Rate for Payer: United Healthcare Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare Medicare |
$411.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,441.60
|
|
|
HC PRO CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Professional
|
Both
|
$3,074.00
|
|
|
Service Code
|
HCPCS 25605 50
|
| Hospital Charge Code |
9832560501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$3,074.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,012.52
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$2,920.30
|
| Rate for Payer: Cash Price |
$2,151.80
|
| Rate for Payer: Cash Price |
$2,151.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,981.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,012.52
|
| Rate for Payer: First Choice Health Commercial |
$2,766.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,920.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$3,074.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,981.78
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$3,012.52
|
| Rate for Payer: PacificSource Commercial |
$2,766.60
|
| Rate for Payer: PHCS PPO |
$2,920.30
|
| Rate for Payer: Three Rivers PPO |
$2,305.50
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$2,674.38
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,612.90
|
|
|
HC PRO CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Professional
|
Both
|
$3,842.00
|
|
|
Service Code
|
HCPCS 25605 50,NONPBBPAYER
|
| Hospital Charge Code |
9832560501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$3,842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,765.16
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$3,649.90
|
| Rate for Payer: Cash Price |
$2,689.40
|
| Rate for Payer: Cash Price |
$2,689.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,726.74
|
| Rate for Payer: Cigna of WY Commercial |
$3,765.16
|
| Rate for Payer: First Choice Health Commercial |
$3,457.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,649.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$3,842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,726.74
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$3,765.16
|
| Rate for Payer: PacificSource Commercial |
$3,457.80
|
| Rate for Payer: PHCS PPO |
$3,649.90
|
| Rate for Payer: Three Rivers PPO |
$2,881.50
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$3,342.54
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,265.70
|
|
|
HC PRO CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Professional
|
Both
|
$1,921.00
|
|
|
Service Code
|
HCPCS 25605 NONPBBPAYER
|
| Hospital Charge Code |
9832560501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,882.58
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$1,824.95
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,863.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,882.58
|
| Rate for Payer: First Choice Health Commercial |
$1,728.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,824.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$1,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,863.37
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,882.58
|
| Rate for Payer: PacificSource Commercial |
$1,728.90
|
| Rate for Payer: PHCS PPO |
$1,824.95
|
| Rate for Payer: Three Rivers PPO |
$1,440.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$1,671.27
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,632.85
|
|
|
HC PRO CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
9832560501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,506.26
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$1,460.15
|
| Rate for Payer: Beech Street Commercial |
$2,470.00
|
| Rate for Payer: Cash Price |
$1,075.90
|
| Rate for Payer: Cash Price |
$1,075.90
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,490.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,506.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: First Choice Health Commercial |
$1,383.30
|
| Rate for Payer: First Choice Health Commercial |
$2,340.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,460.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: HealthUtah PPO |
$1,537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,490.89
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,506.26
|
| Rate for Payer: PacificSource Commercial |
$1,383.30
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,470.00
|
| Rate for Payer: PHCS PPO |
$1,460.15
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: Three Rivers PPO |
$1,152.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,210.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,306.45
|
|
|
HC PRO CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 25600 NONPBBPAYER
|
| Hospital Charge Code |
9832560001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,204.42
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$1,167.55
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,192.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,204.42
|
| Rate for Payer: First Choice Health Commercial |
$1,106.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,167.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$1,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,192.13
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,204.42
|
| Rate for Payer: PacificSource Commercial |
$1,106.10
|
| Rate for Payer: PHCS PPO |
$1,167.55
|
| Rate for Payer: Three Rivers PPO |
$921.75
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$1,069.23
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,044.65
|
|
|
HC PRO CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Professional
|
Both
|
$1,966.00
|
|
|
Service Code
|
HCPCS 25600 50
|
| Hospital Charge Code |
9832560001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,926.68
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$1,867.70
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,907.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,926.68
|
| Rate for Payer: First Choice Health Commercial |
$1,769.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,867.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$1,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,907.02
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,926.68
|
| Rate for Payer: PacificSource Commercial |
$1,769.40
|
| Rate for Payer: PHCS PPO |
$1,867.70
|
| Rate for Payer: Three Rivers PPO |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$1,710.42
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,671.10
|
|
|
HC PRO CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Professional
|
Both
|
$2,458.00
|
|
|
Service Code
|
HCPCS 25600 50,NONPBBPAYER
|
| Hospital Charge Code |
9832560001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$2,458.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,408.84
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$2,335.10
|
| Rate for Payer: Cash Price |
$1,720.60
|
| Rate for Payer: Cash Price |
$1,720.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,384.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,408.84
|
| Rate for Payer: First Choice Health Commercial |
$2,212.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,335.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$2,458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,384.26
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,408.84
|
| Rate for Payer: PacificSource Commercial |
$2,212.20
|
| Rate for Payer: PHCS PPO |
$2,335.10
|
| Rate for Payer: Three Rivers PPO |
$1,843.50
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$2,138.46
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$2,089.30
|
|
|
HC PRO CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
9832560001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$963.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,610.14
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$1,560.85
|
| Rate for Payer: Beech Street Commercial |
$933.85
|
| Rate for Payer: Cash Price |
$1,150.10
|
| Rate for Payer: Cash Price |
$1,150.10
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$953.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,593.71
|
| Rate for Payer: Cigna of WY Commercial |
$1,610.14
|
| Rate for Payer: Cigna of WY Commercial |
$963.34
|
| Rate for Payer: First Choice Health Commercial |
$1,478.70
|
| Rate for Payer: First Choice Health Commercial |
$884.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$933.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,560.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$983.00
|
| Rate for Payer: HealthUtah PPO |
$1,643.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$953.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,593.71
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$963.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,610.14
|
| Rate for Payer: PacificSource Commercial |
$1,478.70
|
| Rate for Payer: PacificSource Commercial |
$884.70
|
| Rate for Payer: PHCS PPO |
$933.85
|
| Rate for Payer: PHCS PPO |
$1,560.85
|
| Rate for Payer: Three Rivers PPO |
$737.25
|
| Rate for Payer: Three Rivers PPO |
$1,232.25
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$1,429.41
|
| Rate for Payer: United Healthcare Commercial |
$855.21
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$835.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,396.55
|
|
|
HC PRO CLOSED TX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$2,611.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
9832778801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$325.99 |
| Max. Negotiated Rate |
$2,611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,558.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Aetna of WY Medicare |
$383.52
|
| Rate for Payer: Aetna of WY Medicare |
$383.52
|
| Rate for Payer: Beech Street Commercial |
$1,889.55
|
| Rate for Payer: Beech Street Commercial |
$2,480.45
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: Cash Price |
$1,827.70
|
| Rate for Payer: Cash Price |
$1,827.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,532.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,558.78
|
| Rate for Payer: First Choice Health Commercial |
$1,790.10
|
| Rate for Payer: First Choice Health Commercial |
$2,349.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,480.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.52
|
| Rate for Payer: HealthUtah PPO |
$2,611.00
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,532.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$325.99
|
| Rate for Payer: Multiplan Medicare/VA |
$325.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,558.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PacificSource Commercial |
$2,349.90
|
| Rate for Payer: PHCS PPO |
$2,480.45
|
| Rate for Payer: PHCS PPO |
$1,889.55
|
| Rate for Payer: Three Rivers PPO |
$1,958.25
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$383.52
|
| Rate for Payer: TriWest Veterans Administration |
$383.52
|
| Rate for Payer: United Healthcare Commercial |
$1,730.43
|
| Rate for Payer: United Healthcare Commercial |
$2,271.57
|
| Rate for Payer: United Healthcare Medicare |
$383.52
|
| Rate for Payer: United Healthcare Medicare |
$383.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,219.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,690.65
|
|
|
HC PRO CLOSED TX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
9832778601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$245.74 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,920.80
|
| Rate for Payer: Aetna of WY Medicare |
$289.10
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,901.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,920.80
|
| Rate for Payer: First Choice Health Commercial |
$1,764.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,862.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.10
|
| Rate for Payer: HealthUtah PPO |
$1,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,901.20
|
| Rate for Payer: Multiplan Medicare/VA |
$245.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,920.80
|
| Rate for Payer: PacificSource Commercial |
$1,764.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,470.00
|
| Rate for Payer: TriWest Veterans Administration |
$289.10
|
| Rate for Payer: United Healthcare Commercial |
$1,705.20
|
| Rate for Payer: United Healthcare Medicare |
$289.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,666.00
|
|
|
HC PRO CLOSED TX DSTL TIBIA
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 27824 NONPBBPAYER
|
| Hospital Charge Code |
9832782401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,537.62
|
| Rate for Payer: Aetna of WY Medicare |
$306.18
|
| Rate for Payer: Beech Street Commercial |
$1,490.55
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,521.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,537.62
|
| Rate for Payer: First Choice Health Commercial |
$1,412.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,490.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.18
|
| Rate for Payer: HealthUtah PPO |
$1,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,521.93
|
| Rate for Payer: Multiplan Medicare/VA |
$260.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,537.62
|
| Rate for Payer: PacificSource Commercial |
$1,412.10
|
| Rate for Payer: PHCS PPO |
$1,490.55
|
| Rate for Payer: Three Rivers PPO |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.18
|
| Rate for Payer: United Healthcare Commercial |
$1,365.03
|
| Rate for Payer: United Healthcare Medicare |
$306.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,333.65
|
|
|
HC PRO CLOSED TX DSTL TIBIA
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
9832782401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,327.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,229.90
|
| Rate for Payer: Aetna of WY Medicare |
$306.18
|
| Rate for Payer: Aetna of WY Medicare |
$306.18
|
| Rate for Payer: Beech Street Commercial |
$1,192.25
|
| Rate for Payer: Beech Street Commercial |
$2,256.25
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,303.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,217.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,229.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,327.50
|
| Rate for Payer: First Choice Health Commercial |
$1,129.50
|
| Rate for Payer: First Choice Health Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,256.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,192.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.18
|
| Rate for Payer: HealthUtah PPO |
$2,375.00
|
| Rate for Payer: HealthUtah PPO |
$1,255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,303.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,217.35
|
| Rate for Payer: Multiplan Medicare/VA |
$260.25
|
| Rate for Payer: Multiplan Medicare/VA |
$260.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,327.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,229.90
|
| Rate for Payer: PacificSource Commercial |
$1,129.50
|
| Rate for Payer: PacificSource Commercial |
$2,137.50
|
| Rate for Payer: PHCS PPO |
$2,256.25
|
| Rate for Payer: PHCS PPO |
$1,192.25
|
| Rate for Payer: Three Rivers PPO |
$1,781.25
|
| Rate for Payer: Three Rivers PPO |
$941.25
|
| Rate for Payer: TriWest Veterans Administration |
$306.18
|
| Rate for Payer: TriWest Veterans Administration |
$306.18
|
| Rate for Payer: United Healthcare Commercial |
$1,091.85
|
| Rate for Payer: United Healthcare Commercial |
$2,066.25
|
| Rate for Payer: United Healthcare Medicare |
$306.18
|
| Rate for Payer: United Healthcare Medicare |
$306.18
|
| Rate for Payer: WINHealth Partners Commercial |
$2,018.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,066.75
|
|
|
HC PRO CLOSED TX ELBOW DISLOCATION W ANES
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
9832460501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$401.83 |
| Max. Negotiated Rate |
$1,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,653.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,266.34
|
| Rate for Payer: Aetna of WY Medicare |
$472.74
|
| Rate for Payer: Aetna of WY Medicare |
$472.74
|
| Rate for Payer: Beech Street Commercial |
$3,166.35
|
| Rate for Payer: Beech Street Commercial |
$1,602.65
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,233.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,636.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,653.26
|
| Rate for Payer: Cigna of WY Commercial |
$3,266.34
|
| Rate for Payer: First Choice Health Commercial |
$2,999.70
|
| Rate for Payer: First Choice Health Commercial |
$1,518.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,602.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,166.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.74
|
| Rate for Payer: HealthUtah PPO |
$1,687.00
|
| Rate for Payer: HealthUtah PPO |
$3,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,233.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,636.39
|
| Rate for Payer: Multiplan Medicare/VA |
$401.83
|
| Rate for Payer: Multiplan Medicare/VA |
$401.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,266.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,653.26
|
| Rate for Payer: PacificSource Commercial |
$1,518.30
|
| Rate for Payer: PacificSource Commercial |
$2,999.70
|
| Rate for Payer: PHCS PPO |
$1,602.65
|
| Rate for Payer: PHCS PPO |
$3,166.35
|
| Rate for Payer: Three Rivers PPO |
$1,265.25
|
| Rate for Payer: Three Rivers PPO |
$2,499.75
|
| Rate for Payer: TriWest Veterans Administration |
$472.74
|
| Rate for Payer: TriWest Veterans Administration |
$472.74
|
| Rate for Payer: United Healthcare Commercial |
$2,899.71
|
| Rate for Payer: United Healthcare Commercial |
$1,467.69
|
| Rate for Payer: United Healthcare Medicare |
$472.74
|
| Rate for Payer: United Healthcare Medicare |
$472.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,433.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,833.05
|
|
|
HC PRO CLOSED TX ELBOW DISLOCATION W/O ANES
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
9832460001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$290.09 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,462.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,362.20
|
| Rate for Payer: Aetna of WY Medicare |
$341.28
|
| Rate for Payer: Aetna of WY Medicare |
$341.28
|
| Rate for Payer: Beech Street Commercial |
$1,320.50
|
| Rate for Payer: Beech Street Commercial |
$2,387.35
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,437.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,348.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,362.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,462.74
|
| Rate for Payer: First Choice Health Commercial |
$1,251.00
|
| Rate for Payer: First Choice Health Commercial |
$2,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,387.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,320.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.28
|
| Rate for Payer: HealthUtah PPO |
$2,513.00
|
| Rate for Payer: HealthUtah PPO |
$1,390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,437.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,348.30
|
| Rate for Payer: Multiplan Medicare/VA |
$290.09
|
| Rate for Payer: Multiplan Medicare/VA |
$290.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,462.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,362.20
|
| Rate for Payer: PacificSource Commercial |
$1,251.00
|
| Rate for Payer: PacificSource Commercial |
$2,261.70
|
| Rate for Payer: PHCS PPO |
$2,387.35
|
| Rate for Payer: PHCS PPO |
$1,320.50
|
| Rate for Payer: Three Rivers PPO |
$1,884.75
|
| Rate for Payer: Three Rivers PPO |
$1,042.50
|
| Rate for Payer: TriWest Veterans Administration |
$341.28
|
| Rate for Payer: TriWest Veterans Administration |
$341.28
|
| Rate for Payer: United Healthcare Commercial |
$1,209.30
|
| Rate for Payer: United Healthcare Commercial |
$2,186.31
|
| Rate for Payer: United Healthcare Medicare |
$341.28
|
| Rate for Payer: United Healthcare Medicare |
$341.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,136.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.50
|
|
