|
HC PRO CLOSED TX NOSE FRACTURE, W/O STABILIZATION
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 21315 NONPBBPAYER
|
| Hospital Charge Code |
9832131501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$756.56
|
| Rate for Payer: Aetna of WY Medicare |
$57.24
|
| Rate for Payer: Beech Street Commercial |
$733.40
|
| Rate for Payer: Cash Price |
$540.40
|
| Rate for Payer: Cash Price |
$540.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$748.84
|
| Rate for Payer: Cigna of WY Commercial |
$756.56
|
| Rate for Payer: First Choice Health Commercial |
$694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$733.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.24
|
| Rate for Payer: HealthUtah PPO |
$772.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$748.84
|
| Rate for Payer: Multiplan Medicare/VA |
$48.65
|
| Rate for Payer: One Health Plan of WY PPO |
$756.56
|
| Rate for Payer: PacificSource Commercial |
$694.80
|
| Rate for Payer: PHCS PPO |
$733.40
|
| Rate for Payer: Three Rivers PPO |
$579.00
|
| Rate for Payer: TriWest Veterans Administration |
$57.24
|
| Rate for Payer: United Healthcare Commercial |
$671.64
|
| Rate for Payer: United Healthcare Medicare |
$57.24
|
| Rate for Payer: WINHealth Partners Commercial |
$656.20
|
|
|
HC PRO CLOSED TX NOSE FRACTURE, W/O STABILIZATION
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
9832131501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,155.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$57.24
|
| Rate for Payer: Aetna of WY Medicare |
$57.24
|
| Rate for Payer: Beech Street Commercial |
$587.10
|
| Rate for Payer: Beech Street Commercial |
$1,120.05
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,143.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,155.42
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: First Choice Health Commercial |
$556.20
|
| Rate for Payer: First Choice Health Commercial |
$1,061.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,120.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.24
|
| Rate for Payer: HealthUtah PPO |
$1,179.00
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,143.63
|
| Rate for Payer: Multiplan Medicare/VA |
$48.65
|
| Rate for Payer: Multiplan Medicare/VA |
$48.65
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,155.42
|
| Rate for Payer: PacificSource Commercial |
$1,061.10
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$1,120.05
|
| Rate for Payer: PHCS PPO |
$587.10
|
| Rate for Payer: Three Rivers PPO |
$884.25
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$57.24
|
| Rate for Payer: TriWest Veterans Administration |
$57.24
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Commercial |
$1,025.73
|
| Rate for Payer: United Healthcare Medicare |
$57.24
|
| Rate for Payer: United Healthcare Medicare |
$57.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1,002.15
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
|
HC PRO CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 27560 NONPBBPAYER
|
| Hospital Charge Code |
9832756001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$1,770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,734.60
|
| Rate for Payer: Aetna of WY Medicare |
$341.39
|
| Rate for Payer: Beech Street Commercial |
$1,681.50
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,716.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,734.60
|
| Rate for Payer: First Choice Health Commercial |
$1,593.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,681.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.39
|
| Rate for Payer: HealthUtah PPO |
$1,770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,716.90
|
| Rate for Payer: Multiplan Medicare/VA |
$290.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,734.60
|
| Rate for Payer: PacificSource Commercial |
$1,593.00
|
| Rate for Payer: PHCS PPO |
$1,681.50
|
| Rate for Payer: Three Rivers PPO |
$1,327.50
|
| Rate for Payer: TriWest Veterans Administration |
$341.39
|
| Rate for Payer: United Healthcare Commercial |
$1,539.90
|
| Rate for Payer: United Healthcare Medicare |
$341.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,504.50
|
|
|
HC PRO CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
9832756001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,387.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,616.60
|
| Rate for Payer: Aetna of WY Medicare |
$341.39
|
| Rate for Payer: Aetna of WY Medicare |
$341.39
|
| Rate for Payer: Beech Street Commercial |
$2,536.50
|
| Rate for Payer: Beech Street Commercial |
$1,345.20
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,589.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,373.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,387.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,616.60
|
| Rate for Payer: First Choice Health Commercial |
$2,403.00
|
| Rate for Payer: First Choice Health Commercial |
$1,274.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,345.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.39
|
| Rate for Payer: HealthUtah PPO |
$1,416.00
|
| Rate for Payer: HealthUtah PPO |
$2,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,589.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,373.52
|
| Rate for Payer: Multiplan Medicare/VA |
$290.18
|
| Rate for Payer: Multiplan Medicare/VA |
$290.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,616.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,387.68
|
| Rate for Payer: PacificSource Commercial |
$1,274.40
|
| Rate for Payer: PacificSource Commercial |
$2,403.00
|
| Rate for Payer: PHCS PPO |
$1,345.20
|
| Rate for Payer: PHCS PPO |
$2,536.50
|
| Rate for Payer: Three Rivers PPO |
$1,062.00
|
| Rate for Payer: Three Rivers PPO |
$2,002.50
|
| Rate for Payer: TriWest Veterans Administration |
$341.39
|
| Rate for Payer: TriWest Veterans Administration |
$341.39
|
| Rate for Payer: United Healthcare Commercial |
$2,322.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.92
|
| Rate for Payer: United Healthcare Medicare |
$341.39
|
| Rate for Payer: United Healthcare Medicare |
$341.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,203.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,269.50
|
|
|
HC PRO CLOSED TX PATELLAR FX W/O MANIPULATIO
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 27520 NONPBBPAYER
|
| Hospital Charge Code |
9832752001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$257.82 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Aetna of WY Medicare |
$303.32
|
| Rate for Payer: Beech Street Commercial |
$1,456.35
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: First Choice Health Commercial |
$1,379.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.32
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$257.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,456.35
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$303.32
|
| Rate for Payer: United Healthcare Commercial |
$1,333.71
|
| Rate for Payer: United Healthcare Medicare |
$303.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,303.05
|
|
|
HC PRO CLOSED TX PATELLAR FX W/O MANIPULATIO
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
9832752001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$257.82 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,201.48
|
| Rate for Payer: Aetna of WY Medicare |
$303.32
|
| Rate for Payer: Beech Street Commercial |
$1,164.70
|
| Rate for Payer: Cash Price |
$858.20
|
| Rate for Payer: Cash Price |
$858.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,189.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,201.48
|
| Rate for Payer: First Choice Health Commercial |
$1,103.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,164.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.32
|
| Rate for Payer: HealthUtah PPO |
$1,226.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,189.22
|
| Rate for Payer: Multiplan Medicare/VA |
$257.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,201.48
|
| Rate for Payer: PacificSource Commercial |
$1,103.40
|
| Rate for Payer: PHCS PPO |
$1,164.70
|
| Rate for Payer: Three Rivers PPO |
$919.50
|
| Rate for Payer: TriWest Veterans Administration |
$303.32
|
| Rate for Payer: United Healthcare Commercial |
$1,066.62
|
| Rate for Payer: United Healthcare Medicare |
$303.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,042.10
|
|
|
HC PRO CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
9832719701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$517.44
|
| Rate for Payer: Aetna of WY Medicare |
$129.64
|
| Rate for Payer: Beech Street Commercial |
$501.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$512.16
|
| Rate for Payer: Cigna of WY Commercial |
$517.44
|
| Rate for Payer: First Choice Health Commercial |
$475.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$501.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.64
|
| Rate for Payer: HealthUtah PPO |
$528.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$512.16
|
| Rate for Payer: Multiplan Medicare/VA |
$110.19
|
| Rate for Payer: One Health Plan of WY PPO |
$517.44
|
| Rate for Payer: PacificSource Commercial |
$475.20
|
| Rate for Payer: PHCS PPO |
$501.60
|
| Rate for Payer: Three Rivers PPO |
$396.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$459.36
|
| Rate for Payer: United Healthcare Medicare |
$129.64
|
| Rate for Payer: WINHealth Partners Commercial |
$448.80
|
|
|
HC PRO CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 27197 NONPBBPAYER
|
| Hospital Charge Code |
9832719701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$129.64
|
| Rate for Payer: Beech Street Commercial |
$627.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: First Choice Health Commercial |
$594.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.64
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$110.19
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$627.00
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$129.64
|
| Rate for Payer: WINHealth Partners Commercial |
$561.00
|
|
|
HC PRO CLOSED TX POST HIP ARTHRP DISLC REQ W/ANESTH
|
Professional
|
Both
|
$3,552.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
9832726601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$483.59 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,480.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,355.92
|
| Rate for Payer: Aetna of WY Medicare |
$568.93
|
| Rate for Payer: Aetna of WY Medicare |
$568.93
|
| Rate for Payer: Beech Street Commercial |
$2,283.80
|
| Rate for Payer: Beech Street Commercial |
$3,374.40
|
| Rate for Payer: Cash Price |
$1,682.80
|
| Rate for Payer: Cash Price |
$1,682.80
|
| Rate for Payer: Cash Price |
$2,486.40
|
| Rate for Payer: Cash Price |
$2,486.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,445.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,331.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,355.92
|
| Rate for Payer: Cigna of WY Commercial |
$3,480.96
|
| Rate for Payer: First Choice Health Commercial |
$2,163.60
|
| Rate for Payer: First Choice Health Commercial |
$3,196.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,374.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,283.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.93
|
| Rate for Payer: HealthUtah PPO |
$3,552.00
|
| Rate for Payer: HealthUtah PPO |
$2,404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,445.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,331.88
|
| Rate for Payer: Multiplan Medicare/VA |
$483.59
|
| Rate for Payer: Multiplan Medicare/VA |
$483.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,480.96
|
| Rate for Payer: One Health Plan of WY PPO |
$2,355.92
|
| Rate for Payer: PacificSource Commercial |
$2,163.60
|
| Rate for Payer: PacificSource Commercial |
$3,196.80
|
| Rate for Payer: PHCS PPO |
$3,374.40
|
| Rate for Payer: PHCS PPO |
$2,283.80
|
| Rate for Payer: Three Rivers PPO |
$2,664.00
|
| Rate for Payer: Three Rivers PPO |
$1,803.00
|
| Rate for Payer: TriWest Veterans Administration |
$568.93
|
| Rate for Payer: TriWest Veterans Administration |
$568.93
|
| Rate for Payer: United Healthcare Commercial |
$2,091.48
|
| Rate for Payer: United Healthcare Commercial |
$3,090.24
|
| Rate for Payer: United Healthcare Medicare |
$568.93
|
| Rate for Payer: United Healthcare Medicare |
$568.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3,019.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,043.40
|
|
|
HC PRO CLOSED TX POST HIP ARTHRP DISLC REQ W/ANESTH
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27266 NONPBBPAYER
|
| Hospital Charge Code |
9832726601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$483.59 |
| Max. Negotiated Rate |
$3,005.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,944.90
|
| Rate for Payer: Aetna of WY Medicare |
$568.93
|
| Rate for Payer: Beech Street Commercial |
$2,854.75
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,914.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,944.90
|
| Rate for Payer: First Choice Health Commercial |
$2,704.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,854.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.93
|
| Rate for Payer: HealthUtah PPO |
$3,005.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,914.85
|
| Rate for Payer: Multiplan Medicare/VA |
$483.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,944.90
|
| Rate for Payer: PacificSource Commercial |
$2,704.50
|
| Rate for Payer: PHCS PPO |
$2,854.75
|
| Rate for Payer: Three Rivers PPO |
$2,253.75
|
| Rate for Payer: TriWest Veterans Administration |
$568.93
|
| Rate for Payer: United Healthcare Commercial |
$2,614.35
|
| Rate for Payer: United Healthcare Medicare |
$568.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,554.25
|
|
|
HC PRO CLOSED TX POST HIP ARTHRPLAS DISLOCATION W/O ANESTH
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
9832726501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$350.97 |
| Max. Negotiated Rate |
$2,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,241.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,635.62
|
| Rate for Payer: Aetna of WY Medicare |
$412.91
|
| Rate for Payer: Aetna of WY Medicare |
$412.91
|
| Rate for Payer: Beech Street Commercial |
$1,585.55
|
| Rate for Payer: Beech Street Commercial |
$2,172.65
|
| Rate for Payer: Cash Price |
$1,168.30
|
| Rate for Payer: Cash Price |
$1,168.30
|
| Rate for Payer: Cash Price |
$1,600.90
|
| Rate for Payer: Cash Price |
$1,600.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,218.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,618.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,635.62
|
| Rate for Payer: Cigna of WY Commercial |
$2,241.26
|
| Rate for Payer: First Choice Health Commercial |
$1,502.10
|
| Rate for Payer: First Choice Health Commercial |
$2,058.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,172.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,585.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.91
|
| Rate for Payer: HealthUtah PPO |
$2,287.00
|
| Rate for Payer: HealthUtah PPO |
$1,669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,218.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,618.93
|
| Rate for Payer: Multiplan Medicare/VA |
$350.97
|
| Rate for Payer: Multiplan Medicare/VA |
$350.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,241.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,635.62
|
| Rate for Payer: PacificSource Commercial |
$1,502.10
|
| Rate for Payer: PacificSource Commercial |
$2,058.30
|
| Rate for Payer: PHCS PPO |
$2,172.65
|
| Rate for Payer: PHCS PPO |
$1,585.55
|
| Rate for Payer: Three Rivers PPO |
$1,715.25
|
| Rate for Payer: Three Rivers PPO |
$1,251.75
|
| Rate for Payer: TriWest Veterans Administration |
$412.91
|
| Rate for Payer: TriWest Veterans Administration |
$412.91
|
| Rate for Payer: United Healthcare Commercial |
$1,452.03
|
| Rate for Payer: United Healthcare Commercial |
$1,989.69
|
| Rate for Payer: United Healthcare Medicare |
$412.91
|
| Rate for Payer: United Healthcare Medicare |
$412.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,943.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,418.65
|
|
|
HC PRO CLOSED TX POST HIP ARTHRPLAS DISLOCATION W/O ANESTH
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 27265 NONPBBPAYER
|
| Hospital Charge Code |
9832726501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$350.97 |
| Max. Negotiated Rate |
$2,086.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,044.28
|
| Rate for Payer: Aetna of WY Medicare |
$412.91
|
| Rate for Payer: Beech Street Commercial |
$1,981.70
|
| Rate for Payer: Cash Price |
$1,460.20
|
| Rate for Payer: Cash Price |
$1,460.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,023.42
|
| Rate for Payer: Cigna of WY Commercial |
$2,044.28
|
| Rate for Payer: First Choice Health Commercial |
$1,877.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,981.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.91
|
| Rate for Payer: HealthUtah PPO |
$2,086.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,023.42
|
| Rate for Payer: Multiplan Medicare/VA |
$350.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,044.28
|
| Rate for Payer: PacificSource Commercial |
$1,877.40
|
| Rate for Payer: PHCS PPO |
$1,981.70
|
| Rate for Payer: Three Rivers PPO |
$1,564.50
|
| Rate for Payer: TriWest Veterans Administration |
$412.91
|
| Rate for Payer: United Healthcare Commercial |
$1,814.82
|
| Rate for Payer: United Healthcare Medicare |
$412.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,773.10
|
|
|
HC PRO CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
9832778001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,895.32
|
| Rate for Payer: Aetna of WY Medicare |
$287.46
|
| Rate for Payer: Aetna of WY Medicare |
$287.46
|
| Rate for Payer: Beech Street Commercial |
$1,837.30
|
| Rate for Payer: Beech Street Commercial |
$1,378.45
|
| Rate for Payer: Cash Price |
$1,353.80
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: Cash Price |
$1,353.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,875.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,895.32
|
| Rate for Payer: First Choice Health Commercial |
$1,740.60
|
| Rate for Payer: First Choice Health Commercial |
$1,305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,837.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.46
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: HealthUtah PPO |
$1,934.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,875.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$244.34
|
| Rate for Payer: Multiplan Medicare/VA |
$244.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,895.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PacificSource Commercial |
$1,740.60
|
| Rate for Payer: PHCS PPO |
$1,378.45
|
| Rate for Payer: PHCS PPO |
$1,837.30
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: Three Rivers PPO |
$1,450.50
|
| Rate for Payer: TriWest Veterans Administration |
$287.46
|
| Rate for Payer: TriWest Veterans Administration |
$287.46
|
| Rate for Payer: United Healthcare Commercial |
$1,682.58
|
| Rate for Payer: United Healthcare Commercial |
$1,262.37
|
| Rate for Payer: United Healthcare Medicare |
$287.46
|
| Rate for Payer: United Healthcare Medicare |
$287.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,233.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,643.90
|
|
|
HC PRO CLOSED TX PROX HUMERUS FX W/ MANIPULATION
|
Professional
|
Both
|
$1,746.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
9832360501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$361.43 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,711.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,694.42
|
| Rate for Payer: Aetna of WY Medicare |
$425.21
|
| Rate for Payer: Aetna of WY Medicare |
$425.21
|
| Rate for Payer: Beech Street Commercial |
$1,642.55
|
| Rate for Payer: Beech Street Commercial |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,210.30
|
| Rate for Payer: Cash Price |
$1,210.30
|
| Rate for Payer: Cash Price |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,222.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,693.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,677.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,694.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,711.08
|
| Rate for Payer: First Choice Health Commercial |
$1,556.10
|
| Rate for Payer: First Choice Health Commercial |
$1,571.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,658.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,642.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.21
|
| Rate for Payer: HealthUtah PPO |
$1,746.00
|
| Rate for Payer: HealthUtah PPO |
$1,729.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,693.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,677.13
|
| Rate for Payer: Multiplan Medicare/VA |
$361.43
|
| Rate for Payer: Multiplan Medicare/VA |
$361.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,711.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,694.42
|
| Rate for Payer: PacificSource Commercial |
$1,556.10
|
| Rate for Payer: PacificSource Commercial |
$1,571.40
|
| Rate for Payer: PHCS PPO |
$1,658.70
|
| Rate for Payer: PHCS PPO |
$1,642.55
|
| Rate for Payer: Three Rivers PPO |
$1,309.50
|
| Rate for Payer: Three Rivers PPO |
$1,296.75
|
| Rate for Payer: TriWest Veterans Administration |
$425.21
|
| Rate for Payer: TriWest Veterans Administration |
$425.21
|
| Rate for Payer: United Healthcare Commercial |
$1,504.23
|
| Rate for Payer: United Healthcare Commercial |
$1,519.02
|
| Rate for Payer: United Healthcare Medicare |
$425.21
|
| Rate for Payer: United Healthcare Medicare |
$425.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,484.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,469.65
|
|
|
HC PRO CLOSED TX PROX HUMERUS FX W/ MANIPULATION
|
Professional
|
Both
|
$4,527.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
9832361501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$727.69 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,436.46
|
| Rate for Payer: Aetna of WY Medicare |
$856.11
|
| Rate for Payer: Beech Street Commercial |
$4,300.65
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,391.19
|
| Rate for Payer: Cigna of WY Commercial |
$4,436.46
|
| Rate for Payer: First Choice Health Commercial |
$4,074.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,300.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.11
|
| Rate for Payer: HealthUtah PPO |
$4,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,391.19
|
| Rate for Payer: Multiplan Medicare/VA |
$727.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,436.46
|
| Rate for Payer: PacificSource Commercial |
$4,074.30
|
| Rate for Payer: PHCS PPO |
$4,300.65
|
| Rate for Payer: Three Rivers PPO |
$3,395.25
|
| Rate for Payer: TriWest Veterans Administration |
$856.11
|
| Rate for Payer: United Healthcare Commercial |
$3,938.49
|
| Rate for Payer: United Healthcare Medicare |
$856.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,847.95
|
|
|
HC PRO CLOSED TX PROX HUMERUS FX W/ MANIPULATION
|
Professional
|
Both
|
$2,182.00
|
|
|
Service Code
|
HCPCS 23605 NONPBBPAYER
|
| Hospital Charge Code |
9832360501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$361.43 |
| Max. Negotiated Rate |
$2,182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,138.36
|
| Rate for Payer: Aetna of WY Medicare |
$425.21
|
| Rate for Payer: Beech Street Commercial |
$2,072.90
|
| Rate for Payer: Cash Price |
$1,527.40
|
| Rate for Payer: Cash Price |
$1,527.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,116.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,138.36
|
| Rate for Payer: First Choice Health Commercial |
$1,963.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,072.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.21
|
| Rate for Payer: HealthUtah PPO |
$2,182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,116.54
|
| Rate for Payer: Multiplan Medicare/VA |
$361.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,138.36
|
| Rate for Payer: PacificSource Commercial |
$1,963.80
|
| Rate for Payer: PHCS PPO |
$2,072.90
|
| Rate for Payer: Three Rivers PPO |
$1,636.50
|
| Rate for Payer: TriWest Veterans Administration |
$425.21
|
| Rate for Payer: United Healthcare Commercial |
$1,898.34
|
| Rate for Payer: United Healthcare Medicare |
$425.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,854.70
|
|
|
HC PRO CLOSED TX PROX HUMERUS FX W/O MANIPULATION
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 23600 NONPBBPAYER
|
| Hospital Charge Code |
9832360001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,517.04
|
| Rate for Payer: Aetna of WY Medicare |
$319.45
|
| Rate for Payer: Beech Street Commercial |
$1,470.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,501.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,517.04
|
| Rate for Payer: First Choice Health Commercial |
$1,393.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,470.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.45
|
| Rate for Payer: HealthUtah PPO |
$1,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,501.56
|
| Rate for Payer: Multiplan Medicare/VA |
$271.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,517.04
|
| Rate for Payer: PacificSource Commercial |
$1,393.20
|
| Rate for Payer: PHCS PPO |
$1,470.60
|
| Rate for Payer: Three Rivers PPO |
$1,161.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.45
|
| Rate for Payer: United Healthcare Commercial |
$1,346.76
|
| Rate for Payer: United Healthcare Medicare |
$319.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,315.80
|
|
|
HC PRO CLOSED TX PROX HUMERUS FX W/O MANIPULATION
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
9832360001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,213.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,099.16
|
| Rate for Payer: Aetna of WY Medicare |
$319.45
|
| Rate for Payer: Aetna of WY Medicare |
$319.45
|
| Rate for Payer: Beech Street Commercial |
$2,034.90
|
| Rate for Payer: Beech Street Commercial |
$1,176.10
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,077.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,200.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,213.24
|
| Rate for Payer: Cigna of WY Commercial |
$2,099.16
|
| Rate for Payer: First Choice Health Commercial |
$1,927.80
|
| Rate for Payer: First Choice Health Commercial |
$1,114.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,176.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,034.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.45
|
| Rate for Payer: HealthUtah PPO |
$1,238.00
|
| Rate for Payer: HealthUtah PPO |
$2,142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,077.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,200.86
|
| Rate for Payer: Multiplan Medicare/VA |
$271.53
|
| Rate for Payer: Multiplan Medicare/VA |
$271.53
|
| Rate for Payer: One Health Plan of WY PPO |
$2,099.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,213.24
|
| Rate for Payer: PacificSource Commercial |
$1,114.20
|
| Rate for Payer: PacificSource Commercial |
$1,927.80
|
| Rate for Payer: PHCS PPO |
$1,176.10
|
| Rate for Payer: PHCS PPO |
$2,034.90
|
| Rate for Payer: Three Rivers PPO |
$928.50
|
| Rate for Payer: Three Rivers PPO |
$1,606.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.45
|
| Rate for Payer: TriWest Veterans Administration |
$319.45
|
| Rate for Payer: United Healthcare Commercial |
$1,863.54
|
| Rate for Payer: United Healthcare Commercial |
$1,077.06
|
| Rate for Payer: United Healthcare Medicare |
$319.45
|
| Rate for Payer: United Healthcare Medicare |
$319.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,052.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,820.70
|
|
|
HC PRO CLOSED TX PROX/MID FING SHFT FX
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
9832672001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$749.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,038.80
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$1,007.00
|
| Rate for Payer: Beech Street Commercial |
$726.75
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$742.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,028.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,038.80
|
| Rate for Payer: Cigna of WY Commercial |
$749.70
|
| Rate for Payer: First Choice Health Commercial |
$954.00
|
| Rate for Payer: First Choice Health Commercial |
$688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,007.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$765.00
|
| Rate for Payer: HealthUtah PPO |
$1,060.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$742.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,028.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$749.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,038.80
|
| Rate for Payer: PacificSource Commercial |
$954.00
|
| Rate for Payer: PacificSource Commercial |
$688.50
|
| Rate for Payer: PHCS PPO |
$726.75
|
| Rate for Payer: PHCS PPO |
$1,007.00
|
| Rate for Payer: Three Rivers PPO |
$573.75
|
| Rate for Payer: Three Rivers PPO |
$795.00
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$922.20
|
| Rate for Payer: United Healthcare Commercial |
$665.55
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$650.25
|
| Rate for Payer: WINHealth Partners Commercial |
$901.00
|
|
|
HC PRO CLOSED TX PROX/MID FING SHFT FX
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 26720 NONPBBPAYER
|
| Hospital Charge Code |
9832672001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.88
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$908.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$927.32
|
| Rate for Payer: Cigna of WY Commercial |
$936.88
|
| Rate for Payer: First Choice Health Commercial |
$860.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$908.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$927.32
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$936.88
|
| Rate for Payer: PacificSource Commercial |
$860.40
|
| Rate for Payer: PHCS PPO |
$908.20
|
| Rate for Payer: Three Rivers PPO |
$717.00
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$831.72
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$812.60
|
|
|
HC PRO CLOSED TX PROX/MID FING SHFT FX,MANIP
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 26725 NONPBBPAYER
|
| Hospital Charge Code |
9832672501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,206.38
|
| Rate for Payer: Aetna of WY Medicare |
$306.16
|
| Rate for Payer: Beech Street Commercial |
$1,169.45
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,194.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,206.38
|
| Rate for Payer: First Choice Health Commercial |
$1,107.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,169.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.16
|
| Rate for Payer: HealthUtah PPO |
$1,231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,194.07
|
| Rate for Payer: Multiplan Medicare/VA |
$260.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,206.38
|
| Rate for Payer: PacificSource Commercial |
$1,107.90
|
| Rate for Payer: PHCS PPO |
$1,169.45
|
| Rate for Payer: Three Rivers PPO |
$923.25
|
| Rate for Payer: TriWest Veterans Administration |
$306.16
|
| Rate for Payer: United Healthcare Commercial |
$1,070.97
|
| Rate for Payer: United Healthcare Medicare |
$306.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,046.35
|
|
|
HC PRO CLOSED TX PROX/MID FING SHFT FX,MANIP
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
9832672501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$965.30
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$306.16
|
| Rate for Payer: Aetna of WY Medicare |
$306.16
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Beech Street Commercial |
$935.75
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$955.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Cigna of WY Commercial |
$965.30
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: First Choice Health Commercial |
$886.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.16
|
| Rate for Payer: HealthUtah PPO |
$985.00
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$955.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$260.24
|
| Rate for Payer: Multiplan Medicare/VA |
$260.24
|
| Rate for Payer: One Health Plan of WY PPO |
$965.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PacificSource Commercial |
$886.50
|
| Rate for Payer: PHCS PPO |
$935.75
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$738.75
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$306.16
|
| Rate for Payer: TriWest Veterans Administration |
$306.16
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$856.95
|
| Rate for Payer: United Healthcare Medicare |
$306.16
|
| Rate for Payer: United Healthcare Medicare |
$306.16
|
| Rate for Payer: WINHealth Partners Commercial |
$837.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
HC PRO CLOSED TX RADIAL HEAD OR NECK FX INTNRL FX W/ RADIAL HEAD PROSTHETIC
|
Professional
|
Both
|
$3,783.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
9832466601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$606.15 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,707.34
|
| Rate for Payer: Aetna of WY Medicare |
$713.12
|
| Rate for Payer: Beech Street Commercial |
$3,593.85
|
| Rate for Payer: Cash Price |
$2,648.10
|
| Rate for Payer: Cash Price |
$2,648.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,669.51
|
| Rate for Payer: Cigna of WY Commercial |
$3,707.34
|
| Rate for Payer: First Choice Health Commercial |
$3,404.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,593.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$713.12
|
| Rate for Payer: HealthUtah PPO |
$3,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,669.51
|
| Rate for Payer: Multiplan Medicare/VA |
$606.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,707.34
|
| Rate for Payer: PacificSource Commercial |
$3,404.70
|
| Rate for Payer: PHCS PPO |
$3,593.85
|
| Rate for Payer: Three Rivers PPO |
$2,837.25
|
| Rate for Payer: TriWest Veterans Administration |
$713.12
|
| Rate for Payer: United Healthcare Commercial |
$3,291.21
|
| Rate for Payer: United Healthcare Medicare |
$713.12
|
| Rate for Payer: WINHealth Partners Commercial |
$3,215.55
|
|
|
HC PRO CLOSED TX RADIAL HEAD OR NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
9832465001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$212.15 |
| Max. Negotiated Rate |
$766.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$750.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,363.18
|
| Rate for Payer: Aetna of WY Medicare |
$249.59
|
| Rate for Payer: Aetna of WY Medicare |
$249.59
|
| Rate for Payer: Beech Street Commercial |
$1,321.45
|
| Rate for Payer: Beech Street Commercial |
$727.70
|
| Rate for Payer: Cash Price |
$973.70
|
| Rate for Payer: Cash Price |
$973.70
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$743.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,349.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,363.18
|
| Rate for Payer: Cigna of WY Commercial |
$750.68
|
| Rate for Payer: First Choice Health Commercial |
$1,251.90
|
| Rate for Payer: First Choice Health Commercial |
$689.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$727.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,321.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.59
|
| Rate for Payer: HealthUtah PPO |
$766.00
|
| Rate for Payer: HealthUtah PPO |
$1,391.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$743.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,349.27
|
| Rate for Payer: Multiplan Medicare/VA |
$212.15
|
| Rate for Payer: Multiplan Medicare/VA |
$212.15
|
| Rate for Payer: One Health Plan of WY PPO |
$750.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,363.18
|
| Rate for Payer: PacificSource Commercial |
$1,251.90
|
| Rate for Payer: PacificSource Commercial |
$689.40
|
| Rate for Payer: PHCS PPO |
$727.70
|
| Rate for Payer: PHCS PPO |
$1,321.45
|
| Rate for Payer: Three Rivers PPO |
$574.50
|
| Rate for Payer: Three Rivers PPO |
$1,043.25
|
| Rate for Payer: TriWest Veterans Administration |
$249.59
|
| Rate for Payer: TriWest Veterans Administration |
$249.59
|
| Rate for Payer: United Healthcare Commercial |
$1,210.17
|
| Rate for Payer: United Healthcare Commercial |
$666.42
|
| Rate for Payer: United Healthcare Medicare |
$249.59
|
| Rate for Payer: United Healthcare Medicare |
$249.59
|
| Rate for Payer: WINHealth Partners Commercial |
$651.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,182.35
|
|
|
HC PRO CLOSED TX RADIAL HEAD OR NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 24650 NONPBBPAYER
|
| Hospital Charge Code |
9832465001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$212.15 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$937.86
|
| Rate for Payer: Aetna of WY Medicare |
$249.59
|
| Rate for Payer: Beech Street Commercial |
$909.15
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$928.29
|
| Rate for Payer: Cigna of WY Commercial |
$937.86
|
| Rate for Payer: First Choice Health Commercial |
$861.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$909.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.59
|
| Rate for Payer: HealthUtah PPO |
$957.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$928.29
|
| Rate for Payer: Multiplan Medicare/VA |
$212.15
|
| Rate for Payer: One Health Plan of WY PPO |
$937.86
|
| Rate for Payer: PacificSource Commercial |
$861.30
|
| Rate for Payer: PHCS PPO |
$909.15
|
| Rate for Payer: Three Rivers PPO |
$717.75
|
| Rate for Payer: TriWest Veterans Administration |
$249.59
|
| Rate for Payer: United Healthcare Commercial |
$832.59
|
| Rate for Payer: United Healthcare Medicare |
$249.59
|
| Rate for Payer: WINHealth Partners Commercial |
$813.45
|
|
