|
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
|
|
|
HC PRO CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
9832726701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$370.31 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,316.32
|
| Rate for Payer: Aetna of WY Medicare |
$435.66
|
| Rate for Payer: Beech Street Commercial |
$3,214.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,282.48
|
| Rate for Payer: Cigna of WY Commercial |
$3,316.32
|
| Rate for Payer: First Choice Health Commercial |
$3,045.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,214.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.66
|
| Rate for Payer: HealthUtah PPO |
$3,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,282.48
|
| Rate for Payer: Multiplan Medicare/VA |
$370.31
|
| Rate for Payer: One Health Plan of WY PPO |
$3,316.32
|
| Rate for Payer: PacificSource Commercial |
$3,045.60
|
| Rate for Payer: PHCS PPO |
$3,214.80
|
| Rate for Payer: Three Rivers PPO |
$2,538.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.66
|
| Rate for Payer: United Healthcare Commercial |
$2,944.08
|
| Rate for Payer: United Healthcare Medicare |
$435.66
|
| Rate for Payer: WINHealth Partners Commercial |
$2,876.40
|
|
|
HC PRO CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 27500 NONPBBPAYER
|
| Hospital Charge Code |
9832750001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$400.88 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,428.44
|
| Rate for Payer: Aetna of WY Medicare |
$471.62
|
| Rate for Payer: Beech Street Commercial |
$2,354.10
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,403.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,428.44
|
| Rate for Payer: First Choice Health Commercial |
$2,230.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.62
|
| Rate for Payer: HealthUtah PPO |
$2,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,403.66
|
| Rate for Payer: Multiplan Medicare/VA |
$400.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,428.44
|
| Rate for Payer: PacificSource Commercial |
$2,230.20
|
| Rate for Payer: PHCS PPO |
$2,354.10
|
| Rate for Payer: Three Rivers PPO |
$1,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.62
|
| Rate for Payer: United Healthcare Commercial |
$2,155.86
|
| Rate for Payer: United Healthcare Medicare |
$471.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,106.30
|
|
|
HC PRO CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$3,251.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
9832750001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$400.88 |
| Max. Negotiated Rate |
$3,251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,185.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,942.36
|
| Rate for Payer: Aetna of WY Medicare |
$471.62
|
| Rate for Payer: Aetna of WY Medicare |
$471.62
|
| Rate for Payer: Beech Street Commercial |
$1,882.90
|
| Rate for Payer: Beech Street Commercial |
$3,088.45
|
| Rate for Payer: Cash Price |
$1,387.40
|
| Rate for Payer: Cash Price |
$1,387.40
|
| Rate for Payer: Cash Price |
$2,275.70
|
| Rate for Payer: Cash Price |
$2,275.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,153.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,922.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,942.36
|
| Rate for Payer: Cigna of WY Commercial |
$3,185.98
|
| Rate for Payer: First Choice Health Commercial |
$1,783.80
|
| Rate for Payer: First Choice Health Commercial |
$2,925.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,088.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,882.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.62
|
| Rate for Payer: HealthUtah PPO |
$3,251.00
|
| Rate for Payer: HealthUtah PPO |
$1,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,153.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,922.54
|
| Rate for Payer: Multiplan Medicare/VA |
$400.88
|
| Rate for Payer: Multiplan Medicare/VA |
$400.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,185.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,942.36
|
| Rate for Payer: PacificSource Commercial |
$1,783.80
|
| Rate for Payer: PacificSource Commercial |
$2,925.90
|
| Rate for Payer: PHCS PPO |
$3,088.45
|
| Rate for Payer: PHCS PPO |
$1,882.90
|
| Rate for Payer: Three Rivers PPO |
$2,438.25
|
| Rate for Payer: Three Rivers PPO |
$1,486.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.62
|
| Rate for Payer: TriWest Veterans Administration |
$471.62
|
| Rate for Payer: United Healthcare Commercial |
$1,724.34
|
| Rate for Payer: United Healthcare Commercial |
$2,828.37
|
| Rate for Payer: United Healthcare Medicare |
$471.62
|
| Rate for Payer: United Healthcare Medicare |
$471.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,763.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,684.70
|
|
|
HC PRO CLOSED TX FMRL SHAFT FX W/ MANIPULATION
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
9832750201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$618.98 |
| Max. Negotiated Rate |
$3,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,071.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,897.86
|
| Rate for Payer: Aetna of WY Medicare |
$728.21
|
| Rate for Payer: Aetna of WY Medicare |
$728.21
|
| Rate for Payer: Beech Street Commercial |
$2,809.15
|
| Rate for Payer: Beech Street Commercial |
$2,977.30
|
| Rate for Payer: Cash Price |
$2,069.90
|
| Rate for Payer: Cash Price |
$2,069.90
|
| Rate for Payer: Cash Price |
$2,193.80
|
| Rate for Payer: Cash Price |
$2,193.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,039.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,868.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,897.86
|
| Rate for Payer: Cigna of WY Commercial |
$3,071.32
|
| Rate for Payer: First Choice Health Commercial |
$2,661.30
|
| Rate for Payer: First Choice Health Commercial |
$2,820.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,977.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,809.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.21
|
| Rate for Payer: HealthUtah PPO |
$3,134.00
|
| Rate for Payer: HealthUtah PPO |
$2,957.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,039.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,868.29
|
| Rate for Payer: Multiplan Medicare/VA |
$618.98
|
| Rate for Payer: Multiplan Medicare/VA |
$618.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,071.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,897.86
|
| Rate for Payer: PacificSource Commercial |
$2,661.30
|
| Rate for Payer: PacificSource Commercial |
$2,820.60
|
| Rate for Payer: PHCS PPO |
$2,977.30
|
| Rate for Payer: PHCS PPO |
$2,809.15
|
| Rate for Payer: Three Rivers PPO |
$2,350.50
|
| Rate for Payer: Three Rivers PPO |
$2,217.75
|
| Rate for Payer: TriWest Veterans Administration |
$728.21
|
| Rate for Payer: TriWest Veterans Administration |
$728.21
|
| Rate for Payer: United Healthcare Commercial |
$2,572.59
|
| Rate for Payer: United Healthcare Commercial |
$2,726.58
|
| Rate for Payer: United Healthcare Medicare |
$728.21
|
| Rate for Payer: United Healthcare Medicare |
$728.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2,663.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,513.45
|
|
|
HC PRO CLOSED TX FMRL SHAFT FX W/ MANIPULATION
|
Professional
|
Both
|
$3,918.00
|
|
|
Service Code
|
HCPCS 27502 NONPBBPAYER
|
| Hospital Charge Code |
9832750201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$618.98 |
| Max. Negotiated Rate |
$3,918.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,839.64
|
| Rate for Payer: Aetna of WY Medicare |
$728.21
|
| Rate for Payer: Beech Street Commercial |
$3,722.10
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,800.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,839.64
|
| Rate for Payer: First Choice Health Commercial |
$3,526.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,722.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.21
|
| Rate for Payer: HealthUtah PPO |
$3,918.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,800.46
|
| Rate for Payer: Multiplan Medicare/VA |
$618.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,839.64
|
| Rate for Payer: PacificSource Commercial |
$3,526.20
|
| Rate for Payer: PHCS PPO |
$3,722.10
|
| Rate for Payer: Three Rivers PPO |
$2,938.50
|
| Rate for Payer: TriWest Veterans Administration |
$728.21
|
| Rate for Payer: United Healthcare Commercial |
$3,408.66
|
| Rate for Payer: United Healthcare Medicare |
$728.21
|
| Rate for Payer: WINHealth Partners Commercial |
$3,330.30
|
|
|
HC PRO CLOSED TX FX GREAT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
9832849001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$680.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$500.78
|
| Rate for Payer: Aetna of WY Medicare |
$125.35
|
| Rate for Payer: Aetna of WY Medicare |
$125.35
|
| Rate for Payer: Beech Street Commercial |
$485.45
|
| Rate for Payer: Beech Street Commercial |
$659.30
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$673.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$495.67
|
| Rate for Payer: Cigna of WY Commercial |
$500.78
|
| Rate for Payer: Cigna of WY Commercial |
$680.12
|
| Rate for Payer: First Choice Health Commercial |
$459.90
|
| Rate for Payer: First Choice Health Commercial |
$624.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$659.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$485.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.35
|
| Rate for Payer: HealthUtah PPO |
$694.00
|
| Rate for Payer: HealthUtah PPO |
$511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$673.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$495.67
|
| Rate for Payer: Multiplan Medicare/VA |
$106.55
|
| Rate for Payer: Multiplan Medicare/VA |
$106.55
|
| Rate for Payer: One Health Plan of WY PPO |
$680.12
|
| Rate for Payer: One Health Plan of WY PPO |
$500.78
|
| Rate for Payer: PacificSource Commercial |
$459.90
|
| Rate for Payer: PacificSource Commercial |
$624.60
|
| Rate for Payer: PHCS PPO |
$659.30
|
| Rate for Payer: PHCS PPO |
$485.45
|
| Rate for Payer: Three Rivers PPO |
$520.50
|
| Rate for Payer: Three Rivers PPO |
$383.25
|
| Rate for Payer: TriWest Veterans Administration |
$125.35
|
| Rate for Payer: TriWest Veterans Administration |
$125.35
|
| Rate for Payer: United Healthcare Commercial |
$444.57
|
| Rate for Payer: United Healthcare Commercial |
$603.78
|
| Rate for Payer: United Healthcare Medicare |
$125.35
|
| Rate for Payer: United Healthcare Medicare |
$125.35
|
| Rate for Payer: WINHealth Partners Commercial |
$589.90
|
| Rate for Payer: WINHealth Partners Commercial |
$434.35
|
|
|
HC PRO CLOSED TX FX GREAT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 28490 NONPBBPAYER
|
| Hospital Charge Code |
9832849001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$626.22
|
| Rate for Payer: Aetna of WY Medicare |
$125.35
|
| Rate for Payer: Beech Street Commercial |
$607.05
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$619.83
|
| Rate for Payer: Cigna of WY Commercial |
$626.22
|
| Rate for Payer: First Choice Health Commercial |
$575.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$607.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.35
|
| Rate for Payer: HealthUtah PPO |
$639.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$619.83
|
| Rate for Payer: Multiplan Medicare/VA |
$106.55
|
| Rate for Payer: One Health Plan of WY PPO |
$626.22
|
| Rate for Payer: PacificSource Commercial |
$575.10
|
| Rate for Payer: PHCS PPO |
$607.05
|
| Rate for Payer: Three Rivers PPO |
$479.25
|
| Rate for Payer: TriWest Veterans Administration |
$125.35
|
| Rate for Payer: United Healthcare Commercial |
$555.93
|
| Rate for Payer: United Healthcare Medicare |
$125.35
|
| Rate for Payer: WINHealth Partners Commercial |
$543.15
|
|
|
HC PRO CLOSED TX FX GREAT TOE W MANIP
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
9832849501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$598.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,113.28
|
| Rate for Payer: Aetna of WY Medicare |
$149.65
|
| Rate for Payer: Aetna of WY Medicare |
$149.65
|
| Rate for Payer: Beech Street Commercial |
$1,079.20
|
| Rate for Payer: Beech Street Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$795.20
|
| Rate for Payer: Cash Price |
$795.20
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$592.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,101.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,113.28
|
| Rate for Payer: Cigna of WY Commercial |
$598.78
|
| Rate for Payer: First Choice Health Commercial |
$1,022.40
|
| Rate for Payer: First Choice Health Commercial |
$549.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,079.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.65
|
| Rate for Payer: HealthUtah PPO |
$611.00
|
| Rate for Payer: HealthUtah PPO |
$1,136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$592.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,101.92
|
| Rate for Payer: Multiplan Medicare/VA |
$127.20
|
| Rate for Payer: Multiplan Medicare/VA |
$127.20
|
| Rate for Payer: One Health Plan of WY PPO |
$598.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,113.28
|
| Rate for Payer: PacificSource Commercial |
$1,022.40
|
| Rate for Payer: PacificSource Commercial |
$549.90
|
| Rate for Payer: PHCS PPO |
$580.45
|
| Rate for Payer: PHCS PPO |
$1,079.20
|
| Rate for Payer: Three Rivers PPO |
$458.25
|
| Rate for Payer: Three Rivers PPO |
$852.00
|
| Rate for Payer: TriWest Veterans Administration |
$149.65
|
| Rate for Payer: TriWest Veterans Administration |
$149.65
|
| Rate for Payer: United Healthcare Commercial |
$988.32
|
| Rate for Payer: United Healthcare Commercial |
$531.57
|
| Rate for Payer: United Healthcare Medicare |
$149.65
|
| Rate for Payer: United Healthcare Medicare |
$149.65
|
| Rate for Payer: WINHealth Partners Commercial |
$519.35
|
| Rate for Payer: WINHealth Partners Commercial |
$965.60
|
|
|
HC PRO CLOSED TX FX GREAT TOE W MANIP
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
HCPCS 28495 NONPBBPAYER
|
| Hospital Charge Code |
9832849501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$748.72
|
| Rate for Payer: Aetna of WY Medicare |
$149.65
|
| Rate for Payer: Beech Street Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$534.80
|
| Rate for Payer: Cash Price |
$534.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$741.08
|
| Rate for Payer: Cigna of WY Commercial |
$748.72
|
| Rate for Payer: First Choice Health Commercial |
$687.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$725.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.65
|
| Rate for Payer: HealthUtah PPO |
$764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$741.08
|
| Rate for Payer: Multiplan Medicare/VA |
$127.20
|
| Rate for Payer: One Health Plan of WY PPO |
$748.72
|
| Rate for Payer: PacificSource Commercial |
$687.60
|
| Rate for Payer: PHCS PPO |
$725.80
|
| Rate for Payer: Three Rivers PPO |
$573.00
|
| Rate for Payer: TriWest Veterans Administration |
$149.65
|
| Rate for Payer: United Healthcare Commercial |
$664.68
|
| Rate for Payer: United Healthcare Medicare |
$149.65
|
| Rate for Payer: WINHealth Partners Commercial |
$649.40
|
|
|
HC PRO CLOSED TX FX PHLX/PHLG OTH/THN GREAT TOE W/O MANJ
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
9832851001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$656.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$484.12
|
| Rate for Payer: Aetna of WY Medicare |
$121.59
|
| Rate for Payer: Aetna of WY Medicare |
$121.59
|
| Rate for Payer: Beech Street Commercial |
$469.30
|
| Rate for Payer: Beech Street Commercial |
$636.50
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$649.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$479.18
|
| Rate for Payer: Cigna of WY Commercial |
$484.12
|
| Rate for Payer: Cigna of WY Commercial |
$656.60
|
| Rate for Payer: First Choice Health Commercial |
$444.60
|
| Rate for Payer: First Choice Health Commercial |
$603.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$469.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.59
|
| Rate for Payer: HealthUtah PPO |
$670.00
|
| Rate for Payer: HealthUtah PPO |
$494.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$649.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$479.18
|
| Rate for Payer: Multiplan Medicare/VA |
$103.35
|
| Rate for Payer: Multiplan Medicare/VA |
$103.35
|
| Rate for Payer: One Health Plan of WY PPO |
$656.60
|
| Rate for Payer: One Health Plan of WY PPO |
$484.12
|
| Rate for Payer: PacificSource Commercial |
$444.60
|
| Rate for Payer: PacificSource Commercial |
$603.00
|
| Rate for Payer: PHCS PPO |
$636.50
|
| Rate for Payer: PHCS PPO |
$469.30
|
| Rate for Payer: Three Rivers PPO |
$502.50
|
| Rate for Payer: Three Rivers PPO |
$370.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.59
|
| Rate for Payer: TriWest Veterans Administration |
$121.59
|
| Rate for Payer: United Healthcare Commercial |
$429.78
|
| Rate for Payer: United Healthcare Commercial |
$582.90
|
| Rate for Payer: United Healthcare Medicare |
$121.59
|
| Rate for Payer: United Healthcare Medicare |
$121.59
|
| Rate for Payer: WINHealth Partners Commercial |
$569.50
|
| Rate for Payer: WINHealth Partners Commercial |
$419.90
|
|
|
HC PRO CLOSED TX FX PHLX/PHLG OTH/THN GREAT TOE W/O MANJ
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
HCPCS 28510 NONPBBPAYER
|
| Hospital Charge Code |
9832851001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$604.66
|
| Rate for Payer: Aetna of WY Medicare |
$121.59
|
| Rate for Payer: Beech Street Commercial |
$586.15
|
| Rate for Payer: Cash Price |
$431.90
|
| Rate for Payer: Cash Price |
$431.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$598.49
|
| Rate for Payer: Cigna of WY Commercial |
$604.66
|
| Rate for Payer: First Choice Health Commercial |
$555.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$586.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.59
|
| Rate for Payer: HealthUtah PPO |
$617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$598.49
|
| Rate for Payer: Multiplan Medicare/VA |
$103.35
|
| Rate for Payer: One Health Plan of WY PPO |
$604.66
|
| Rate for Payer: PacificSource Commercial |
$555.30
|
| Rate for Payer: PHCS PPO |
$586.15
|
| Rate for Payer: Three Rivers PPO |
$462.75
|
| Rate for Payer: TriWest Veterans Administration |
$121.59
|
| Rate for Payer: United Healthcare Commercial |
$536.79
|
| Rate for Payer: United Healthcare Medicare |
$121.59
|
| Rate for Payer: WINHealth Partners Commercial |
$524.45
|
|
|
HC PRO CLOSED TX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
9832724601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$324.57 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,079.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,562.70
|
| Rate for Payer: Aetna of WY Medicare |
$381.85
|
| Rate for Payer: Aetna of WY Medicare |
$381.85
|
| Rate for Payer: Beech Street Commercial |
$2,484.25
|
| Rate for Payer: Beech Street Commercial |
$1,046.90
|
| Rate for Payer: Cash Price |
$1,830.50
|
| Rate for Payer: Cash Price |
$771.40
|
| Rate for Payer: Cash Price |
$771.40
|
| Rate for Payer: Cash Price |
$1,830.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,536.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,068.94
|
| Rate for Payer: Cigna of WY Commercial |
$1,079.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,562.70
|
| Rate for Payer: First Choice Health Commercial |
$2,353.50
|
| Rate for Payer: First Choice Health Commercial |
$991.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,046.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,484.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.85
|
| Rate for Payer: HealthUtah PPO |
$1,102.00
|
| Rate for Payer: HealthUtah PPO |
$2,615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,536.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,068.94
|
| Rate for Payer: Multiplan Medicare/VA |
$324.57
|
| Rate for Payer: Multiplan Medicare/VA |
$324.57
|
| Rate for Payer: One Health Plan of WY PPO |
$2,562.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,079.96
|
| Rate for Payer: PacificSource Commercial |
$991.80
|
| Rate for Payer: PacificSource Commercial |
$2,353.50
|
| Rate for Payer: PHCS PPO |
$1,046.90
|
| Rate for Payer: PHCS PPO |
$2,484.25
|
| Rate for Payer: Three Rivers PPO |
$826.50
|
| Rate for Payer: Three Rivers PPO |
$1,961.25
|
| Rate for Payer: TriWest Veterans Administration |
$381.85
|
| Rate for Payer: TriWest Veterans Administration |
$381.85
|
| Rate for Payer: United Healthcare Commercial |
$2,275.05
|
| Rate for Payer: United Healthcare Commercial |
$958.74
|
| Rate for Payer: United Healthcare Medicare |
$381.85
|
| Rate for Payer: United Healthcare Medicare |
$381.85
|
| Rate for Payer: WINHealth Partners Commercial |
$936.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,222.75
|
|
|
HC PRO CLOSED TX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 27246 NONPBBPAYER
|
| Hospital Charge Code |
9832724601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$324.57 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,349.46
|
| Rate for Payer: Aetna of WY Medicare |
$381.85
|
| Rate for Payer: Beech Street Commercial |
$1,308.15
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,335.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,349.46
|
| Rate for Payer: First Choice Health Commercial |
$1,239.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,308.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.85
|
| Rate for Payer: HealthUtah PPO |
$1,377.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,335.69
|
| Rate for Payer: Multiplan Medicare/VA |
$324.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,349.46
|
| Rate for Payer: PacificSource Commercial |
$1,239.30
|
| Rate for Payer: PHCS PPO |
$1,308.15
|
| Rate for Payer: Three Rivers PPO |
$1,032.75
|
| Rate for Payer: TriWest Veterans Administration |
$381.85
|
| Rate for Payer: United Healthcare Commercial |
$1,197.99
|
| Rate for Payer: United Healthcare Medicare |
$381.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,170.45
|
|
|
HC PRO CLOSED TX GR TUBEROSITY HUM FX
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
9832362001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,028.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,007.44
|
| Rate for Payer: Aetna of WY Medicare |
$262.59
|
| Rate for Payer: Beech Street Commercial |
$976.60
|
| Rate for Payer: Cash Price |
$719.60
|
| Rate for Payer: Cash Price |
$719.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$997.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,007.44
|
| Rate for Payer: First Choice Health Commercial |
$925.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$976.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.59
|
| Rate for Payer: HealthUtah PPO |
$1,028.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$997.16
|
| Rate for Payer: Multiplan Medicare/VA |
$223.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,007.44
|
| Rate for Payer: PacificSource Commercial |
$925.20
|
| Rate for Payer: PHCS PPO |
$976.60
|
| Rate for Payer: Three Rivers PPO |
$771.00
|
| Rate for Payer: TriWest Veterans Administration |
$262.59
|
| Rate for Payer: United Healthcare Commercial |
$894.36
|
| Rate for Payer: United Healthcare Medicare |
$262.59
|
| Rate for Payer: WINHealth Partners Commercial |
$873.80
|
|
|
HC PRO CLOSED TX GR TUBEROSITY HUM FX
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 23620 NONPBBPAYER
|
| Hospital Charge Code |
9832362001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,259.30
|
| Rate for Payer: Aetna of WY Medicare |
$262.59
|
| Rate for Payer: Beech Street Commercial |
$1,220.75
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,246.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,259.30
|
| Rate for Payer: First Choice Health Commercial |
$1,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,220.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.59
|
| Rate for Payer: HealthUtah PPO |
$1,285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,246.45
|
| Rate for Payer: Multiplan Medicare/VA |
$223.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,259.30
|
| Rate for Payer: PacificSource Commercial |
$1,156.50
|
| Rate for Payer: PHCS PPO |
$1,220.75
|
| Rate for Payer: Three Rivers PPO |
$963.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.59
|
| Rate for Payer: United Healthcare Commercial |
$1,117.95
|
| Rate for Payer: United Healthcare Medicare |
$262.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,092.25
|
|
|
HC PRO CLOSED TX HUM EPICONDYLER FX W/O MANIPULATION
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
9832456001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,252.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.98
|
| Rate for Payer: Aetna of WY Medicare |
$297.51
|
| Rate for Payer: Aetna of WY Medicare |
$297.51
|
| Rate for Payer: Beech Street Commercial |
$428.45
|
| Rate for Payer: Beech Street Commercial |
$2,183.10
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,229.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,252.04
|
| Rate for Payer: Cigna of WY Commercial |
$441.98
|
| Rate for Payer: First Choice Health Commercial |
$405.90
|
| Rate for Payer: First Choice Health Commercial |
$2,068.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,183.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.51
|
| Rate for Payer: HealthUtah PPO |
$2,298.00
|
| Rate for Payer: HealthUtah PPO |
$451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,229.06
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: One Health Plan of WY PPO |
$441.98
|
| Rate for Payer: One Health Plan of WY PPO |
$2,252.04
|
| Rate for Payer: PacificSource Commercial |
$2,068.20
|
| Rate for Payer: PacificSource Commercial |
$405.90
|
| Rate for Payer: PHCS PPO |
$2,183.10
|
| Rate for Payer: PHCS PPO |
$428.45
|
| Rate for Payer: Three Rivers PPO |
$1,723.50
|
| Rate for Payer: Three Rivers PPO |
$338.25
|
| Rate for Payer: TriWest Veterans Administration |
$297.51
|
| Rate for Payer: TriWest Veterans Administration |
$297.51
|
| Rate for Payer: United Healthcare Commercial |
$392.37
|
| Rate for Payer: United Healthcare Commercial |
$1,999.26
|
| Rate for Payer: United Healthcare Medicare |
$297.51
|
| Rate for Payer: United Healthcare Medicare |
$297.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,953.30
|
| Rate for Payer: WINHealth Partners Commercial |
$383.35
|
|
|
HC PRO CLOSED TX HUM EPICONDYLER FX W/O MANIPULATION
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 24560 NONPBBPAYER
|
| Hospital Charge Code |
9832456001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.72
|
| Rate for Payer: Aetna of WY Medicare |
$297.51
|
| Rate for Payer: Beech Street Commercial |
$535.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$547.08
|
| Rate for Payer: Cigna of WY Commercial |
$552.72
|
| Rate for Payer: First Choice Health Commercial |
$507.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.51
|
| Rate for Payer: HealthUtah PPO |
$564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$547.08
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: One Health Plan of WY PPO |
$552.72
|
| Rate for Payer: PacificSource Commercial |
$507.60
|
| Rate for Payer: PHCS PPO |
$535.80
|
| Rate for Payer: Three Rivers PPO |
$423.00
|
| Rate for Payer: TriWest Veterans Administration |
$297.51
|
| Rate for Payer: United Healthcare Commercial |
$490.68
|
| Rate for Payer: United Healthcare Medicare |
$297.51
|
| Rate for Payer: WINHealth Partners Commercial |
$479.40
|
|
|
HC PRO CLOSED TX HUMERAL SUPRACONDYLAR FX
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 24530 NONPBBPAYER
|
| Hospital Charge Code |
9832453001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,749.30
|
| Rate for Payer: Aetna of WY Medicare |
$353.53
|
| Rate for Payer: Beech Street Commercial |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,731.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,749.30
|
| Rate for Payer: First Choice Health Commercial |
$1,606.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,695.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.53
|
| Rate for Payer: HealthUtah PPO |
$1,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,731.45
|
| Rate for Payer: Multiplan Medicare/VA |
$300.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,749.30
|
| Rate for Payer: PacificSource Commercial |
$1,606.50
|
| Rate for Payer: PHCS PPO |
$1,695.75
|
| Rate for Payer: Three Rivers PPO |
$1,338.75
|
| Rate for Payer: TriWest Veterans Administration |
$353.53
|
| Rate for Payer: United Healthcare Commercial |
$1,552.95
|
| Rate for Payer: United Healthcare Medicare |
$353.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,517.25
|
|
|
HC PRO CLOSED TX HUMERAL SUPRACONDYLAR FX
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
9832453001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$1,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,399.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,664.62
|
| Rate for Payer: Aetna of WY Medicare |
$353.53
|
| Rate for Payer: Aetna of WY Medicare |
$353.53
|
| Rate for Payer: Beech Street Commercial |
$2,583.05
|
| Rate for Payer: Beech Street Commercial |
$1,356.60
|
| Rate for Payer: Cash Price |
$1,903.30
|
| Rate for Payer: Cash Price |
$999.60
|
| Rate for Payer: Cash Price |
$999.60
|
| Rate for Payer: Cash Price |
$1,903.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,637.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,385.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,399.44
|
| Rate for Payer: Cigna of WY Commercial |
$2,664.62
|
| Rate for Payer: First Choice Health Commercial |
$2,447.10
|
| Rate for Payer: First Choice Health Commercial |
$1,285.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,356.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,583.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.53
|
| Rate for Payer: HealthUtah PPO |
$1,428.00
|
| Rate for Payer: HealthUtah PPO |
$2,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,637.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,385.16
|
| Rate for Payer: Multiplan Medicare/VA |
$300.50
|
| Rate for Payer: Multiplan Medicare/VA |
$300.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,664.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,399.44
|
| Rate for Payer: PacificSource Commercial |
$1,285.20
|
| Rate for Payer: PacificSource Commercial |
$2,447.10
|
| Rate for Payer: PHCS PPO |
$1,356.60
|
| Rate for Payer: PHCS PPO |
$2,583.05
|
| Rate for Payer: Three Rivers PPO |
$1,071.00
|
| Rate for Payer: Three Rivers PPO |
$2,039.25
|
| Rate for Payer: TriWest Veterans Administration |
$353.53
|
| Rate for Payer: TriWest Veterans Administration |
$353.53
|
| Rate for Payer: United Healthcare Commercial |
$2,365.53
|
| Rate for Payer: United Healthcare Commercial |
$1,242.36
|
| Rate for Payer: United Healthcare Medicare |
$353.53
|
| Rate for Payer: United Healthcare Medicare |
$353.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,213.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,311.15
|
|
|
HC PRO CLOSED TX HUMERUS SHAFT FX W/ MANIPULATION
|
Professional
|
Both
|
$2,318.00
|
|
|
Service Code
|
HCPCS 24505 NONPBBPAYER
|
| Hospital Charge Code |
9832450501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$382.28 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,271.64
|
| Rate for Payer: Aetna of WY Medicare |
$449.74
|
| Rate for Payer: Beech Street Commercial |
$2,202.10
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,248.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,271.64
|
| Rate for Payer: First Choice Health Commercial |
$2,086.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,202.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.74
|
| Rate for Payer: HealthUtah PPO |
$2,318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,248.46
|
| Rate for Payer: Multiplan Medicare/VA |
$382.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,271.64
|
| Rate for Payer: PacificSource Commercial |
$2,086.20
|
| Rate for Payer: PHCS PPO |
$2,202.10
|
| Rate for Payer: Three Rivers PPO |
$1,738.50
|
| Rate for Payer: TriWest Veterans Administration |
$449.74
|
| Rate for Payer: United Healthcare Commercial |
$2,016.66
|
| Rate for Payer: United Healthcare Medicare |
$449.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,970.30
|
|
|
HC PRO CLOSED TX HUMERUS SHAFT FX W/ MANIPULATION
|
Professional
|
Both
|
$1,909.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
9832450501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$382.28 |
| Max. Negotiated Rate |
$1,909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,870.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,816.92
|
| Rate for Payer: Aetna of WY Medicare |
$449.74
|
| Rate for Payer: Aetna of WY Medicare |
$449.74
|
| Rate for Payer: Beech Street Commercial |
$1,761.30
|
| Rate for Payer: Beech Street Commercial |
$1,813.55
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,336.30
|
| Rate for Payer: Cash Price |
$1,336.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,851.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,798.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,816.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,870.82
|
| Rate for Payer: First Choice Health Commercial |
$1,668.60
|
| Rate for Payer: First Choice Health Commercial |
$1,718.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,813.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,761.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.74
|
| Rate for Payer: HealthUtah PPO |
$1,909.00
|
| Rate for Payer: HealthUtah PPO |
$1,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,851.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,798.38
|
| Rate for Payer: Multiplan Medicare/VA |
$382.28
|
| Rate for Payer: Multiplan Medicare/VA |
$382.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,870.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,816.92
|
| Rate for Payer: PacificSource Commercial |
$1,668.60
|
| Rate for Payer: PacificSource Commercial |
$1,718.10
|
| Rate for Payer: PHCS PPO |
$1,813.55
|
| Rate for Payer: PHCS PPO |
$1,761.30
|
| Rate for Payer: Three Rivers PPO |
$1,431.75
|
| Rate for Payer: Three Rivers PPO |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration |
$449.74
|
| Rate for Payer: TriWest Veterans Administration |
$449.74
|
| Rate for Payer: United Healthcare Commercial |
$1,612.98
|
| Rate for Payer: United Healthcare Commercial |
$1,660.83
|
| Rate for Payer: United Healthcare Medicare |
$449.74
|
| Rate for Payer: United Healthcare Medicare |
$449.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,622.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.90
|
|
|
HC PRO CLOSED TX HUMERUS SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
9832450001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$286.67 |
| Max. Negotiated Rate |
$1,358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,330.84
|
| Rate for Payer: Aetna of WY Medicare |
$337.26
|
| Rate for Payer: Beech Street Commercial |
$1,290.10
|
| Rate for Payer: Cash Price |
$950.60
|
| Rate for Payer: Cash Price |
$950.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,317.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,330.84
|
| Rate for Payer: First Choice Health Commercial |
$1,222.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,290.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.26
|
| Rate for Payer: HealthUtah PPO |
$1,358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,317.26
|
| Rate for Payer: Multiplan Medicare/VA |
$286.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,330.84
|
| Rate for Payer: PacificSource Commercial |
$1,222.20
|
| Rate for Payer: PHCS PPO |
$1,290.10
|
| Rate for Payer: Three Rivers PPO |
$1,018.50
|
| Rate for Payer: TriWest Veterans Administration |
$337.26
|
| Rate for Payer: United Healthcare Commercial |
$1,181.46
|
| Rate for Payer: United Healthcare Medicare |
$337.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,154.30
|
|
|
HC PRO CLOSED TX HUMERUS SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 24500 NONPBBPAYER
|
| Hospital Charge Code |
9832450001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$286.67 |
| Max. Negotiated Rate |
$1,698.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,664.04
|
| Rate for Payer: Aetna of WY Medicare |
$337.26
|
| Rate for Payer: Beech Street Commercial |
$1,613.10
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,647.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,664.04
|
| Rate for Payer: First Choice Health Commercial |
$1,528.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,613.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.26
|
| Rate for Payer: HealthUtah PPO |
$1,698.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,647.06
|
| Rate for Payer: Multiplan Medicare/VA |
$286.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,664.04
|
| Rate for Payer: PacificSource Commercial |
$1,528.20
|
| Rate for Payer: PHCS PPO |
$1,613.10
|
| Rate for Payer: Three Rivers PPO |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration |
$337.26
|
| Rate for Payer: United Healthcare Commercial |
$1,477.26
|
| Rate for Payer: United Healthcare Medicare |
$337.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,443.30
|
|
|
HC PRO CLOSED TX HUM SUPRACONDYLR FX W/ MANIPULATION
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 24535 NONPBBPAYER
|
| Hospital Charge Code |
9832453501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$481.47 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,866.50
|
| Rate for Payer: Aetna of WY Medicare |
$566.44
|
| Rate for Payer: Beech Street Commercial |
$2,778.75
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,837.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,866.50
|
| Rate for Payer: First Choice Health Commercial |
$2,632.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,778.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.44
|
| Rate for Payer: HealthUtah PPO |
$2,925.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,837.25
|
| Rate for Payer: Multiplan Medicare/VA |
$481.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,866.50
|
| Rate for Payer: PacificSource Commercial |
$2,632.50
|
| Rate for Payer: PHCS PPO |
$2,778.75
|
| Rate for Payer: Three Rivers PPO |
$2,193.75
|
| Rate for Payer: TriWest Veterans Administration |
$566.44
|
| Rate for Payer: United Healthcare Commercial |
$2,544.75
|
| Rate for Payer: United Healthcare Medicare |
$566.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.25
|
|
