|
HC PRO CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
9832860501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.13 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,349.46
|
| Rate for Payer: Aetna of WY Medicare |
$306.03
|
| Rate for Payer: Beech Street Commercial |
$1,308.15
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,335.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,349.46
|
| Rate for Payer: First Choice Health Commercial |
$1,239.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,308.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.03
|
| Rate for Payer: HealthUtah PPO |
$1,377.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,335.69
|
| Rate for Payer: Multiplan Medicare/VA |
$260.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,349.46
|
| Rate for Payer: PacificSource Commercial |
$1,239.30
|
| Rate for Payer: PHCS PPO |
$1,308.15
|
| Rate for Payer: Three Rivers PPO |
$1,032.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.03
|
| Rate for Payer: United Healthcare Commercial |
$1,197.99
|
| Rate for Payer: United Healthcare Medicare |
$306.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,170.45
|
|
|
HC PRO CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 28605 NONPBBPAYER
|
| Hospital Charge Code |
9832860501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$260.13 |
| Max. Negotiated Rate |
$1,721.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,686.58
|
| Rate for Payer: Aetna of WY Medicare |
$306.03
|
| Rate for Payer: Beech Street Commercial |
$1,634.95
|
| Rate for Payer: Cash Price |
$1,204.70
|
| Rate for Payer: Cash Price |
$1,204.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,669.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,686.58
|
| Rate for Payer: First Choice Health Commercial |
$1,548.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.03
|
| Rate for Payer: HealthUtah PPO |
$1,721.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,669.37
|
| Rate for Payer: Multiplan Medicare/VA |
$260.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,686.58
|
| Rate for Payer: PacificSource Commercial |
$1,548.90
|
| Rate for Payer: PHCS PPO |
$1,634.95
|
| Rate for Payer: Three Rivers PPO |
$1,290.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.03
|
| Rate for Payer: United Healthcare Commercial |
$1,497.27
|
| Rate for Payer: United Healthcare Medicare |
$306.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.85
|
|
|
HC PRO CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 21480 NONPBBPAYER
|
| Hospital Charge Code |
9832148001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.98
|
| Rate for Payer: Aetna of WY Medicare |
$29.43
|
| Rate for Payer: Beech Street Commercial |
$570.95
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.97
|
| Rate for Payer: Cigna of WY Commercial |
$588.98
|
| Rate for Payer: First Choice Health Commercial |
$540.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.43
|
| Rate for Payer: HealthUtah PPO |
$601.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.97
|
| Rate for Payer: Multiplan Medicare/VA |
$25.02
|
| Rate for Payer: One Health Plan of WY PPO |
$588.98
|
| Rate for Payer: PacificSource Commercial |
$540.90
|
| Rate for Payer: PHCS PPO |
$570.95
|
| Rate for Payer: Three Rivers PPO |
$450.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.43
|
| Rate for Payer: United Healthcare Commercial |
$522.87
|
| Rate for Payer: United Healthcare Medicare |
$29.43
|
| Rate for Payer: WINHealth Partners Commercial |
$510.85
|
|
|
HC PRO CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
9832148001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$29.43
|
| Rate for Payer: Aetna of WY Medicare |
$29.43
|
| Rate for Payer: Beech Street Commercial |
$456.95
|
| Rate for Payer: Beech Street Commercial |
$492.10
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$466.57
|
| Rate for Payer: Cigna of WY Commercial |
$471.38
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: First Choice Health Commercial |
$432.90
|
| Rate for Payer: First Choice Health Commercial |
$466.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.43
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$25.02
|
| Rate for Payer: Multiplan Medicare/VA |
$25.02
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: One Health Plan of WY PPO |
$471.38
|
| Rate for Payer: PacificSource Commercial |
$432.90
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$492.10
|
| Rate for Payer: PHCS PPO |
$456.95
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: Three Rivers PPO |
$360.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.43
|
| Rate for Payer: TriWest Veterans Administration |
$29.43
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Commercial |
$450.66
|
| Rate for Payer: United Healthcare Medicare |
$29.43
|
| Rate for Payer: United Healthcare Medicare |
$29.43
|
| Rate for Payer: WINHealth Partners Commercial |
$440.30
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
HC PRO CLOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
9832753001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$1,171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,147.58
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,919.82
|
| Rate for Payer: Aetna of WY Medicare |
$292.22
|
| Rate for Payer: Aetna of WY Medicare |
$292.22
|
| Rate for Payer: Beech Street Commercial |
$1,861.05
|
| Rate for Payer: Beech Street Commercial |
$1,112.45
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$819.70
|
| Rate for Payer: Cash Price |
$819.70
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,900.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,135.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,147.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,919.82
|
| Rate for Payer: First Choice Health Commercial |
$1,763.10
|
| Rate for Payer: First Choice Health Commercial |
$1,053.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,112.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,861.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.22
|
| Rate for Payer: HealthUtah PPO |
$1,171.00
|
| Rate for Payer: HealthUtah PPO |
$1,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,900.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,135.87
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,919.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,147.58
|
| Rate for Payer: PacificSource Commercial |
$1,053.90
|
| Rate for Payer: PacificSource Commercial |
$1,763.10
|
| Rate for Payer: PHCS PPO |
$1,112.45
|
| Rate for Payer: PHCS PPO |
$1,861.05
|
| Rate for Payer: Three Rivers PPO |
$878.25
|
| Rate for Payer: Three Rivers PPO |
$1,469.25
|
| Rate for Payer: TriWest Veterans Administration |
$292.22
|
| Rate for Payer: TriWest Veterans Administration |
$292.22
|
| Rate for Payer: United Healthcare Commercial |
$1,704.33
|
| Rate for Payer: United Healthcare Commercial |
$1,018.77
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
| Rate for Payer: WINHealth Partners Commercial |
$995.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,665.15
|
|
|
HC PRO CLOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 27530 NONPBBPAYER
|
| Hospital Charge Code |
9832753001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$292.22
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.22
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$292.22
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX,MANIPULATN
|
Professional
|
Both
|
$2,031.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
9832775201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$2,031.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,990.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Aetna of WY Medicare |
$483.41
|
| Rate for Payer: Aetna of WY Medicare |
$483.41
|
| Rate for Payer: Beech Street Commercial |
$3,163.50
|
| Rate for Payer: Beech Street Commercial |
$1,929.45
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cash Price |
$1,421.70
|
| Rate for Payer: Cash Price |
$1,421.70
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,970.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,990.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: First Choice Health Commercial |
$2,997.00
|
| Rate for Payer: First Choice Health Commercial |
$1,827.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,929.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.41
|
| Rate for Payer: HealthUtah PPO |
$2,031.00
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,970.07
|
| Rate for Payer: Multiplan Medicare/VA |
$410.90
|
| Rate for Payer: Multiplan Medicare/VA |
$410.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,990.38
|
| Rate for Payer: PacificSource Commercial |
$1,827.90
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$1,929.45
|
| Rate for Payer: PHCS PPO |
$3,163.50
|
| Rate for Payer: Three Rivers PPO |
$1,523.25
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$483.41
|
| Rate for Payer: TriWest Veterans Administration |
$483.41
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Commercial |
$1,766.97
|
| Rate for Payer: United Healthcare Medicare |
$483.41
|
| Rate for Payer: United Healthcare Medicare |
$483.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,726.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,830.50
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX,MANIPULATN
|
Professional
|
Both
|
$2,539.00
|
|
|
Service Code
|
HCPCS 27752 NONPBBPAYER
|
| Hospital Charge Code |
9832775201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$2,539.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,488.22
|
| Rate for Payer: Aetna of WY Medicare |
$483.41
|
| Rate for Payer: Beech Street Commercial |
$2,412.05
|
| Rate for Payer: Cash Price |
$1,777.30
|
| Rate for Payer: Cash Price |
$1,777.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,462.83
|
| Rate for Payer: Cigna of WY Commercial |
$2,488.22
|
| Rate for Payer: First Choice Health Commercial |
$2,285.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,412.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.41
|
| Rate for Payer: HealthUtah PPO |
$2,539.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,462.83
|
| Rate for Payer: Multiplan Medicare/VA |
$410.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,488.22
|
| Rate for Payer: PacificSource Commercial |
$2,285.10
|
| Rate for Payer: PHCS PPO |
$2,412.05
|
| Rate for Payer: Three Rivers PPO |
$1,904.25
|
| Rate for Payer: TriWest Veterans Administration |
$483.41
|
| Rate for Payer: United Healthcare Commercial |
$2,208.93
|
| Rate for Payer: United Healthcare Medicare |
$483.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,158.15
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27750 NONPBBPAYER
|
| Hospital Charge Code |
9832775001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,614.06
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$1,564.65
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,597.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,614.06
|
| Rate for Payer: First Choice Health Commercial |
$1,482.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,564.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$1,647.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,597.59
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,614.06
|
| Rate for Payer: PacificSource Commercial |
$1,482.30
|
| Rate for Payer: PHCS PPO |
$1,564.65
|
| Rate for Payer: Three Rivers PPO |
$1,235.25
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$1,432.89
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$1,399.95
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Professional
|
Both
|
$3,294.00
|
|
|
Service Code
|
HCPCS 27750 50,NONPBBPAYER
|
| Hospital Charge Code |
9832775001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$3,294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,228.12
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$3,129.30
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,195.18
|
| Rate for Payer: Cigna of WY Commercial |
$3,228.12
|
| Rate for Payer: First Choice Health Commercial |
$2,964.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,129.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$3,294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,195.18
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,228.12
|
| Rate for Payer: PacificSource Commercial |
$2,964.60
|
| Rate for Payer: PHCS PPO |
$3,129.30
|
| Rate for Payer: Three Rivers PPO |
$2,470.50
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$2,865.78
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,799.90
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
9832775001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$1,318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,291.64
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$1,252.10
|
| Rate for Payer: Cash Price |
$922.60
|
| Rate for Payer: Cash Price |
$922.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,278.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,291.64
|
| Rate for Payer: First Choice Health Commercial |
$1,186.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,252.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$1,318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,278.46
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,291.64
|
| Rate for Payer: PacificSource Commercial |
$1,186.20
|
| Rate for Payer: PHCS PPO |
$1,252.10
|
| Rate for Payer: Three Rivers PPO |
$988.50
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$1,146.66
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$1,120.30
|
|
|
HC PRO CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 27750 50
|
| Hospital Charge Code |
9832775001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$2,636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,583.28
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$2,504.20
|
| Rate for Payer: Cash Price |
$1,845.20
|
| Rate for Payer: Cash Price |
$1,845.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,556.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,583.28
|
| Rate for Payer: First Choice Health Commercial |
$2,372.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,504.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$2,636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,556.92
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$2,583.28
|
| Rate for Payer: PacificSource Commercial |
$2,372.40
|
| Rate for Payer: PHCS PPO |
$2,504.20
|
| Rate for Payer: Three Rivers PPO |
$1,977.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$2,293.32
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,240.60
|
|
|
HC PRO CLOSED TX TOE FX,MANIPULATION
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
9832851501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.62 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$958.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$576.24
|
| Rate for Payer: Aetna of WY Medicare |
$144.26
|
| Rate for Payer: Aetna of WY Medicare |
$144.26
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Beech Street Commercial |
$929.10
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$948.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$570.36
|
| Rate for Payer: Cigna of WY Commercial |
$576.24
|
| Rate for Payer: Cigna of WY Commercial |
$958.44
|
| Rate for Payer: First Choice Health Commercial |
$529.20
|
| Rate for Payer: First Choice Health Commercial |
$880.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$558.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.26
|
| Rate for Payer: HealthUtah PPO |
$978.00
|
| Rate for Payer: HealthUtah PPO |
$588.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$948.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$570.36
|
| Rate for Payer: Multiplan Medicare/VA |
$122.62
|
| Rate for Payer: Multiplan Medicare/VA |
$122.62
|
| Rate for Payer: One Health Plan of WY PPO |
$958.44
|
| Rate for Payer: One Health Plan of WY PPO |
$576.24
|
| Rate for Payer: PacificSource Commercial |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$880.20
|
| Rate for Payer: PHCS PPO |
$929.10
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$733.50
|
| Rate for Payer: Three Rivers PPO |
$441.00
|
| Rate for Payer: TriWest Veterans Administration |
$144.26
|
| Rate for Payer: TriWest Veterans Administration |
$144.26
|
| Rate for Payer: United Healthcare Commercial |
$511.56
|
| Rate for Payer: United Healthcare Commercial |
$850.86
|
| Rate for Payer: United Healthcare Medicare |
$144.26
|
| Rate for Payer: United Healthcare Medicare |
$144.26
|
| Rate for Payer: WINHealth Partners Commercial |
$831.30
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
|
|
HC PRO CLOSED TX TOE FX,MANIPULATION
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28515 NONPBBPAYER
|
| Hospital Charge Code |
9832851501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.62 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Aetna of WY Medicare |
$144.26
|
| Rate for Payer: Beech Street Commercial |
$698.25
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: First Choice Health Commercial |
$661.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.26
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$122.62
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$698.25
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.26
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$144.26
|
| Rate for Payer: WINHealth Partners Commercial |
$624.75
|
|
|
HC PRO CLOSED TX TRAUMA HIP DISLOC,ANESTH
|
Professional
|
Both
|
$5,044.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
9832725201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$615.38 |
| Max. Negotiated Rate |
$5,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,943.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,990.16
|
| Rate for Payer: Aetna of WY Medicare |
$723.98
|
| Rate for Payer: Aetna of WY Medicare |
$723.98
|
| Rate for Payer: Beech Street Commercial |
$4,837.40
|
| Rate for Payer: Beech Street Commercial |
$4,791.80
|
| Rate for Payer: Cash Price |
$3,564.40
|
| Rate for Payer: Cash Price |
$3,530.80
|
| Rate for Payer: Cash Price |
$3,530.80
|
| Rate for Payer: Cash Price |
$3,564.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,939.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,892.68
|
| Rate for Payer: Cigna of WY Commercial |
$4,943.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,990.16
|
| Rate for Payer: First Choice Health Commercial |
$4,582.80
|
| Rate for Payer: First Choice Health Commercial |
$4,539.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,791.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,837.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.98
|
| Rate for Payer: HealthUtah PPO |
$5,044.00
|
| Rate for Payer: HealthUtah PPO |
$5,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,939.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,892.68
|
| Rate for Payer: Multiplan Medicare/VA |
$615.38
|
| Rate for Payer: Multiplan Medicare/VA |
$615.38
|
| Rate for Payer: One Health Plan of WY PPO |
$4,990.16
|
| Rate for Payer: One Health Plan of WY PPO |
$4,943.12
|
| Rate for Payer: PacificSource Commercial |
$4,539.60
|
| Rate for Payer: PacificSource Commercial |
$4,582.80
|
| Rate for Payer: PHCS PPO |
$4,791.80
|
| Rate for Payer: PHCS PPO |
$4,837.40
|
| Rate for Payer: Three Rivers PPO |
$3,783.00
|
| Rate for Payer: Three Rivers PPO |
$3,819.00
|
| Rate for Payer: TriWest Veterans Administration |
$723.98
|
| Rate for Payer: TriWest Veterans Administration |
$723.98
|
| Rate for Payer: United Healthcare Commercial |
$4,430.04
|
| Rate for Payer: United Healthcare Commercial |
$4,388.28
|
| Rate for Payer: United Healthcare Medicare |
$723.98
|
| Rate for Payer: United Healthcare Medicare |
$723.98
|
| Rate for Payer: WINHealth Partners Commercial |
$4,287.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4,328.20
|
|
|
HC PRO CLOSED TX TRAUMA HIP DISLOC,ANESTH
|
Professional
|
Both
|
$6,305.00
|
|
|
Service Code
|
HCPCS 27252 NONPBBPAYER
|
| Hospital Charge Code |
9832725201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$615.38 |
| Max. Negotiated Rate |
$6,305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,178.90
|
| Rate for Payer: Aetna of WY Medicare |
$723.98
|
| Rate for Payer: Beech Street Commercial |
$5,989.75
|
| Rate for Payer: Cash Price |
$4,413.50
|
| Rate for Payer: Cash Price |
$4,413.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,115.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,178.90
|
| Rate for Payer: First Choice Health Commercial |
$5,674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,989.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.98
|
| Rate for Payer: HealthUtah PPO |
$6,305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,115.85
|
| Rate for Payer: Multiplan Medicare/VA |
$615.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,178.90
|
| Rate for Payer: PacificSource Commercial |
$5,674.50
|
| Rate for Payer: PHCS PPO |
$5,989.75
|
| Rate for Payer: Three Rivers PPO |
$4,728.75
|
| Rate for Payer: TriWest Veterans Administration |
$723.98
|
| Rate for Payer: United Healthcare Commercial |
$5,485.35
|
| Rate for Payer: United Healthcare Medicare |
$723.98
|
| Rate for Payer: WINHealth Partners Commercial |
$5,359.25
|
|
|
HC PRO CLOSED TX TRAUMATIC HIP DISLOCATN
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
9832725001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$143.72 |
| Max. Negotiated Rate |
$1,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,342.60
|
| Rate for Payer: Aetna of WY Medicare |
$169.08
|
| Rate for Payer: Beech Street Commercial |
$1,301.50
|
| Rate for Payer: Cash Price |
$959.00
|
| Rate for Payer: Cash Price |
$959.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,328.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,342.60
|
| Rate for Payer: First Choice Health Commercial |
$1,233.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,301.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.08
|
| Rate for Payer: HealthUtah PPO |
$1,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,328.90
|
| Rate for Payer: Multiplan Medicare/VA |
$143.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,342.60
|
| Rate for Payer: PacificSource Commercial |
$1,233.00
|
| Rate for Payer: PHCS PPO |
$1,301.50
|
| Rate for Payer: Three Rivers PPO |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration |
$169.08
|
| Rate for Payer: United Healthcare Commercial |
$1,191.90
|
| Rate for Payer: United Healthcare Medicare |
$169.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,164.50
|
|
|
HC PRO CLOSED TX TRIMALLEOLAR FX,MANIP
|
Professional
|
Both
|
$2,462.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
9832781801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$370.86 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,412.76
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,375.92
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Beech Street Commercial |
$1,333.80
|
| Rate for Payer: Beech Street Commercial |
$2,338.90
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$1,723.40
|
| Rate for Payer: Cash Price |
$1,723.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,388.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,361.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,375.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,412.76
|
| Rate for Payer: First Choice Health Commercial |
$1,263.60
|
| Rate for Payer: First Choice Health Commercial |
$2,215.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,338.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,333.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: HealthUtah PPO |
$2,462.00
|
| Rate for Payer: HealthUtah PPO |
$1,404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,388.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,361.88
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,412.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,375.92
|
| Rate for Payer: PacificSource Commercial |
$1,263.60
|
| Rate for Payer: PacificSource Commercial |
$2,215.80
|
| Rate for Payer: PHCS PPO |
$2,338.90
|
| Rate for Payer: PHCS PPO |
$1,333.80
|
| Rate for Payer: Three Rivers PPO |
$1,846.50
|
| Rate for Payer: Three Rivers PPO |
$1,053.00
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: United Healthcare Commercial |
$1,221.48
|
| Rate for Payer: United Healthcare Commercial |
$2,141.94
|
| Rate for Payer: United Healthcare Medicare |
$436.30
|
| Rate for Payer: United Healthcare Medicare |
$436.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,092.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,193.40
|
|
|
HC PRO CLOSED TX TRIMALLEOLAR FX,MANIP
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 27818 NONPBBPAYER
|
| Hospital Charge Code |
9832781801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$370.86 |
| Max. Negotiated Rate |
$1,755.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,719.90
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Beech Street Commercial |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,702.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,719.90
|
| Rate for Payer: First Choice Health Commercial |
$1,579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,667.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: HealthUtah PPO |
$1,755.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,702.35
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,719.90
|
| Rate for Payer: PacificSource Commercial |
$1,579.50
|
| Rate for Payer: PHCS PPO |
$1,667.25
|
| Rate for Payer: Three Rivers PPO |
$1,316.25
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: United Healthcare Commercial |
$1,526.85
|
| Rate for Payer: United Healthcare Medicare |
$436.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,491.75
|
|
|
HC PRO CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATION
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
9832467001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$229.94 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,034.48
|
| Rate for Payer: Aetna of WY Medicare |
$270.52
|
| Rate for Payer: Aetna of WY Medicare |
$270.52
|
| Rate for Payer: Beech Street Commercial |
$1,972.20
|
| Rate for Payer: Beech Street Commercial |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,453.20
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$1,453.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,013.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,034.48
|
| Rate for Payer: First Choice Health Commercial |
$1,868.40
|
| Rate for Payer: First Choice Health Commercial |
$982.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,972.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.52
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: HealthUtah PPO |
$2,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,013.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$229.94
|
| Rate for Payer: Multiplan Medicare/VA |
$229.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,034.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PacificSource Commercial |
$1,868.40
|
| Rate for Payer: PHCS PPO |
$1,037.40
|
| Rate for Payer: PHCS PPO |
$1,972.20
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: Three Rivers PPO |
$1,557.00
|
| Rate for Payer: TriWest Veterans Administration |
$270.52
|
| Rate for Payer: TriWest Veterans Administration |
$270.52
|
| Rate for Payer: United Healthcare Commercial |
$1,806.12
|
| Rate for Payer: United Healthcare Commercial |
$950.04
|
| Rate for Payer: United Healthcare Medicare |
$270.52
|
| Rate for Payer: United Healthcare Medicare |
$270.52
|
| Rate for Payer: WINHealth Partners Commercial |
$928.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.60
|
|
|
HC PRO CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATION
|
Professional
|
Both
|
$1,365.00
|
|
|
Service Code
|
HCPCS 24670 NONPBBPAYER
|
| Hospital Charge Code |
9832467001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$229.94 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,337.70
|
| Rate for Payer: Aetna of WY Medicare |
$270.52
|
| Rate for Payer: Beech Street Commercial |
$1,296.75
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,324.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,337.70
|
| Rate for Payer: First Choice Health Commercial |
$1,228.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,296.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.52
|
| Rate for Payer: HealthUtah PPO |
$1,365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,324.05
|
| Rate for Payer: Multiplan Medicare/VA |
$229.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,337.70
|
| Rate for Payer: PacificSource Commercial |
$1,228.50
|
| Rate for Payer: PHCS PPO |
$1,296.75
|
| Rate for Payer: Three Rivers PPO |
$1,023.75
|
| Rate for Payer: TriWest Veterans Administration |
$270.52
|
| Rate for Payer: United Healthcare Commercial |
$1,187.55
|
| Rate for Payer: United Healthcare Medicare |
$270.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,160.25
|
|
|
HC PRO CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 25530 NONPBBPAYER
|
| Hospital Charge Code |
9832553001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$209.80 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.74
|
| Rate for Payer: Aetna of WY Medicare |
$246.82
|
| Rate for Payer: Beech Street Commercial |
$914.85
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$934.11
|
| Rate for Payer: Cigna of WY Commercial |
$943.74
|
| Rate for Payer: First Choice Health Commercial |
$866.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.82
|
| Rate for Payer: HealthUtah PPO |
$963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$934.11
|
| Rate for Payer: Multiplan Medicare/VA |
$209.80
|
| Rate for Payer: One Health Plan of WY PPO |
$943.74
|
| Rate for Payer: PacificSource Commercial |
$866.70
|
| Rate for Payer: PHCS PPO |
$914.85
|
| Rate for Payer: Three Rivers PPO |
$722.25
|
| Rate for Payer: TriWest Veterans Administration |
$246.82
|
| Rate for Payer: United Healthcare Commercial |
$837.81
|
| Rate for Payer: United Healthcare Medicare |
$246.82
|
| Rate for Payer: WINHealth Partners Commercial |
$818.55
|
|
|
HC PRO CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
9832553001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$209.80 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,617.98
|
| Rate for Payer: Aetna of WY Medicare |
$246.82
|
| Rate for Payer: Aetna of WY Medicare |
$246.82
|
| Rate for Payer: Beech Street Commercial |
$1,568.45
|
| Rate for Payer: Beech Street Commercial |
$731.50
|
| Rate for Payer: Cash Price |
$1,155.70
|
| Rate for Payer: Cash Price |
$1,155.70
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,601.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,617.98
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: First Choice Health Commercial |
$1,485.90
|
| Rate for Payer: First Choice Health Commercial |
$693.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,568.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.82
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: HealthUtah PPO |
$1,651.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,601.47
|
| Rate for Payer: Multiplan Medicare/VA |
$209.80
|
| Rate for Payer: Multiplan Medicare/VA |
$209.80
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,617.98
|
| Rate for Payer: PacificSource Commercial |
$1,485.90
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$731.50
|
| Rate for Payer: PHCS PPO |
$1,568.45
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: Three Rivers PPO |
$1,238.25
|
| Rate for Payer: TriWest Veterans Administration |
$246.82
|
| Rate for Payer: TriWest Veterans Administration |
$246.82
|
| Rate for Payer: United Healthcare Commercial |
$1,436.37
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$246.82
|
| Rate for Payer: United Healthcare Medicare |
$246.82
|
| Rate for Payer: WINHealth Partners Commercial |
$654.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,403.35
|
|
|
HC PRO CLOSED TX ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
9832565001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.06 |
| Max. Negotiated Rate |
$398.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$390.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,326.52
|
| Rate for Payer: Aetna of WY Medicare |
$308.31
|
| Rate for Payer: Aetna of WY Medicare |
$308.31
|
| Rate for Payer: Beech Street Commercial |
$2,255.30
|
| Rate for Payer: Beech Street Commercial |
$378.10
|
| Rate for Payer: Cash Price |
$1,661.80
|
| Rate for Payer: Cash Price |
$1,661.80
|
| Rate for Payer: Cash Price |
$278.60
|
| Rate for Payer: Cash Price |
$278.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$386.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,302.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,326.52
|
| Rate for Payer: Cigna of WY Commercial |
$390.04
|
| Rate for Payer: First Choice Health Commercial |
$2,136.60
|
| Rate for Payer: First Choice Health Commercial |
$358.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$378.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,255.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.31
|
| Rate for Payer: HealthUtah PPO |
$398.00
|
| Rate for Payer: HealthUtah PPO |
$2,374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$386.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,302.78
|
| Rate for Payer: Multiplan Medicare/VA |
$262.06
|
| Rate for Payer: Multiplan Medicare/VA |
$262.06
|
| Rate for Payer: One Health Plan of WY PPO |
$390.04
|
| Rate for Payer: One Health Plan of WY PPO |
$2,326.52
|
| Rate for Payer: PacificSource Commercial |
$2,136.60
|
| Rate for Payer: PacificSource Commercial |
$358.20
|
| Rate for Payer: PHCS PPO |
$378.10
|
| Rate for Payer: PHCS PPO |
$2,255.30
|
| Rate for Payer: Three Rivers PPO |
$298.50
|
| Rate for Payer: Three Rivers PPO |
$1,780.50
|
| Rate for Payer: TriWest Veterans Administration |
$308.31
|
| Rate for Payer: TriWest Veterans Administration |
$308.31
|
| Rate for Payer: United Healthcare Commercial |
$2,065.38
|
| Rate for Payer: United Healthcare Commercial |
$346.26
|
| Rate for Payer: United Healthcare Medicare |
$308.31
|
| Rate for Payer: United Healthcare Medicare |
$308.31
|
| Rate for Payer: WINHealth Partners Commercial |
$338.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,017.90
|
|
|
HC PRO CLOSED TX ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 25650 NONPBBPAYER
|
| Hospital Charge Code |
9832565001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.06 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$488.04
|
| Rate for Payer: Aetna of WY Medicare |
$308.31
|
| Rate for Payer: Beech Street Commercial |
$473.10
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$483.06
|
| Rate for Payer: Cigna of WY Commercial |
$488.04
|
| Rate for Payer: First Choice Health Commercial |
$448.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$473.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.31
|
| Rate for Payer: HealthUtah PPO |
$498.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$483.06
|
| Rate for Payer: Multiplan Medicare/VA |
$262.06
|
| Rate for Payer: One Health Plan of WY PPO |
$488.04
|
| Rate for Payer: PacificSource Commercial |
$448.20
|
| Rate for Payer: PHCS PPO |
$473.10
|
| Rate for Payer: Three Rivers PPO |
$373.50
|
| Rate for Payer: TriWest Veterans Administration |
$308.31
|
| Rate for Payer: United Healthcare Commercial |
$433.26
|
| Rate for Payer: United Healthcare Medicare |
$308.31
|
| Rate for Payer: WINHealth Partners Commercial |
$423.30
|
|
