|
HC PRO CLOSED TX RADIAL HEAD SUBLUXATION W/ MANIPULATION CHILD
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 24640 NONPBBPAYER
|
| Hospital Charge Code |
9832464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.47
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.47
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.70
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.47
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$78.47
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
|
|
HC PRO CLOSED TX RADIAL HEAD SUBLUXATION W/ MANIPULATION CHILD
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
9832464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$78.47
|
| Rate for Payer: Aetna of WY Medicare |
$78.47
|
| Rate for Payer: Beech Street Commercial |
$308.75
|
| Rate for Payer: Beech Street Commercial |
$640.30
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: First Choice Health Commercial |
$292.50
|
| Rate for Payer: First Choice Health Commercial |
$606.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.47
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$66.70
|
| Rate for Payer: Multiplan Medicare/VA |
$66.70
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$640.30
|
| Rate for Payer: PHCS PPO |
$308.75
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.47
|
| Rate for Payer: TriWest Veterans Administration |
$78.47
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Commercial |
$586.38
|
| Rate for Payer: United Healthcare Medicare |
$78.47
|
| Rate for Payer: United Healthcare Medicare |
$78.47
|
| Rate for Payer: WINHealth Partners Commercial |
$572.90
|
| Rate for Payer: WINHealth Partners Commercial |
$276.25
|
|
|
HC PRO CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
9832550501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$390.63 |
| Max. Negotiated Rate |
$3,910.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,831.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,385.72
|
| Rate for Payer: Aetna of WY Medicare |
$459.57
|
| Rate for Payer: Aetna of WY Medicare |
$459.57
|
| Rate for Payer: Beech Street Commercial |
$1,343.30
|
| Rate for Payer: Beech Street Commercial |
$3,714.50
|
| Rate for Payer: Cash Price |
$989.80
|
| Rate for Payer: Cash Price |
$989.80
|
| Rate for Payer: Cash Price |
$2,737.00
|
| Rate for Payer: Cash Price |
$2,737.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,792.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,371.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,385.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,831.80
|
| Rate for Payer: First Choice Health Commercial |
$1,272.60
|
| Rate for Payer: First Choice Health Commercial |
$3,519.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,714.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,343.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.57
|
| Rate for Payer: HealthUtah PPO |
$3,910.00
|
| Rate for Payer: HealthUtah PPO |
$1,414.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,792.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,371.58
|
| Rate for Payer: Multiplan Medicare/VA |
$390.63
|
| Rate for Payer: Multiplan Medicare/VA |
$390.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,831.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,385.72
|
| Rate for Payer: PacificSource Commercial |
$1,272.60
|
| Rate for Payer: PacificSource Commercial |
$3,519.00
|
| Rate for Payer: PHCS PPO |
$3,714.50
|
| Rate for Payer: PHCS PPO |
$1,343.30
|
| Rate for Payer: Three Rivers PPO |
$2,932.50
|
| Rate for Payer: Three Rivers PPO |
$1,060.50
|
| Rate for Payer: TriWest Veterans Administration |
$459.57
|
| Rate for Payer: TriWest Veterans Administration |
$459.57
|
| Rate for Payer: United Healthcare Commercial |
$1,230.18
|
| Rate for Payer: United Healthcare Commercial |
$3,401.70
|
| Rate for Payer: United Healthcare Medicare |
$459.57
|
| Rate for Payer: United Healthcare Medicare |
$459.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3,323.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.90
|
|
|
HC PRO CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25505 NONPBBPAYER
|
| Hospital Charge Code |
9832550501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$390.63 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,731.66
|
| Rate for Payer: Aetna of WY Medicare |
$459.57
|
| Rate for Payer: Beech Street Commercial |
$1,678.65
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,713.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,731.66
|
| Rate for Payer: First Choice Health Commercial |
$1,590.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.57
|
| Rate for Payer: HealthUtah PPO |
$1,767.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,713.99
|
| Rate for Payer: Multiplan Medicare/VA |
$390.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,731.66
|
| Rate for Payer: PacificSource Commercial |
$1,590.30
|
| Rate for Payer: PHCS PPO |
$1,678.65
|
| Rate for Payer: Three Rivers PPO |
$1,325.25
|
| Rate for Payer: TriWest Veterans Administration |
$459.57
|
| Rate for Payer: United Healthcare Commercial |
$1,537.29
|
| Rate for Payer: United Healthcare Medicare |
$459.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,501.95
|
|
|
HC PRO CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
9832550001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$222.09 |
| Max. Negotiated Rate |
$1,994.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,954.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$708.54
|
| Rate for Payer: Aetna of WY Medicare |
$261.28
|
| Rate for Payer: Aetna of WY Medicare |
$261.28
|
| Rate for Payer: Beech Street Commercial |
$686.85
|
| Rate for Payer: Beech Street Commercial |
$1,894.30
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$1,395.80
|
| Rate for Payer: Cash Price |
$1,395.80
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$701.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,934.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,954.12
|
| Rate for Payer: Cigna of WY Commercial |
$708.54
|
| Rate for Payer: First Choice Health Commercial |
$650.70
|
| Rate for Payer: First Choice Health Commercial |
$1,794.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,894.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$686.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.28
|
| Rate for Payer: HealthUtah PPO |
$1,994.00
|
| Rate for Payer: HealthUtah PPO |
$723.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$701.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,934.18
|
| Rate for Payer: Multiplan Medicare/VA |
$222.09
|
| Rate for Payer: Multiplan Medicare/VA |
$222.09
|
| Rate for Payer: One Health Plan of WY PPO |
$708.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,954.12
|
| Rate for Payer: PacificSource Commercial |
$1,794.60
|
| Rate for Payer: PacificSource Commercial |
$650.70
|
| Rate for Payer: PHCS PPO |
$1,894.30
|
| Rate for Payer: PHCS PPO |
$686.85
|
| Rate for Payer: Three Rivers PPO |
$1,495.50
|
| Rate for Payer: Three Rivers PPO |
$542.25
|
| Rate for Payer: TriWest Veterans Administration |
$261.28
|
| Rate for Payer: TriWest Veterans Administration |
$261.28
|
| Rate for Payer: United Healthcare Commercial |
$629.01
|
| Rate for Payer: United Healthcare Commercial |
$1,734.78
|
| Rate for Payer: United Healthcare Medicare |
$261.28
|
| Rate for Payer: United Healthcare Medicare |
$261.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,694.90
|
| Rate for Payer: WINHealth Partners Commercial |
$614.55
|
|
|
HC PRO CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 25500 NONPBBPAYER
|
| Hospital Charge Code |
9832550001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$222.09 |
| Max. Negotiated Rate |
$904.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$885.92
|
| Rate for Payer: Aetna of WY Medicare |
$261.28
|
| Rate for Payer: Beech Street Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$876.88
|
| Rate for Payer: Cigna of WY Commercial |
$885.92
|
| Rate for Payer: First Choice Health Commercial |
$813.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$858.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.28
|
| Rate for Payer: HealthUtah PPO |
$904.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$876.88
|
| Rate for Payer: Multiplan Medicare/VA |
$222.09
|
| Rate for Payer: One Health Plan of WY PPO |
$885.92
|
| Rate for Payer: PacificSource Commercial |
$813.60
|
| Rate for Payer: PHCS PPO |
$858.80
|
| Rate for Payer: Three Rivers PPO |
$678.00
|
| Rate for Payer: TriWest Veterans Administration |
$261.28
|
| Rate for Payer: United Healthcare Commercial |
$786.48
|
| Rate for Payer: United Healthcare Medicare |
$261.28
|
| Rate for Payer: WINHealth Partners Commercial |
$768.40
|
|
|
HC PRO CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/MANIPULATION
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 25565 NONPBBPAYER
|
| Hospital Charge Code |
9832556501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$461.50
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.50
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$392.28
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$461.50
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$461.50
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
|
HC PRO CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/MANIPULATION
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
9832556501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$381.75 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,878.84
|
| Rate for Payer: Aetna of WY Medicare |
$461.50
|
| Rate for Payer: Aetna of WY Medicare |
$461.50
|
| Rate for Payer: Beech Street Commercial |
$3,760.10
|
| Rate for Payer: Beech Street Commercial |
$483.55
|
| Rate for Payer: Cash Price |
$2,770.60
|
| Rate for Payer: Cash Price |
$2,770.60
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,839.26
|
| Rate for Payer: Cigna of WY Commercial |
$3,878.84
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: First Choice Health Commercial |
$3,562.20
|
| Rate for Payer: First Choice Health Commercial |
$458.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,760.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.50
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: HealthUtah PPO |
$3,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,839.26
|
| Rate for Payer: Multiplan Medicare/VA |
$392.28
|
| Rate for Payer: Multiplan Medicare/VA |
$392.28
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,878.84
|
| Rate for Payer: PacificSource Commercial |
$3,562.20
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$483.55
|
| Rate for Payer: PHCS PPO |
$3,760.10
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: Three Rivers PPO |
$2,968.50
|
| Rate for Payer: TriWest Veterans Administration |
$461.50
|
| Rate for Payer: TriWest Veterans Administration |
$461.50
|
| Rate for Payer: United Healthcare Commercial |
$3,443.46
|
| Rate for Payer: United Healthcare Commercial |
$442.83
|
| Rate for Payer: United Healthcare Medicare |
$461.50
|
| Rate for Payer: United Healthcare Medicare |
$461.50
|
| Rate for Payer: WINHealth Partners Commercial |
$432.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3,364.30
|
|
|
HC PRO CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/O MANIPULATION
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
9832556001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.13 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,029.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,962.94
|
| Rate for Payer: Aetna of WY Medicare |
$262.51
|
| Rate for Payer: Aetna of WY Medicare |
$262.51
|
| Rate for Payer: Beech Street Commercial |
$1,902.85
|
| Rate for Payer: Beech Street Commercial |
$997.50
|
| Rate for Payer: Cash Price |
$1,402.10
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$1,402.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,942.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,018.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,029.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,962.94
|
| Rate for Payer: First Choice Health Commercial |
$1,802.70
|
| Rate for Payer: First Choice Health Commercial |
$945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$997.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,902.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.51
|
| Rate for Payer: HealthUtah PPO |
$1,050.00
|
| Rate for Payer: HealthUtah PPO |
$2,003.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,942.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,018.50
|
| Rate for Payer: Multiplan Medicare/VA |
$223.13
|
| Rate for Payer: Multiplan Medicare/VA |
$223.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,962.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,029.00
|
| Rate for Payer: PacificSource Commercial |
$945.00
|
| Rate for Payer: PacificSource Commercial |
$1,802.70
|
| Rate for Payer: PHCS PPO |
$997.50
|
| Rate for Payer: PHCS PPO |
$1,902.85
|
| Rate for Payer: Three Rivers PPO |
$787.50
|
| Rate for Payer: Three Rivers PPO |
$1,502.25
|
| Rate for Payer: TriWest Veterans Administration |
$262.51
|
| Rate for Payer: TriWest Veterans Administration |
$262.51
|
| Rate for Payer: United Healthcare Commercial |
$1,742.61
|
| Rate for Payer: United Healthcare Commercial |
$913.50
|
| Rate for Payer: United Healthcare Medicare |
$262.51
|
| Rate for Payer: United Healthcare Medicare |
$262.51
|
| Rate for Payer: WINHealth Partners Commercial |
$892.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,702.55
|
|
|
HC PRO CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/O MANIPULATION
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 25560 NONPBBPAYER
|
| Hospital Charge Code |
9832556001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.13 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,285.76
|
| Rate for Payer: Aetna of WY Medicare |
$262.51
|
| Rate for Payer: Beech Street Commercial |
$1,246.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,272.64
|
| Rate for Payer: Cigna of WY Commercial |
$1,285.76
|
| Rate for Payer: First Choice Health Commercial |
$1,180.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.51
|
| Rate for Payer: HealthUtah PPO |
$1,312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,272.64
|
| Rate for Payer: Multiplan Medicare/VA |
$223.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,285.76
|
| Rate for Payer: PacificSource Commercial |
$1,180.80
|
| Rate for Payer: PHCS PPO |
$1,246.40
|
| Rate for Payer: Three Rivers PPO |
$984.00
|
| Rate for Payer: TriWest Veterans Administration |
$262.51
|
| Rate for Payer: United Healthcare Commercial |
$1,141.44
|
| Rate for Payer: United Healthcare Medicare |
$262.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,115.20
|
|
|
HC PRO CLOSED TX SCAPULA FX W/MANIPULATION
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
9832357501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$322.59 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,538.60
|
| Rate for Payer: Aetna of WY Medicare |
$379.52
|
| Rate for Payer: Beech Street Commercial |
$1,491.50
|
| Rate for Payer: Cash Price |
$1,099.00
|
| Rate for Payer: Cash Price |
$1,099.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,522.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,538.60
|
| Rate for Payer: First Choice Health Commercial |
$1,413.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,491.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.52
|
| Rate for Payer: HealthUtah PPO |
$1,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,522.90
|
| Rate for Payer: Multiplan Medicare/VA |
$322.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,538.60
|
| Rate for Payer: PacificSource Commercial |
$1,413.00
|
| Rate for Payer: PHCS PPO |
$1,491.50
|
| Rate for Payer: Three Rivers PPO |
$1,177.50
|
| Rate for Payer: TriWest Veterans Administration |
$379.52
|
| Rate for Payer: United Healthcare Commercial |
$1,365.90
|
| Rate for Payer: United Healthcare Medicare |
$379.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,334.50
|
|
|
HC PRO CLOSED TX SCAPULA FX W/MANIPULATION
|
Professional
|
Both
|
$1,963.00
|
|
|
Service Code
|
HCPCS 23575 NONPBBPAYER
|
| Hospital Charge Code |
9832357501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$322.59 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,923.74
|
| Rate for Payer: Aetna of WY Medicare |
$379.52
|
| Rate for Payer: Beech Street Commercial |
$1,864.85
|
| Rate for Payer: Cash Price |
$1,374.10
|
| Rate for Payer: Cash Price |
$1,374.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,904.11
|
| Rate for Payer: Cigna of WY Commercial |
$1,923.74
|
| Rate for Payer: First Choice Health Commercial |
$1,766.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,864.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.52
|
| Rate for Payer: HealthUtah PPO |
$1,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,904.11
|
| Rate for Payer: Multiplan Medicare/VA |
$322.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,923.74
|
| Rate for Payer: PacificSource Commercial |
$1,766.70
|
| Rate for Payer: PHCS PPO |
$1,864.85
|
| Rate for Payer: Three Rivers PPO |
$1,472.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.52
|
| Rate for Payer: United Healthcare Commercial |
$1,707.81
|
| Rate for Payer: United Healthcare Medicare |
$379.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,668.55
|
|
|
HC PRO CLOSED TX SCAPULAR FX W/O ANIPULATION
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 23570 NONPBBPAYER
|
| Hospital Charge Code |
9832357001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,172.08
|
| Rate for Payer: Aetna of WY Medicare |
$245.49
|
| Rate for Payer: Beech Street Commercial |
$1,136.20
|
| Rate for Payer: Cash Price |
$837.20
|
| Rate for Payer: Cash Price |
$837.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,160.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,172.08
|
| Rate for Payer: First Choice Health Commercial |
$1,076.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,136.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.49
|
| Rate for Payer: HealthUtah PPO |
$1,196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,160.12
|
| Rate for Payer: Multiplan Medicare/VA |
$208.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,172.08
|
| Rate for Payer: PacificSource Commercial |
$1,076.40
|
| Rate for Payer: PHCS PPO |
$1,136.20
|
| Rate for Payer: Three Rivers PPO |
$897.00
|
| Rate for Payer: TriWest Veterans Administration |
$245.49
|
| Rate for Payer: United Healthcare Commercial |
$1,040.52
|
| Rate for Payer: United Healthcare Medicare |
$245.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,016.60
|
|
|
HC PRO CLOSED TX SCAPULAR FX W/O ANIPULATION
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
9832357001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$937.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,612.10
|
| Rate for Payer: Aetna of WY Medicare |
$245.49
|
| Rate for Payer: Aetna of WY Medicare |
$245.49
|
| Rate for Payer: Beech Street Commercial |
$1,562.75
|
| Rate for Payer: Beech Street Commercial |
$909.15
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| 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: ChoiceCare Network Commercial |
$1,595.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,612.10
|
| Rate for Payer: Cigna of WY Commercial |
$937.86
|
| Rate for Payer: First Choice Health Commercial |
$1,480.50
|
| 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) Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.49
|
| Rate for Payer: HealthUtah PPO |
$957.00
|
| Rate for Payer: HealthUtah PPO |
$1,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$928.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,595.65
|
| Rate for Payer: Multiplan Medicare/VA |
$208.67
|
| Rate for Payer: Multiplan Medicare/VA |
$208.67
|
| Rate for Payer: One Health Plan of WY PPO |
$937.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,612.10
|
| Rate for Payer: PacificSource Commercial |
$1,480.50
|
| Rate for Payer: PacificSource Commercial |
$861.30
|
| Rate for Payer: PHCS PPO |
$909.15
|
| Rate for Payer: PHCS PPO |
$1,562.75
|
| Rate for Payer: Three Rivers PPO |
$717.75
|
| Rate for Payer: Three Rivers PPO |
$1,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$245.49
|
| Rate for Payer: TriWest Veterans Administration |
$245.49
|
| Rate for Payer: United Healthcare Commercial |
$1,431.15
|
| Rate for Payer: United Healthcare Commercial |
$832.59
|
| Rate for Payer: United Healthcare Medicare |
$245.49
|
| Rate for Payer: United Healthcare Medicare |
$245.49
|
| Rate for Payer: WINHealth Partners Commercial |
$813.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.25
|
|
|
HC PRO CLOSED TX SHLDR DISLOCATION W/O ANES
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
9832365001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$1,657.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,623.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,132.88
|
| Rate for Payer: Aetna of WY Medicare |
$301.56
|
| Rate for Payer: Aetna of WY Medicare |
$301.56
|
| Rate for Payer: Beech Street Commercial |
$1,098.20
|
| Rate for Payer: Beech Street Commercial |
$1,574.15
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: Cash Price |
$1,159.90
|
| Rate for Payer: Cash Price |
$1,159.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,607.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,121.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,132.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,623.86
|
| Rate for Payer: First Choice Health Commercial |
$1,040.40
|
| Rate for Payer: First Choice Health Commercial |
$1,491.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,574.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,098.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.56
|
| Rate for Payer: HealthUtah PPO |
$1,657.00
|
| Rate for Payer: HealthUtah PPO |
$1,156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,607.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,121.32
|
| Rate for Payer: Multiplan Medicare/VA |
$256.33
|
| Rate for Payer: Multiplan Medicare/VA |
$256.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,623.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,132.88
|
| Rate for Payer: PacificSource Commercial |
$1,040.40
|
| Rate for Payer: PacificSource Commercial |
$1,491.30
|
| Rate for Payer: PHCS PPO |
$1,574.15
|
| Rate for Payer: PHCS PPO |
$1,098.20
|
| Rate for Payer: Three Rivers PPO |
$1,242.75
|
| Rate for Payer: Three Rivers PPO |
$867.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.56
|
| Rate for Payer: TriWest Veterans Administration |
$301.56
|
| Rate for Payer: United Healthcare Commercial |
$1,005.72
|
| Rate for Payer: United Healthcare Commercial |
$1,441.59
|
| Rate for Payer: United Healthcare Medicare |
$301.56
|
| Rate for Payer: United Healthcare Medicare |
$301.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,408.45
|
| Rate for Payer: WINHealth Partners Commercial |
$982.60
|
|
|
HC PRO CLOSED TX SHLDR DISLOCATION W/O ANES
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 23650 NONPBBPAYER
|
| Hospital Charge Code |
9832365001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,416.10
|
| Rate for Payer: Aetna of WY Medicare |
$301.56
|
| Rate for Payer: Beech Street Commercial |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,401.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,416.10
|
| Rate for Payer: First Choice Health Commercial |
$1,300.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,372.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.56
|
| Rate for Payer: HealthUtah PPO |
$1,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,401.65
|
| Rate for Payer: Multiplan Medicare/VA |
$256.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,416.10
|
| Rate for Payer: PacificSource Commercial |
$1,300.50
|
| Rate for Payer: PHCS PPO |
$1,372.75
|
| Rate for Payer: Three Rivers PPO |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration |
$301.56
|
| Rate for Payer: United Healthcare Commercial |
$1,257.15
|
| Rate for Payer: United Healthcare Medicare |
$301.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,228.25
|
|
|
HC PRO CLOSED TX SHLDR DISLOC W FX GR HUMERAL TUBEROSITY W MANIP
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
9832366501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,546.44
|
| Rate for Payer: Aetna of WY Medicare |
$399.70
|
| Rate for Payer: Beech Street Commercial |
$1,499.10
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,530.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,546.44
|
| Rate for Payer: First Choice Health Commercial |
$1,420.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,499.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.70
|
| Rate for Payer: HealthUtah PPO |
$1,578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,530.66
|
| Rate for Payer: Multiplan Medicare/VA |
$339.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,546.44
|
| Rate for Payer: PacificSource Commercial |
$1,420.20
|
| Rate for Payer: PHCS PPO |
$1,499.10
|
| Rate for Payer: Three Rivers PPO |
$1,183.50
|
| Rate for Payer: TriWest Veterans Administration |
$399.70
|
| Rate for Payer: United Healthcare Commercial |
$1,372.86
|
| Rate for Payer: United Healthcare Medicare |
$399.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,341.30
|
|
|
HC PRO CLOSED TX SHLDR DISLOC W FX GR HUMERAL TUBEROSITY W MANIP
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 23665 NONPBBPAYER
|
| Hospital Charge Code |
9832366501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$1,973.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,933.54
|
| Rate for Payer: Aetna of WY Medicare |
$399.70
|
| Rate for Payer: Beech Street Commercial |
$1,874.35
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,913.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,933.54
|
| Rate for Payer: First Choice Health Commercial |
$1,775.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,874.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.70
|
| Rate for Payer: HealthUtah PPO |
$1,973.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,913.81
|
| Rate for Payer: Multiplan Medicare/VA |
$339.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,933.54
|
| Rate for Payer: PacificSource Commercial |
$1,775.70
|
| Rate for Payer: PHCS PPO |
$1,874.35
|
| Rate for Payer: Three Rivers PPO |
$1,479.75
|
| Rate for Payer: TriWest Veterans Administration |
$399.70
|
| Rate for Payer: United Healthcare Commercial |
$1,716.51
|
| Rate for Payer: United Healthcare Medicare |
$399.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,677.05
|
|
|
HC PRO CLOSED TX SHLDR DISLOLOCATION W/MANIPULATION ANES
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 23655 NONPBBPAYER
|
| Hospital Charge Code |
9832365501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,974.70
|
| Rate for Payer: Aetna of WY Medicare |
$404.29
|
| Rate for Payer: Beech Street Commercial |
$1,914.25
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,954.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,974.70
|
| Rate for Payer: First Choice Health Commercial |
$1,813.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,914.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.29
|
| Rate for Payer: HealthUtah PPO |
$2,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,954.55
|
| Rate for Payer: Multiplan Medicare/VA |
$343.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,974.70
|
| Rate for Payer: PacificSource Commercial |
$1,813.50
|
| Rate for Payer: PHCS PPO |
$1,914.25
|
| Rate for Payer: Three Rivers PPO |
$1,511.25
|
| Rate for Payer: TriWest Veterans Administration |
$404.29
|
| Rate for Payer: United Healthcare Commercial |
$1,753.05
|
| Rate for Payer: United Healthcare Medicare |
$404.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.75
|
|
|
HC PRO CLOSED TX SHLDR DISLOLOCATION W/MANIPULATION ANES
|
Professional
|
Both
|
$3,043.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
9832365501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$3,043.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,982.14
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,579.76
|
| Rate for Payer: Aetna of WY Medicare |
$404.29
|
| Rate for Payer: Aetna of WY Medicare |
$404.29
|
| Rate for Payer: Beech Street Commercial |
$1,531.40
|
| Rate for Payer: Beech Street Commercial |
$2,890.85
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$2,130.10
|
| Rate for Payer: Cash Price |
$2,130.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,951.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,563.64
|
| Rate for Payer: Cigna of WY Commercial |
$1,579.76
|
| Rate for Payer: Cigna of WY Commercial |
$2,982.14
|
| Rate for Payer: First Choice Health Commercial |
$1,450.80
|
| Rate for Payer: First Choice Health Commercial |
$2,738.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,890.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,531.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.29
|
| Rate for Payer: HealthUtah PPO |
$3,043.00
|
| Rate for Payer: HealthUtah PPO |
$1,612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,951.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,563.64
|
| Rate for Payer: Multiplan Medicare/VA |
$343.65
|
| Rate for Payer: Multiplan Medicare/VA |
$343.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,982.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,579.76
|
| Rate for Payer: PacificSource Commercial |
$1,450.80
|
| Rate for Payer: PacificSource Commercial |
$2,738.70
|
| Rate for Payer: PHCS PPO |
$2,890.85
|
| Rate for Payer: PHCS PPO |
$1,531.40
|
| Rate for Payer: Three Rivers PPO |
$2,282.25
|
| Rate for Payer: Three Rivers PPO |
$1,209.00
|
| Rate for Payer: TriWest Veterans Administration |
$404.29
|
| Rate for Payer: TriWest Veterans Administration |
$404.29
|
| Rate for Payer: United Healthcare Commercial |
$1,402.44
|
| Rate for Payer: United Healthcare Commercial |
$2,647.41
|
| Rate for Payer: United Healthcare Medicare |
$404.29
|
| Rate for Payer: United Healthcare Medicare |
$404.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,586.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,370.20
|
|
|
HC PRO CLOSED TX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ
|
Professional
|
Both
|
$1,999.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
9832367501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$1,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,959.02
|
| Rate for Payer: Aetna of WY Medicare |
$497.25
|
| Rate for Payer: Beech Street Commercial |
$1,899.05
|
| Rate for Payer: Cash Price |
$1,399.30
|
| Rate for Payer: Cash Price |
$1,399.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,939.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,959.02
|
| Rate for Payer: First Choice Health Commercial |
$1,799.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,899.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.25
|
| Rate for Payer: HealthUtah PPO |
$1,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,939.03
|
| Rate for Payer: Multiplan Medicare/VA |
$422.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,959.02
|
| Rate for Payer: PacificSource Commercial |
$1,799.10
|
| Rate for Payer: PHCS PPO |
$1,899.05
|
| Rate for Payer: Three Rivers PPO |
$1,499.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$1,739.13
|
| Rate for Payer: United Healthcare Medicare |
$497.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,699.15
|
|
|
HC PRO CLOSED TX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ
|
Professional
|
Both
|
$2,499.00
|
|
|
Service Code
|
HCPCS 23675 NONPBBPAYER
|
| Hospital Charge Code |
9832367501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$497.25
|
| Rate for Payer: Beech Street Commercial |
$2,374.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: First Choice Health Commercial |
$2,249.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.25
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$422.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,374.05
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$2,174.13
|
| Rate for Payer: United Healthcare Medicare |
$497.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,124.15
|
|
|
HC PRO CLOSED TX TALUS FX
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 28430 NONPBBPAYER
|
| Hospital Charge Code |
9832843001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$179.69 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Aetna of WY Medicare |
$211.40
|
| Rate for Payer: Beech Street Commercial |
$1,030.75
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: First Choice Health Commercial |
$976.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.40
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$179.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,030.75
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.40
|
| Rate for Payer: United Healthcare Commercial |
$943.95
|
| Rate for Payer: United Healthcare Medicare |
$211.40
|
| Rate for Payer: WINHealth Partners Commercial |
$922.25
|
|
|
HC PRO CLOSED TX TALUS FX
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
9832843001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$179.69 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$850.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,598.38
|
| Rate for Payer: Aetna of WY Medicare |
$211.40
|
| Rate for Payer: Aetna of WY Medicare |
$211.40
|
| Rate for Payer: Beech Street Commercial |
$1,549.45
|
| Rate for Payer: Beech Street Commercial |
$824.60
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$841.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,582.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,598.38
|
| Rate for Payer: Cigna of WY Commercial |
$850.64
|
| Rate for Payer: First Choice Health Commercial |
$1,467.90
|
| Rate for Payer: First Choice Health Commercial |
$781.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$824.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.40
|
| Rate for Payer: HealthUtah PPO |
$868.00
|
| Rate for Payer: HealthUtah PPO |
$1,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$841.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,582.07
|
| Rate for Payer: Multiplan Medicare/VA |
$179.69
|
| Rate for Payer: Multiplan Medicare/VA |
$179.69
|
| Rate for Payer: One Health Plan of WY PPO |
$850.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,598.38
|
| Rate for Payer: PacificSource Commercial |
$1,467.90
|
| Rate for Payer: PacificSource Commercial |
$781.20
|
| Rate for Payer: PHCS PPO |
$824.60
|
| Rate for Payer: PHCS PPO |
$1,549.45
|
| Rate for Payer: Three Rivers PPO |
$651.00
|
| Rate for Payer: Three Rivers PPO |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$211.40
|
| Rate for Payer: TriWest Veterans Administration |
$211.40
|
| Rate for Payer: United Healthcare Commercial |
$1,418.97
|
| Rate for Payer: United Healthcare Commercial |
$755.16
|
| Rate for Payer: United Healthcare Medicare |
$211.40
|
| Rate for Payer: United Healthcare Medicare |
$211.40
|
| Rate for Payer: WINHealth Partners Commercial |
$737.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.35
|
|
|
HC PRO CLOSED TX TALUS FX,MANIPULATN
|
Professional
|
Both
|
$2,276.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
9832843501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$278.59 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,230.48
|
| Rate for Payer: Aetna of WY Medicare |
$327.75
|
| Rate for Payer: Beech Street Commercial |
$2,162.20
|
| Rate for Payer: Cash Price |
$1,593.20
|
| Rate for Payer: Cash Price |
$1,593.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,207.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,230.48
|
| Rate for Payer: First Choice Health Commercial |
$2,048.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,162.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.75
|
| Rate for Payer: HealthUtah PPO |
$2,276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,207.72
|
| Rate for Payer: Multiplan Medicare/VA |
$278.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,230.48
|
| Rate for Payer: PacificSource Commercial |
$2,048.40
|
| Rate for Payer: PHCS PPO |
$2,162.20
|
| Rate for Payer: Three Rivers PPO |
$1,707.00
|
| Rate for Payer: TriWest Veterans Administration |
$327.75
|
| Rate for Payer: United Healthcare Commercial |
$1,980.12
|
| Rate for Payer: United Healthcare Medicare |
$327.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,934.60
|
|
