|
HC PRO EXPLORE PENETRATING WOUND,EXTREMITY
|
Professional
|
Both
|
$2,292.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
9832010301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,246.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,751.26
|
| Rate for Payer: Aetna of WY Medicare |
$331.08
|
| Rate for Payer: Aetna of WY Medicare |
$331.08
|
| Rate for Payer: Beech Street Commercial |
$1,697.65
|
| Rate for Payer: Beech Street Commercial |
$2,177.40
|
| Rate for Payer: Cash Price |
$1,250.90
|
| Rate for Payer: Cash Price |
$1,250.90
|
| Rate for Payer: Cash Price |
$1,604.40
|
| Rate for Payer: Cash Price |
$1,604.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,223.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,733.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,751.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,246.16
|
| Rate for Payer: First Choice Health Commercial |
$1,608.30
|
| Rate for Payer: First Choice Health Commercial |
$2,062.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,177.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,697.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.08
|
| Rate for Payer: HealthUtah PPO |
$2,292.00
|
| Rate for Payer: HealthUtah PPO |
$1,787.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,223.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,733.39
|
| Rate for Payer: Multiplan Medicare/VA |
$281.42
|
| Rate for Payer: Multiplan Medicare/VA |
$281.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,246.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,751.26
|
| Rate for Payer: PacificSource Commercial |
$1,608.30
|
| Rate for Payer: PacificSource Commercial |
$2,062.80
|
| Rate for Payer: PHCS PPO |
$2,177.40
|
| Rate for Payer: PHCS PPO |
$1,697.65
|
| Rate for Payer: Three Rivers PPO |
$1,719.00
|
| Rate for Payer: Three Rivers PPO |
$1,340.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.08
|
| Rate for Payer: TriWest Veterans Administration |
$331.08
|
| Rate for Payer: United Healthcare Commercial |
$1,554.69
|
| Rate for Payer: United Healthcare Commercial |
$1,994.04
|
| Rate for Payer: United Healthcare Medicare |
$331.08
|
| Rate for Payer: United Healthcare Medicare |
$331.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,948.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,518.95
|
|
|
HC PRO EXPL PENETRATING WOUND ABD/BACK
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
9832010201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,295.56
|
| Rate for Payer: Aetna of WY Medicare |
$244.17
|
| Rate for Payer: Beech Street Commercial |
$1,255.90
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,282.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,295.56
|
| Rate for Payer: First Choice Health Commercial |
$1,189.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,255.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.17
|
| Rate for Payer: HealthUtah PPO |
$1,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,282.34
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,295.56
|
| Rate for Payer: PacificSource Commercial |
$1,189.80
|
| Rate for Payer: PHCS PPO |
$1,255.90
|
| Rate for Payer: Three Rivers PPO |
$991.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.17
|
| Rate for Payer: United Healthcare Commercial |
$1,150.14
|
| Rate for Payer: United Healthcare Medicare |
$244.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,123.70
|
|
|
HC PRO EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
9833584001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$970.93 |
| Max. Negotiated Rate |
$4,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,994.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,142.27
|
| Rate for Payer: Beech Street Commercial |
$3,872.20
|
| Rate for Payer: Cash Price |
$2,853.20
|
| Rate for Payer: Cash Price |
$2,853.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,953.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,994.48
|
| Rate for Payer: First Choice Health Commercial |
$3,668.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,872.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.27
|
| Rate for Payer: HealthUtah PPO |
$4,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,953.72
|
| Rate for Payer: Multiplan Medicare/VA |
$970.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,994.48
|
| Rate for Payer: PacificSource Commercial |
$3,668.40
|
| Rate for Payer: PHCS PPO |
$3,872.20
|
| Rate for Payer: Three Rivers PPO |
$3,057.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.27
|
| Rate for Payer: United Healthcare Commercial |
$3,546.12
|
| Rate for Payer: United Healthcare Medicare |
$1,142.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,464.60
|
|
|
HC PRO EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$2,785.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
9823586001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$663.22 |
| Max. Negotiated Rate |
$2,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,729.30
|
| Rate for Payer: Aetna of WY Medicare |
$780.26
|
| Rate for Payer: Beech Street Commercial |
$2,645.75
|
| Rate for Payer: Cash Price |
$1,949.50
|
| Rate for Payer: Cash Price |
$1,949.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,701.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,729.30
|
| Rate for Payer: First Choice Health Commercial |
$2,506.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,645.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$780.26
|
| Rate for Payer: HealthUtah PPO |
$2,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,701.45
|
| Rate for Payer: Multiplan Medicare/VA |
$663.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,729.30
|
| Rate for Payer: PacificSource Commercial |
$2,506.50
|
| Rate for Payer: PHCS PPO |
$2,645.75
|
| Rate for Payer: Three Rivers PPO |
$2,088.75
|
| Rate for Payer: TriWest Veterans Administration |
$780.26
|
| Rate for Payer: United Healthcare Commercial |
$2,422.95
|
| Rate for Payer: United Healthcare Medicare |
$780.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,367.25
|
|
|
HC PRO EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 93244
|
| Hospital Charge Code |
9859324401
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$22.10
|
| Rate for Payer: Beech Street Commercial |
$63.65
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: First Choice Health Commercial |
$60.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.10
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$18.78
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$63.65
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.10
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
| Rate for Payer: United Healthcare Medicare |
$22.10
|
| Rate for Payer: WINHealth Partners Commercial |
$63.65
|
|
|
HC PRO EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 93248
|
| Hospital Charge Code |
9859324801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Aetna of WY Medicare |
$24.39
|
| Rate for Payer: Beech Street Commercial |
$68.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: First Choice Health Commercial |
$64.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.39
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$20.73
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$68.40
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.39
|
| Rate for Payer: United Healthcare Commercial |
$62.64
|
| Rate for Payer: United Healthcare Medicare |
$24.39
|
| Rate for Payer: WINHealth Partners Commercial |
$68.40
|
|
|
HC PRO FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
9832806001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$299.72 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Aetna of WY Medicare |
$352.61
|
| Rate for Payer: Beech Street Commercial |
$1,767.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: First Choice Health Commercial |
$1,674.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.61
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$299.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,767.00
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$352.61
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$352.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,581.00
|
|
|
HC PRO FASCIOTOMY,PALMAR,OPEN PARTIAL
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
9832604501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$395.64 |
| Max. Negotiated Rate |
$2,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,379.44
|
| Rate for Payer: Aetna of WY Medicare |
$465.46
|
| Rate for Payer: Beech Street Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,355.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,379.44
|
| Rate for Payer: First Choice Health Commercial |
$2,185.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,306.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.46
|
| Rate for Payer: HealthUtah PPO |
$2,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,355.16
|
| Rate for Payer: Multiplan Medicare/VA |
$395.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,379.44
|
| Rate for Payer: PacificSource Commercial |
$2,185.20
|
| Rate for Payer: PHCS PPO |
$2,306.60
|
| Rate for Payer: Three Rivers PPO |
$1,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$465.46
|
| Rate for Payer: United Healthcare Commercial |
$2,112.36
|
| Rate for Payer: United Healthcare Medicare |
$465.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,063.80
|
|
|
HC PRO FETAL NON-STRESS TEST
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
9835902501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$47.26
|
| Rate for Payer: Beech Street Commercial |
$135.85
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: First Choice Health Commercial |
$128.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.26
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$40.17
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$135.85
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$47.26
|
| Rate for Payer: United Healthcare Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare |
$47.26
|
| Rate for Payer: WINHealth Partners Commercial |
$121.55
|
|
|
HC PRO FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
9831002101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$833.98
|
| Rate for Payer: Aetna of WY Medicare |
$52.18
|
| Rate for Payer: Aetna of WY Medicare |
$52.18
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Beech Street Commercial |
$808.45
|
| Rate for Payer: Cash Price |
$595.70
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$595.70
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$825.47
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: Cigna of WY Commercial |
$833.98
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: First Choice Health Commercial |
$765.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$808.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.18
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: HealthUtah PPO |
$851.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$825.47
|
| Rate for Payer: Multiplan Medicare/VA |
$44.35
|
| Rate for Payer: Multiplan Medicare/VA |
$44.35
|
| Rate for Payer: One Health Plan of WY PPO |
$833.98
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PacificSource Commercial |
$765.90
|
| Rate for Payer: PHCS PPO |
$808.45
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: Three Rivers PPO |
$638.25
|
| Rate for Payer: TriWest Veterans Administration |
$52.18
|
| Rate for Payer: TriWest Veterans Administration |
$52.18
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Commercial |
$740.37
|
| Rate for Payer: United Healthcare Medicare |
$52.18
|
| Rate for Payer: United Healthcare Medicare |
$52.18
|
| Rate for Payer: WINHealth Partners Commercial |
$235.45
|
| Rate for Payer: WINHealth Partners Commercial |
$723.35
|
|
|
HC PRO FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 46200
|
| Hospital Charge Code |
9824620001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$281.13 |
| Max. Negotiated Rate |
$6,523.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,392.54
|
| Rate for Payer: Aetna of WY Medicare |
$330.74
|
| Rate for Payer: Beech Street Commercial |
$6,196.85
|
| Rate for Payer: Cash Price |
$4,566.10
|
| Rate for Payer: Cash Price |
$4,566.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,327.31
|
| Rate for Payer: Cigna of WY Commercial |
$6,392.54
|
| Rate for Payer: First Choice Health Commercial |
$5,870.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,196.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.74
|
| Rate for Payer: HealthUtah PPO |
$6,523.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,327.31
|
| Rate for Payer: Multiplan Medicare/VA |
$281.13
|
| Rate for Payer: One Health Plan of WY PPO |
$6,392.54
|
| Rate for Payer: PacificSource Commercial |
$5,870.70
|
| Rate for Payer: PHCS PPO |
$6,196.85
|
| Rate for Payer: Three Rivers PPO |
$4,892.25
|
| Rate for Payer: TriWest Veterans Administration |
$330.74
|
| Rate for Payer: United Healthcare Commercial |
$5,675.01
|
| Rate for Payer: United Healthcare Medicare |
$330.74
|
| Rate for Payer: WINHealth Partners Commercial |
$5,544.55
|
|
|
HC PRO FIT/INSERT INTRAVAG SUPPORT DEVICE
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
9835716001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.26
|
| Rate for Payer: Aetna of WY Medicare |
$43.66
|
| Rate for Payer: Beech Street Commercial |
$177.65
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.39
|
| Rate for Payer: Cigna of WY Commercial |
$183.26
|
| Rate for Payer: First Choice Health Commercial |
$168.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.66
|
| Rate for Payer: HealthUtah PPO |
$187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.39
|
| Rate for Payer: Multiplan Medicare/VA |
$37.11
|
| Rate for Payer: One Health Plan of WY PPO |
$183.26
|
| Rate for Payer: PacificSource Commercial |
$168.30
|
| Rate for Payer: PHCS PPO |
$177.65
|
| Rate for Payer: Three Rivers PPO |
$140.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.66
|
| Rate for Payer: United Healthcare Commercial |
$162.69
|
| Rate for Payer: United Healthcare Medicare |
$43.66
|
| Rate for Payer: WINHealth Partners Commercial |
$158.95
|
|
|
HC PRO FIT/INSERT INTRAVAG SUPPORT DEVICE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 57160 NONPBBPAYER
|
| Hospital Charge Code |
9835716001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$43.66
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.66
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$37.11
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.66
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$43.66
|
| Rate for Payer: WINHealth Partners Commercial |
$198.90
|
|
|
HC PRO FIXATION OF KNEE JOINT
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
9832757001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,528.80
|
| Rate for Payer: Aetna of WY Medicare |
$150.74
|
| Rate for Payer: Beech Street Commercial |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,513.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,528.80
|
| Rate for Payer: First Choice Health Commercial |
$1,404.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.74
|
| Rate for Payer: HealthUtah PPO |
$1,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,513.20
|
| Rate for Payer: Multiplan Medicare/VA |
$128.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,528.80
|
| Rate for Payer: PacificSource Commercial |
$1,404.00
|
| Rate for Payer: PHCS PPO |
$1,482.00
|
| Rate for Payer: Three Rivers PPO |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.74
|
| Rate for Payer: United Healthcare Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare Medicare |
$150.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.00
|
|
|
HC PRO FIXATION OF KNEE JOINT
|
Professional
|
Both
|
$3,119.00
|
|
|
Service Code
|
HCPCS 27570 50
|
| Hospital Charge Code |
9832757001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$3,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,056.62
|
| Rate for Payer: Aetna of WY Medicare |
$150.74
|
| Rate for Payer: Beech Street Commercial |
$2,963.05
|
| Rate for Payer: Cash Price |
$2,183.30
|
| Rate for Payer: Cash Price |
$2,183.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,025.43
|
| Rate for Payer: Cigna of WY Commercial |
$3,056.62
|
| Rate for Payer: First Choice Health Commercial |
$2,807.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,963.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.74
|
| Rate for Payer: HealthUtah PPO |
$3,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,025.43
|
| Rate for Payer: Multiplan Medicare/VA |
$128.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3,056.62
|
| Rate for Payer: PacificSource Commercial |
$2,807.10
|
| Rate for Payer: PHCS PPO |
$2,963.05
|
| Rate for Payer: Three Rivers PPO |
$2,339.25
|
| Rate for Payer: TriWest Veterans Administration |
$150.74
|
| Rate for Payer: United Healthcare Commercial |
$2,713.53
|
| Rate for Payer: United Healthcare Medicare |
$150.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2,651.15
|
|
|
HC PRO FIX COLLAT LIG,MC-P JT,I-P JT
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
9832654001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$3,469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,399.62
|
| Rate for Payer: Aetna of WY Medicare |
$686.11
|
| Rate for Payer: Beech Street Commercial |
$3,295.55
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,364.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,399.62
|
| Rate for Payer: First Choice Health Commercial |
$3,122.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,295.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.11
|
| Rate for Payer: HealthUtah PPO |
$3,469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,364.93
|
| Rate for Payer: Multiplan Medicare/VA |
$583.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,399.62
|
| Rate for Payer: PacificSource Commercial |
$3,122.10
|
| Rate for Payer: PHCS PPO |
$3,295.55
|
| Rate for Payer: Three Rivers PPO |
$2,601.75
|
| Rate for Payer: TriWest Veterans Administration |
$686.11
|
| Rate for Payer: United Healthcare Commercial |
$3,018.03
|
| Rate for Payer: United Healthcare Medicare |
$686.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,948.65
|
|
|
HC PRO FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$4,179.00
|
|
|
Service Code
|
HCPCS 15740
|
| Hospital Charge Code |
9831574001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$690.94 |
| Max. Negotiated Rate |
$4,179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,095.42
|
| Rate for Payer: Aetna of WY Medicare |
$812.87
|
| Rate for Payer: Beech Street Commercial |
$3,970.05
|
| Rate for Payer: Cash Price |
$2,925.30
|
| Rate for Payer: Cash Price |
$2,925.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,053.63
|
| Rate for Payer: Cigna of WY Commercial |
$4,095.42
|
| Rate for Payer: First Choice Health Commercial |
$3,761.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,970.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$812.87
|
| Rate for Payer: HealthUtah PPO |
$4,179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,053.63
|
| Rate for Payer: Multiplan Medicare/VA |
$690.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,095.42
|
| Rate for Payer: PacificSource Commercial |
$3,761.10
|
| Rate for Payer: PHCS PPO |
$3,970.05
|
| Rate for Payer: Three Rivers PPO |
$3,134.25
|
| Rate for Payer: TriWest Veterans Administration |
$812.87
|
| Rate for Payer: United Healthcare Commercial |
$3,635.73
|
| Rate for Payer: United Healthcare Medicare |
$812.87
|
| Rate for Payer: WINHealth Partners Commercial |
$3,552.15
|
|
|
HC PRO FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
9837700201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$113.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Medicare |
$113.61
|
| Rate for Payer: Beech Street Commercial |
$74.10
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: First Choice Health Commercial |
$70.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.61
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Multiplan Medicare/VA |
$96.57
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$74.10
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: TriWest Veterans Administration |
$113.61
|
| Rate for Payer: United Healthcare Commercial |
$67.86
|
| Rate for Payer: United Healthcare Medicare |
$113.61
|
| Rate for Payer: WINHealth Partners Commercial |
$74.10
|
|
|
HC PRO FRACTURE / ACROMIOCLAVICLE
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23540
|
| Hospital Charge Code |
9832354001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$902.58
|
| Rate for Payer: Aetna of WY Medicare |
$239.27
|
| Rate for Payer: Beech Street Commercial |
$874.95
|
| Rate for Payer: Cash Price |
$644.70
|
| Rate for Payer: Cash Price |
$644.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$893.37
|
| Rate for Payer: Cigna of WY Commercial |
$902.58
|
| Rate for Payer: First Choice Health Commercial |
$828.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.27
|
| Rate for Payer: HealthUtah PPO |
$921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$893.37
|
| Rate for Payer: Multiplan Medicare/VA |
$203.38
|
| Rate for Payer: One Health Plan of WY PPO |
$902.58
|
| Rate for Payer: PacificSource Commercial |
$828.90
|
| Rate for Payer: PHCS PPO |
$874.95
|
| Rate for Payer: Three Rivers PPO |
$690.75
|
| Rate for Payer: TriWest Veterans Administration |
$239.27
|
| Rate for Payer: United Healthcare Commercial |
$801.27
|
| Rate for Payer: United Healthcare Medicare |
$239.27
|
| Rate for Payer: WINHealth Partners Commercial |
$782.85
|
|
|
HC PRO FRACTURE / ACROMIOCLAVICLE
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 23540 NONPBBPAYER
|
| Hospital Charge Code |
9832354001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$1,151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,127.98
|
| Rate for Payer: Aetna of WY Medicare |
$239.27
|
| Rate for Payer: Beech Street Commercial |
$1,093.45
|
| Rate for Payer: Cash Price |
$805.70
|
| Rate for Payer: Cash Price |
$805.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,116.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,127.98
|
| Rate for Payer: First Choice Health Commercial |
$1,035.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,093.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.27
|
| Rate for Payer: HealthUtah PPO |
$1,151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,116.47
|
| Rate for Payer: Multiplan Medicare/VA |
$203.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,127.98
|
| Rate for Payer: PacificSource Commercial |
$1,035.90
|
| Rate for Payer: PHCS PPO |
$1,093.45
|
| Rate for Payer: Three Rivers PPO |
$863.25
|
| Rate for Payer: TriWest Veterans Administration |
$239.27
|
| Rate for Payer: United Healthcare Commercial |
$1,001.37
|
| Rate for Payer: United Healthcare Medicare |
$239.27
|
| Rate for Payer: WINHealth Partners Commercial |
$978.35
|
|
|
HC PRO FRACTURE/ANKLE
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
9832780801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,529.78
|
| Rate for Payer: Aetna of WY Medicare |
$308.49
|
| Rate for Payer: Beech Street Commercial |
$1,482.95
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,514.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,529.78
|
| Rate for Payer: First Choice Health Commercial |
$1,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.49
|
| Rate for Payer: HealthUtah PPO |
$1,561.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,514.17
|
| Rate for Payer: Multiplan Medicare/VA |
$262.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,529.78
|
| Rate for Payer: PacificSource Commercial |
$1,404.90
|
| Rate for Payer: PHCS PPO |
$1,482.95
|
| Rate for Payer: Three Rivers PPO |
$1,170.75
|
| Rate for Payer: TriWest Veterans Administration |
$308.49
|
| Rate for Payer: United Healthcare Commercial |
$1,358.07
|
| Rate for Payer: United Healthcare Medicare |
$308.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.85
|
|
|
HC PRO FRACTURE / ARTICULAR CLOSED
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
9832674001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$856.52
|
| Rate for Payer: Aetna of WY Medicare |
$223.91
|
| Rate for Payer: Beech Street Commercial |
$830.30
|
| Rate for Payer: Cash Price |
$611.80
|
| Rate for Payer: Cash Price |
$611.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$847.78
|
| Rate for Payer: Cigna of WY Commercial |
$856.52
|
| Rate for Payer: First Choice Health Commercial |
$786.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$830.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.91
|
| Rate for Payer: HealthUtah PPO |
$874.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$847.78
|
| Rate for Payer: Multiplan Medicare/VA |
$190.32
|
| Rate for Payer: One Health Plan of WY PPO |
$856.52
|
| Rate for Payer: PacificSource Commercial |
$786.60
|
| Rate for Payer: PHCS PPO |
$830.30
|
| Rate for Payer: Three Rivers PPO |
$655.50
|
| Rate for Payer: TriWest Veterans Administration |
$223.91
|
| Rate for Payer: United Healthcare Commercial |
$760.38
|
| Rate for Payer: United Healthcare Medicare |
$223.91
|
| Rate for Payer: WINHealth Partners Commercial |
$742.90
|
|
|
HC PRO FRACTURE / ARTICULAR CLOSED
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 26740 NONPBBPAYER
|
| Hospital Charge Code |
9832674001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Medicare |
$223.91
|
| Rate for Payer: Beech Street Commercial |
$1,037.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| 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) Medicare |
$223.91
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$190.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PHCS PPO |
$1,037.40
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: TriWest Veterans Administration |
$223.91
|
| Rate for Payer: United Healthcare Commercial |
$950.04
|
| Rate for Payer: United Healthcare Medicare |
$223.91
|
| Rate for Payer: WINHealth Partners Commercial |
$928.20
|
|
|
HC PRO FRACTURE / CARPOMETACARPAL
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
9832667001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.16 |
| Max. Negotiated Rate |
$1,271.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,245.58
|
| Rate for Payer: Aetna of WY Medicare |
$314.31
|
| Rate for Payer: Beech Street Commercial |
$1,207.45
|
| Rate for Payer: Cash Price |
$889.70
|
| Rate for Payer: Cash Price |
$889.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,232.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,245.58
|
| Rate for Payer: First Choice Health Commercial |
$1,143.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,207.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.31
|
| Rate for Payer: HealthUtah PPO |
$1,271.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,232.87
|
| Rate for Payer: Multiplan Medicare/VA |
$267.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,245.58
|
| Rate for Payer: PacificSource Commercial |
$1,143.90
|
| Rate for Payer: PHCS PPO |
$1,207.45
|
| Rate for Payer: Three Rivers PPO |
$953.25
|
| Rate for Payer: TriWest Veterans Administration |
$314.31
|
| Rate for Payer: United Healthcare Commercial |
$1,105.77
|
| Rate for Payer: United Healthcare Medicare |
$314.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,080.35
|
|
|
HC PRO FRACTURE / CARPOMETACARPAL
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 26670 NONPBBPAYER
|
| Hospital Charge Code |
9832667001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.16 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$314.31
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.31
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$267.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$314.31
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$314.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
