|
HC PRO LAYR CLOS WND REST BODY 7.6-12.5 CM
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
9831204401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$840.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,591.52
|
| Rate for Payer: Aetna of WY Medicare |
$206.37
|
| Rate for Payer: Aetna of WY Medicare |
$206.37
|
| Rate for Payer: Beech Street Commercial |
$1,542.80
|
| Rate for Payer: Beech Street Commercial |
$815.10
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$832.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,575.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,591.52
|
| Rate for Payer: Cigna of WY Commercial |
$840.84
|
| Rate for Payer: First Choice Health Commercial |
$1,461.60
|
| Rate for Payer: First Choice Health Commercial |
$772.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$815.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,542.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.37
|
| Rate for Payer: HealthUtah PPO |
$858.00
|
| Rate for Payer: HealthUtah PPO |
$1,624.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$832.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,575.28
|
| Rate for Payer: Multiplan Medicare/VA |
$175.41
|
| Rate for Payer: Multiplan Medicare/VA |
$175.41
|
| Rate for Payer: One Health Plan of WY PPO |
$840.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,591.52
|
| Rate for Payer: PacificSource Commercial |
$1,461.60
|
| Rate for Payer: PacificSource Commercial |
$772.20
|
| Rate for Payer: PHCS PPO |
$815.10
|
| Rate for Payer: PHCS PPO |
$1,542.80
|
| Rate for Payer: Three Rivers PPO |
$643.50
|
| Rate for Payer: Three Rivers PPO |
$1,218.00
|
| Rate for Payer: TriWest Veterans Administration |
$206.37
|
| Rate for Payer: TriWest Veterans Administration |
$206.37
|
| Rate for Payer: United Healthcare Commercial |
$1,412.88
|
| Rate for Payer: United Healthcare Commercial |
$746.46
|
| Rate for Payer: United Healthcare Medicare |
$206.37
|
| Rate for Payer: United Healthcare Medicare |
$206.37
|
| Rate for Payer: WINHealth Partners Commercial |
$729.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,380.40
|
|
|
HC PRO LAYR CLOS WND REST BODY 7.6-12.5 CM
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
HCPCS 12044 NONPBBPAYER
|
| Hospital Charge Code |
9831204401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$1,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,051.54
|
| Rate for Payer: Aetna of WY Medicare |
$206.37
|
| Rate for Payer: Beech Street Commercial |
$1,019.35
|
| Rate for Payer: Cash Price |
$751.10
|
| Rate for Payer: Cash Price |
$751.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,040.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,051.54
|
| Rate for Payer: First Choice Health Commercial |
$965.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,019.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.37
|
| Rate for Payer: HealthUtah PPO |
$1,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,040.81
|
| Rate for Payer: Multiplan Medicare/VA |
$175.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,051.54
|
| Rate for Payer: PacificSource Commercial |
$965.70
|
| Rate for Payer: PHCS PPO |
$1,019.35
|
| Rate for Payer: Three Rivers PPO |
$804.75
|
| Rate for Payer: TriWest Veterans Administration |
$206.37
|
| Rate for Payer: United Healthcare Commercial |
$933.51
|
| Rate for Payer: United Healthcare Medicare |
$206.37
|
| Rate for Payer: WINHealth Partners Commercial |
$912.05
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
9831203501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$196.93 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,579.76
|
| Rate for Payer: Aetna of WY Medicare |
$231.68
|
| Rate for Payer: Aetna of WY Medicare |
$231.68
|
| Rate for Payer: Beech Street Commercial |
$1,531.40
|
| Rate for Payer: Beech Street Commercial |
$917.70
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,563.64
|
| Rate for Payer: Cigna of WY Commercial |
$1,579.76
|
| Rate for Payer: Cigna of WY Commercial |
$946.68
|
| Rate for Payer: First Choice Health Commercial |
$1,450.80
|
| Rate for Payer: First Choice Health Commercial |
$869.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,531.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.68
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: HealthUtah PPO |
$1,612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,563.64
|
| Rate for Payer: Multiplan Medicare/VA |
$196.93
|
| Rate for Payer: Multiplan Medicare/VA |
$196.93
|
| Rate for Payer: One Health Plan of WY PPO |
$946.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,579.76
|
| Rate for Payer: PacificSource Commercial |
$1,450.80
|
| Rate for Payer: PacificSource Commercial |
$869.40
|
| Rate for Payer: PHCS PPO |
$917.70
|
| Rate for Payer: PHCS PPO |
$1,531.40
|
| Rate for Payer: Three Rivers PPO |
$724.50
|
| Rate for Payer: Three Rivers PPO |
$1,209.00
|
| Rate for Payer: TriWest Veterans Administration |
$231.68
|
| Rate for Payer: TriWest Veterans Administration |
$231.68
|
| Rate for Payer: United Healthcare Commercial |
$1,402.44
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$231.68
|
| Rate for Payer: United Healthcare Medicare |
$231.68
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,370.20
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 12035 NONPBBPAYER
|
| Hospital Charge Code |
9831203501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$196.93 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,182.86
|
| Rate for Payer: Aetna of WY Medicare |
$231.68
|
| Rate for Payer: Beech Street Commercial |
$1,146.65
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,170.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,182.86
|
| Rate for Payer: First Choice Health Commercial |
$1,086.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,146.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.68
|
| Rate for Payer: HealthUtah PPO |
$1,207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,170.79
|
| Rate for Payer: Multiplan Medicare/VA |
$196.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,182.86
|
| Rate for Payer: PacificSource Commercial |
$1,086.30
|
| Rate for Payer: PHCS PPO |
$1,146.65
|
| Rate for Payer: Three Rivers PPO |
$905.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.68
|
| Rate for Payer: United Healthcare Commercial |
$1,050.09
|
| Rate for Payer: United Healthcare Medicare |
$231.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,025.95
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 12031 NONPBBPAYER
|
| Hospital Charge Code |
9831203101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$745.78
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Beech Street Commercial |
$722.95
|
| Rate for Payer: Cash Price |
$532.70
|
| Rate for Payer: Cash Price |
$532.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$738.17
|
| Rate for Payer: Cigna of WY Commercial |
$745.78
|
| Rate for Payer: First Choice Health Commercial |
$684.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$722.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.52
|
| Rate for Payer: HealthUtah PPO |
$761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$738.17
|
| Rate for Payer: Multiplan Medicare/VA |
$124.54
|
| Rate for Payer: One Health Plan of WY PPO |
$745.78
|
| Rate for Payer: PacificSource Commercial |
$684.90
|
| Rate for Payer: PHCS PPO |
$722.95
|
| Rate for Payer: Three Rivers PPO |
$570.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.52
|
| Rate for Payer: United Healthcare Commercial |
$662.07
|
| Rate for Payer: United Healthcare Medicare |
$146.52
|
| Rate for Payer: WINHealth Partners Commercial |
$646.85
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
9831203101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$757.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$741.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$596.82
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Beech Street Commercial |
$578.55
|
| Rate for Payer: Beech Street Commercial |
$719.15
|
| Rate for Payer: Cash Price |
$426.30
|
| Rate for Payer: Cash Price |
$426.30
|
| Rate for Payer: Cash Price |
$529.90
|
| Rate for Payer: Cash Price |
$529.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$734.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$590.73
|
| Rate for Payer: Cigna of WY Commercial |
$596.82
|
| Rate for Payer: Cigna of WY Commercial |
$741.86
|
| Rate for Payer: First Choice Health Commercial |
$548.10
|
| Rate for Payer: First Choice Health Commercial |
$681.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$719.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$578.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.52
|
| Rate for Payer: HealthUtah PPO |
$757.00
|
| Rate for Payer: HealthUtah PPO |
$609.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$734.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$590.73
|
| Rate for Payer: Multiplan Medicare/VA |
$124.54
|
| Rate for Payer: Multiplan Medicare/VA |
$124.54
|
| Rate for Payer: One Health Plan of WY PPO |
$741.86
|
| Rate for Payer: One Health Plan of WY PPO |
$596.82
|
| Rate for Payer: PacificSource Commercial |
$548.10
|
| Rate for Payer: PacificSource Commercial |
$681.30
|
| Rate for Payer: PHCS PPO |
$719.15
|
| Rate for Payer: PHCS PPO |
$578.55
|
| Rate for Payer: Three Rivers PPO |
$567.75
|
| Rate for Payer: Three Rivers PPO |
$456.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.52
|
| Rate for Payer: TriWest Veterans Administration |
$146.52
|
| Rate for Payer: United Healthcare Commercial |
$529.83
|
| Rate for Payer: United Healthcare Commercial |
$658.59
|
| Rate for Payer: United Healthcare Medicare |
$146.52
|
| Rate for Payer: United Healthcare Medicare |
$146.52
|
| Rate for Payer: WINHealth Partners Commercial |
$643.45
|
| Rate for Payer: WINHealth Partners Commercial |
$517.65
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Professional
|
Both
|
$1,558.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
9831203201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,526.84
|
| Rate for Payer: Aetna of WY Medicare |
$184.16
|
| Rate for Payer: Beech Street Commercial |
$1,480.10
|
| Rate for Payer: Cash Price |
$1,090.60
|
| Rate for Payer: Cash Price |
$1,090.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,511.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,526.84
|
| Rate for Payer: First Choice Health Commercial |
$1,402.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,480.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.16
|
| Rate for Payer: HealthUtah PPO |
$1,558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,511.26
|
| Rate for Payer: Multiplan Medicare/VA |
$156.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,526.84
|
| Rate for Payer: PacificSource Commercial |
$1,402.20
|
| Rate for Payer: PHCS PPO |
$1,480.10
|
| Rate for Payer: Three Rivers PPO |
$1,168.50
|
| Rate for Payer: TriWest Veterans Administration |
$184.16
|
| Rate for Payer: United Healthcare Commercial |
$1,355.46
|
| Rate for Payer: United Healthcare Medicare |
$184.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,324.30
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
9831203401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$168.27 |
| Max. Negotiated Rate |
$1,255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,229.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$808.50
|
| Rate for Payer: Aetna of WY Medicare |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$197.96
|
| Rate for Payer: Beech Street Commercial |
$783.75
|
| Rate for Payer: Beech Street Commercial |
$1,192.25
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$800.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,217.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,229.90
|
| Rate for Payer: Cigna of WY Commercial |
$808.50
|
| Rate for Payer: First Choice Health Commercial |
$742.50
|
| Rate for Payer: First Choice Health Commercial |
$1,129.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,192.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$783.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.96
|
| Rate for Payer: HealthUtah PPO |
$1,255.00
|
| Rate for Payer: HealthUtah PPO |
$825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$800.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,217.35
|
| Rate for Payer: Multiplan Medicare/VA |
$168.27
|
| Rate for Payer: Multiplan Medicare/VA |
$168.27
|
| Rate for Payer: One Health Plan of WY PPO |
$808.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,229.90
|
| Rate for Payer: PacificSource Commercial |
$1,129.50
|
| Rate for Payer: PacificSource Commercial |
$742.50
|
| Rate for Payer: PHCS PPO |
$1,192.25
|
| Rate for Payer: PHCS PPO |
$783.75
|
| Rate for Payer: Three Rivers PPO |
$941.25
|
| Rate for Payer: Three Rivers PPO |
$618.75
|
| Rate for Payer: TriWest Veterans Administration |
$197.96
|
| Rate for Payer: TriWest Veterans Administration |
$197.96
|
| Rate for Payer: United Healthcare Commercial |
$717.75
|
| Rate for Payer: United Healthcare Commercial |
$1,091.85
|
| Rate for Payer: United Healthcare Medicare |
$197.96
|
| Rate for Payer: United Healthcare Medicare |
$197.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,066.75
|
| Rate for Payer: WINHealth Partners Commercial |
$701.25
|
|
|
HC PRO LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 12034 NONPBBPAYER
|
| Hospital Charge Code |
9831203401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$168.27 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,010.38
|
| Rate for Payer: Aetna of WY Medicare |
$197.96
|
| Rate for Payer: Beech Street Commercial |
$979.45
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,000.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,010.38
|
| Rate for Payer: First Choice Health Commercial |
$927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$979.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.96
|
| Rate for Payer: HealthUtah PPO |
$1,031.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,000.07
|
| Rate for Payer: Multiplan Medicare/VA |
$168.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,010.38
|
| Rate for Payer: PacificSource Commercial |
$927.90
|
| Rate for Payer: PHCS PPO |
$979.45
|
| Rate for Payer: Three Rivers PPO |
$773.25
|
| Rate for Payer: TriWest Veterans Administration |
$197.96
|
| Rate for Payer: United Healthcare Commercial |
$896.97
|
| Rate for Payer: United Healthcare Medicare |
$197.96
|
| Rate for Payer: WINHealth Partners Commercial |
$876.35
|
|
|
HC PRO LIGATION OR BX OF TEMPORAL ARTERY
|
Professional
|
Both
|
$2,141.00
|
|
|
Service Code
|
HCPCS 37609 50
|
| Hospital Charge Code |
9833760901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$165.41 |
| Max. Negotiated Rate |
$2,141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,098.18
|
| Rate for Payer: Aetna of WY Medicare |
$194.60
|
| Rate for Payer: Beech Street Commercial |
$2,033.95
|
| Rate for Payer: Cash Price |
$1,498.70
|
| Rate for Payer: Cash Price |
$1,498.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,076.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,098.18
|
| Rate for Payer: First Choice Health Commercial |
$1,926.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.60
|
| Rate for Payer: HealthUtah PPO |
$2,141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,076.77
|
| Rate for Payer: Multiplan Medicare/VA |
$165.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,098.18
|
| Rate for Payer: PacificSource Commercial |
$1,926.90
|
| Rate for Payer: PHCS PPO |
$2,033.95
|
| Rate for Payer: Three Rivers PPO |
$1,605.75
|
| Rate for Payer: TriWest Veterans Administration |
$194.60
|
| Rate for Payer: United Healthcare Commercial |
$1,862.67
|
| Rate for Payer: United Healthcare Medicare |
$194.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.85
|
|
|
HC PRO LIGATION OR BX OF TEMPORAL ARTERY
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
9833760901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$165.41 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$194.60
|
| Rate for Payer: Beech Street Commercial |
$1,017.45
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: First Choice Health Commercial |
$963.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.60
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$165.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,017.45
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.60
|
| Rate for Payer: United Healthcare Commercial |
$931.77
|
| Rate for Payer: United Healthcare Medicare |
$194.60
|
| Rate for Payer: WINHealth Partners Commercial |
$910.35
|
|
|
HC PRO LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
9835861101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,617.00
|
| Rate for Payer: Aetna of WY Medicare |
$71.62
|
| Rate for Payer: Beech Street Commercial |
$1,567.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,600.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,617.00
|
| Rate for Payer: First Choice Health Commercial |
$1,485.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,567.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.62
|
| Rate for Payer: HealthUtah PPO |
$1,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,600.50
|
| Rate for Payer: Multiplan Medicare/VA |
$60.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,617.00
|
| Rate for Payer: PacificSource Commercial |
$1,485.00
|
| Rate for Payer: PHCS PPO |
$1,567.50
|
| Rate for Payer: Three Rivers PPO |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.62
|
| Rate for Payer: United Healthcare Commercial |
$1,435.50
|
| Rate for Payer: United Healthcare Medicare |
$71.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
|
|
HC PRO LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
9832528001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$555.16
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$555.16
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$471.89
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$555.16
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$555.16
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
HC PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 99417
|
| Hospital Charge Code |
5109941701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
|
|
HC PRO LYSIS/EXCISION PENILE POST CIRCUMCISION LESION
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 54162 NONPBBPAYER
|
| Hospital Charge Code |
9835416201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$982.94
|
| Rate for Payer: Aetna of WY Medicare |
$193.70
|
| 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 |
$193.70
|
| Rate for Payer: HealthUtah PPO |
$1,003.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$972.91
|
| Rate for Payer: Multiplan Medicare/VA |
$164.64
|
| 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 |
$193.70
|
| Rate for Payer: United Healthcare Commercial |
$872.61
|
| Rate for Payer: United Healthcare Medicare |
$193.70
|
| Rate for Payer: WINHealth Partners Commercial |
$852.55
|
|
|
HC PRO LYSIS/EXCISION PENILE POST CIRCUMCISION LESION
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
9835416201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$785.96
|
| Rate for Payer: Aetna of WY Medicare |
$193.70
|
| Rate for Payer: Beech Street Commercial |
$761.90
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$777.94
|
| Rate for Payer: Cigna of WY Commercial |
$785.96
|
| Rate for Payer: First Choice Health Commercial |
$721.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.70
|
| Rate for Payer: HealthUtah PPO |
$802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$777.94
|
| Rate for Payer: Multiplan Medicare/VA |
$164.64
|
| Rate for Payer: One Health Plan of WY PPO |
$785.96
|
| Rate for Payer: PacificSource Commercial |
$721.80
|
| Rate for Payer: PHCS PPO |
$761.90
|
| Rate for Payer: Three Rivers PPO |
$601.50
|
| Rate for Payer: TriWest Veterans Administration |
$193.70
|
| Rate for Payer: United Healthcare Commercial |
$697.74
|
| Rate for Payer: United Healthcare Medicare |
$193.70
|
| Rate for Payer: WINHealth Partners Commercial |
$681.70
|
|
|
HC PRO MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
9832634001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$303.77 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$357.38
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$357.38
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$303.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$357.38
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$357.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
HC PRO MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
9832370001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$162.25 |
| Max. Negotiated Rate |
$806.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$789.88
|
| Rate for Payer: Aetna of WY Medicare |
$190.88
|
| 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 |
$190.88
|
| Rate for Payer: HealthUtah PPO |
$806.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$781.82
|
| Rate for Payer: Multiplan Medicare/VA |
$162.25
|
| 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 |
$190.88
|
| Rate for Payer: United Healthcare Commercial |
$701.22
|
| Rate for Payer: United Healthcare Medicare |
$190.88
|
| Rate for Payer: WINHealth Partners Commercial |
$685.10
|
|
|
HC PRO MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS
|
Professional
|
Both
|
$1,007.00
|
|
|
Service Code
|
HCPCS 23700 NONPBBPAYER
|
| Hospital Charge Code |
9832370001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$162.25 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$986.86
|
| Rate for Payer: Aetna of WY Medicare |
$190.88
|
| Rate for Payer: Beech Street Commercial |
$956.65
|
| Rate for Payer: Cash Price |
$704.90
|
| Rate for Payer: Cash Price |
$704.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$976.79
|
| Rate for Payer: Cigna of WY Commercial |
$986.86
|
| Rate for Payer: First Choice Health Commercial |
$906.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$956.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.88
|
| Rate for Payer: HealthUtah PPO |
$1,007.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$976.79
|
| Rate for Payer: Multiplan Medicare/VA |
$162.25
|
| Rate for Payer: One Health Plan of WY PPO |
$986.86
|
| Rate for Payer: PacificSource Commercial |
$906.30
|
| Rate for Payer: PHCS PPO |
$956.65
|
| Rate for Payer: Three Rivers PPO |
$755.25
|
| Rate for Payer: TriWest Veterans Administration |
$190.88
|
| Rate for Payer: United Healthcare Commercial |
$876.09
|
| Rate for Payer: United Healthcare Medicare |
$190.88
|
| Rate for Payer: WINHealth Partners Commercial |
$855.95
|
|
|
HC PRO MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
9835644001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Aetna of WY Medicare |
$175.66
|
| Rate for Payer: Beech Street Commercial |
$476.90
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: First Choice Health Commercial |
$451.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.66
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$149.31
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PHCS PPO |
$476.90
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.66
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Medicare |
$175.66
|
| Rate for Payer: WINHealth Partners Commercial |
$426.70
|
|
|
HC PRO MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 56440 NONPBBPAYER
|
| Hospital Charge Code |
9835644001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$614.46
|
| Rate for Payer: Aetna of WY Medicare |
$175.66
|
| Rate for Payer: Beech Street Commercial |
$595.65
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$608.19
|
| Rate for Payer: Cigna of WY Commercial |
$614.46
|
| Rate for Payer: First Choice Health Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$595.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.66
|
| Rate for Payer: HealthUtah PPO |
$627.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$608.19
|
| Rate for Payer: Multiplan Medicare/VA |
$149.31
|
| Rate for Payer: One Health Plan of WY PPO |
$614.46
|
| Rate for Payer: PacificSource Commercial |
$564.30
|
| Rate for Payer: PHCS PPO |
$595.65
|
| Rate for Payer: Three Rivers PPO |
$470.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.66
|
| Rate for Payer: United Healthcare Commercial |
$545.49
|
| Rate for Payer: United Healthcare Medicare |
$175.66
|
| Rate for Payer: WINHealth Partners Commercial |
$532.95
|
|
|
HC PRO MASTECTOMY MODF RADICAL W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$6,176.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
9831930701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$956.39 |
| Max. Negotiated Rate |
$6,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,052.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,125.17
|
| Rate for Payer: Beech Street Commercial |
$5,867.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,990.72
|
| Rate for Payer: Cigna of WY Commercial |
$6,052.48
|
| Rate for Payer: First Choice Health Commercial |
$5,558.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,867.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,125.17
|
| Rate for Payer: HealthUtah PPO |
$6,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,990.72
|
| Rate for Payer: Multiplan Medicare/VA |
$956.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,052.48
|
| Rate for Payer: PacificSource Commercial |
$5,558.40
|
| Rate for Payer: PHCS PPO |
$5,867.20
|
| Rate for Payer: Three Rivers PPO |
$4,632.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,125.17
|
| Rate for Payer: United Healthcare Commercial |
$5,373.12
|
| Rate for Payer: United Healthcare Medicare |
$1,125.17
|
| Rate for Payer: WINHealth Partners Commercial |
$5,249.60
|
|
|
HC PRO MASTECTOMY PARTIAL
|
Professional
|
Both
|
$3,363.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
9831930101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$536.10 |
| Max. Negotiated Rate |
$3,363.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,295.74
|
| Rate for Payer: Aetna of WY Medicare |
$630.71
|
| Rate for Payer: Beech Street Commercial |
$3,194.85
|
| Rate for Payer: Cash Price |
$2,354.10
|
| Rate for Payer: Cash Price |
$2,354.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,262.11
|
| Rate for Payer: Cigna of WY Commercial |
$3,295.74
|
| Rate for Payer: First Choice Health Commercial |
$3,026.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,194.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$630.71
|
| Rate for Payer: HealthUtah PPO |
$3,363.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,262.11
|
| Rate for Payer: Multiplan Medicare/VA |
$536.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,295.74
|
| Rate for Payer: PacificSource Commercial |
$3,026.70
|
| Rate for Payer: PHCS PPO |
$3,194.85
|
| Rate for Payer: Three Rivers PPO |
$2,522.25
|
| Rate for Payer: TriWest Veterans Administration |
$630.71
|
| Rate for Payer: United Healthcare Commercial |
$2,925.81
|
| Rate for Payer: United Healthcare Medicare |
$630.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2,858.55
|
|
|
HC PRO MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$4,913.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
9831930301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$776.42 |
| Max. Negotiated Rate |
$4,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,814.74
|
| Rate for Payer: Aetna of WY Medicare |
$913.43
|
| Rate for Payer: Beech Street Commercial |
$4,667.35
|
| Rate for Payer: Cash Price |
$3,439.10
|
| Rate for Payer: Cash Price |
$3,439.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,765.61
|
| Rate for Payer: Cigna of WY Commercial |
$4,814.74
|
| Rate for Payer: First Choice Health Commercial |
$4,421.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,667.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.43
|
| Rate for Payer: HealthUtah PPO |
$4,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,765.61
|
| Rate for Payer: Multiplan Medicare/VA |
$776.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4,814.74
|
| Rate for Payer: PacificSource Commercial |
$4,421.70
|
| Rate for Payer: PHCS PPO |
$4,667.35
|
| Rate for Payer: Three Rivers PPO |
$3,684.75
|
| Rate for Payer: TriWest Veterans Administration |
$913.43
|
| Rate for Payer: United Healthcare Commercial |
$4,274.31
|
| Rate for Payer: United Healthcare Medicare |
$913.43
|
| Rate for Payer: WINHealth Partners Commercial |
$4,176.05
|
|
|
HC PRO MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$9,826.00
|
|
|
Service Code
|
HCPCS 19303 50
|
| Hospital Charge Code |
9831930301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$776.42 |
| Max. Negotiated Rate |
$9,826.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,629.48
|
| Rate for Payer: Aetna of WY Medicare |
$913.43
|
| Rate for Payer: Beech Street Commercial |
$9,334.70
|
| Rate for Payer: Cash Price |
$6,878.20
|
| Rate for Payer: Cash Price |
$6,878.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,531.22
|
| Rate for Payer: Cigna of WY Commercial |
$9,629.48
|
| Rate for Payer: First Choice Health Commercial |
$8,843.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,334.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.43
|
| Rate for Payer: HealthUtah PPO |
$9,826.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,531.22
|
| Rate for Payer: Multiplan Medicare/VA |
$776.42
|
| Rate for Payer: One Health Plan of WY PPO |
$9,629.48
|
| Rate for Payer: PacificSource Commercial |
$8,843.40
|
| Rate for Payer: PHCS PPO |
$9,334.70
|
| Rate for Payer: Three Rivers PPO |
$7,369.50
|
| Rate for Payer: TriWest Veterans Administration |
$913.43
|
| Rate for Payer: United Healthcare Commercial |
$8,548.62
|
| Rate for Payer: United Healthcare Medicare |
$913.43
|
| Rate for Payer: WINHealth Partners Commercial |
$8,352.10
|
|
