|
HC PRO LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$6,423.00
|
|
|
Service Code
|
HCPCS 58550
|
| Hospital Charge Code |
9835855001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$721.90 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,294.54
|
| Rate for Payer: Aetna of WY Medicare |
$849.29
|
| Rate for Payer: Beech Street Commercial |
$6,101.85
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,230.31
|
| Rate for Payer: Cigna of WY Commercial |
$6,294.54
|
| Rate for Payer: First Choice Health Commercial |
$5,780.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,101.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$849.29
|
| Rate for Payer: HealthUtah PPO |
$6,423.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,230.31
|
| Rate for Payer: Multiplan Medicare/VA |
$721.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,294.54
|
| Rate for Payer: PacificSource Commercial |
$5,780.70
|
| Rate for Payer: PHCS PPO |
$6,101.85
|
| Rate for Payer: Three Rivers PPO |
$4,817.25
|
| Rate for Payer: TriWest Veterans Administration |
$849.29
|
| Rate for Payer: United Healthcare Commercial |
$5,588.01
|
| Rate for Payer: United Healthcare Medicare |
$849.29
|
| Rate for Payer: WINHealth Partners Commercial |
$5,459.55
|
|
|
HC PRO LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$3,944.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
9835855201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$801.62 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,865.12
|
| Rate for Payer: Aetna of WY Medicare |
$943.08
|
| Rate for Payer: Beech Street Commercial |
$3,746.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,825.68
|
| Rate for Payer: Cigna of WY Commercial |
$3,865.12
|
| Rate for Payer: First Choice Health Commercial |
$3,549.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,746.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.08
|
| Rate for Payer: HealthUtah PPO |
$3,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,825.68
|
| Rate for Payer: Multiplan Medicare/VA |
$801.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,865.12
|
| Rate for Payer: PacificSource Commercial |
$3,549.60
|
| Rate for Payer: PHCS PPO |
$3,746.80
|
| Rate for Payer: Three Rivers PPO |
$2,958.00
|
| Rate for Payer: TriWest Veterans Administration |
$943.08
|
| Rate for Payer: United Healthcare Commercial |
$3,431.28
|
| Rate for Payer: United Healthcare Medicare |
$943.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.40
|
|
|
HC PRO LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS
|
Professional
|
Both
|
$3,833.00
|
|
|
Service Code
|
HCPCS 58553
|
| Hospital Charge Code |
9835855301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$912.98 |
| Max. Negotiated Rate |
$3,833.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,756.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,074.09
|
| Rate for Payer: Beech Street Commercial |
$3,641.35
|
| Rate for Payer: Cash Price |
$2,683.10
|
| Rate for Payer: Cash Price |
$2,683.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,718.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,756.34
|
| Rate for Payer: First Choice Health Commercial |
$3,449.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,641.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,074.09
|
| Rate for Payer: HealthUtah PPO |
$3,833.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,718.01
|
| Rate for Payer: Multiplan Medicare/VA |
$912.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,756.34
|
| Rate for Payer: PacificSource Commercial |
$3,449.70
|
| Rate for Payer: PHCS PPO |
$3,641.35
|
| Rate for Payer: Three Rivers PPO |
$2,874.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,074.09
|
| Rate for Payer: United Healthcare Commercial |
$3,334.71
|
| Rate for Payer: United Healthcare Medicare |
$1,074.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.05
|
|
|
HC PRO LAP W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$5,882.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
9835867101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$305.78 |
| Max. Negotiated Rate |
$5,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,764.36
|
| Rate for Payer: Aetna of WY Medicare |
$359.74
|
| Rate for Payer: Beech Street Commercial |
$5,587.90
|
| Rate for Payer: Cash Price |
$4,117.40
|
| Rate for Payer: Cash Price |
$4,117.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,705.54
|
| Rate for Payer: Cigna of WY Commercial |
$5,764.36
|
| Rate for Payer: First Choice Health Commercial |
$5,293.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,587.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.74
|
| Rate for Payer: HealthUtah PPO |
$5,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,705.54
|
| Rate for Payer: Multiplan Medicare/VA |
$305.78
|
| Rate for Payer: One Health Plan of WY PPO |
$5,764.36
|
| Rate for Payer: PacificSource Commercial |
$5,293.80
|
| Rate for Payer: PHCS PPO |
$5,587.90
|
| Rate for Payer: Three Rivers PPO |
$4,411.50
|
| Rate for Payer: TriWest Veterans Administration |
$359.74
|
| Rate for Payer: United Healthcare Commercial |
$5,117.34
|
| Rate for Payer: United Healthcare Medicare |
$359.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4,999.70
|
|
|
HC PRO LARYNGOSCOPY,DIRCT,OP SCOPE,BIOPSY
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 31536
|
| Hospital Charge Code |
9833153601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$701.68
|
| Rate for Payer: Aetna of WY Medicare |
$200.62
|
| Rate for Payer: Beech Street Commercial |
$680.20
|
| Rate for Payer: Cash Price |
$501.20
|
| Rate for Payer: Cash Price |
$501.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$694.52
|
| Rate for Payer: Cigna of WY Commercial |
$701.68
|
| Rate for Payer: First Choice Health Commercial |
$644.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$680.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.62
|
| Rate for Payer: HealthUtah PPO |
$716.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$694.52
|
| Rate for Payer: Multiplan Medicare/VA |
$170.53
|
| Rate for Payer: One Health Plan of WY PPO |
$701.68
|
| Rate for Payer: PacificSource Commercial |
$644.40
|
| Rate for Payer: PHCS PPO |
$680.20
|
| Rate for Payer: Three Rivers PPO |
$537.00
|
| Rate for Payer: TriWest Veterans Administration |
$200.62
|
| Rate for Payer: United Healthcare Commercial |
$622.92
|
| Rate for Payer: United Healthcare Medicare |
$200.62
|
| Rate for Payer: WINHealth Partners Commercial |
$608.60
|
|
|
HC PRO LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
9833153501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$153.64 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.74
|
| Rate for Payer: Aetna of WY Medicare |
$180.75
|
| Rate for Payer: Beech Street Commercial |
$914.85
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$934.11
|
| Rate for Payer: Cigna of WY Commercial |
$943.74
|
| Rate for Payer: First Choice Health Commercial |
$866.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.75
|
| Rate for Payer: HealthUtah PPO |
$963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$934.11
|
| Rate for Payer: Multiplan Medicare/VA |
$153.64
|
| Rate for Payer: One Health Plan of WY PPO |
$943.74
|
| Rate for Payer: PacificSource Commercial |
$866.70
|
| Rate for Payer: PHCS PPO |
$914.85
|
| Rate for Payer: Three Rivers PPO |
$722.25
|
| Rate for Payer: TriWest Veterans Administration |
$180.75
|
| Rate for Payer: United Healthcare Commercial |
$837.81
|
| Rate for Payer: United Healthcare Medicare |
$180.75
|
| Rate for Payer: WINHealth Partners Commercial |
$818.55
|
|
|
HC PRO LARYNGOSCOPY,DIRECT,SCOPE,INJ CORDS
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 31571
|
| Hospital Charge Code |
9833157101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$237.34
|
| 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 |
$237.34
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$201.74
|
| 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 |
$237.34
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$237.34
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
HC PRO LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
9833157501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$66.26
|
| Rate for Payer: Beech Street Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: First Choice Health Commercial |
$306.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.26
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$56.32
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$323.00
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.26
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$66.26
|
| Rate for Payer: WINHealth Partners Commercial |
$289.00
|
|
|
HC PRO LARYNGOSCOPY INDIRECT DIAGN SPX PRO FEE
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
9833150501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Aetna of WY Medicare |
$48.11
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.11
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$40.89
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.11
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: United Healthcare Medicare |
$48.11
|
| Rate for Payer: WINHealth Partners Commercial |
$266.90
|
|
|
HC PRO LARYNGOSCOPY INDIRECT W/VOCAL
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 31513
|
| Hospital Charge Code |
9833151301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$607.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$594.86
|
| Rate for Payer: Aetna of WY Medicare |
$126.04
|
| Rate for Payer: Beech Street Commercial |
$576.65
|
| Rate for Payer: Cash Price |
$424.90
|
| Rate for Payer: Cash Price |
$424.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$588.79
|
| Rate for Payer: Cigna of WY Commercial |
$594.86
|
| Rate for Payer: First Choice Health Commercial |
$546.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$576.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.04
|
| Rate for Payer: HealthUtah PPO |
$607.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$588.79
|
| Rate for Payer: Multiplan Medicare/VA |
$107.13
|
| Rate for Payer: One Health Plan of WY PPO |
$594.86
|
| Rate for Payer: PacificSource Commercial |
$546.30
|
| Rate for Payer: PHCS PPO |
$576.65
|
| Rate for Payer: Three Rivers PPO |
$455.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.04
|
| Rate for Payer: United Healthcare Commercial |
$528.09
|
| Rate for Payer: United Healthcare Medicare |
$126.04
|
| Rate for Payer: WINHealth Partners Commercial |
$515.95
|
|
|
HC PRO LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$1,598.00
|
|
|
Service Code
|
HCPCS 27425
|
| Hospital Charge Code |
9832742501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$380.48 |
| Max. Negotiated Rate |
$1,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,566.04
|
| Rate for Payer: Aetna of WY Medicare |
$447.62
|
| Rate for Payer: Beech Street Commercial |
$1,518.10
|
| Rate for Payer: Cash Price |
$1,118.60
|
| Rate for Payer: Cash Price |
$1,118.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,550.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,566.04
|
| Rate for Payer: First Choice Health Commercial |
$1,438.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,518.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$447.62
|
| Rate for Payer: HealthUtah PPO |
$1,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,550.06
|
| Rate for Payer: Multiplan Medicare/VA |
$380.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,566.04
|
| Rate for Payer: PacificSource Commercial |
$1,438.20
|
| Rate for Payer: PHCS PPO |
$1,518.10
|
| Rate for Payer: Three Rivers PPO |
$1,198.50
|
| Rate for Payer: TriWest Veterans Administration |
$447.62
|
| Rate for Payer: United Healthcare Commercial |
$1,390.26
|
| Rate for Payer: United Healthcare Medicare |
$447.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,358.30
|
|
|
HC PRO LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$3,196.00
|
|
|
Service Code
|
HCPCS 27425 50
|
| Hospital Charge Code |
9832742501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$380.48 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,132.08
|
| Rate for Payer: Aetna of WY Medicare |
$447.62
|
| Rate for Payer: Beech Street Commercial |
$3,036.20
|
| Rate for Payer: Cash Price |
$2,237.20
|
| Rate for Payer: Cash Price |
$2,237.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,100.12
|
| Rate for Payer: Cigna of WY Commercial |
$3,132.08
|
| Rate for Payer: First Choice Health Commercial |
$2,876.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,036.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$447.62
|
| Rate for Payer: HealthUtah PPO |
$3,196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,100.12
|
| Rate for Payer: Multiplan Medicare/VA |
$380.48
|
| Rate for Payer: One Health Plan of WY PPO |
$3,132.08
|
| Rate for Payer: PacificSource Commercial |
$2,876.40
|
| Rate for Payer: PHCS PPO |
$3,036.20
|
| Rate for Payer: Three Rivers PPO |
$2,397.00
|
| Rate for Payer: TriWest Veterans Administration |
$447.62
|
| Rate for Payer: United Healthcare Commercial |
$2,780.52
|
| Rate for Payer: United Healthcare Medicare |
$447.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,716.60
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 12.6-20 CM
|
Professional
|
Both
|
$2,273.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
9831205501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$2,273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,227.54
|
| Rate for Payer: Aetna of WY Medicare |
$289.41
|
| Rate for Payer: Beech Street Commercial |
$2,159.35
|
| Rate for Payer: Cash Price |
$1,591.10
|
| Rate for Payer: Cash Price |
$1,591.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,204.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,227.54
|
| Rate for Payer: First Choice Health Commercial |
$2,045.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,159.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.41
|
| Rate for Payer: HealthUtah PPO |
$2,273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,204.81
|
| Rate for Payer: Multiplan Medicare/VA |
$246.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,227.54
|
| Rate for Payer: PacificSource Commercial |
$2,045.70
|
| Rate for Payer: PHCS PPO |
$2,159.35
|
| Rate for Payer: Three Rivers PPO |
$1,704.75
|
| Rate for Payer: TriWest Veterans Administration |
$289.41
|
| Rate for Payer: United Healthcare Commercial |
$1,977.51
|
| Rate for Payer: United Healthcare Medicare |
$289.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,932.05
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
9831205101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$663.46
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,966.86
|
| Rate for Payer: Aetna of WY Medicare |
$163.69
|
| Rate for Payer: Aetna of WY Medicare |
$163.69
|
| Rate for Payer: Beech Street Commercial |
$1,906.65
|
| Rate for Payer: Beech Street Commercial |
$643.15
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$656.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,946.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,966.86
|
| Rate for Payer: Cigna of WY Commercial |
$663.46
|
| Rate for Payer: First Choice Health Commercial |
$1,806.30
|
| Rate for Payer: First Choice Health Commercial |
$609.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,906.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.69
|
| Rate for Payer: HealthUtah PPO |
$677.00
|
| Rate for Payer: HealthUtah PPO |
$2,007.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$656.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,946.79
|
| Rate for Payer: Multiplan Medicare/VA |
$139.14
|
| Rate for Payer: Multiplan Medicare/VA |
$139.14
|
| Rate for Payer: One Health Plan of WY PPO |
$663.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,966.86
|
| Rate for Payer: PacificSource Commercial |
$1,806.30
|
| Rate for Payer: PacificSource Commercial |
$609.30
|
| Rate for Payer: PHCS PPO |
$643.15
|
| Rate for Payer: PHCS PPO |
$1,906.65
|
| Rate for Payer: Three Rivers PPO |
$507.75
|
| Rate for Payer: Three Rivers PPO |
$1,505.25
|
| Rate for Payer: TriWest Veterans Administration |
$163.69
|
| Rate for Payer: TriWest Veterans Administration |
$163.69
|
| Rate for Payer: United Healthcare Commercial |
$1,746.09
|
| Rate for Payer: United Healthcare Commercial |
$588.99
|
| Rate for Payer: United Healthcare Medicare |
$163.69
|
| Rate for Payer: United Healthcare Medicare |
$163.69
|
| Rate for Payer: WINHealth Partners Commercial |
$575.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,705.95
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 12051 NONPBBPAYER
|
| Hospital Charge Code |
9831205101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$163.69
|
| 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 |
$163.69
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$139.14
|
| 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 |
$163.69
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$163.69
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 2.6-5 CM
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
9831205201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$785.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$1,157.10
|
| Rate for Payer: Beech Street Commercial |
$761.90
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$777.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: Cigna of WY Commercial |
$785.96
|
| Rate for Payer: First Choice Health Commercial |
$1,096.20
|
| Rate for Payer: First Choice Health Commercial |
$721.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$802.00
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$777.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$785.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PacificSource Commercial |
$721.80
|
| Rate for Payer: PHCS PPO |
$761.90
|
| Rate for Payer: PHCS PPO |
$1,157.10
|
| Rate for Payer: Three Rivers PPO |
$601.50
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$1,059.66
|
| Rate for Payer: United Healthcare Commercial |
$697.74
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$681.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,035.30
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 2.6-5 CM
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 12052 NONPBBPAYER
|
| Hospital Charge Code |
9831205201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$982.94
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$952.85
|
| Rate for Payer: Cash Price |
$702.10
|
| Rate for Payer: Cash Price |
$702.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$972.91
|
| Rate for Payer: Cigna of WY Commercial |
$982.94
|
| Rate for Payer: First Choice Health Commercial |
$902.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$952.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$1,003.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$972.91
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$982.94
|
| Rate for Payer: PacificSource Commercial |
$902.70
|
| Rate for Payer: PHCS PPO |
$952.85
|
| Rate for Payer: Three Rivers PPO |
$752.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$872.61
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$852.55
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 12053 NONPBBPAYER
|
| Hospital Charge Code |
9831205301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$176.33 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,058.40
|
| Rate for Payer: Aetna of WY Medicare |
$207.45
|
| Rate for Payer: Beech Street Commercial |
$1,026.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,047.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,058.40
|
| Rate for Payer: First Choice Health Commercial |
$972.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.45
|
| Rate for Payer: HealthUtah PPO |
$1,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,047.60
|
| Rate for Payer: Multiplan Medicare/VA |
$176.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,058.40
|
| Rate for Payer: PacificSource Commercial |
$972.00
|
| Rate for Payer: PHCS PPO |
$1,026.00
|
| Rate for Payer: Three Rivers PPO |
$810.00
|
| Rate for Payer: TriWest Veterans Administration |
$207.45
|
| Rate for Payer: United Healthcare Commercial |
$939.60
|
| Rate for Payer: United Healthcare Medicare |
$207.45
|
| Rate for Payer: WINHealth Partners Commercial |
$918.00
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
9831205301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$176.33 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$846.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,171.10
|
| Rate for Payer: Aetna of WY Medicare |
$207.45
|
| Rate for Payer: Aetna of WY Medicare |
$207.45
|
| Rate for Payer: Beech Street Commercial |
$1,135.25
|
| Rate for Payer: Beech Street Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$838.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,159.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,171.10
|
| Rate for Payer: Cigna of WY Commercial |
$846.72
|
| Rate for Payer: First Choice Health Commercial |
$1,075.50
|
| Rate for Payer: First Choice Health Commercial |
$777.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$820.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.45
|
| Rate for Payer: HealthUtah PPO |
$864.00
|
| Rate for Payer: HealthUtah PPO |
$1,195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$838.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,159.15
|
| Rate for Payer: Multiplan Medicare/VA |
$176.33
|
| Rate for Payer: Multiplan Medicare/VA |
$176.33
|
| Rate for Payer: One Health Plan of WY PPO |
$846.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,171.10
|
| Rate for Payer: PacificSource Commercial |
$1,075.50
|
| Rate for Payer: PacificSource Commercial |
$777.60
|
| Rate for Payer: PHCS PPO |
$820.80
|
| Rate for Payer: PHCS PPO |
$1,135.25
|
| Rate for Payer: Three Rivers PPO |
$648.00
|
| Rate for Payer: Three Rivers PPO |
$896.25
|
| Rate for Payer: TriWest Veterans Administration |
$207.45
|
| Rate for Payer: TriWest Veterans Administration |
$207.45
|
| Rate for Payer: United Healthcare Commercial |
$1,039.65
|
| Rate for Payer: United Healthcare Commercial |
$751.68
|
| Rate for Payer: United Healthcare Medicare |
$207.45
|
| Rate for Payer: United Healthcare Medicare |
$207.45
|
| Rate for Payer: WINHealth Partners Commercial |
$734.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,015.75
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
9831205401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$179.64 |
| Max. Negotiated Rate |
$883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$865.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,625.82
|
| Rate for Payer: Aetna of WY Medicare |
$211.34
|
| Rate for Payer: Aetna of WY Medicare |
$211.34
|
| Rate for Payer: Beech Street Commercial |
$1,576.05
|
| Rate for Payer: Beech Street Commercial |
$838.85
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: Cash Price |
$618.10
|
| Rate for Payer: Cash Price |
$618.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$856.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,609.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,625.82
|
| Rate for Payer: Cigna of WY Commercial |
$865.34
|
| Rate for Payer: First Choice Health Commercial |
$1,493.10
|
| Rate for Payer: First Choice Health Commercial |
$794.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$838.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,576.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.34
|
| Rate for Payer: HealthUtah PPO |
$883.00
|
| Rate for Payer: HealthUtah PPO |
$1,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$856.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,609.23
|
| Rate for Payer: Multiplan Medicare/VA |
$179.64
|
| Rate for Payer: Multiplan Medicare/VA |
$179.64
|
| Rate for Payer: One Health Plan of WY PPO |
$865.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,625.82
|
| Rate for Payer: PacificSource Commercial |
$1,493.10
|
| Rate for Payer: PacificSource Commercial |
$794.70
|
| Rate for Payer: PHCS PPO |
$838.85
|
| Rate for Payer: PHCS PPO |
$1,576.05
|
| Rate for Payer: Three Rivers PPO |
$662.25
|
| Rate for Payer: Three Rivers PPO |
$1,244.25
|
| Rate for Payer: TriWest Veterans Administration |
$211.34
|
| Rate for Payer: TriWest Veterans Administration |
$211.34
|
| Rate for Payer: United Healthcare Commercial |
$1,443.33
|
| Rate for Payer: United Healthcare Commercial |
$768.21
|
| Rate for Payer: United Healthcare Medicare |
$211.34
|
| Rate for Payer: United Healthcare Medicare |
$211.34
|
| Rate for Payer: WINHealth Partners Commercial |
$750.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,410.15
|
|
|
HC PRO LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 12054 NONPBBPAYER
|
| Hospital Charge Code |
9831205401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$179.64 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,081.92
|
| Rate for Payer: Aetna of WY Medicare |
$211.34
|
| Rate for Payer: Beech Street Commercial |
$1,048.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,070.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,081.92
|
| Rate for Payer: First Choice Health Commercial |
$993.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,048.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.34
|
| Rate for Payer: HealthUtah PPO |
$1,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Medicare/VA |
$179.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,081.92
|
| Rate for Payer: PacificSource Commercial |
$993.60
|
| Rate for Payer: PHCS PPO |
$1,048.80
|
| Rate for Payer: Three Rivers PPO |
$828.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.34
|
| Rate for Payer: United Healthcare Commercial |
$960.48
|
| Rate for Payer: United Healthcare Medicare |
$211.34
|
| Rate for Payer: WINHealth Partners Commercial |
$938.40
|
|
|
HC PRO LAYR CLOS WND REST BODY <2.5 CM
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
9831204101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.19 |
| Max. Negotiated Rate |
$806.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$789.88
|
| Rate for Payer: Aetna of WY Medicare |
$140.22
|
| Rate for Payer: Beech Street Commercial |
$765.70
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$781.82
|
| Rate for Payer: Cigna of WY Commercial |
$789.88
|
| Rate for Payer: First Choice Health Commercial |
$725.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$765.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.22
|
| Rate for Payer: HealthUtah PPO |
$806.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$781.82
|
| Rate for Payer: Multiplan Medicare/VA |
$119.19
|
| Rate for Payer: One Health Plan of WY PPO |
$789.88
|
| Rate for Payer: PacificSource Commercial |
$725.40
|
| Rate for Payer: PHCS PPO |
$765.70
|
| Rate for Payer: Three Rivers PPO |
$604.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$701.22
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
| Rate for Payer: WINHealth Partners Commercial |
$685.10
|
|
|
HC PRO LAYR CLOS WND REST BODY <2.5 CM
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 12041 NONPBBPAYER
|
| Hospital Charge Code |
9831204101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.19 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.28
|
| Rate for Payer: Aetna of WY Medicare |
$140.22
|
| Rate for Payer: Beech Street Commercial |
$699.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.92
|
| Rate for Payer: Cigna of WY Commercial |
$721.28
|
| Rate for Payer: First Choice Health Commercial |
$662.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.22
|
| Rate for Payer: HealthUtah PPO |
$736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.92
|
| Rate for Payer: Multiplan Medicare/VA |
$119.19
|
| Rate for Payer: One Health Plan of WY PPO |
$721.28
|
| Rate for Payer: PacificSource Commercial |
$662.40
|
| Rate for Payer: PHCS PPO |
$699.20
|
| Rate for Payer: Three Rivers PPO |
$552.00
|
| Rate for Payer: TriWest Veterans Administration |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$640.32
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
| Rate for Payer: WINHealth Partners Commercial |
$625.60
|
|
|
HC PRO LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
9831204201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$160.70 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$958.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$773.22
|
| Rate for Payer: Aetna of WY Medicare |
$189.06
|
| Rate for Payer: Aetna of WY Medicare |
$189.06
|
| Rate for Payer: Beech Street Commercial |
$749.55
|
| Rate for Payer: Beech Street Commercial |
$929.10
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$948.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$765.33
|
| Rate for Payer: Cigna of WY Commercial |
$773.22
|
| Rate for Payer: Cigna of WY Commercial |
$958.44
|
| Rate for Payer: First Choice Health Commercial |
$710.10
|
| Rate for Payer: First Choice Health Commercial |
$880.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$749.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.06
|
| Rate for Payer: HealthUtah PPO |
$978.00
|
| Rate for Payer: HealthUtah PPO |
$789.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$948.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$765.33
|
| Rate for Payer: Multiplan Medicare/VA |
$160.70
|
| Rate for Payer: Multiplan Medicare/VA |
$160.70
|
| Rate for Payer: One Health Plan of WY PPO |
$958.44
|
| Rate for Payer: One Health Plan of WY PPO |
$773.22
|
| Rate for Payer: PacificSource Commercial |
$710.10
|
| Rate for Payer: PacificSource Commercial |
$880.20
|
| Rate for Payer: PHCS PPO |
$929.10
|
| Rate for Payer: PHCS PPO |
$749.55
|
| Rate for Payer: Three Rivers PPO |
$733.50
|
| Rate for Payer: Three Rivers PPO |
$591.75
|
| Rate for Payer: TriWest Veterans Administration |
$189.06
|
| Rate for Payer: TriWest Veterans Administration |
$189.06
|
| Rate for Payer: United Healthcare Commercial |
$686.43
|
| Rate for Payer: United Healthcare Commercial |
$850.86
|
| Rate for Payer: United Healthcare Medicare |
$189.06
|
| Rate for Payer: United Healthcare Medicare |
$189.06
|
| Rate for Payer: WINHealth Partners Commercial |
$831.30
|
| Rate for Payer: WINHealth Partners Commercial |
$670.65
|
|
|
HC PRO LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 12042 NONPBBPAYER
|
| Hospital Charge Code |
9831204201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$160.70 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$966.28
|
| Rate for Payer: Aetna of WY Medicare |
$189.06
|
| Rate for Payer: Beech Street Commercial |
$936.70
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$956.42
|
| Rate for Payer: Cigna of WY Commercial |
$966.28
|
| Rate for Payer: First Choice Health Commercial |
$887.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$936.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.06
|
| Rate for Payer: HealthUtah PPO |
$986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$956.42
|
| Rate for Payer: Multiplan Medicare/VA |
$160.70
|
| Rate for Payer: One Health Plan of WY PPO |
$966.28
|
| Rate for Payer: PacificSource Commercial |
$887.40
|
| Rate for Payer: PHCS PPO |
$936.70
|
| Rate for Payer: Three Rivers PPO |
$739.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.06
|
| Rate for Payer: United Healthcare Commercial |
$857.82
|
| Rate for Payer: United Healthcare Medicare |
$189.06
|
| Rate for Payer: WINHealth Partners Commercial |
$838.10
|
|
