|
HC PRO NASAL/SINUS TOTAL ETHOIDECTOM BILAT
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 31255 50
|
| Hospital Charge Code |
9833125501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,156.00
|
| Rate for Payer: Aetna of WY Medicare |
$308.23
|
| Rate for Payer: Beech Street Commercial |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,134.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,156.00
|
| Rate for Payer: First Choice Health Commercial |
$1,980.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,090.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.23
|
| Rate for Payer: HealthUtah PPO |
$2,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,134.00
|
| Rate for Payer: Multiplan Medicare/VA |
$262.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,156.00
|
| Rate for Payer: PacificSource Commercial |
$1,980.00
|
| Rate for Payer: PHCS PPO |
$2,090.00
|
| Rate for Payer: Three Rivers PPO |
$1,650.00
|
| Rate for Payer: TriWest Veterans Administration |
$308.23
|
| Rate for Payer: United Healthcare Commercial |
$1,914.00
|
| Rate for Payer: United Healthcare Medicare |
$308.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,870.00
|
|
|
HC PRO NASAL SINUS WITH REMOVAL OF TISSUE
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 31253
|
| Hospital Charge Code |
9833125301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$404.63 |
| Max. Negotiated Rate |
$2,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,241.26
|
| Rate for Payer: Aetna of WY Medicare |
$476.04
|
| Rate for Payer: Beech Street Commercial |
$2,172.65
|
| Rate for Payer: Cash Price |
$1,600.90
|
| Rate for Payer: Cash Price |
$1,600.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,218.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,241.26
|
| Rate for Payer: First Choice Health Commercial |
$2,058.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,172.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.04
|
| Rate for Payer: HealthUtah PPO |
$2,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,218.39
|
| Rate for Payer: Multiplan Medicare/VA |
$404.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,241.26
|
| Rate for Payer: PacificSource Commercial |
$2,058.30
|
| Rate for Payer: PHCS PPO |
$2,172.65
|
| Rate for Payer: Three Rivers PPO |
$1,715.25
|
| Rate for Payer: TriWest Veterans Administration |
$476.04
|
| Rate for Payer: United Healthcare Commercial |
$1,989.69
|
| Rate for Payer: United Healthcare Medicare |
$476.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,943.95
|
|
|
HC PRO NASOPHARYNGOSCOPY W ENDOSCOPE
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 92511
|
| Hospital Charge Code |
9839251101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Aetna of WY Medicare |
$36.66
|
| Rate for Payer: Beech Street Commercial |
$477.85
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: First Choice Health Commercial |
$452.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.66
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$31.16
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$477.85
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.66
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$36.66
|
| Rate for Payer: WINHealth Partners Commercial |
$477.85
|
|
|
HC PRO NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
9835171501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$189.49
|
| Rate for Payer: Beech Street Commercial |
$1,197.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: First Choice Health Commercial |
$1,134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.49
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$161.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,197.00
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$189.49
|
| Rate for Payer: United Healthcare Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare Medicare |
$189.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,071.00
|
|
|
HC PRO NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$2,630.00
|
|
|
Service Code
|
HCPCS 29848
|
| Hospital Charge Code |
9832984801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$2,630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,577.40
|
| Rate for Payer: Aetna of WY Medicare |
$502.92
|
| Rate for Payer: Beech Street Commercial |
$2,498.50
|
| Rate for Payer: Cash Price |
$1,841.00
|
| Rate for Payer: Cash Price |
$1,841.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,551.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,577.40
|
| Rate for Payer: First Choice Health Commercial |
$2,367.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,498.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$502.92
|
| Rate for Payer: HealthUtah PPO |
$2,630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,551.10
|
| Rate for Payer: Multiplan Medicare/VA |
$427.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,577.40
|
| Rate for Payer: PacificSource Commercial |
$2,367.00
|
| Rate for Payer: PHCS PPO |
$2,498.50
|
| Rate for Payer: Three Rivers PPO |
$1,972.50
|
| Rate for Payer: TriWest Veterans Administration |
$502.92
|
| Rate for Payer: United Healthcare Commercial |
$2,288.10
|
| Rate for Payer: United Healthcare Medicare |
$502.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,235.50
|
|
|
HC PRO NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$5,260.00
|
|
|
Service Code
|
HCPCS 29848 50
|
| Hospital Charge Code |
9832984801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,154.80
|
| Rate for Payer: Aetna of WY Medicare |
$502.92
|
| Rate for Payer: Beech Street Commercial |
$4,997.00
|
| Rate for Payer: Cash Price |
$3,682.00
|
| Rate for Payer: Cash Price |
$3,682.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,102.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,154.80
|
| Rate for Payer: First Choice Health Commercial |
$4,734.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,997.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$502.92
|
| Rate for Payer: HealthUtah PPO |
$5,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,102.20
|
| Rate for Payer: Multiplan Medicare/VA |
$427.48
|
| Rate for Payer: One Health Plan of WY PPO |
$5,154.80
|
| Rate for Payer: PacificSource Commercial |
$4,734.00
|
| Rate for Payer: PHCS PPO |
$4,997.00
|
| Rate for Payer: Three Rivers PPO |
$3,945.00
|
| Rate for Payer: TriWest Veterans Administration |
$502.92
|
| Rate for Payer: United Healthcare Commercial |
$4,576.20
|
| Rate for Payer: United Healthcare Medicare |
$502.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,471.00
|
|
|
HC PRO NEEDLE BIOPSY LIVER ADD-ON
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
9834700101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$96.51
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.51
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.51
|
| Rate for Payer: United Healthcare Commercial |
$468.06
|
| Rate for Payer: United Healthcare Medicare |
$96.51
|
| Rate for Payer: WINHealth Partners Commercial |
$457.30
|
|
|
HC PRO NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM PRO
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 97605 NONPBBPAYER
|
| Hospital Charge Code |
9839760501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$423.36
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$419.04
|
| Rate for Payer: Cigna of WY Commercial |
$423.36
|
| Rate for Payer: First Choice Health Commercial |
$388.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$419.04
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$423.36
|
| Rate for Payer: PacificSource Commercial |
$388.80
|
| Rate for Payer: PHCS PPO |
$410.40
|
| Rate for Payer: Three Rivers PPO |
$324.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$375.84
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$410.40
|
|
|
HC PRO NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM PRO
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
9839760501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.08
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$328.70
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.62
|
| Rate for Payer: Cigna of WY Commercial |
$339.08
|
| Rate for Payer: First Choice Health Commercial |
$311.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.62
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$339.08
|
| Rate for Payer: PacificSource Commercial |
$311.40
|
| Rate for Payer: PHCS PPO |
$328.70
|
| Rate for Payer: Three Rivers PPO |
$259.50
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$301.02
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$328.70
|
|
|
HC PRO NERVE REPAIR W/ALLOGRAFT OR SYNTH
|
Professional
|
Both
|
$4,073.00
|
|
|
Service Code
|
HCPCS 64910
|
| Hospital Charge Code |
9836491001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$626.37 |
| Max. Negotiated Rate |
$4,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,991.54
|
| Rate for Payer: Aetna of WY Medicare |
$736.91
|
| Rate for Payer: Beech Street Commercial |
$3,869.35
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,950.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,991.54
|
| Rate for Payer: First Choice Health Commercial |
$3,665.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,869.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.91
|
| Rate for Payer: HealthUtah PPO |
$4,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,950.81
|
| Rate for Payer: Multiplan Medicare/VA |
$626.37
|
| Rate for Payer: One Health Plan of WY PPO |
$3,991.54
|
| Rate for Payer: PacificSource Commercial |
$3,665.70
|
| Rate for Payer: PHCS PPO |
$3,869.35
|
| Rate for Payer: Three Rivers PPO |
$3,054.75
|
| Rate for Payer: TriWest Veterans Administration |
$736.91
|
| Rate for Payer: United Healthcare Commercial |
$3,543.51
|
| Rate for Payer: United Healthcare Medicare |
$736.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.05
|
|
|
HC PRO NERVOUS SYSTEM SURGERY UNLISTED
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
9836499901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,132.50 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,479.80
|
| Rate for Payer: Beech Street Commercial |
$1,434.50
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,464.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,479.80
|
| Rate for Payer: First Choice Health Commercial |
$1,359.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,434.50
|
| Rate for Payer: HealthUtah PPO |
$1,510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,464.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,479.80
|
| Rate for Payer: PacificSource Commercial |
$1,359.00
|
| Rate for Payer: PHCS PPO |
$1,434.50
|
| Rate for Payer: Three Rivers PPO |
$1,132.50
|
| Rate for Payer: United Healthcare Commercial |
$1,313.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,283.50
|
|
|
HC PRO NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01967
|
| Hospital Charge Code |
9640196701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| 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: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| 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: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO NEUROPLASTY BRACHIAL PLEXUS,OPEN
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 64713
|
| Hospital Charge Code |
9836471301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$656.29 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,613.26
|
| Rate for Payer: Aetna of WY Medicare |
$772.11
|
| Rate for Payer: Beech Street Commercial |
$3,502.65
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,576.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,613.26
|
| Rate for Payer: First Choice Health Commercial |
$3,318.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,502.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$772.11
|
| Rate for Payer: HealthUtah PPO |
$3,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,576.39
|
| Rate for Payer: Multiplan Medicare/VA |
$656.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3,613.26
|
| Rate for Payer: PacificSource Commercial |
$3,318.30
|
| Rate for Payer: PHCS PPO |
$3,502.65
|
| Rate for Payer: Three Rivers PPO |
$2,765.25
|
| Rate for Payer: TriWest Veterans Administration |
$772.11
|
| Rate for Payer: United Healthcare Commercial |
$3,207.69
|
| Rate for Payer: United Healthcare Medicare |
$772.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,133.95
|
|
|
HC PRO NEUROPLASTY OTHER ARM/LEG NERVE,OPEN
|
Professional
|
Both
|
$2,599.00
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
9836470801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$423.09 |
| Max. Negotiated Rate |
$2,599.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,547.02
|
| Rate for Payer: Aetna of WY Medicare |
$497.75
|
| Rate for Payer: Beech Street Commercial |
$2,469.05
|
| Rate for Payer: Cash Price |
$1,819.30
|
| Rate for Payer: Cash Price |
$1,819.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,521.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,547.02
|
| Rate for Payer: First Choice Health Commercial |
$2,339.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,469.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.75
|
| Rate for Payer: HealthUtah PPO |
$2,599.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,521.03
|
| Rate for Payer: Multiplan Medicare/VA |
$423.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,547.02
|
| Rate for Payer: PacificSource Commercial |
$2,339.10
|
| Rate for Payer: PHCS PPO |
$2,469.05
|
| Rate for Payer: Three Rivers PPO |
$1,949.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.75
|
| Rate for Payer: United Healthcare Commercial |
$2,261.13
|
| Rate for Payer: United Healthcare Medicare |
$497.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,209.15
|
|
|
HC PRO NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
9826471901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,034.48
|
| Rate for Payer: Aetna of WY Medicare |
$399.70
|
| Rate for Payer: Beech Street Commercial |
$1,972.20
|
| Rate for Payer: Cash Price |
$1,453.20
|
| Rate for Payer: Cash Price |
$1,453.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,013.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,034.48
|
| Rate for Payer: First Choice Health Commercial |
$1,868.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,972.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.70
|
| Rate for Payer: HealthUtah PPO |
$2,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,013.72
|
| Rate for Payer: Multiplan Medicare/VA |
$339.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,034.48
|
| Rate for Payer: PacificSource Commercial |
$1,868.40
|
| Rate for Payer: PHCS PPO |
$1,972.20
|
| Rate for Payer: Three Rivers PPO |
$1,557.00
|
| Rate for Payer: TriWest Veterans Administration |
$399.70
|
| Rate for Payer: United Healthcare Commercial |
$1,806.12
|
| Rate for Payer: United Healthcare Medicare |
$399.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.60
|
|
|
HC PRO NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
9836472101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$364.79 |
| Max. Negotiated Rate |
$2,217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,172.66
|
| Rate for Payer: Aetna of WY Medicare |
$429.16
|
| Rate for Payer: Beech Street Commercial |
$2,106.15
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,150.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,172.66
|
| Rate for Payer: First Choice Health Commercial |
$1,995.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,106.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.16
|
| Rate for Payer: HealthUtah PPO |
$2,217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,150.49
|
| Rate for Payer: Multiplan Medicare/VA |
$364.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,172.66
|
| Rate for Payer: PacificSource Commercial |
$1,995.30
|
| Rate for Payer: PHCS PPO |
$2,106.15
|
| Rate for Payer: Three Rivers PPO |
$1,662.75
|
| Rate for Payer: TriWest Veterans Administration |
$429.16
|
| Rate for Payer: United Healthcare Commercial |
$1,928.79
|
| Rate for Payer: United Healthcare Medicare |
$429.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,884.45
|
|
|
HC PRO NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL
|
Professional
|
Both
|
$4,434.00
|
|
|
Service Code
|
HCPCS 64721 50
|
| Hospital Charge Code |
9836472101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$364.79 |
| Max. Negotiated Rate |
$4,434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,345.32
|
| Rate for Payer: Aetna of WY Medicare |
$429.16
|
| Rate for Payer: Beech Street Commercial |
$4,212.30
|
| Rate for Payer: Cash Price |
$3,103.80
|
| Rate for Payer: Cash Price |
$3,103.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,300.98
|
| Rate for Payer: Cigna of WY Commercial |
$4,345.32
|
| Rate for Payer: First Choice Health Commercial |
$3,990.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,212.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.16
|
| Rate for Payer: HealthUtah PPO |
$4,434.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,300.98
|
| Rate for Payer: Multiplan Medicare/VA |
$364.79
|
| Rate for Payer: One Health Plan of WY PPO |
$4,345.32
|
| Rate for Payer: PacificSource Commercial |
$3,990.60
|
| Rate for Payer: PHCS PPO |
$4,212.30
|
| Rate for Payer: Three Rivers PPO |
$3,325.50
|
| Rate for Payer: TriWest Veterans Administration |
$429.16
|
| Rate for Payer: United Healthcare Commercial |
$3,857.58
|
| Rate for Payer: United Healthcare Medicare |
$429.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3,768.90
|
|
|
HC PRO NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 64480 50
|
| Hospital Charge Code |
9836448001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$938.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$919.24
|
| Rate for Payer: Aetna of WY Medicare |
$58.33
|
| Rate for Payer: Beech Street Commercial |
$891.10
|
| Rate for Payer: Cash Price |
$656.60
|
| Rate for Payer: Cash Price |
$656.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$909.86
|
| Rate for Payer: Cigna of WY Commercial |
$919.24
|
| Rate for Payer: First Choice Health Commercial |
$844.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$891.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.33
|
| Rate for Payer: HealthUtah PPO |
$938.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$909.86
|
| Rate for Payer: Multiplan Medicare/VA |
$49.58
|
| Rate for Payer: One Health Plan of WY PPO |
$919.24
|
| Rate for Payer: PacificSource Commercial |
$844.20
|
| Rate for Payer: PHCS PPO |
$891.10
|
| Rate for Payer: Three Rivers PPO |
$703.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.33
|
| Rate for Payer: United Healthcare Commercial |
$816.06
|
| Rate for Payer: United Healthcare Medicare |
$58.33
|
| Rate for Payer: WINHealth Partners Commercial |
$797.30
|
|
|
HC PRO NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
9836448001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$459.62
|
| Rate for Payer: Aetna of WY Medicare |
$58.33
|
| Rate for Payer: Beech Street Commercial |
$445.55
|
| Rate for Payer: Cash Price |
$328.30
|
| Rate for Payer: Cash Price |
$328.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$454.93
|
| Rate for Payer: Cigna of WY Commercial |
$459.62
|
| Rate for Payer: First Choice Health Commercial |
$422.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$445.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.33
|
| Rate for Payer: HealthUtah PPO |
$469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$454.93
|
| Rate for Payer: Multiplan Medicare/VA |
$49.58
|
| Rate for Payer: One Health Plan of WY PPO |
$459.62
|
| Rate for Payer: PacificSource Commercial |
$422.10
|
| Rate for Payer: PHCS PPO |
$445.55
|
| Rate for Payer: Three Rivers PPO |
$351.75
|
| Rate for Payer: TriWest Veterans Administration |
$58.33
|
| Rate for Payer: United Healthcare Commercial |
$408.03
|
| Rate for Payer: United Healthcare Medicare |
$58.33
|
| Rate for Payer: WINHealth Partners Commercial |
$398.65
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$1,128.00
|
|
|
Service Code
|
HCPCS 62325 50
|
| Hospital Charge Code |
9836232501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,105.44
|
| Rate for Payer: Aetna of WY Medicare |
$105.69
|
| Rate for Payer: Beech Street Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,094.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,105.44
|
| Rate for Payer: First Choice Health Commercial |
$1,015.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,071.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.69
|
| Rate for Payer: HealthUtah PPO |
$1,128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,094.16
|
| Rate for Payer: Multiplan Medicare/VA |
$89.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,105.44
|
| Rate for Payer: PacificSource Commercial |
$1,015.20
|
| Rate for Payer: PHCS PPO |
$1,071.60
|
| Rate for Payer: Three Rivers PPO |
$846.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.69
|
| Rate for Payer: United Healthcare Commercial |
$981.36
|
| Rate for Payer: United Healthcare Medicare |
$105.69
|
| Rate for Payer: WINHealth Partners Commercial |
$958.80
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
9836232501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.72
|
| Rate for Payer: Aetna of WY Medicare |
$105.69
|
| Rate for Payer: Beech Street Commercial |
$535.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$547.08
|
| Rate for Payer: Cigna of WY Commercial |
$552.72
|
| Rate for Payer: First Choice Health Commercial |
$507.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.69
|
| Rate for Payer: HealthUtah PPO |
$564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$547.08
|
| Rate for Payer: Multiplan Medicare/VA |
$89.84
|
| Rate for Payer: One Health Plan of WY PPO |
$552.72
|
| Rate for Payer: PacificSource Commercial |
$507.60
|
| Rate for Payer: PHCS PPO |
$535.80
|
| Rate for Payer: Three Rivers PPO |
$423.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.69
|
| Rate for Payer: United Healthcare Commercial |
$490.68
|
| Rate for Payer: United Healthcare Medicare |
$105.69
|
| Rate for Payer: WINHealth Partners Commercial |
$479.40
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 62321 50
|
| Hospital Charge Code |
9836232101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$1,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,089.76
|
| Rate for Payer: Aetna of WY Medicare |
$103.16
|
| Rate for Payer: Beech Street Commercial |
$1,056.40
|
| Rate for Payer: Cash Price |
$778.40
|
| Rate for Payer: Cash Price |
$778.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,078.64
|
| Rate for Payer: Cigna of WY Commercial |
$1,089.76
|
| Rate for Payer: First Choice Health Commercial |
$1,000.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,056.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.16
|
| Rate for Payer: HealthUtah PPO |
$1,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,078.64
|
| Rate for Payer: Multiplan Medicare/VA |
$87.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,089.76
|
| Rate for Payer: PacificSource Commercial |
$1,000.80
|
| Rate for Payer: PHCS PPO |
$1,056.40
|
| Rate for Payer: Three Rivers PPO |
$834.00
|
| Rate for Payer: TriWest Veterans Administration |
$103.16
|
| Rate for Payer: United Healthcare Commercial |
$967.44
|
| Rate for Payer: United Healthcare Medicare |
$103.16
|
| Rate for Payer: WINHealth Partners Commercial |
$945.20
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
9836232101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$544.88
|
| Rate for Payer: Aetna of WY Medicare |
$103.16
|
| Rate for Payer: Beech Street Commercial |
$528.20
|
| Rate for Payer: Cash Price |
$389.20
|
| Rate for Payer: Cash Price |
$389.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$539.32
|
| Rate for Payer: Cigna of WY Commercial |
$544.88
|
| Rate for Payer: First Choice Health Commercial |
$500.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$528.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.16
|
| Rate for Payer: HealthUtah PPO |
$556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$539.32
|
| Rate for Payer: Multiplan Medicare/VA |
$87.69
|
| Rate for Payer: One Health Plan of WY PPO |
$544.88
|
| Rate for Payer: PacificSource Commercial |
$500.40
|
| Rate for Payer: PHCS PPO |
$528.20
|
| Rate for Payer: Three Rivers PPO |
$417.00
|
| Rate for Payer: TriWest Veterans Administration |
$103.16
|
| Rate for Payer: United Healthcare Commercial |
$483.72
|
| Rate for Payer: United Healthcare Medicare |
$103.16
|
| Rate for Payer: WINHealth Partners Commercial |
$472.60
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 62324
|
| Hospital Charge Code |
9836232401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$454.72
|
| Rate for Payer: Aetna of WY Medicare |
$85.08
|
| Rate for Payer: Beech Street Commercial |
$440.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$450.08
|
| Rate for Payer: Cigna of WY Commercial |
$454.72
|
| Rate for Payer: First Choice Health Commercial |
$417.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.08
|
| Rate for Payer: HealthUtah PPO |
$464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$450.08
|
| Rate for Payer: Multiplan Medicare/VA |
$72.32
|
| Rate for Payer: One Health Plan of WY PPO |
$454.72
|
| Rate for Payer: PacificSource Commercial |
$417.60
|
| Rate for Payer: PHCS PPO |
$440.80
|
| Rate for Payer: Three Rivers PPO |
$348.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.08
|
| Rate for Payer: United Healthcare Commercial |
$403.68
|
| Rate for Payer: United Healthcare Medicare |
$85.08
|
| Rate for Payer: WINHealth Partners Commercial |
$394.40
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 62324 50
|
| Hospital Charge Code |
9836232401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$910.42
|
| Rate for Payer: Aetna of WY Medicare |
$85.08
|
| Rate for Payer: Beech Street Commercial |
$882.55
|
| Rate for Payer: Cash Price |
$650.30
|
| Rate for Payer: Cash Price |
$650.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$901.13
|
| Rate for Payer: Cigna of WY Commercial |
$910.42
|
| Rate for Payer: First Choice Health Commercial |
$836.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$882.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.08
|
| Rate for Payer: HealthUtah PPO |
$929.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$901.13
|
| Rate for Payer: Multiplan Medicare/VA |
$72.32
|
| Rate for Payer: One Health Plan of WY PPO |
$910.42
|
| Rate for Payer: PacificSource Commercial |
$836.10
|
| Rate for Payer: PHCS PPO |
$882.55
|
| Rate for Payer: Three Rivers PPO |
$696.75
|
| Rate for Payer: TriWest Veterans Administration |
$85.08
|
| Rate for Payer: United Healthcare Commercial |
$808.23
|
| Rate for Payer: United Healthcare Medicare |
$85.08
|
| Rate for Payer: WINHealth Partners Commercial |
$789.65
|
|
