|
HC PRO CLOSE TX DIST FINGER FX W/O MANIP
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
9832675001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$731.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,376.90
|
| Rate for Payer: Aetna of WY Medicare |
$193.47
|
| Rate for Payer: Aetna of WY Medicare |
$193.47
|
| Rate for Payer: Beech Street Commercial |
$1,334.75
|
| Rate for Payer: Beech Street Commercial |
$708.70
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$723.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,362.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,376.90
|
| Rate for Payer: Cigna of WY Commercial |
$731.08
|
| Rate for Payer: First Choice Health Commercial |
$1,264.50
|
| Rate for Payer: First Choice Health Commercial |
$671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$708.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,334.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.47
|
| Rate for Payer: HealthUtah PPO |
$746.00
|
| Rate for Payer: HealthUtah PPO |
$1,405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$723.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,362.85
|
| Rate for Payer: Multiplan Medicare/VA |
$164.45
|
| Rate for Payer: Multiplan Medicare/VA |
$164.45
|
| Rate for Payer: One Health Plan of WY PPO |
$731.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,376.90
|
| Rate for Payer: PacificSource Commercial |
$1,264.50
|
| Rate for Payer: PacificSource Commercial |
$671.40
|
| Rate for Payer: PHCS PPO |
$708.70
|
| Rate for Payer: PHCS PPO |
$1,334.75
|
| Rate for Payer: Three Rivers PPO |
$559.50
|
| Rate for Payer: Three Rivers PPO |
$1,053.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.47
|
| Rate for Payer: TriWest Veterans Administration |
$193.47
|
| Rate for Payer: United Healthcare Commercial |
$1,222.35
|
| Rate for Payer: United Healthcare Commercial |
$649.02
|
| Rate for Payer: United Healthcare Medicare |
$193.47
|
| Rate for Payer: United Healthcare Medicare |
$193.47
|
| Rate for Payer: WINHealth Partners Commercial |
$634.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,194.25
|
|
|
HC PRO CLOSE TX DIST FINGER FX W/O MANIP
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 26750 NONPBBPAYER
|
| Hospital Charge Code |
9832675001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$913.36
|
| Rate for Payer: Aetna of WY Medicare |
$193.47
|
| Rate for Payer: Beech Street Commercial |
$885.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$904.04
|
| Rate for Payer: Cigna of WY Commercial |
$913.36
|
| Rate for Payer: First Choice Health Commercial |
$838.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$885.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.47
|
| Rate for Payer: HealthUtah PPO |
$932.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$904.04
|
| Rate for Payer: Multiplan Medicare/VA |
$164.45
|
| Rate for Payer: One Health Plan of WY PPO |
$913.36
|
| Rate for Payer: PacificSource Commercial |
$838.80
|
| Rate for Payer: PHCS PPO |
$885.40
|
| Rate for Payer: Three Rivers PPO |
$699.00
|
| Rate for Payer: TriWest Veterans Administration |
$193.47
|
| Rate for Payer: United Healthcare Commercial |
$810.84
|
| Rate for Payer: United Healthcare Medicare |
$193.47
|
| Rate for Payer: WINHealth Partners Commercial |
$792.20
|
|
|
HC PRO CLOSE TX DIST FINGR FX,MANIPULATN
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
9832675501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$688.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,275.16
|
| Rate for Payer: Aetna of WY Medicare |
$275.15
|
| Rate for Payer: Aetna of WY Medicare |
$275.15
|
| Rate for Payer: Beech Street Commercial |
$3,174.90
|
| Rate for Payer: Beech Street Commercial |
$667.85
|
| Rate for Payer: Cash Price |
$2,339.40
|
| Rate for Payer: Cash Price |
$2,339.40
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$681.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,241.74
|
| Rate for Payer: Cigna of WY Commercial |
$3,275.16
|
| Rate for Payer: Cigna of WY Commercial |
$688.94
|
| Rate for Payer: First Choice Health Commercial |
$3,007.80
|
| Rate for Payer: First Choice Health Commercial |
$632.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$667.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,174.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.15
|
| Rate for Payer: HealthUtah PPO |
$703.00
|
| Rate for Payer: HealthUtah PPO |
$3,342.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$681.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,241.74
|
| Rate for Payer: Multiplan Medicare/VA |
$233.88
|
| Rate for Payer: Multiplan Medicare/VA |
$233.88
|
| Rate for Payer: One Health Plan of WY PPO |
$688.94
|
| Rate for Payer: One Health Plan of WY PPO |
$3,275.16
|
| Rate for Payer: PacificSource Commercial |
$3,007.80
|
| Rate for Payer: PacificSource Commercial |
$632.70
|
| Rate for Payer: PHCS PPO |
$667.85
|
| Rate for Payer: PHCS PPO |
$3,174.90
|
| Rate for Payer: Three Rivers PPO |
$527.25
|
| Rate for Payer: Three Rivers PPO |
$2,506.50
|
| Rate for Payer: TriWest Veterans Administration |
$275.15
|
| Rate for Payer: TriWest Veterans Administration |
$275.15
|
| Rate for Payer: United Healthcare Commercial |
$2,907.54
|
| Rate for Payer: United Healthcare Commercial |
$611.61
|
| Rate for Payer: United Healthcare Medicare |
$275.15
|
| Rate for Payer: United Healthcare Medicare |
$275.15
|
| Rate for Payer: WINHealth Partners Commercial |
$597.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,840.70
|
|
|
HC PRO CLOSE TX DIST FINGR FX,MANIPULATN
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 26755 NONPBBPAYER
|
| Hospital Charge Code |
9832675501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$861.42
|
| Rate for Payer: Aetna of WY Medicare |
$275.15
|
| Rate for Payer: Beech Street Commercial |
$835.05
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$852.63
|
| Rate for Payer: Cigna of WY Commercial |
$861.42
|
| Rate for Payer: First Choice Health Commercial |
$791.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.15
|
| Rate for Payer: HealthUtah PPO |
$879.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$852.63
|
| Rate for Payer: Multiplan Medicare/VA |
$233.88
|
| Rate for Payer: One Health Plan of WY PPO |
$861.42
|
| Rate for Payer: PacificSource Commercial |
$791.10
|
| Rate for Payer: PHCS PPO |
$835.05
|
| Rate for Payer: Three Rivers PPO |
$659.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.15
|
| Rate for Payer: United Healthcare Commercial |
$764.73
|
| Rate for Payer: United Healthcare Medicare |
$275.15
|
| Rate for Payer: WINHealth Partners Commercial |
$747.15
|
|
|
HC PRO CLOSE TX FINGR ARTICULAR FX,MANIP
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
9832674201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$1,343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,316.14
|
| Rate for Payer: Aetna of WY Medicare |
$335.18
|
| Rate for Payer: Beech Street Commercial |
$1,275.85
|
| Rate for Payer: Cash Price |
$940.10
|
| Rate for Payer: Cash Price |
$940.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,302.71
|
| Rate for Payer: Cigna of WY Commercial |
$1,316.14
|
| Rate for Payer: First Choice Health Commercial |
$1,208.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,275.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.18
|
| Rate for Payer: HealthUtah PPO |
$1,343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,302.71
|
| Rate for Payer: Multiplan Medicare/VA |
$284.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,316.14
|
| Rate for Payer: PacificSource Commercial |
$1,208.70
|
| Rate for Payer: PHCS PPO |
$1,275.85
|
| Rate for Payer: Three Rivers PPO |
$1,007.25
|
| Rate for Payer: TriWest Veterans Administration |
$335.18
|
| Rate for Payer: United Healthcare Commercial |
$1,168.41
|
| Rate for Payer: United Healthcare Medicare |
$335.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.55
|
|
|
HC PRO CLOSE TX FINGR ARTICULAR FX,MANIP
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 26742 NONPBBPAYER
|
| Hospital Charge Code |
9832674201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$1,679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,645.42
|
| Rate for Payer: Aetna of WY Medicare |
$335.18
|
| Rate for Payer: Beech Street Commercial |
$1,595.05
|
| Rate for Payer: Cash Price |
$1,175.30
|
| Rate for Payer: Cash Price |
$1,175.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,628.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,645.42
|
| Rate for Payer: First Choice Health Commercial |
$1,511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,595.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.18
|
| Rate for Payer: HealthUtah PPO |
$1,679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,628.63
|
| Rate for Payer: Multiplan Medicare/VA |
$284.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,645.42
|
| Rate for Payer: PacificSource Commercial |
$1,511.10
|
| Rate for Payer: PHCS PPO |
$1,595.05
|
| Rate for Payer: Three Rivers PPO |
$1,259.25
|
| Rate for Payer: TriWest Veterans Administration |
$335.18
|
| Rate for Payer: United Healthcare Commercial |
$1,460.73
|
| Rate for Payer: United Healthcare Medicare |
$335.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,427.15
|
|
|
HC PRO CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$4,481.00
|
|
|
Service Code
|
HCPCS 44620
|
| Hospital Charge Code |
9834462001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$697.45 |
| Max. Negotiated Rate |
$4,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,391.38
|
| Rate for Payer: Aetna of WY Medicare |
$820.53
|
| Rate for Payer: Beech Street Commercial |
$4,256.95
|
| Rate for Payer: Cash Price |
$3,136.70
|
| Rate for Payer: Cash Price |
$3,136.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,346.57
|
| Rate for Payer: Cigna of WY Commercial |
$4,391.38
|
| Rate for Payer: First Choice Health Commercial |
$4,032.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,256.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.53
|
| Rate for Payer: HealthUtah PPO |
$4,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,346.57
|
| Rate for Payer: Multiplan Medicare/VA |
$697.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4,391.38
|
| Rate for Payer: PacificSource Commercial |
$4,032.90
|
| Rate for Payer: PHCS PPO |
$4,256.95
|
| Rate for Payer: Three Rivers PPO |
$3,360.75
|
| Rate for Payer: TriWest Veterans Administration |
$820.53
|
| Rate for Payer: United Healthcare Commercial |
$3,898.47
|
| Rate for Payer: United Healthcare Medicare |
$820.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,808.85
|
|
|
HC PRO CLOSURE OF VAGINA
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
9835712001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$437.05 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,799.28
|
| Rate for Payer: Aetna of WY Medicare |
$514.18
|
| Rate for Payer: Beech Street Commercial |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,780.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,799.28
|
| Rate for Payer: First Choice Health Commercial |
$1,652.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,744.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.18
|
| Rate for Payer: HealthUtah PPO |
$1,836.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,780.92
|
| Rate for Payer: Multiplan Medicare/VA |
$437.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,799.28
|
| Rate for Payer: PacificSource Commercial |
$1,652.40
|
| Rate for Payer: PHCS PPO |
$1,744.20
|
| Rate for Payer: Three Rivers PPO |
$1,377.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.18
|
| Rate for Payer: United Healthcare Commercial |
$1,597.32
|
| Rate for Payer: United Healthcare Medicare |
$514.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,560.60
|
|
|
HC PRO CLOSURE SUPERF WND DEHIS SIMPLE
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 12020 NONPBBPAYER
|
| Hospital Charge Code |
9831202001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Aetna of WY Medicare |
$181.74
|
| Rate for Payer: Beech Street Commercial |
$897.75
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: First Choice Health Commercial |
$850.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.74
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$154.48
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$897.75
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$181.74
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$181.74
|
| Rate for Payer: WINHealth Partners Commercial |
$803.25
|
|
|
HC PRO CLOSURE SUPERF WND DEHIS SIMPLE
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
9831202001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,417.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$181.74
|
| Rate for Payer: Aetna of WY Medicare |
$181.74
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Beech Street Commercial |
$1,373.70
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,402.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,417.08
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: First Choice Health Commercial |
$1,301.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,373.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.74
|
| Rate for Payer: HealthUtah PPO |
$1,446.00
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,402.62
|
| Rate for Payer: Multiplan Medicare/VA |
$154.48
|
| Rate for Payer: Multiplan Medicare/VA |
$154.48
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,417.08
|
| Rate for Payer: PacificSource Commercial |
$1,301.40
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$1,373.70
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$1,084.50
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$181.74
|
| Rate for Payer: TriWest Veterans Administration |
$181.74
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Commercial |
$1,258.02
|
| Rate for Payer: United Healthcare Medicare |
$181.74
|
| Rate for Payer: United Healthcare Medicare |
$181.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
HC PRO CLOSURE SUPERF WND DEHIS W PACKING
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
HCPCS 12021 NONPBBPAYER
|
| Hospital Charge Code |
9831202101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$698.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$684.04
|
| Rate for Payer: Aetna of WY Medicare |
$136.51
|
| Rate for Payer: Beech Street Commercial |
$663.10
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$677.06
|
| Rate for Payer: Cigna of WY Commercial |
$684.04
|
| Rate for Payer: First Choice Health Commercial |
$628.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.51
|
| Rate for Payer: HealthUtah PPO |
$698.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$677.06
|
| Rate for Payer: Multiplan Medicare/VA |
$116.03
|
| Rate for Payer: One Health Plan of WY PPO |
$684.04
|
| Rate for Payer: PacificSource Commercial |
$628.20
|
| Rate for Payer: PHCS PPO |
$663.10
|
| Rate for Payer: Three Rivers PPO |
$523.50
|
| Rate for Payer: TriWest Veterans Administration |
$136.51
|
| Rate for Payer: United Healthcare Commercial |
$607.26
|
| Rate for Payer: United Healthcare Medicare |
$136.51
|
| Rate for Payer: WINHealth Partners Commercial |
$593.30
|
|
|
HC PRO CLOSURE SUPERF WND DEHIS W PACKING
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
9831202101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$937.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$918.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$546.84
|
| Rate for Payer: Aetna of WY Medicare |
$136.51
|
| Rate for Payer: Aetna of WY Medicare |
$136.51
|
| Rate for Payer: Beech Street Commercial |
$530.10
|
| Rate for Payer: Beech Street Commercial |
$890.15
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$655.90
|
| Rate for Payer: Cash Price |
$655.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$908.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$541.26
|
| Rate for Payer: Cigna of WY Commercial |
$546.84
|
| Rate for Payer: Cigna of WY Commercial |
$918.26
|
| Rate for Payer: First Choice Health Commercial |
$502.20
|
| Rate for Payer: First Choice Health Commercial |
$843.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$890.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$530.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.51
|
| Rate for Payer: HealthUtah PPO |
$937.00
|
| Rate for Payer: HealthUtah PPO |
$558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$908.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$541.26
|
| Rate for Payer: Multiplan Medicare/VA |
$116.03
|
| Rate for Payer: Multiplan Medicare/VA |
$116.03
|
| Rate for Payer: One Health Plan of WY PPO |
$918.26
|
| Rate for Payer: One Health Plan of WY PPO |
$546.84
|
| Rate for Payer: PacificSource Commercial |
$502.20
|
| Rate for Payer: PacificSource Commercial |
$843.30
|
| Rate for Payer: PHCS PPO |
$890.15
|
| Rate for Payer: PHCS PPO |
$530.10
|
| Rate for Payer: Three Rivers PPO |
$702.75
|
| Rate for Payer: Three Rivers PPO |
$418.50
|
| Rate for Payer: TriWest Veterans Administration |
$136.51
|
| Rate for Payer: TriWest Veterans Administration |
$136.51
|
| Rate for Payer: United Healthcare Commercial |
$485.46
|
| Rate for Payer: United Healthcare Commercial |
$815.19
|
| Rate for Payer: United Healthcare Medicare |
$136.51
|
| Rate for Payer: United Healthcare Medicare |
$136.51
|
| Rate for Payer: WINHealth Partners Commercial |
$796.45
|
| Rate for Payer: WINHealth Partners Commercial |
$474.30
|
|
|
HC PRO CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
9834462501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,133.24
|
| Rate for Payer: Aetna of WY Medicare |
$958.48
|
| Rate for Payer: Beech Street Commercial |
$4,976.10
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,080.86
|
| Rate for Payer: Cigna of WY Commercial |
$5,133.24
|
| Rate for Payer: First Choice Health Commercial |
$4,714.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,976.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$958.48
|
| Rate for Payer: HealthUtah PPO |
$5,238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,080.86
|
| Rate for Payer: Multiplan Medicare/VA |
$814.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,133.24
|
| Rate for Payer: PacificSource Commercial |
$4,714.20
|
| Rate for Payer: PHCS PPO |
$4,976.10
|
| Rate for Payer: Three Rivers PPO |
$3,928.50
|
| Rate for Payer: TriWest Veterans Administration |
$958.48
|
| Rate for Payer: United Healthcare Commercial |
$4,557.06
|
| Rate for Payer: United Healthcare Medicare |
$958.48
|
| Rate for Payer: WINHealth Partners Commercial |
$4,452.30
|
|
|
HC PRO CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
9834462601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,499.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
HC PRO CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 27220 NONPBBPAYER
|
| Hospital Charge Code |
9832722001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,144.24
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$2,078.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,122.36
|
| Rate for Payer: Cigna of WY Commercial |
$2,144.24
|
| Rate for Payer: First Choice Health Commercial |
$1,969.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$2,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,122.36
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,144.24
|
| Rate for Payer: PacificSource Commercial |
$1,969.20
|
| Rate for Payer: PHCS PPO |
$2,078.60
|
| Rate for Payer: Three Rivers PPO |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,903.56
|
| Rate for Payer: United Healthcare Medicare |
$403.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,859.80
|
|
|
HC PRO CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
9832722001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: First Choice Health Commercial |
$1,575.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,662.50
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare Medicare |
$403.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,487.50
|
|
|
HC PRO CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
9832643201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,586.25 |
| Max. Negotiated Rate |
$2,115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,072.70
|
| Rate for Payer: Beech Street Commercial |
$2,009.25
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,051.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,072.70
|
| Rate for Payer: First Choice Health Commercial |
$1,903.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,009.25
|
| Rate for Payer: HealthUtah PPO |
$2,115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,051.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2,072.70
|
| Rate for Payer: PacificSource Commercial |
$1,903.50
|
| Rate for Payer: PHCS PPO |
$2,009.25
|
| Rate for Payer: Three Rivers PPO |
$1,586.25
|
| Rate for Payer: United Healthcare Commercial |
$1,840.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,797.75
|
|
|
HC PRO CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 26432 NONPBBPAYER
|
| Hospital Charge Code |
9832643201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,983.00 |
| Max. Negotiated Rate |
$2,644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,591.12
|
| Rate for Payer: Beech Street Commercial |
$2,511.80
|
| Rate for Payer: Cash Price |
$1,850.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,564.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,591.12
|
| Rate for Payer: First Choice Health Commercial |
$2,379.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,511.80
|
| Rate for Payer: HealthUtah PPO |
$2,644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,564.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,591.12
|
| Rate for Payer: PacificSource Commercial |
$2,379.60
|
| Rate for Payer: PHCS PPO |
$2,511.80
|
| Rate for Payer: Three Rivers PPO |
$1,983.00
|
| Rate for Payer: United Healthcare Commercial |
$2,300.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,247.40
|
|
|
HC PRO CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 24576 NONPBBPAYER
|
| Hospital Charge Code |
9832457601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$981.96
|
| Rate for Payer: Aetna of WY Medicare |
$317.32
|
| Rate for Payer: Beech Street Commercial |
$951.90
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$971.94
|
| Rate for Payer: Cigna of WY Commercial |
$981.96
|
| Rate for Payer: First Choice Health Commercial |
$901.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.32
|
| Rate for Payer: HealthUtah PPO |
$1,002.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$971.94
|
| Rate for Payer: Multiplan Medicare/VA |
$269.72
|
| Rate for Payer: One Health Plan of WY PPO |
$981.96
|
| Rate for Payer: PacificSource Commercial |
$901.80
|
| Rate for Payer: PHCS PPO |
$951.90
|
| Rate for Payer: Three Rivers PPO |
$751.50
|
| Rate for Payer: TriWest Veterans Administration |
$317.32
|
| Rate for Payer: United Healthcare Commercial |
$871.74
|
| Rate for Payer: United Healthcare Medicare |
$317.32
|
| Rate for Payer: WINHealth Partners Commercial |
$851.70
|
|
|
HC PRO CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
9832457601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$785.96
|
| Rate for Payer: Aetna of WY Medicare |
$317.32
|
| Rate for Payer: Beech Street Commercial |
$761.90
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$777.94
|
| Rate for Payer: Cigna of WY Commercial |
$785.96
|
| Rate for Payer: First Choice Health Commercial |
$721.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.32
|
| Rate for Payer: HealthUtah PPO |
$802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$777.94
|
| Rate for Payer: Multiplan Medicare/VA |
$269.72
|
| Rate for Payer: One Health Plan of WY PPO |
$785.96
|
| Rate for Payer: PacificSource Commercial |
$721.80
|
| Rate for Payer: PHCS PPO |
$761.90
|
| Rate for Payer: Three Rivers PPO |
$601.50
|
| Rate for Payer: TriWest Veterans Administration |
$317.32
|
| Rate for Payer: United Healthcare Commercial |
$697.74
|
| Rate for Payer: United Healthcare Medicare |
$317.32
|
| Rate for Payer: WINHealth Partners Commercial |
$681.70
|
|
|
HC PRO CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$2,567.00
|
|
|
Service Code
|
HCPCS 27501 NONPBBPAYER
|
| Hospital Charge Code |
9832750101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$2,567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,515.66
|
| Rate for Payer: Aetna of WY Medicare |
$488.15
|
| Rate for Payer: Beech Street Commercial |
$2,438.65
|
| Rate for Payer: Cash Price |
$1,796.90
|
| Rate for Payer: Cash Price |
$1,796.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,489.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,515.66
|
| Rate for Payer: First Choice Health Commercial |
$2,310.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,438.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$488.15
|
| Rate for Payer: HealthUtah PPO |
$2,567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,489.99
|
| Rate for Payer: Multiplan Medicare/VA |
$414.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,515.66
|
| Rate for Payer: PacificSource Commercial |
$2,310.30
|
| Rate for Payer: PHCS PPO |
$2,438.65
|
| Rate for Payer: Three Rivers PPO |
$1,925.25
|
| Rate for Payer: TriWest Veterans Administration |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$2,233.29
|
| Rate for Payer: United Healthcare Medicare |
$488.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,181.95
|
|
|
HC PRO CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
9832750101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$2,054.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,012.92
|
| Rate for Payer: Aetna of WY Medicare |
$488.15
|
| Rate for Payer: Beech Street Commercial |
$1,951.30
|
| Rate for Payer: Cash Price |
$1,437.80
|
| Rate for Payer: Cash Price |
$1,437.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,992.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,012.92
|
| Rate for Payer: First Choice Health Commercial |
$1,848.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,951.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$488.15
|
| Rate for Payer: HealthUtah PPO |
$2,054.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,992.38
|
| Rate for Payer: Multiplan Medicare/VA |
$414.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,012.92
|
| Rate for Payer: PacificSource Commercial |
$1,848.60
|
| Rate for Payer: PHCS PPO |
$1,951.30
|
| Rate for Payer: Three Rivers PPO |
$1,540.50
|
| Rate for Payer: TriWest Veterans Administration |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$1,786.98
|
| Rate for Payer: United Healthcare Medicare |
$488.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,745.90
|
|
|
HC PRO CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$3,887.00
|
|
|
Service Code
|
HCPCS 57260
|
| Hospital Charge Code |
9835726001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$637.61 |
| Max. Negotiated Rate |
$3,887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,809.26
|
| Rate for Payer: Aetna of WY Medicare |
$750.13
|
| Rate for Payer: Beech Street Commercial |
$3,692.65
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,770.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,809.26
|
| Rate for Payer: First Choice Health Commercial |
$3,498.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,692.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$750.13
|
| Rate for Payer: HealthUtah PPO |
$3,887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,770.39
|
| Rate for Payer: Multiplan Medicare/VA |
$637.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,809.26
|
| Rate for Payer: PacificSource Commercial |
$3,498.30
|
| Rate for Payer: PHCS PPO |
$3,692.65
|
| Rate for Payer: Three Rivers PPO |
$2,915.25
|
| Rate for Payer: TriWest Veterans Administration |
$750.13
|
| Rate for Payer: United Healthcare Commercial |
$3,381.69
|
| Rate for Payer: United Healthcare Medicare |
$750.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3,303.95
|
|
|
HC PRO CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$5,269.00
|
|
|
Service Code
|
HCPCS 57265
|
| Hospital Charge Code |
9835726501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$712.53 |
| Max. Negotiated Rate |
$5,269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,163.62
|
| Rate for Payer: Aetna of WY Medicare |
$838.27
|
| Rate for Payer: Beech Street Commercial |
$5,005.55
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,110.93
|
| Rate for Payer: Cigna of WY Commercial |
$5,163.62
|
| Rate for Payer: First Choice Health Commercial |
$4,742.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,005.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$838.27
|
| Rate for Payer: HealthUtah PPO |
$5,269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,110.93
|
| Rate for Payer: Multiplan Medicare/VA |
$712.53
|
| Rate for Payer: One Health Plan of WY PPO |
$5,163.62
|
| Rate for Payer: PacificSource Commercial |
$4,742.10
|
| Rate for Payer: PHCS PPO |
$5,005.55
|
| Rate for Payer: Three Rivers PPO |
$3,951.75
|
| Rate for Payer: TriWest Veterans Administration |
$838.27
|
| Rate for Payer: United Healthcare Commercial |
$4,584.03
|
| Rate for Payer: United Healthcare Medicare |
$838.27
|
| Rate for Payer: WINHealth Partners Commercial |
$4,478.65
|
|
|
HC PRO CNTRL NASAL HEMORRHA
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 30906 NONPBBPAYER
|
| Hospital Charge Code |
9833090601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$1,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,279.88
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$1,240.70
|
| Rate for Payer: Cash Price |
$914.20
|
| Rate for Payer: Cash Price |
$914.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,266.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,279.88
|
| Rate for Payer: First Choice Health Commercial |
$1,175.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,240.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$1,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,266.82
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,279.88
|
| Rate for Payer: PacificSource Commercial |
$1,175.40
|
| Rate for Payer: PHCS PPO |
$1,240.70
|
| Rate for Payer: Three Rivers PPO |
$979.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$1,136.22
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,110.10
|
|
