|
HC PRO CLOSED TX HUM SUPRACONDYLR FX W/ MANIPULATION
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
9832453501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$481.47 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,293.20
|
| Rate for Payer: Aetna of WY Medicare |
$566.44
|
| Rate for Payer: Beech Street Commercial |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,269.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,293.20
|
| Rate for Payer: First Choice Health Commercial |
$2,106.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.44
|
| Rate for Payer: HealthUtah PPO |
$2,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,269.80
|
| Rate for Payer: Multiplan Medicare/VA |
$481.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,293.20
|
| Rate for Payer: PacificSource Commercial |
$2,106.00
|
| Rate for Payer: PHCS PPO |
$2,223.00
|
| Rate for Payer: Three Rivers PPO |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration |
$566.44
|
| Rate for Payer: United Healthcare Commercial |
$2,035.80
|
| Rate for Payer: United Healthcare Medicare |
$566.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,989.00
|
|
|
HC PRO CLOSED TX INTERPHALANGEAL
|
Professional
|
Both
|
$413.00
|
|
| Hospital Charge Code |
9830000001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$309.75 |
| Max. Negotiated Rate |
$413.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$404.74
|
| Rate for Payer: Beech Street Commercial |
$392.35
|
| Rate for Payer: Cash Price |
$289.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$400.61
|
| Rate for Payer: Cigna of WY Commercial |
$404.74
|
| Rate for Payer: First Choice Health Commercial |
$371.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$392.35
|
| Rate for Payer: HealthUtah PPO |
$413.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$400.61
|
| Rate for Payer: One Health Plan of WY PPO |
$404.74
|
| Rate for Payer: PacificSource Commercial |
$371.70
|
| Rate for Payer: PHCS PPO |
$392.35
|
| Rate for Payer: Three Rivers PPO |
$309.75
|
| Rate for Payer: United Healthcare Commercial |
$359.31
|
| Rate for Payer: WINHealth Partners Commercial |
$392.35
|
|
|
HC PRO CLOSED TX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
9832866001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$458.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$92.25
|
| Rate for Payer: Aetna of WY Medicare |
$92.25
|
| Rate for Payer: Beech Street Commercial |
$503.50
|
| Rate for Payer: Beech Street Commercial |
$444.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$453.96
|
| Rate for Payer: Cigna of WY Commercial |
$458.64
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: First Choice Health Commercial |
$477.00
|
| Rate for Payer: First Choice Health Commercial |
$421.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.25
|
| Rate for Payer: HealthUtah PPO |
$468.00
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$453.96
|
| Rate for Payer: Multiplan Medicare/VA |
$78.41
|
| Rate for Payer: Multiplan Medicare/VA |
$78.41
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: One Health Plan of WY PPO |
$458.64
|
| Rate for Payer: PacificSource Commercial |
$421.20
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$444.60
|
| Rate for Payer: PHCS PPO |
$503.50
|
| Rate for Payer: Three Rivers PPO |
$351.00
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$92.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Commercial |
$407.16
|
| Rate for Payer: United Healthcare Medicare |
$92.25
|
| Rate for Payer: United Healthcare Medicare |
$92.25
|
| Rate for Payer: WINHealth Partners Commercial |
$397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$450.50
|
|
|
HC PRO CLOSED TX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
9832677501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,362.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.81
|
| Rate for Payer: Aetna of WY Medicare |
$356.81
|
| Rate for Payer: Beech Street Commercial |
$1,320.50
|
| Rate for Payer: Beech Street Commercial |
$674.50
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| 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 |
$695.80
|
| Rate for Payer: First Choice Health Commercial |
$1,251.00
|
| Rate for Payer: First Choice Health Commercial |
$639.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,320.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.81
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: HealthUtah PPO |
$1,390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,348.30
|
| Rate for Payer: Multiplan Medicare/VA |
$303.29
|
| Rate for Payer: Multiplan Medicare/VA |
$303.29
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| 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 |
$639.00
|
| Rate for Payer: PHCS PPO |
$674.50
|
| Rate for Payer: PHCS PPO |
$1,320.50
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: Three Rivers PPO |
$1,042.50
|
| Rate for Payer: TriWest Veterans Administration |
$356.81
|
| Rate for Payer: TriWest Veterans Administration |
$356.81
|
| Rate for Payer: United Healthcare Commercial |
$1,209.30
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$356.81
|
| Rate for Payer: United Healthcare Medicare |
$356.81
|
| Rate for Payer: WINHealth Partners Commercial |
$603.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.50
|
|
|
HC PRO CLOSED TX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
HCPCS 26775 NONPBBPAYER
|
| Hospital Charge Code |
9832677501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,702.26
|
| Rate for Payer: Aetna of WY Medicare |
$356.81
|
| Rate for Payer: Beech Street Commercial |
$1,650.15
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,684.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,702.26
|
| Rate for Payer: First Choice Health Commercial |
$1,563.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,650.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.81
|
| Rate for Payer: HealthUtah PPO |
$1,737.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,684.89
|
| Rate for Payer: Multiplan Medicare/VA |
$303.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,702.26
|
| Rate for Payer: PacificSource Commercial |
$1,563.30
|
| Rate for Payer: PHCS PPO |
$1,650.15
|
| Rate for Payer: Three Rivers PPO |
$1,302.75
|
| Rate for Payer: TriWest Veterans Administration |
$356.81
|
| Rate for Payer: United Healthcare Commercial |
$1,511.19
|
| Rate for Payer: United Healthcare Medicare |
$356.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,476.45
|
|
|
HC PRO CLOSED TX IP JT DISLOCATION
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
HCPCS 26770 NONPBBPAYER
|
| Hospital Charge Code |
9832677001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,021.16
|
| Rate for Payer: Aetna of WY Medicare |
$264.84
|
| Rate for Payer: Beech Street Commercial |
$989.90
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,010.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,021.16
|
| Rate for Payer: First Choice Health Commercial |
$937.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$989.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.84
|
| Rate for Payer: HealthUtah PPO |
$1,042.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,010.74
|
| Rate for Payer: Multiplan Medicare/VA |
$225.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,021.16
|
| Rate for Payer: PacificSource Commercial |
$937.80
|
| Rate for Payer: PHCS PPO |
$989.90
|
| Rate for Payer: Three Rivers PPO |
$781.50
|
| Rate for Payer: TriWest Veterans Administration |
$264.84
|
| Rate for Payer: United Healthcare Commercial |
$906.54
|
| Rate for Payer: United Healthcare Medicare |
$264.84
|
| Rate for Payer: WINHealth Partners Commercial |
$885.70
|
|
|
HC PRO CLOSED TX IP JT DISLOCATION
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
9832677001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$834.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$817.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,292.62
|
| Rate for Payer: Aetna of WY Medicare |
$264.84
|
| Rate for Payer: Aetna of WY Medicare |
$264.84
|
| Rate for Payer: Beech Street Commercial |
$1,253.05
|
| Rate for Payer: Beech Street Commercial |
$792.30
|
| Rate for Payer: Cash Price |
$923.30
|
| Rate for Payer: Cash Price |
$923.30
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$808.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,279.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,292.62
|
| Rate for Payer: Cigna of WY Commercial |
$817.32
|
| Rate for Payer: First Choice Health Commercial |
$1,187.10
|
| Rate for Payer: First Choice Health Commercial |
$750.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$792.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,253.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.84
|
| Rate for Payer: HealthUtah PPO |
$834.00
|
| Rate for Payer: HealthUtah PPO |
$1,319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$808.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,279.43
|
| Rate for Payer: Multiplan Medicare/VA |
$225.11
|
| Rate for Payer: Multiplan Medicare/VA |
$225.11
|
| Rate for Payer: One Health Plan of WY PPO |
$817.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,292.62
|
| Rate for Payer: PacificSource Commercial |
$1,187.10
|
| Rate for Payer: PacificSource Commercial |
$750.60
|
| Rate for Payer: PHCS PPO |
$792.30
|
| Rate for Payer: PHCS PPO |
$1,253.05
|
| Rate for Payer: Three Rivers PPO |
$625.50
|
| Rate for Payer: Three Rivers PPO |
$989.25
|
| Rate for Payer: TriWest Veterans Administration |
$264.84
|
| Rate for Payer: TriWest Veterans Administration |
$264.84
|
| Rate for Payer: United Healthcare Commercial |
$1,147.53
|
| Rate for Payer: United Healthcare Commercial |
$725.58
|
| Rate for Payer: United Healthcare Medicare |
$264.84
|
| Rate for Payer: United Healthcare Medicare |
$264.84
|
| Rate for Payer: WINHealth Partners Commercial |
$708.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,121.15
|
|
|
HC PRO CLOSED TX KNEE DIS
|
Professional
|
Both
|
$3,765.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
9832755001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$394.92 |
| Max. Negotiated Rate |
$3,765.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,689.70
|
| Rate for Payer: Aetna of WY Medicare |
$464.61
|
| Rate for Payer: Beech Street Commercial |
$3,576.75
|
| Rate for Payer: Cash Price |
$2,635.50
|
| Rate for Payer: Cash Price |
$2,635.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,652.05
|
| Rate for Payer: Cigna of WY Commercial |
$3,689.70
|
| Rate for Payer: First Choice Health Commercial |
$3,388.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,576.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$464.61
|
| Rate for Payer: HealthUtah PPO |
$3,765.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,652.05
|
| Rate for Payer: Multiplan Medicare/VA |
$394.92
|
| Rate for Payer: One Health Plan of WY PPO |
$3,689.70
|
| Rate for Payer: PacificSource Commercial |
$3,388.50
|
| Rate for Payer: PHCS PPO |
$3,576.75
|
| Rate for Payer: Three Rivers PPO |
$2,823.75
|
| Rate for Payer: TriWest Veterans Administration |
$464.61
|
| Rate for Payer: United Healthcare Commercial |
$3,275.55
|
| Rate for Payer: United Healthcare Medicare |
$464.61
|
| Rate for Payer: WINHealth Partners Commercial |
$3,200.25
|
|
|
HC PRO CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 27760 NONPBBPAYER
|
| Hospital Charge Code |
9832776001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,549.38
|
| Rate for Payer: Aetna of WY Medicare |
$310.13
|
| Rate for Payer: Beech Street Commercial |
$1,501.95
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,533.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,549.38
|
| Rate for Payer: First Choice Health Commercial |
$1,422.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.13
|
| Rate for Payer: HealthUtah PPO |
$1,581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,533.57
|
| Rate for Payer: Multiplan Medicare/VA |
$263.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,549.38
|
| Rate for Payer: PacificSource Commercial |
$1,422.90
|
| Rate for Payer: PHCS PPO |
$1,501.95
|
| Rate for Payer: Three Rivers PPO |
$1,185.75
|
| Rate for Payer: TriWest Veterans Administration |
$310.13
|
| Rate for Payer: United Healthcare Commercial |
$1,375.47
|
| Rate for Payer: United Healthcare Medicare |
$310.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,343.85
|
|
|
HC PRO CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
5102776001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.68
|
| Rate for Payer: Aetna of WY Medicare |
$310.13
|
| Rate for Payer: Beech Street Commercial |
$300.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.52
|
| Rate for Payer: Cigna of WY Commercial |
$309.68
|
| Rate for Payer: First Choice Health Commercial |
$284.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.13
|
| Rate for Payer: HealthUtah PPO |
$316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.52
|
| Rate for Payer: Multiplan Medicare/VA |
$263.61
|
| Rate for Payer: One Health Plan of WY PPO |
$309.68
|
| Rate for Payer: PacificSource Commercial |
$284.40
|
| Rate for Payer: PHCS PPO |
$300.20
|
| Rate for Payer: Three Rivers PPO |
$237.00
|
| Rate for Payer: TriWest Veterans Administration |
$310.13
|
| Rate for Payer: United Healthcare Commercial |
$274.92
|
| Rate for Payer: United Healthcare Medicare |
$310.13
|
| Rate for Payer: WINHealth Partners Commercial |
$268.60
|
|
|
HC PRO CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
9832776001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$310.13
|
| Rate for Payer: Beech Street Commercial |
$1,201.75
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: First Choice Health Commercial |
$1,138.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.13
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$263.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,201.75
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$310.13
|
| Rate for Payer: United Healthcare Commercial |
$1,100.55
|
| Rate for Payer: United Healthcare Medicare |
$310.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,075.25
|
|
|
HC PRO CLOSED TX METACARPAL FX,MANIP
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 26605 NONPBBPAYER
|
| Hospital Charge Code |
9832660501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,486.66
|
| Rate for Payer: Aetna of WY Medicare |
$299.81
|
| Rate for Payer: Beech Street Commercial |
$1,441.15
|
| Rate for Payer: Cash Price |
$1,061.90
|
| Rate for Payer: Cash Price |
$1,061.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,471.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,486.66
|
| Rate for Payer: First Choice Health Commercial |
$1,365.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,441.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.81
|
| Rate for Payer: HealthUtah PPO |
$1,517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,471.49
|
| Rate for Payer: Multiplan Medicare/VA |
$254.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,486.66
|
| Rate for Payer: PacificSource Commercial |
$1,365.30
|
| Rate for Payer: PHCS PPO |
$1,441.15
|
| Rate for Payer: Three Rivers PPO |
$1,137.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.81
|
| Rate for Payer: United Healthcare Commercial |
$1,319.79
|
| Rate for Payer: United Healthcare Medicare |
$299.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,289.45
|
|
|
HC PRO CLOSED TX METACARPAL FX,MANIP
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
9832660501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,681.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,647.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,189.72
|
| Rate for Payer: Aetna of WY Medicare |
$299.81
|
| Rate for Payer: Aetna of WY Medicare |
$299.81
|
| Rate for Payer: Beech Street Commercial |
$1,153.30
|
| Rate for Payer: Beech Street Commercial |
$1,596.95
|
| Rate for Payer: Cash Price |
$849.80
|
| Rate for Payer: Cash Price |
$849.80
|
| Rate for Payer: Cash Price |
$1,176.70
|
| Rate for Payer: Cash Price |
$1,176.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,630.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,177.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,189.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,647.38
|
| Rate for Payer: First Choice Health Commercial |
$1,092.60
|
| Rate for Payer: First Choice Health Commercial |
$1,512.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,596.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,153.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.81
|
| Rate for Payer: HealthUtah PPO |
$1,681.00
|
| Rate for Payer: HealthUtah PPO |
$1,214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,630.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,177.58
|
| Rate for Payer: Multiplan Medicare/VA |
$254.84
|
| Rate for Payer: Multiplan Medicare/VA |
$254.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,189.72
|
| Rate for Payer: PacificSource Commercial |
$1,092.60
|
| Rate for Payer: PacificSource Commercial |
$1,512.90
|
| Rate for Payer: PHCS PPO |
$1,596.95
|
| Rate for Payer: PHCS PPO |
$1,153.30
|
| Rate for Payer: Three Rivers PPO |
$1,260.75
|
| Rate for Payer: Three Rivers PPO |
$910.50
|
| Rate for Payer: TriWest Veterans Administration |
$299.81
|
| Rate for Payer: TriWest Veterans Administration |
$299.81
|
| Rate for Payer: United Healthcare Commercial |
$1,056.18
|
| Rate for Payer: United Healthcare Commercial |
$1,462.47
|
| Rate for Payer: United Healthcare Medicare |
$299.81
|
| Rate for Payer: United Healthcare Medicare |
$299.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,428.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,031.90
|
|
|
HC PRO CLOSED TX METACARPAL FX WO MANIP
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
9832660001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$247.42 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,583.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$291.08
|
| Rate for Payer: Aetna of WY Medicare |
$291.08
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Beech Street Commercial |
$1,535.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,567.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,583.68
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: First Choice Health Commercial |
$1,454.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,535.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.08
|
| Rate for Payer: HealthUtah PPO |
$1,616.00
|
| Rate for Payer: HealthUtah PPO |
$546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,567.52
|
| Rate for Payer: Multiplan Medicare/VA |
$247.42
|
| Rate for Payer: Multiplan Medicare/VA |
$247.42
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,583.68
|
| Rate for Payer: PacificSource Commercial |
$1,454.40
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$1,535.20
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$1,212.00
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$291.08
|
| Rate for Payer: TriWest Veterans Administration |
$291.08
|
| Rate for Payer: United Healthcare Commercial |
$475.02
|
| Rate for Payer: United Healthcare Commercial |
$1,405.92
|
| Rate for Payer: United Healthcare Medicare |
$291.08
|
| Rate for Payer: United Healthcare Medicare |
$291.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,373.60
|
| Rate for Payer: WINHealth Partners Commercial |
$464.10
|
|
|
HC PRO CLOSED TX METACARPAL FX WO MANIP
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 26600 NONPBBPAYER
|
| Hospital Charge Code |
9832660001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$247.42 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$291.08
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.08
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$247.42
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$291.08
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$291.08
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
HC PRO CLOSED TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
9832670001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$976.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$956.48
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,351.02
|
| Rate for Payer: Aetna of WY Medicare |
$314.40
|
| Rate for Payer: Aetna of WY Medicare |
$314.40
|
| Rate for Payer: Beech Street Commercial |
$2,279.05
|
| Rate for Payer: Beech Street Commercial |
$927.20
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$946.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,327.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,351.02
|
| Rate for Payer: Cigna of WY Commercial |
$956.48
|
| Rate for Payer: First Choice Health Commercial |
$2,159.10
|
| Rate for Payer: First Choice Health Commercial |
$878.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$927.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,279.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.40
|
| Rate for Payer: HealthUtah PPO |
$976.00
|
| Rate for Payer: HealthUtah PPO |
$2,399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$946.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,327.03
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$956.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,351.02
|
| Rate for Payer: PacificSource Commercial |
$2,159.10
|
| Rate for Payer: PacificSource Commercial |
$878.40
|
| Rate for Payer: PHCS PPO |
$927.20
|
| Rate for Payer: PHCS PPO |
$2,279.05
|
| Rate for Payer: Three Rivers PPO |
$732.00
|
| Rate for Payer: Three Rivers PPO |
$1,799.25
|
| Rate for Payer: TriWest Veterans Administration |
$314.40
|
| Rate for Payer: TriWest Veterans Administration |
$314.40
|
| Rate for Payer: United Healthcare Commercial |
$2,087.13
|
| Rate for Payer: United Healthcare Commercial |
$849.12
|
| Rate for Payer: United Healthcare Medicare |
$314.40
|
| Rate for Payer: United Healthcare Medicare |
$314.40
|
| Rate for Payer: WINHealth Partners Commercial |
$829.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,039.15
|
|
|
HC PRO CLOSED TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 26700 NONPBBPAYER
|
| Hospital Charge Code |
9832670001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Aetna of WY Medicare |
$314.40
|
| Rate for Payer: Beech Street Commercial |
$1,159.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: First Choice Health Commercial |
$1,098.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.40
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,159.00
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$314.40
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$314.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,037.00
|
|
|
HC PRO CLOSED TX METATARSAL FX W/MANI PRO FEE
|
Professional
|
Both
|
$1,172.00
|
|
|
Service Code
|
HCPCS 28475 NONPBBPAYER
|
| Hospital Charge Code |
9832847501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$1,172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,148.56
|
| Rate for Payer: Aetna of WY Medicare |
$228.67
|
| Rate for Payer: Beech Street Commercial |
$1,113.40
|
| Rate for Payer: Cash Price |
$820.40
|
| Rate for Payer: Cash Price |
$820.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,136.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,148.56
|
| Rate for Payer: First Choice Health Commercial |
$1,054.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,113.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.67
|
| Rate for Payer: HealthUtah PPO |
$1,172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,136.84
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,148.56
|
| Rate for Payer: PacificSource Commercial |
$1,054.80
|
| Rate for Payer: PHCS PPO |
$1,113.40
|
| Rate for Payer: Three Rivers PPO |
$879.00
|
| Rate for Payer: TriWest Veterans Administration |
$228.67
|
| Rate for Payer: United Healthcare Commercial |
$1,019.64
|
| Rate for Payer: United Healthcare Medicare |
$228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$996.20
|
|
|
HC PRO CLOSED TX METATARSAL FX W/MANI PRO FEE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
9832847501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$938.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$919.24
|
| Rate for Payer: Aetna of WY Medicare |
$228.67
|
| Rate for Payer: Beech Street Commercial |
$891.10
|
| Rate for Payer: Cash Price |
$656.60
|
| Rate for Payer: Cash Price |
$656.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$909.86
|
| Rate for Payer: Cigna of WY Commercial |
$919.24
|
| Rate for Payer: First Choice Health Commercial |
$844.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$891.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.67
|
| Rate for Payer: HealthUtah PPO |
$938.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$909.86
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$919.24
|
| Rate for Payer: PacificSource Commercial |
$844.20
|
| Rate for Payer: PHCS PPO |
$891.10
|
| Rate for Payer: Three Rivers PPO |
$703.50
|
| Rate for Payer: TriWest Veterans Administration |
$228.67
|
| Rate for Payer: United Healthcare Commercial |
$816.06
|
| Rate for Payer: United Healthcare Medicare |
$228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$797.30
|
|
|
HC PRO CLOSED TX METATARSAL FX W/O MANIPULATION
|
Professional
|
Both
|
$841.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
9832847001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.47 |
| Max. Negotiated Rate |
$841.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$824.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$206.43
|
| Rate for Payer: Aetna of WY Medicare |
$206.43
|
| Rate for Payer: Beech Street Commercial |
$1,097.25
|
| Rate for Payer: Beech Street Commercial |
$798.95
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cash Price |
$588.70
|
| Rate for Payer: Cash Price |
$588.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$815.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Cigna of WY Commercial |
$824.18
|
| Rate for Payer: First Choice Health Commercial |
$1,039.50
|
| Rate for Payer: First Choice Health Commercial |
$756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.43
|
| Rate for Payer: HealthUtah PPO |
$841.00
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$815.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$175.47
|
| Rate for Payer: Multiplan Medicare/VA |
$175.47
|
| Rate for Payer: One Health Plan of WY PPO |
$824.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PacificSource Commercial |
$756.90
|
| Rate for Payer: PHCS PPO |
$798.95
|
| Rate for Payer: PHCS PPO |
$1,097.25
|
| Rate for Payer: Three Rivers PPO |
$630.75
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$206.43
|
| Rate for Payer: TriWest Veterans Administration |
$206.43
|
| Rate for Payer: United Healthcare Commercial |
$1,004.85
|
| Rate for Payer: United Healthcare Commercial |
$731.67
|
| Rate for Payer: United Healthcare Medicare |
$206.43
|
| Rate for Payer: United Healthcare Medicare |
$206.43
|
| Rate for Payer: WINHealth Partners Commercial |
$714.85
|
| Rate for Payer: WINHealth Partners Commercial |
$981.75
|
|
|
HC PRO CLOSED TX METATARSAL FX W/O MANIPULATION
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 28470 NONPBBPAYER
|
| Hospital Charge Code |
9832847001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.47 |
| Max. Negotiated Rate |
$1,051.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,029.98
|
| Rate for Payer: Aetna of WY Medicare |
$206.43
|
| Rate for Payer: Beech Street Commercial |
$998.45
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,019.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,029.98
|
| Rate for Payer: First Choice Health Commercial |
$945.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$998.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.43
|
| Rate for Payer: HealthUtah PPO |
$1,051.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,019.47
|
| Rate for Payer: Multiplan Medicare/VA |
$175.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,029.98
|
| Rate for Payer: PacificSource Commercial |
$945.90
|
| Rate for Payer: PHCS PPO |
$998.45
|
| Rate for Payer: Three Rivers PPO |
$788.25
|
| Rate for Payer: TriWest Veterans Administration |
$206.43
|
| Rate for Payer: United Healthcare Commercial |
$914.37
|
| Rate for Payer: United Healthcare Medicare |
$206.43
|
| Rate for Payer: WINHealth Partners Commercial |
$893.35
|
|
|
HC PRO CLOSED TX MONTEGGIA FX/DISLOC ELBOW W/ MANIPULATION
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
9832462001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$492.59 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$796.74
|
| Rate for Payer: Aetna of WY Medicare |
$579.52
|
| Rate for Payer: Beech Street Commercial |
$772.35
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$788.61
|
| Rate for Payer: Cigna of WY Commercial |
$796.74
|
| Rate for Payer: First Choice Health Commercial |
$731.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$772.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$579.52
|
| Rate for Payer: HealthUtah PPO |
$813.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$788.61
|
| Rate for Payer: Multiplan Medicare/VA |
$492.59
|
| Rate for Payer: One Health Plan of WY PPO |
$796.74
|
| Rate for Payer: PacificSource Commercial |
$731.70
|
| Rate for Payer: PHCS PPO |
$772.35
|
| Rate for Payer: Three Rivers PPO |
$609.75
|
| Rate for Payer: TriWest Veterans Administration |
$579.52
|
| Rate for Payer: United Healthcare Commercial |
$707.31
|
| Rate for Payer: United Healthcare Medicare |
$579.52
|
| Rate for Payer: WINHealth Partners Commercial |
$691.05
|
|
|
HC PRO CLOSED TX MONTEGGIA FX/DISLOC ELBOW W/ MANIPULATION
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 24620 NONPBBPAYER
|
| Hospital Charge Code |
9832462001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$492.59 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$995.68
|
| Rate for Payer: Aetna of WY Medicare |
$579.52
|
| Rate for Payer: Beech Street Commercial |
$965.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$985.52
|
| Rate for Payer: Cigna of WY Commercial |
$995.68
|
| Rate for Payer: First Choice Health Commercial |
$914.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$965.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$579.52
|
| Rate for Payer: HealthUtah PPO |
$1,016.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$985.52
|
| Rate for Payer: Multiplan Medicare/VA |
$492.59
|
| Rate for Payer: One Health Plan of WY PPO |
$995.68
|
| Rate for Payer: PacificSource Commercial |
$914.40
|
| Rate for Payer: PHCS PPO |
$965.20
|
| Rate for Payer: Three Rivers PPO |
$762.00
|
| Rate for Payer: TriWest Veterans Administration |
$579.52
|
| Rate for Payer: United Healthcare Commercial |
$883.92
|
| Rate for Payer: United Healthcare Medicare |
$579.52
|
| Rate for Payer: WINHealth Partners Commercial |
$863.60
|
|
|
HC PRO CLOSED TX NASAL SEPTAL FX W /WO STABIL
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 21337 NONPBBPAYER
|
| Hospital Charge Code |
9832133701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$250.61 |
| Max. Negotiated Rate |
$1,509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,478.82
|
| Rate for Payer: Aetna of WY Medicare |
$294.84
|
| Rate for Payer: Beech Street Commercial |
$1,433.55
|
| Rate for Payer: Cash Price |
$1,056.30
|
| Rate for Payer: Cash Price |
$1,056.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,463.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,478.82
|
| Rate for Payer: First Choice Health Commercial |
$1,358.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,433.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.84
|
| Rate for Payer: HealthUtah PPO |
$1,509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,463.73
|
| Rate for Payer: Multiplan Medicare/VA |
$250.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,478.82
|
| Rate for Payer: PacificSource Commercial |
$1,358.10
|
| Rate for Payer: PHCS PPO |
$1,433.55
|
| Rate for Payer: Three Rivers PPO |
$1,131.75
|
| Rate for Payer: TriWest Veterans Administration |
$294.84
|
| Rate for Payer: United Healthcare Commercial |
$1,312.83
|
| Rate for Payer: United Healthcare Medicare |
$294.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,282.65
|
|
|
HC PRO CLOSED TX NASAL SEPTAL FX W /WO STABIL
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
9832133701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$250.61 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,182.86
|
| Rate for Payer: Aetna of WY Medicare |
$294.84
|
| Rate for Payer: Beech Street Commercial |
$1,146.65
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,170.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,182.86
|
| Rate for Payer: First Choice Health Commercial |
$1,086.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,146.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.84
|
| Rate for Payer: HealthUtah PPO |
$1,207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,170.79
|
| Rate for Payer: Multiplan Medicare/VA |
$250.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,182.86
|
| Rate for Payer: PacificSource Commercial |
$1,086.30
|
| Rate for Payer: PHCS PPO |
$1,146.65
|
| Rate for Payer: Three Rivers PPO |
$905.25
|
| Rate for Payer: TriWest Veterans Administration |
$294.84
|
| Rate for Payer: United Healthcare Commercial |
$1,050.09
|
| Rate for Payer: United Healthcare Medicare |
$294.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,025.95
|
|
