|
HC PRO FRACTURE/ COCCYX
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 27200 NONPBBPAYER
|
| Hospital Charge Code |
9832720001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$949.62
|
| Rate for Payer: Aetna of WY Medicare |
$192.56
|
| Rate for Payer: Beech Street Commercial |
$920.55
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$939.93
|
| Rate for Payer: Cigna of WY Commercial |
$949.62
|
| Rate for Payer: First Choice Health Commercial |
$872.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$920.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.56
|
| Rate for Payer: HealthUtah PPO |
$969.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$939.93
|
| Rate for Payer: Multiplan Medicare/VA |
$163.68
|
| Rate for Payer: One Health Plan of WY PPO |
$949.62
|
| Rate for Payer: PacificSource Commercial |
$872.10
|
| Rate for Payer: PHCS PPO |
$920.55
|
| Rate for Payer: Three Rivers PPO |
$726.75
|
| Rate for Payer: TriWest Veterans Administration |
$192.56
|
| Rate for Payer: United Healthcare Commercial |
$843.03
|
| Rate for Payer: United Healthcare Medicare |
$192.56
|
| Rate for Payer: WINHealth Partners Commercial |
$823.65
|
|
|
HC PRO FRACTURE/ COCCYX
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
9832720001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$759.50
|
| Rate for Payer: Aetna of WY Medicare |
$192.56
|
| Rate for Payer: Beech Street Commercial |
$736.25
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$751.75
|
| Rate for Payer: Cigna of WY Commercial |
$759.50
|
| Rate for Payer: First Choice Health Commercial |
$697.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.56
|
| Rate for Payer: HealthUtah PPO |
$775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$751.75
|
| Rate for Payer: Multiplan Medicare/VA |
$163.68
|
| Rate for Payer: One Health Plan of WY PPO |
$759.50
|
| Rate for Payer: PacificSource Commercial |
$697.50
|
| Rate for Payer: PHCS PPO |
$736.25
|
| Rate for Payer: Three Rivers PPO |
$581.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.56
|
| Rate for Payer: United Healthcare Commercial |
$674.25
|
| Rate for Payer: United Healthcare Medicare |
$192.56
|
| Rate for Payer: WINHealth Partners Commercial |
$658.75
|
|
|
HC PRO FRACTURE / DISLO PATELLA AN
|
Professional
|
Both
|
$2,006.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
9832756201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.34 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,965.88
|
| Rate for Payer: Aetna of WY Medicare |
$483.93
|
| Rate for Payer: Beech Street Commercial |
$1,905.70
|
| Rate for Payer: Cash Price |
$1,404.20
|
| Rate for Payer: Cash Price |
$1,404.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,945.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,965.88
|
| Rate for Payer: First Choice Health Commercial |
$1,805.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,905.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.93
|
| Rate for Payer: HealthUtah PPO |
$2,006.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,945.82
|
| Rate for Payer: Multiplan Medicare/VA |
$411.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,965.88
|
| Rate for Payer: PacificSource Commercial |
$1,805.40
|
| Rate for Payer: PHCS PPO |
$1,905.70
|
| Rate for Payer: Three Rivers PPO |
$1,504.50
|
| Rate for Payer: TriWest Veterans Administration |
$483.93
|
| Rate for Payer: United Healthcare Commercial |
$1,745.22
|
| Rate for Payer: United Healthcare Medicare |
$483.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,705.10
|
|
|
HC PRO FRACTURE / DISLO PATELLA AN
|
Professional
|
Both
|
$2,508.00
|
|
|
Service Code
|
HCPCS 27562 NONPBBPAYER
|
| Hospital Charge Code |
9832756201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.34 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,457.84
|
| Rate for Payer: Aetna of WY Medicare |
$483.93
|
| Rate for Payer: Beech Street Commercial |
$2,382.60
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,432.76
|
| Rate for Payer: Cigna of WY Commercial |
$2,457.84
|
| Rate for Payer: First Choice Health Commercial |
$2,257.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,382.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.93
|
| Rate for Payer: HealthUtah PPO |
$2,508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,432.76
|
| Rate for Payer: Multiplan Medicare/VA |
$411.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,457.84
|
| Rate for Payer: PacificSource Commercial |
$2,257.20
|
| Rate for Payer: PHCS PPO |
$2,382.60
|
| Rate for Payer: Three Rivers PPO |
$1,881.00
|
| Rate for Payer: TriWest Veterans Administration |
$483.93
|
| Rate for Payer: United Healthcare Commercial |
$2,181.96
|
| Rate for Payer: United Healthcare Medicare |
$483.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,131.80
|
|
|
HC PRO FRACTURE / FEMORAL
|
Professional
|
Both
|
$2,806.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
9832751001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$563.13 |
| Max. Negotiated Rate |
$2,806.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,749.88
|
| Rate for Payer: Aetna of WY Medicare |
$662.51
|
| Rate for Payer: Beech Street Commercial |
$2,665.70
|
| Rate for Payer: Cash Price |
$1,964.20
|
| Rate for Payer: Cash Price |
$1,964.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,721.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,749.88
|
| Rate for Payer: First Choice Health Commercial |
$2,525.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,665.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.51
|
| Rate for Payer: HealthUtah PPO |
$2,806.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,721.82
|
| Rate for Payer: Multiplan Medicare/VA |
$563.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,749.88
|
| Rate for Payer: PacificSource Commercial |
$2,525.40
|
| Rate for Payer: PHCS PPO |
$2,665.70
|
| Rate for Payer: Three Rivers PPO |
$2,104.50
|
| Rate for Payer: TriWest Veterans Administration |
$662.51
|
| Rate for Payer: United Healthcare Commercial |
$2,441.22
|
| Rate for Payer: United Healthcare Medicare |
$662.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,385.10
|
|
|
HC PRO FRACTURE / FEMORAL
|
Professional
|
Both
|
$3,508.00
|
|
|
Service Code
|
HCPCS 27510 NONPBBPAYER
|
| Hospital Charge Code |
9832751001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$563.13 |
| Max. Negotiated Rate |
$3,508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,437.84
|
| Rate for Payer: Aetna of WY Medicare |
$662.51
|
| Rate for Payer: Beech Street Commercial |
$3,332.60
|
| Rate for Payer: Cash Price |
$2,455.60
|
| Rate for Payer: Cash Price |
$2,455.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,402.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,437.84
|
| Rate for Payer: First Choice Health Commercial |
$3,157.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,332.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.51
|
| Rate for Payer: HealthUtah PPO |
$3,508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,402.76
|
| Rate for Payer: Multiplan Medicare/VA |
$563.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3,437.84
|
| Rate for Payer: PacificSource Commercial |
$3,157.20
|
| Rate for Payer: PHCS PPO |
$3,332.60
|
| Rate for Payer: Three Rivers PPO |
$2,631.00
|
| Rate for Payer: TriWest Veterans Administration |
$662.51
|
| Rate for Payer: United Healthcare Commercial |
$3,051.96
|
| Rate for Payer: United Healthcare Medicare |
$662.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,981.80
|
|
|
HC PRO FRACTURE / FEMORAL
|
Professional
|
Both
|
$1,959.00
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
9832723001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$1,959.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,919.82
|
| Rate for Payer: Aetna of WY Medicare |
$471.98
|
| Rate for Payer: Beech Street Commercial |
$1,861.05
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,900.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,919.82
|
| Rate for Payer: First Choice Health Commercial |
$1,763.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,861.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.98
|
| Rate for Payer: HealthUtah PPO |
$1,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,900.23
|
| Rate for Payer: Multiplan Medicare/VA |
$401.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,919.82
|
| Rate for Payer: PacificSource Commercial |
$1,763.10
|
| Rate for Payer: PHCS PPO |
$1,861.05
|
| Rate for Payer: Three Rivers PPO |
$1,469.25
|
| Rate for Payer: TriWest Veterans Administration |
$471.98
|
| Rate for Payer: United Healthcare Commercial |
$1,704.33
|
| Rate for Payer: United Healthcare Medicare |
$471.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,665.15
|
|
|
HC PRO FRACTURE / FEMORAL
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 27230 NONPBBPAYER
|
| Hospital Charge Code |
9832723001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$2,449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,400.02
|
| Rate for Payer: Aetna of WY Medicare |
$471.98
|
| Rate for Payer: Beech Street Commercial |
$2,326.55
|
| Rate for Payer: Cash Price |
$1,714.30
|
| Rate for Payer: Cash Price |
$1,714.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,375.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,400.02
|
| Rate for Payer: First Choice Health Commercial |
$2,204.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,326.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.98
|
| Rate for Payer: HealthUtah PPO |
$2,449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,375.53
|
| Rate for Payer: Multiplan Medicare/VA |
$401.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,400.02
|
| Rate for Payer: PacificSource Commercial |
$2,204.10
|
| Rate for Payer: PHCS PPO |
$2,326.55
|
| Rate for Payer: Three Rivers PPO |
$1,836.75
|
| Rate for Payer: TriWest Veterans Administration |
$471.98
|
| Rate for Payer: United Healthcare Commercial |
$2,130.63
|
| Rate for Payer: United Healthcare Medicare |
$471.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,081.65
|
|
|
HC PRO FRACTURE / GALEAZZI RADIAL
|
Professional
|
Both
|
$2,907.00
|
|
|
Service Code
|
HCPCS 25520 NONPBBPAYER
|
| Hospital Charge Code |
9832552001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$458.97 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,848.86
|
| Rate for Payer: Aetna of WY Medicare |
$539.96
|
| Rate for Payer: Beech Street Commercial |
$2,761.65
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,819.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,848.86
|
| Rate for Payer: First Choice Health Commercial |
$2,616.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,761.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.96
|
| Rate for Payer: HealthUtah PPO |
$2,907.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,819.79
|
| Rate for Payer: Multiplan Medicare/VA |
$458.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,848.86
|
| Rate for Payer: PacificSource Commercial |
$2,616.30
|
| Rate for Payer: PHCS PPO |
$2,761.65
|
| Rate for Payer: Three Rivers PPO |
$2,180.25
|
| Rate for Payer: TriWest Veterans Administration |
$539.96
|
| Rate for Payer: United Healthcare Commercial |
$2,529.09
|
| Rate for Payer: United Healthcare Medicare |
$539.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.95
|
|
|
HC PRO FRACTURE / GALEAZZI RADIAL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
9832552001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$458.97 |
| Max. Negotiated Rate |
$2,326.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,279.48
|
| Rate for Payer: Aetna of WY Medicare |
$539.96
|
| Rate for Payer: Beech Street Commercial |
$2,209.70
|
| Rate for Payer: Cash Price |
$1,628.20
|
| Rate for Payer: Cash Price |
$1,628.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,256.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,279.48
|
| Rate for Payer: First Choice Health Commercial |
$2,093.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.96
|
| Rate for Payer: HealthUtah PPO |
$2,326.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,256.22
|
| Rate for Payer: Multiplan Medicare/VA |
$458.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,279.48
|
| Rate for Payer: PacificSource Commercial |
$2,093.40
|
| Rate for Payer: PHCS PPO |
$2,209.70
|
| Rate for Payer: Three Rivers PPO |
$1,744.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.96
|
| Rate for Payer: United Healthcare Commercial |
$2,023.62
|
| Rate for Payer: United Healthcare Medicare |
$539.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.10
|
|
|
HC PRO FRACTURE / KNEE W ANES
|
Professional
|
Both
|
$3,246.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
9832755201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$528.10 |
| Max. Negotiated Rate |
$3,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,181.08
|
| Rate for Payer: Aetna of WY Medicare |
$621.29
|
| Rate for Payer: Beech Street Commercial |
$3,083.70
|
| Rate for Payer: Cash Price |
$2,272.20
|
| Rate for Payer: Cash Price |
$2,272.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,148.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,181.08
|
| Rate for Payer: First Choice Health Commercial |
$2,921.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,083.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$621.29
|
| Rate for Payer: HealthUtah PPO |
$3,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,148.62
|
| Rate for Payer: Multiplan Medicare/VA |
$528.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,181.08
|
| Rate for Payer: PacificSource Commercial |
$2,921.40
|
| Rate for Payer: PHCS PPO |
$3,083.70
|
| Rate for Payer: Three Rivers PPO |
$2,434.50
|
| Rate for Payer: TriWest Veterans Administration |
$621.29
|
| Rate for Payer: United Healthcare Commercial |
$2,824.02
|
| Rate for Payer: United Healthcare Medicare |
$621.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,759.10
|
|
|
HC PRO FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
9833093001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Aetna of WY Medicare |
$115.93
|
| Rate for Payer: Beech Street Commercial |
$460.75
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: First Choice Health Commercial |
$436.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.93
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$98.54
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$460.75
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$115.93
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$115.93
|
| Rate for Payer: WINHealth Partners Commercial |
$412.25
|
|
|
HC PRO FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 30930 NONPBBPAYER
|
| Hospital Charge Code |
9833093001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.88
|
| Rate for Payer: Aetna of WY Medicare |
$115.93
|
| Rate for Payer: Beech Street Commercial |
$575.70
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.82
|
| Rate for Payer: Cigna of WY Commercial |
$593.88
|
| Rate for Payer: First Choice Health Commercial |
$545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.93
|
| Rate for Payer: HealthUtah PPO |
$606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.82
|
| Rate for Payer: Multiplan Medicare/VA |
$98.54
|
| Rate for Payer: One Health Plan of WY PPO |
$593.88
|
| Rate for Payer: PacificSource Commercial |
$545.40
|
| Rate for Payer: PHCS PPO |
$575.70
|
| Rate for Payer: Three Rivers PPO |
$454.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.93
|
| Rate for Payer: United Healthcare Commercial |
$527.22
|
| Rate for Payer: United Healthcare Medicare |
$115.93
|
| Rate for Payer: WINHealth Partners Commercial |
$515.10
|
|
|
HC PRO FRACTURE/NASAL W STABILIZ
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
9832132001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$536.06
|
| Rate for Payer: Aetna of WY Medicare |
$91.27
|
| Rate for Payer: Beech Street Commercial |
$519.65
|
| Rate for Payer: Cash Price |
$382.90
|
| Rate for Payer: Cash Price |
$382.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$530.59
|
| Rate for Payer: Cigna of WY Commercial |
$536.06
|
| Rate for Payer: First Choice Health Commercial |
$492.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$519.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.27
|
| Rate for Payer: HealthUtah PPO |
$547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$530.59
|
| Rate for Payer: Multiplan Medicare/VA |
$77.58
|
| Rate for Payer: One Health Plan of WY PPO |
$536.06
|
| Rate for Payer: PacificSource Commercial |
$492.30
|
| Rate for Payer: PHCS PPO |
$519.65
|
| Rate for Payer: Three Rivers PPO |
$410.25
|
| Rate for Payer: TriWest Veterans Administration |
$91.27
|
| Rate for Payer: United Healthcare Commercial |
$475.89
|
| Rate for Payer: United Healthcare Medicare |
$91.27
|
| Rate for Payer: WINHealth Partners Commercial |
$464.95
|
|
|
HC PRO FRACTURE/NASAL W STABILIZ
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 21320 NONPBBPAYER
|
| Hospital Charge Code |
9832132001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$670.32
|
| Rate for Payer: Aetna of WY Medicare |
$91.27
|
| Rate for Payer: Beech Street Commercial |
$649.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$663.48
|
| Rate for Payer: Cigna of WY Commercial |
$670.32
|
| Rate for Payer: First Choice Health Commercial |
$615.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$649.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.27
|
| Rate for Payer: HealthUtah PPO |
$684.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$663.48
|
| Rate for Payer: Multiplan Medicare/VA |
$77.58
|
| Rate for Payer: One Health Plan of WY PPO |
$670.32
|
| Rate for Payer: PacificSource Commercial |
$615.60
|
| Rate for Payer: PHCS PPO |
$649.80
|
| Rate for Payer: Three Rivers PPO |
$513.00
|
| Rate for Payer: TriWest Veterans Administration |
$91.27
|
| Rate for Payer: United Healthcare Commercial |
$595.08
|
| Rate for Payer: United Healthcare Medicare |
$91.27
|
| Rate for Payer: WINHealth Partners Commercial |
$581.40
|
|
|
HC PRO FRACTURE / RADIAL HEAD W MANIP
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
9832465501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$345.46 |
| Max. Negotiated Rate |
$1,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,612.10
|
| Rate for Payer: Aetna of WY Medicare |
$406.42
|
| Rate for Payer: Beech Street Commercial |
$1,562.75
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,595.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,612.10
|
| Rate for Payer: First Choice Health Commercial |
$1,480.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.42
|
| Rate for Payer: HealthUtah PPO |
$1,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,595.65
|
| Rate for Payer: Multiplan Medicare/VA |
$345.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,612.10
|
| Rate for Payer: PacificSource Commercial |
$1,480.50
|
| Rate for Payer: PHCS PPO |
$1,562.75
|
| Rate for Payer: Three Rivers PPO |
$1,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$406.42
|
| Rate for Payer: United Healthcare Commercial |
$1,431.15
|
| Rate for Payer: United Healthcare Medicare |
$406.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.25
|
|
|
HC PRO FRACTURE / RADIAL HEAD W MANIP
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 24655 NONPBBPAYER
|
| Hospital Charge Code |
9832465501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$345.46 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,014.88
|
| Rate for Payer: Aetna of WY Medicare |
$406.42
|
| Rate for Payer: Beech Street Commercial |
$1,953.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,994.32
|
| Rate for Payer: Cigna of WY Commercial |
$2,014.88
|
| Rate for Payer: First Choice Health Commercial |
$1,850.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,953.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.42
|
| Rate for Payer: HealthUtah PPO |
$2,056.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,994.32
|
| Rate for Payer: Multiplan Medicare/VA |
$345.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,014.88
|
| Rate for Payer: PacificSource Commercial |
$1,850.40
|
| Rate for Payer: PHCS PPO |
$1,953.20
|
| Rate for Payer: Three Rivers PPO |
$1,542.00
|
| Rate for Payer: TriWest Veterans Administration |
$406.42
|
| Rate for Payer: United Healthcare Commercial |
$1,788.72
|
| Rate for Payer: United Healthcare Medicare |
$406.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,747.60
|
|
|
HC PRO FRACTURE / TRANS-SCAPHOPERI
|
Professional
|
Both
|
$2,164.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
9832568001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$2,164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,120.72
|
| Rate for Payer: Aetna of WY Medicare |
$525.08
|
| Rate for Payer: Beech Street Commercial |
$2,055.80
|
| Rate for Payer: Cash Price |
$1,514.80
|
| Rate for Payer: Cash Price |
$1,514.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,099.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,120.72
|
| Rate for Payer: First Choice Health Commercial |
$1,947.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,055.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$525.08
|
| Rate for Payer: HealthUtah PPO |
$2,164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,099.08
|
| Rate for Payer: Multiplan Medicare/VA |
$446.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,120.72
|
| Rate for Payer: PacificSource Commercial |
$1,947.60
|
| Rate for Payer: PHCS PPO |
$2,055.80
|
| Rate for Payer: Three Rivers PPO |
$1,623.00
|
| Rate for Payer: TriWest Veterans Administration |
$525.08
|
| Rate for Payer: United Healthcare Commercial |
$1,882.68
|
| Rate for Payer: United Healthcare Medicare |
$525.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,839.40
|
|
|
HC PRO FRACTURE / TRANS-SCAPHOPERI
|
Professional
|
Both
|
$2,705.00
|
|
|
Service Code
|
HCPCS 25680 NONPBBPAYER
|
| Hospital Charge Code |
9832568001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$2,705.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,650.90
|
| Rate for Payer: Aetna of WY Medicare |
$525.08
|
| Rate for Payer: Beech Street Commercial |
$2,569.75
|
| Rate for Payer: Cash Price |
$1,893.50
|
| Rate for Payer: Cash Price |
$1,893.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,623.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,650.90
|
| Rate for Payer: First Choice Health Commercial |
$2,434.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,569.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$525.08
|
| Rate for Payer: HealthUtah PPO |
$2,705.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,623.85
|
| Rate for Payer: Multiplan Medicare/VA |
$446.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,650.90
|
| Rate for Payer: PacificSource Commercial |
$2,434.50
|
| Rate for Payer: PHCS PPO |
$2,569.75
|
| Rate for Payer: Three Rivers PPO |
$2,028.75
|
| Rate for Payer: TriWest Veterans Administration |
$525.08
|
| Rate for Payer: United Healthcare Commercial |
$2,353.35
|
| Rate for Payer: United Healthcare Medicare |
$525.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,299.25
|
|
|
HC PRO FRACTURE / ULNAR SHAFT W MANIP
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
9832553501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$387.45 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$455.82
|
| Rate for Payer: Beech Street Commercial |
$803.70
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$820.62
|
| Rate for Payer: Cigna of WY Commercial |
$829.08
|
| Rate for Payer: First Choice Health Commercial |
$761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.82
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$387.45
|
| Rate for Payer: One Health Plan of WY PPO |
$829.08
|
| Rate for Payer: PacificSource Commercial |
$761.40
|
| Rate for Payer: PHCS PPO |
$803.70
|
| Rate for Payer: Three Rivers PPO |
$634.50
|
| Rate for Payer: TriWest Veterans Administration |
$455.82
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$455.82
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
HC PRO FRACTURE / ULNAR SHAFT W MANIP
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 25535 NONPBBPAYER
|
| Hospital Charge Code |
9832553501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$387.45 |
| Max. Negotiated Rate |
$1,057.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,035.86
|
| Rate for Payer: Aetna of WY Medicare |
$455.82
|
| Rate for Payer: Beech Street Commercial |
$1,004.15
|
| Rate for Payer: Cash Price |
$739.90
|
| Rate for Payer: Cash Price |
$739.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,025.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,035.86
|
| Rate for Payer: First Choice Health Commercial |
$951.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,004.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.82
|
| Rate for Payer: HealthUtah PPO |
$1,057.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,025.29
|
| Rate for Payer: Multiplan Medicare/VA |
$387.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,035.86
|
| Rate for Payer: PacificSource Commercial |
$951.30
|
| Rate for Payer: PHCS PPO |
$1,004.15
|
| Rate for Payer: Three Rivers PPO |
$792.75
|
| Rate for Payer: TriWest Veterans Administration |
$455.82
|
| Rate for Payer: United Healthcare Commercial |
$919.59
|
| Rate for Payer: United Healthcare Medicare |
$455.82
|
| Rate for Payer: WINHealth Partners Commercial |
$898.45
|
|
|
HC PRO FRACTURE / ULNAR W MAN
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
9832467501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.80 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$416.23
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.23
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$353.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$416.23
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$416.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
HC PRO FRACTURE / ULNAR W MAN
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 24675 NONPBBPAYER
|
| Hospital Charge Code |
9832467501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.80 |
| Max. Negotiated Rate |
$2,149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,106.02
|
| Rate for Payer: Aetna of WY Medicare |
$416.23
|
| Rate for Payer: Beech Street Commercial |
$2,041.55
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,084.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,106.02
|
| Rate for Payer: First Choice Health Commercial |
$1,934.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,041.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.23
|
| Rate for Payer: HealthUtah PPO |
$2,149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,084.53
|
| Rate for Payer: Multiplan Medicare/VA |
$353.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,106.02
|
| Rate for Payer: PacificSource Commercial |
$1,934.10
|
| Rate for Payer: PHCS PPO |
$2,041.55
|
| Rate for Payer: Three Rivers PPO |
$1,611.75
|
| Rate for Payer: TriWest Veterans Administration |
$416.23
|
| Rate for Payer: United Healthcare Commercial |
$1,869.63
|
| Rate for Payer: United Healthcare Medicare |
$416.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,826.65
|
|
|
HC PRO FRACTURE/VERTEBRAL WO MAN
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
9832231001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,175.02
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,139.05
|
| Rate for Payer: Cash Price |
$839.30
|
| Rate for Payer: Cash Price |
$839.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,163.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,175.02
|
| Rate for Payer: First Choice Health Commercial |
$1,079.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,139.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,163.03
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,175.02
|
| Rate for Payer: PacificSource Commercial |
$1,079.10
|
| Rate for Payer: PHCS PPO |
$1,139.05
|
| Rate for Payer: Three Rivers PPO |
$899.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,043.13
|
| Rate for Payer: United Healthcare Medicare |
$291.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,019.15
|
|
|
HC PRO FRACTURE/VERTEBRAL WO MAN
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 22310 NONPBBPAYER
|
| Hospital Charge Code |
9832231001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,469.02
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,424.05
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,454.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,469.02
|
| Rate for Payer: First Choice Health Commercial |
$1,349.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,424.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,454.03
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,469.02
|
| Rate for Payer: PacificSource Commercial |
$1,349.10
|
| Rate for Payer: PHCS PPO |
$1,424.05
|
| Rate for Payer: Three Rivers PPO |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,304.13
|
| Rate for Payer: United Healthcare Medicare |
$291.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.15
|
|
