|
HC PRO DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
9831101101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,180.90
|
| Rate for Payer: Aetna of WY Medicare |
$282.48
|
| Rate for Payer: Beech Street Commercial |
$1,144.75
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,168.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,180.90
|
| Rate for Payer: First Choice Health Commercial |
$1,084.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$282.48
|
| Rate for Payer: HealthUtah PPO |
$1,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,168.85
|
| Rate for Payer: Multiplan Medicare/VA |
$240.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,180.90
|
| Rate for Payer: PacificSource Commercial |
$1,084.50
|
| Rate for Payer: PHCS PPO |
$1,144.75
|
| Rate for Payer: Three Rivers PPO |
$903.75
|
| Rate for Payer: TriWest Veterans Administration |
$282.48
|
| Rate for Payer: United Healthcare Commercial |
$1,048.35
|
| Rate for Payer: United Healthcare Medicare |
$282.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,024.25
|
|
|
HC PRO DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,506.00
|
|
|
Service Code
|
HCPCS 11011 NONPBBPAYER
|
| Hospital Charge Code |
9831101101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,506.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,475.88
|
| Rate for Payer: Aetna of WY Medicare |
$282.48
|
| Rate for Payer: Beech Street Commercial |
$1,430.70
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,460.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,475.88
|
| Rate for Payer: First Choice Health Commercial |
$1,355.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,430.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$282.48
|
| Rate for Payer: HealthUtah PPO |
$1,506.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,460.82
|
| Rate for Payer: Multiplan Medicare/VA |
$240.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,475.88
|
| Rate for Payer: PacificSource Commercial |
$1,355.40
|
| Rate for Payer: PHCS PPO |
$1,430.70
|
| Rate for Payer: Three Rivers PPO |
$1,129.50
|
| Rate for Payer: TriWest Veterans Administration |
$282.48
|
| Rate for Payer: United Healthcare Commercial |
$1,310.22
|
| Rate for Payer: United Healthcare Medicare |
$282.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,280.10
|
|
|
HC PRO DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$5,160.00
|
|
|
Service Code
|
HCPCS 25023
|
| Hospital Charge Code |
9832502301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,080.65 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,056.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,271.35
|
| Rate for Payer: Beech Street Commercial |
$4,902.00
|
| Rate for Payer: Cash Price |
$3,612.00
|
| Rate for Payer: Cash Price |
$3,612.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,005.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,056.80
|
| Rate for Payer: First Choice Health Commercial |
$4,644.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,902.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,271.35
|
| Rate for Payer: HealthUtah PPO |
$5,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,005.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,080.65
|
| Rate for Payer: One Health Plan of WY PPO |
$5,056.80
|
| Rate for Payer: PacificSource Commercial |
$4,644.00
|
| Rate for Payer: PHCS PPO |
$4,902.00
|
| Rate for Payer: Three Rivers PPO |
$3,870.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,271.35
|
| Rate for Payer: United Healthcare Commercial |
$4,489.20
|
| Rate for Payer: United Healthcare Medicare |
$1,271.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4,386.00
|
|
|
HC PRO DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
9832502001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$615.15 |
| Max. Negotiated Rate |
$2,582.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,530.36
|
| Rate for Payer: Aetna of WY Medicare |
$723.71
|
| Rate for Payer: Beech Street Commercial |
$2,452.90
|
| Rate for Payer: Cash Price |
$1,807.40
|
| Rate for Payer: Cash Price |
$1,807.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,504.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,530.36
|
| Rate for Payer: First Choice Health Commercial |
$2,323.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,452.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.71
|
| Rate for Payer: HealthUtah PPO |
$2,582.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,504.54
|
| Rate for Payer: Multiplan Medicare/VA |
$615.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,530.36
|
| Rate for Payer: PacificSource Commercial |
$2,323.80
|
| Rate for Payer: PHCS PPO |
$2,452.90
|
| Rate for Payer: Three Rivers PPO |
$1,936.50
|
| Rate for Payer: TriWest Veterans Administration |
$723.71
|
| Rate for Payer: United Healthcare Commercial |
$2,246.34
|
| Rate for Payer: United Healthcare Medicare |
$723.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2,194.70
|
|
|
HC PRO DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$5,164.00
|
|
|
Service Code
|
HCPCS 25020 50
|
| Hospital Charge Code |
9832502001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$615.15 |
| Max. Negotiated Rate |
$5,164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,060.72
|
| Rate for Payer: Aetna of WY Medicare |
$723.71
|
| Rate for Payer: Beech Street Commercial |
$4,905.80
|
| Rate for Payer: Cash Price |
$3,614.80
|
| Rate for Payer: Cash Price |
$3,614.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,009.08
|
| Rate for Payer: Cigna of WY Commercial |
$5,060.72
|
| Rate for Payer: First Choice Health Commercial |
$4,647.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,905.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.71
|
| Rate for Payer: HealthUtah PPO |
$5,164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,009.08
|
| Rate for Payer: Multiplan Medicare/VA |
$615.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,060.72
|
| Rate for Payer: PacificSource Commercial |
$4,647.60
|
| Rate for Payer: PHCS PPO |
$4,905.80
|
| Rate for Payer: Three Rivers PPO |
$3,873.00
|
| Rate for Payer: TriWest Veterans Administration |
$723.71
|
| Rate for Payer: United Healthcare Commercial |
$4,492.68
|
| Rate for Payer: United Healthcare Medicare |
$723.71
|
| Rate for Payer: WINHealth Partners Commercial |
$4,389.40
|
|
|
HC PRO DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
9832760001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$326.66 |
| Max. Negotiated Rate |
$2,090.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,048.20
|
| Rate for Payer: Aetna of WY Medicare |
$384.30
|
| Rate for Payer: Beech Street Commercial |
$1,985.50
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,027.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,048.20
|
| Rate for Payer: First Choice Health Commercial |
$1,881.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,985.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.30
|
| Rate for Payer: HealthUtah PPO |
$2,090.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,027.30
|
| Rate for Payer: Multiplan Medicare/VA |
$326.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,048.20
|
| Rate for Payer: PacificSource Commercial |
$1,881.00
|
| Rate for Payer: PHCS PPO |
$1,985.50
|
| Rate for Payer: Three Rivers PPO |
$1,567.50
|
| Rate for Payer: TriWest Veterans Administration |
$384.30
|
| Rate for Payer: United Healthcare Commercial |
$1,818.30
|
| Rate for Payer: United Healthcare Medicare |
$384.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
|
|
HC PRO DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ
|
Professional
|
Both
|
$1,833.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
9831101001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$224.52 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,796.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,083.88
|
| Rate for Payer: Aetna of WY Medicare |
$264.14
|
| Rate for Payer: Aetna of WY Medicare |
$264.14
|
| Rate for Payer: Beech Street Commercial |
$1,050.70
|
| Rate for Payer: Beech Street Commercial |
$1,741.35
|
| Rate for Payer: Cash Price |
$774.20
|
| Rate for Payer: Cash Price |
$774.20
|
| Rate for Payer: Cash Price |
$1,283.10
|
| Rate for Payer: Cash Price |
$1,283.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,778.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,072.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,083.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,796.34
|
| Rate for Payer: First Choice Health Commercial |
$995.40
|
| Rate for Payer: First Choice Health Commercial |
$1,649.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,741.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,050.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.14
|
| Rate for Payer: HealthUtah PPO |
$1,833.00
|
| Rate for Payer: HealthUtah PPO |
$1,106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,778.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,072.82
|
| Rate for Payer: Multiplan Medicare/VA |
$224.52
|
| Rate for Payer: Multiplan Medicare/VA |
$224.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,796.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,083.88
|
| Rate for Payer: PacificSource Commercial |
$995.40
|
| Rate for Payer: PacificSource Commercial |
$1,649.70
|
| Rate for Payer: PHCS PPO |
$1,741.35
|
| Rate for Payer: PHCS PPO |
$1,050.70
|
| Rate for Payer: Three Rivers PPO |
$1,374.75
|
| Rate for Payer: Three Rivers PPO |
$829.50
|
| Rate for Payer: TriWest Veterans Administration |
$264.14
|
| Rate for Payer: TriWest Veterans Administration |
$264.14
|
| Rate for Payer: United Healthcare Commercial |
$962.22
|
| Rate for Payer: United Healthcare Commercial |
$1,594.71
|
| Rate for Payer: United Healthcare Medicare |
$264.14
|
| Rate for Payer: United Healthcare Medicare |
$264.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,558.05
|
| Rate for Payer: WINHealth Partners Commercial |
$940.10
|
|
|
HC PRO DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ
|
Professional
|
Both
|
$1,383.00
|
|
|
Service Code
|
HCPCS 11010 NONPBBPAYER
|
| Hospital Charge Code |
9831101001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$224.52 |
| Max. Negotiated Rate |
$1,383.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,355.34
|
| Rate for Payer: Aetna of WY Medicare |
$264.14
|
| Rate for Payer: Beech Street Commercial |
$1,313.85
|
| Rate for Payer: Cash Price |
$968.10
|
| Rate for Payer: Cash Price |
$968.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,341.51
|
| Rate for Payer: Cigna of WY Commercial |
$1,355.34
|
| Rate for Payer: First Choice Health Commercial |
$1,244.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,313.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.14
|
| Rate for Payer: HealthUtah PPO |
$1,383.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,341.51
|
| Rate for Payer: Multiplan Medicare/VA |
$224.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,355.34
|
| Rate for Payer: PacificSource Commercial |
$1,244.70
|
| Rate for Payer: PHCS PPO |
$1,313.85
|
| Rate for Payer: Three Rivers PPO |
$1,037.25
|
| Rate for Payer: TriWest Veterans Administration |
$264.14
|
| Rate for Payer: United Healthcare Commercial |
$1,203.21
|
| Rate for Payer: United Healthcare Medicare |
$264.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,175.55
|
|
|
HC PRO DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE
|
Professional
|
Both
|
$3,468.00
|
|
|
Service Code
|
HCPCS 11012
|
| Hospital Charge Code |
9831101201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$335.39 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,398.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,758.12
|
| Rate for Payer: Aetna of WY Medicare |
$394.58
|
| Rate for Payer: Aetna of WY Medicare |
$394.58
|
| Rate for Payer: Beech Street Commercial |
$1,704.30
|
| Rate for Payer: Beech Street Commercial |
$3,294.60
|
| Rate for Payer: Cash Price |
$1,255.80
|
| Rate for Payer: Cash Price |
$1,255.80
|
| Rate for Payer: Cash Price |
$2,427.60
|
| Rate for Payer: Cash Price |
$2,427.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,363.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,740.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,758.12
|
| Rate for Payer: Cigna of WY Commercial |
$3,398.64
|
| Rate for Payer: First Choice Health Commercial |
$1,614.60
|
| Rate for Payer: First Choice Health Commercial |
$3,121.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,294.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,704.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.58
|
| Rate for Payer: HealthUtah PPO |
$3,468.00
|
| Rate for Payer: HealthUtah PPO |
$1,794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,363.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,740.18
|
| Rate for Payer: Multiplan Medicare/VA |
$335.39
|
| Rate for Payer: Multiplan Medicare/VA |
$335.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,398.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,758.12
|
| Rate for Payer: PacificSource Commercial |
$1,614.60
|
| Rate for Payer: PacificSource Commercial |
$3,121.20
|
| Rate for Payer: PHCS PPO |
$3,294.60
|
| Rate for Payer: PHCS PPO |
$1,704.30
|
| Rate for Payer: Three Rivers PPO |
$2,601.00
|
| Rate for Payer: Three Rivers PPO |
$1,345.50
|
| Rate for Payer: TriWest Veterans Administration |
$394.58
|
| Rate for Payer: TriWest Veterans Administration |
$394.58
|
| Rate for Payer: United Healthcare Commercial |
$1,560.78
|
| Rate for Payer: United Healthcare Commercial |
$3,017.16
|
| Rate for Payer: United Healthcare Medicare |
$394.58
|
| Rate for Payer: United Healthcare Medicare |
$394.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,947.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,524.90
|
|
|
HC PRO DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 11012 NONPBBPAYER
|
| Hospital Charge Code |
9831101201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$335.39 |
| Max. Negotiated Rate |
$2,243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,198.14
|
| Rate for Payer: Aetna of WY Medicare |
$394.58
|
| Rate for Payer: Beech Street Commercial |
$2,130.85
|
| Rate for Payer: Cash Price |
$1,570.10
|
| Rate for Payer: Cash Price |
$1,570.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,175.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,198.14
|
| Rate for Payer: First Choice Health Commercial |
$2,018.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,130.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.58
|
| Rate for Payer: HealthUtah PPO |
$2,243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,175.71
|
| Rate for Payer: Multiplan Medicare/VA |
$335.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,198.14
|
| Rate for Payer: PacificSource Commercial |
$2,018.70
|
| Rate for Payer: PHCS PPO |
$2,130.85
|
| Rate for Payer: Three Rivers PPO |
$1,682.25
|
| Rate for Payer: TriWest Veterans Administration |
$394.58
|
| Rate for Payer: United Healthcare Commercial |
$1,951.41
|
| Rate for Payer: United Healthcare Medicare |
$394.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,906.55
|
|
|
HC PRO DEBRIDEMENT INFECTED SKIN UP TO 10% BSA
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 11000 NONPBBPAYER
|
| Hospital Charge Code |
9831100001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$26.42
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.42
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$22.46
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.42
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$26.42
|
| Rate for Payer: WINHealth Partners Commercial |
$175.95
|
|
|
HC PRO DEBRIDEMENT INFECTED SKIN UP TO 10% BSA
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
9831100001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$162.68
|
| Rate for Payer: Aetna of WY Medicare |
$26.42
|
| Rate for Payer: Aetna of WY Medicare |
$26.42
|
| Rate for Payer: Beech Street Commercial |
$157.70
|
| Rate for Payer: Beech Street Commercial |
$176.70
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.02
|
| Rate for Payer: Cigna of WY Commercial |
$162.68
|
| Rate for Payer: Cigna of WY Commercial |
$182.28
|
| Rate for Payer: First Choice Health Commercial |
$149.40
|
| Rate for Payer: First Choice Health Commercial |
$167.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$157.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.42
|
| Rate for Payer: HealthUtah PPO |
$186.00
|
| Rate for Payer: HealthUtah PPO |
$166.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.02
|
| Rate for Payer: Multiplan Medicare/VA |
$22.46
|
| Rate for Payer: Multiplan Medicare/VA |
$22.46
|
| Rate for Payer: One Health Plan of WY PPO |
$182.28
|
| Rate for Payer: One Health Plan of WY PPO |
$162.68
|
| Rate for Payer: PacificSource Commercial |
$149.40
|
| Rate for Payer: PacificSource Commercial |
$167.40
|
| Rate for Payer: PHCS PPO |
$176.70
|
| Rate for Payer: PHCS PPO |
$157.70
|
| Rate for Payer: Three Rivers PPO |
$139.50
|
| Rate for Payer: Three Rivers PPO |
$124.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.42
|
| Rate for Payer: TriWest Veterans Administration |
$26.42
|
| Rate for Payer: United Healthcare Commercial |
$144.42
|
| Rate for Payer: United Healthcare Commercial |
$161.82
|
| Rate for Payer: United Healthcare Medicare |
$26.42
|
| Rate for Payer: United Healthcare Medicare |
$26.42
|
| Rate for Payer: WINHealth Partners Commercial |
$158.10
|
| Rate for Payer: WINHealth Partners Commercial |
$141.10
|
|
|
HC PRO DEBRIDEMENT OF NAIL(S) 1-5
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
9831172001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$55.10
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: First Choice Health Commercial |
$52.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$11.48
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$55.10
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$49.30
|
|
|
HC PRO DEBRIDEMENT OF NAIL(S) 1-5
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 11720 NONPBBPAYER
|
| Hospital Charge Code |
9831172001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Aetna of WY Medicare |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: Multiplan Medicare/VA |
$11.48
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
|
|
HC PRO DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
9839759701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$258.72
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$256.08
|
| Rate for Payer: Cigna of WY Commercial |
$258.72
|
| Rate for Payer: First Choice Health Commercial |
$237.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$250.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$264.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$256.08
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$258.72
|
| Rate for Payer: PacificSource Commercial |
$237.60
|
| Rate for Payer: PHCS PPO |
$250.80
|
| Rate for Payer: Three Rivers PPO |
$198.00
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$229.68
|
| Rate for Payer: United Healthcare Medicare |
$33.87
|
| Rate for Payer: WINHealth Partners Commercial |
$250.80
|
|
|
HC PRO DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 97597 NONPBBPAYER
|
| Hospital Charge Code |
9839759701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$313.50
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: First Choice Health Commercial |
$297.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$313.50
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$33.87
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
9831104201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$443.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$354.76
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Beech Street Commercial |
$343.90
|
| Rate for Payer: Beech Street Commercial |
$430.35
|
| Rate for Payer: Cash Price |
$253.40
|
| Rate for Payer: Cash Price |
$253.40
|
| Rate for Payer: Cash Price |
$317.10
|
| Rate for Payer: Cash Price |
$317.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$439.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$351.14
|
| Rate for Payer: Cigna of WY Commercial |
$354.76
|
| Rate for Payer: Cigna of WY Commercial |
$443.94
|
| Rate for Payer: First Choice Health Commercial |
$325.80
|
| Rate for Payer: First Choice Health Commercial |
$407.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$430.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$343.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: HealthUtah PPO |
$453.00
|
| Rate for Payer: HealthUtah PPO |
$362.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$439.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$351.14
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: One Health Plan of WY PPO |
$443.94
|
| Rate for Payer: One Health Plan of WY PPO |
$354.76
|
| Rate for Payer: PacificSource Commercial |
$325.80
|
| Rate for Payer: PacificSource Commercial |
$407.70
|
| Rate for Payer: PHCS PPO |
$430.35
|
| Rate for Payer: PHCS PPO |
$343.90
|
| Rate for Payer: Three Rivers PPO |
$339.75
|
| Rate for Payer: Three Rivers PPO |
$271.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$314.94
|
| Rate for Payer: United Healthcare Commercial |
$394.11
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
| Rate for Payer: WINHealth Partners Commercial |
$385.05
|
| Rate for Payer: WINHealth Partners Commercial |
$307.70
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 11042 NONPBBPAYER
|
| Hospital Charge Code |
9831104201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.96
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Beech Street Commercial |
$429.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$438.44
|
| Rate for Payer: Cigna of WY Commercial |
$442.96
|
| Rate for Payer: First Choice Health Commercial |
$406.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$429.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: HealthUtah PPO |
$452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$438.44
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: One Health Plan of WY PPO |
$442.96
|
| Rate for Payer: PacificSource Commercial |
$406.80
|
| Rate for Payer: PHCS PPO |
$429.40
|
| Rate for Payer: Three Rivers PPO |
$339.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$393.24
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
| Rate for Payer: WINHealth Partners Commercial |
$384.20
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
9831104501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$23.87
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.87
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$20.29
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.87
|
| Rate for Payer: United Healthcare Commercial |
$93.96
|
| Rate for Payer: United Healthcare Medicare |
$23.87
|
| Rate for Payer: WINHealth Partners Commercial |
$91.80
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 11045 NONPBBPAYER
|
| Hospital Charge Code |
9831104501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.87
|
| Rate for Payer: Beech Street Commercial |
$128.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: First Choice Health Commercial |
$121.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.87
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.29
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$128.25
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.87
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$23.87
|
| Rate for Payer: WINHealth Partners Commercial |
$114.75
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 11043 NONPBBPAYER
|
| Hospital Charge Code |
9831104301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$146.55
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
9831104301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,262.24
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Beech Street Commercial |
$1,223.60
|
| Rate for Payer: Beech Street Commercial |
$611.80
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,262.24
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: First Choice Health Commercial |
$1,159.20
|
| Rate for Payer: First Choice Health Commercial |
$579.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: HealthUtah PPO |
$1,288.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.36
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,262.24
|
| Rate for Payer: PacificSource Commercial |
$1,159.20
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$611.80
|
| Rate for Payer: PHCS PPO |
$1,223.60
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: Three Rivers PPO |
$966.00
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: United Healthcare Commercial |
$1,120.56
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$146.55
|
| Rate for Payer: United Healthcare Medicare |
$146.55
|
| Rate for Payer: WINHealth Partners Commercial |
$547.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,094.80
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
9831104401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$891.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,140.72
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$1,105.80
|
| Rate for Payer: Beech Street Commercial |
$864.50
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$882.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,140.72
|
| Rate for Payer: Cigna of WY Commercial |
$891.80
|
| Rate for Payer: First Choice Health Commercial |
$1,047.60
|
| Rate for Payer: First Choice Health Commercial |
$819.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,105.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$910.00
|
| Rate for Payer: HealthUtah PPO |
$1,164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$882.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.08
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$891.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,140.72
|
| Rate for Payer: PacificSource Commercial |
$1,047.60
|
| Rate for Payer: PacificSource Commercial |
$819.00
|
| Rate for Payer: PHCS PPO |
$864.50
|
| Rate for Payer: PHCS PPO |
$1,105.80
|
| Rate for Payer: Three Rivers PPO |
$682.50
|
| Rate for Payer: Three Rivers PPO |
$873.00
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,012.68
|
| Rate for Payer: United Healthcare Commercial |
$791.70
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$773.50
|
| Rate for Payer: WINHealth Partners Commercial |
$989.40
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 11044 NONPBBPAYER
|
| Hospital Charge Code |
9831104401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$1,138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,115.24
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$1,081.10
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,115.24
|
| Rate for Payer: First Choice Health Commercial |
$1,024.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,081.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$1,138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.86
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,115.24
|
| Rate for Payer: PacificSource Commercial |
$1,024.20
|
| Rate for Payer: PHCS PPO |
$1,081.10
|
| Rate for Payer: Three Rivers PPO |
$853.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$990.06
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$967.30
|
|
|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 11046 NONPBBPAYER
|
| Hospital Charge Code |
9831104601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.75
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.75
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.99
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$51.75
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
