|
HC PRO OFFICE OUTPATIENT NEW 30-44 MINUTES
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 99203 NONPBBPAYER
|
| Hospital Charge Code |
9839920301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$290.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$78.53
|
| Rate for Payer: Beech Street Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: First Choice Health Commercial |
$266.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.53
|
| Rate for Payer: HealthUtah PPO |
$115.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$66.75
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$281.20
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.53
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$78.53
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
|
|
HC PRO OFFICE OUTPATIENT NEW 45-59 MINUTES
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 99204
|
| Hospital Charge Code |
9839920401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$316.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$127.94
|
| Rate for Payer: Beech Street Commercial |
$306.85
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: First Choice Health Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.94
|
| Rate for Payer: HealthUtah PPO |
$164.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$108.75
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$306.85
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.94
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$127.94
|
| Rate for Payer: WINHealth Partners Commercial |
$306.85
|
|
|
HC PRO OFFICE OUTPATIENT NEW 45-59 MINUTES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99204 NONPBBPAYER
|
| Hospital Charge Code |
9839920401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$395.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$127.94
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.94
|
| Rate for Payer: HealthUtah PPO |
$164.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$108.75
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.94
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$127.94
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
|
|
HC PRO OFFICE OUTPATIENT NEW 60-74 MINUTES
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
9839920501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$428.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.26
|
| Rate for Payer: Aetna of WY Medicare |
$174.00
|
| Rate for Payer: Beech Street Commercial |
$415.15
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$423.89
|
| Rate for Payer: Cigna of WY Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$210.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$423.89
|
| Rate for Payer: Multiplan Medicare/VA |
$147.90
|
| Rate for Payer: One Health Plan of WY PPO |
$428.26
|
| Rate for Payer: PacificSource Commercial |
$393.30
|
| Rate for Payer: PHCS PPO |
$415.15
|
| Rate for Payer: Three Rivers PPO |
$327.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$380.19
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$415.15
|
|
|
HC PRO OFFICE OUTPATIENT NEW 60-74 MINUTES
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 99205 NONPBBPAYER
|
| Hospital Charge Code |
9839920501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$535.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$174.00
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$210.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Multiplan Medicare/VA |
$147.90
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$475.02
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$518.70
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 10-19 MINUTES
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
9839921201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$103.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$100.70
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: First Choice Health Commercial |
$95.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$45.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$100.70
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$92.22
|
| Rate for Payer: United Healthcare Medicare |
$33.87
|
| Rate for Payer: WINHealth Partners Commercial |
$100.70
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 10-19 MINUTES
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 99212 NONPBBPAYER
|
| Hospital Charge Code |
9839921201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: First Choice Health Commercial |
$118.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$45.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$125.40
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$33.87
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 20-29 MINUTES
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
9839921301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$63.32
|
| Rate for Payer: Beech Street Commercial |
$123.50
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: First Choice Health Commercial |
$117.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.32
|
| Rate for Payer: HealthUtah PPO |
$63.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$53.82
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$123.50
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.32
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$63.32
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 20-29 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99213 NONPBBPAYER
|
| Hospital Charge Code |
9839921301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$159.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$63.32
|
| Rate for Payer: Beech Street Commercial |
$154.85
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: First Choice Health Commercial |
$146.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.32
|
| Rate for Payer: HealthUtah PPO |
$63.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$53.82
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$154.85
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$63.32
|
| Rate for Payer: United Healthcare Commercial |
$141.81
|
| Rate for Payer: United Healthcare Medicare |
$63.32
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 30-39 MINUTES
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
9839921401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Beech Street Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: First Choice Health Commercial |
$172.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: HealthUtah PPO |
$99.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$182.40
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
|
|
HC PRO OFFICE OUTPATIENT VISIT EST 30-39 MINUTES
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99214 NONPBBPAYER
|
| Hospital Charge Code |
9839921401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: HealthUtah PPO |
$99.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
HC PRO OPEN IMPLTJ HPGLSL NRV NSTIM RA PG & RESPIR SENSOR
|
Professional
|
Both
|
$2,827.00
|
|
|
Service Code
|
HCPCS 64582
|
| Hospital Charge Code |
9756458201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$684.62 |
| Max. Negotiated Rate |
$2,827.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,770.46
|
| Rate for Payer: Aetna of WY Medicare |
$805.43
|
| Rate for Payer: Beech Street Commercial |
$2,685.65
|
| Rate for Payer: Cash Price |
$1,978.90
|
| Rate for Payer: Cash Price |
$1,978.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,742.19
|
| Rate for Payer: Cigna of WY Commercial |
$2,770.46
|
| Rate for Payer: First Choice Health Commercial |
$2,544.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,685.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$805.43
|
| Rate for Payer: HealthUtah PPO |
$2,827.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,742.19
|
| Rate for Payer: Multiplan Medicare/VA |
$684.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,770.46
|
| Rate for Payer: PacificSource Commercial |
$2,544.30
|
| Rate for Payer: PHCS PPO |
$2,685.65
|
| Rate for Payer: Three Rivers PPO |
$2,120.25
|
| Rate for Payer: TriWest Veterans Administration |
$805.43
|
| Rate for Payer: United Healthcare Commercial |
$2,459.49
|
| Rate for Payer: United Healthcare Medicare |
$805.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,402.95
|
|
|
HC PRO OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE
|
Professional
|
Both
|
$3,943.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
9752552501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.95 |
| Max. Negotiated Rate |
$3,943.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,864.14
|
| Rate for Payer: Aetna of WY Medicare |
$770.53
|
| Rate for Payer: Beech Street Commercial |
$3,745.85
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,824.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,864.14
|
| Rate for Payer: First Choice Health Commercial |
$3,548.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,745.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.53
|
| Rate for Payer: HealthUtah PPO |
$3,943.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,824.71
|
| Rate for Payer: Multiplan Medicare/VA |
$654.95
|
| Rate for Payer: One Health Plan of WY PPO |
$3,864.14
|
| Rate for Payer: PacificSource Commercial |
$3,548.70
|
| Rate for Payer: PHCS PPO |
$3,745.85
|
| Rate for Payer: Three Rivers PPO |
$2,957.25
|
| Rate for Payer: TriWest Veterans Administration |
$770.53
|
| Rate for Payer: United Healthcare Commercial |
$3,430.41
|
| Rate for Payer: United Healthcare Medicare |
$770.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,351.55
|
|
|
HC PRO OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$5,779.00
|
|
|
Service Code
|
HCPCS 28415
|
| Hospital Charge Code |
9752841501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$923.22 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,663.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,086.14
|
| Rate for Payer: Beech Street Commercial |
$5,490.05
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,605.63
|
| Rate for Payer: Cigna of WY Commercial |
$5,663.42
|
| Rate for Payer: First Choice Health Commercial |
$5,201.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,490.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,086.14
|
| Rate for Payer: HealthUtah PPO |
$5,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,605.63
|
| Rate for Payer: Multiplan Medicare/VA |
$923.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5,663.42
|
| Rate for Payer: PacificSource Commercial |
$5,201.10
|
| Rate for Payer: PHCS PPO |
$5,490.05
|
| Rate for Payer: Three Rivers PPO |
$4,334.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,086.14
|
| Rate for Payer: United Healthcare Commercial |
$5,027.73
|
| Rate for Payer: United Healthcare Medicare |
$1,086.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,912.15
|
|
|
HC PRO OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
Both
|
$6,270.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
9752782801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,088.40 |
| Max. Negotiated Rate |
$6,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,144.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,280.47
|
| Rate for Payer: Beech Street Commercial |
$5,956.50
|
| Rate for Payer: Cash Price |
$4,389.00
|
| Rate for Payer: Cash Price |
$4,389.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,081.90
|
| Rate for Payer: Cigna of WY Commercial |
$6,144.60
|
| Rate for Payer: First Choice Health Commercial |
$5,643.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,956.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,280.47
|
| Rate for Payer: HealthUtah PPO |
$6,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,081.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,088.40
|
| Rate for Payer: One Health Plan of WY PPO |
$6,144.60
|
| Rate for Payer: PacificSource Commercial |
$5,643.00
|
| Rate for Payer: PHCS PPO |
$5,956.50
|
| Rate for Payer: Three Rivers PPO |
$4,702.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,280.47
|
| Rate for Payer: United Healthcare Commercial |
$5,454.90
|
| Rate for Payer: United Healthcare Medicare |
$1,280.47
|
| Rate for Payer: WINHealth Partners Commercial |
$5,329.50
|
|
|
HC PRO OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY
|
Professional
|
Both
|
$5,733.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
9752782701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$5,733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,618.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,084.92
|
| Rate for Payer: Beech Street Commercial |
$5,446.35
|
| Rate for Payer: Cash Price |
$4,013.10
|
| Rate for Payer: Cash Price |
$4,013.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,561.01
|
| Rate for Payer: Cigna of WY Commercial |
$5,618.34
|
| Rate for Payer: First Choice Health Commercial |
$5,159.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,446.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.92
|
| Rate for Payer: HealthUtah PPO |
$5,733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,561.01
|
| Rate for Payer: Multiplan Medicare/VA |
$922.18
|
| Rate for Payer: One Health Plan of WY PPO |
$5,618.34
|
| Rate for Payer: PacificSource Commercial |
$5,159.70
|
| Rate for Payer: PHCS PPO |
$5,446.35
|
| Rate for Payer: Three Rivers PPO |
$4,299.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.92
|
| Rate for Payer: United Healthcare Commercial |
$4,987.71
|
| Rate for Payer: United Healthcare Medicare |
$1,084.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,873.05
|
|
|
HC PRO OPEN TREATMENT GREATER TROCHANTERIC FRACTURE
|
Professional
|
Both
|
$3,854.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
9752724801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$611.29 |
| Max. Negotiated Rate |
$3,854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,776.92
|
| Rate for Payer: Aetna of WY Medicare |
$719.17
|
| Rate for Payer: Beech Street Commercial |
$3,661.30
|
| Rate for Payer: Cash Price |
$2,697.80
|
| Rate for Payer: Cash Price |
$2,697.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,738.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,776.92
|
| Rate for Payer: First Choice Health Commercial |
$3,468.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,661.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$719.17
|
| Rate for Payer: HealthUtah PPO |
$3,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,738.38
|
| Rate for Payer: Multiplan Medicare/VA |
$611.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3,776.92
|
| Rate for Payer: PacificSource Commercial |
$3,468.60
|
| Rate for Payer: PHCS PPO |
$3,661.30
|
| Rate for Payer: Three Rivers PPO |
$2,890.50
|
| Rate for Payer: TriWest Veterans Administration |
$719.17
|
| Rate for Payer: United Healthcare Commercial |
$3,352.98
|
| Rate for Payer: United Healthcare Medicare |
$719.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3,275.90
|
|
|
HC PRO OPEN TREATMENT HUMERAL CONDYLAR FRACTURE
|
Professional
|
Both
|
$2,896.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
9752457901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.62 |
| Max. Negotiated Rate |
$2,896.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,838.08
|
| Rate for Payer: Aetna of WY Medicare |
$811.32
|
| Rate for Payer: Beech Street Commercial |
$2,751.20
|
| Rate for Payer: Cash Price |
$2,027.20
|
| Rate for Payer: Cash Price |
$2,027.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,809.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,838.08
|
| Rate for Payer: First Choice Health Commercial |
$2,606.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,751.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.32
|
| Rate for Payer: HealthUtah PPO |
$2,896.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,809.12
|
| Rate for Payer: Multiplan Medicare/VA |
$689.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,838.08
|
| Rate for Payer: PacificSource Commercial |
$2,606.40
|
| Rate for Payer: PHCS PPO |
$2,751.20
|
| Rate for Payer: Three Rivers PPO |
$2,172.00
|
| Rate for Payer: TriWest Veterans Administration |
$811.32
|
| Rate for Payer: United Healthcare Commercial |
$2,519.52
|
| Rate for Payer: United Healthcare Medicare |
$811.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2,461.60
|
|
|
HC PRO OPEN TREATMENT OF ANKLE FRACTU
|
Professional
|
Both
|
$3,044.00
|
|
|
Service Code
|
HCPCS 27792 NONPBBPAYER
|
| Hospital Charge Code |
9832779201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$534.31 |
| Max. Negotiated Rate |
$3,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,983.12
|
| Rate for Payer: Aetna of WY Medicare |
$628.60
|
| Rate for Payer: Beech Street Commercial |
$2,891.80
|
| Rate for Payer: Cash Price |
$2,130.80
|
| Rate for Payer: Cash Price |
$2,130.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,952.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,983.12
|
| Rate for Payer: First Choice Health Commercial |
$2,739.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,891.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$628.60
|
| Rate for Payer: HealthUtah PPO |
$3,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,952.68
|
| Rate for Payer: Multiplan Medicare/VA |
$534.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2,983.12
|
| Rate for Payer: PacificSource Commercial |
$2,739.60
|
| Rate for Payer: PHCS PPO |
$2,891.80
|
| Rate for Payer: Three Rivers PPO |
$2,283.00
|
| Rate for Payer: TriWest Veterans Administration |
$628.60
|
| Rate for Payer: United Healthcare Commercial |
$2,648.28
|
| Rate for Payer: United Healthcare Medicare |
$628.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,587.40
|
|
|
HC PRO OPEN TREATMENT OF ANKLE FRACTU
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
9832779201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$534.31 |
| Max. Negotiated Rate |
$2,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,386.30
|
| Rate for Payer: Aetna of WY Medicare |
$628.60
|
| Rate for Payer: Beech Street Commercial |
$2,313.25
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,361.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,386.30
|
| Rate for Payer: First Choice Health Commercial |
$2,191.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,313.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$628.60
|
| Rate for Payer: HealthUtah PPO |
$2,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,361.95
|
| Rate for Payer: Multiplan Medicare/VA |
$534.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2,386.30
|
| Rate for Payer: PacificSource Commercial |
$2,191.50
|
| Rate for Payer: PHCS PPO |
$2,313.25
|
| Rate for Payer: Three Rivers PPO |
$1,826.25
|
| Rate for Payer: TriWest Veterans Administration |
$628.60
|
| Rate for Payer: United Healthcare Commercial |
$2,118.45
|
| Rate for Payer: United Healthcare Medicare |
$628.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,069.75
|
|
|
HC PRO OPEN TREATMENT OF ULNAR SHAFT FRACTURE
|
Professional
|
Both
|
$2,187.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
9832554501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$520.83 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,143.26
|
| Rate for Payer: Aetna of WY Medicare |
$612.74
|
| Rate for Payer: Beech Street Commercial |
$2,077.65
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,121.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,143.26
|
| Rate for Payer: First Choice Health Commercial |
$1,968.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,077.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$612.74
|
| Rate for Payer: HealthUtah PPO |
$2,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,121.39
|
| Rate for Payer: Multiplan Medicare/VA |
$520.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,143.26
|
| Rate for Payer: PacificSource Commercial |
$1,968.30
|
| Rate for Payer: PHCS PPO |
$2,077.65
|
| Rate for Payer: Three Rivers PPO |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$612.74
|
| Rate for Payer: United Healthcare Commercial |
$1,902.69
|
| Rate for Payer: United Healthcare Medicare |
$612.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,858.95
|
|
|
HC PRO OPEN TREATMENT RADIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,341.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
9752551501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$557.65 |
| Max. Negotiated Rate |
$2,341.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,294.18
|
| Rate for Payer: Aetna of WY Medicare |
$656.06
|
| Rate for Payer: Beech Street Commercial |
$2,223.95
|
| Rate for Payer: Cash Price |
$1,638.70
|
| Rate for Payer: Cash Price |
$1,638.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,270.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,294.18
|
| Rate for Payer: First Choice Health Commercial |
$2,106.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.06
|
| Rate for Payer: HealthUtah PPO |
$2,341.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,270.77
|
| Rate for Payer: Multiplan Medicare/VA |
$557.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,294.18
|
| Rate for Payer: PacificSource Commercial |
$2,106.90
|
| Rate for Payer: PHCS PPO |
$2,223.95
|
| Rate for Payer: Three Rivers PPO |
$1,755.75
|
| Rate for Payer: TriWest Veterans Administration |
$656.06
|
| Rate for Payer: United Healthcare Commercial |
$2,036.67
|
| Rate for Payer: United Healthcare Medicare |
$656.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,989.85
|
|
|
HC PRO OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,771.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
9752355001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.27 |
| Max. Negotiated Rate |
$2,771.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,715.58
|
| Rate for Payer: Aetna of WY Medicare |
$559.14
|
| Rate for Payer: Beech Street Commercial |
$2,632.45
|
| Rate for Payer: Cash Price |
$1,939.70
|
| Rate for Payer: Cash Price |
$1,939.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,687.87
|
| Rate for Payer: Cigna of WY Commercial |
$2,715.58
|
| Rate for Payer: First Choice Health Commercial |
$2,493.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,632.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$559.14
|
| Rate for Payer: HealthUtah PPO |
$2,771.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,687.87
|
| Rate for Payer: Multiplan Medicare/VA |
$475.27
|
| Rate for Payer: One Health Plan of WY PPO |
$2,715.58
|
| Rate for Payer: PacificSource Commercial |
$2,493.90
|
| Rate for Payer: PHCS PPO |
$2,632.45
|
| Rate for Payer: Three Rivers PPO |
$2,078.25
|
| Rate for Payer: TriWest Veterans Administration |
$559.14
|
| Rate for Payer: United Healthcare Commercial |
$2,410.77
|
| Rate for Payer: United Healthcare Medicare |
$559.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,355.35
|
|
|
HC PRO OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA
|
Professional
|
Both
|
$2,583.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
9752674601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$615.37 |
| Max. Negotiated Rate |
$2,583.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,531.34
|
| Rate for Payer: Aetna of WY Medicare |
$723.97
|
| Rate for Payer: Beech Street Commercial |
$2,453.85
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,505.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,531.34
|
| Rate for Payer: First Choice Health Commercial |
$2,324.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,453.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.97
|
| Rate for Payer: HealthUtah PPO |
$2,583.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,505.51
|
| Rate for Payer: Multiplan Medicare/VA |
$615.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,531.34
|
| Rate for Payer: PacificSource Commercial |
$2,324.70
|
| Rate for Payer: PHCS PPO |
$2,453.85
|
| Rate for Payer: Three Rivers PPO |
$1,937.25
|
| Rate for Payer: TriWest Veterans Administration |
$723.97
|
| Rate for Payer: United Healthcare Commercial |
$2,247.21
|
| Rate for Payer: United Healthcare Medicare |
$723.97
|
| Rate for Payer: WINHealth Partners Commercial |
$2,195.55
|
|
|
HC PRO OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE
|
Professional
|
Both
|
$3,711.00
|
|
|
Service Code
|
HCPCS 25628
|
| Hospital Charge Code |
9832562801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$3,711.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,636.78
|
| Rate for Payer: Aetna of WY Medicare |
$701.96
|
| Rate for Payer: Beech Street Commercial |
$3,525.45
|
| Rate for Payer: Cash Price |
$2,597.70
|
| Rate for Payer: Cash Price |
$2,597.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,599.67
|
| Rate for Payer: Cigna of WY Commercial |
$3,636.78
|
| Rate for Payer: First Choice Health Commercial |
$3,339.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,525.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$701.96
|
| Rate for Payer: HealthUtah PPO |
$3,711.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,599.67
|
| Rate for Payer: Multiplan Medicare/VA |
$596.67
|
| Rate for Payer: One Health Plan of WY PPO |
$3,636.78
|
| Rate for Payer: PacificSource Commercial |
$3,339.90
|
| Rate for Payer: PHCS PPO |
$3,525.45
|
| Rate for Payer: Three Rivers PPO |
$2,783.25
|
| Rate for Payer: TriWest Veterans Administration |
$701.96
|
| Rate for Payer: United Healthcare Commercial |
$3,228.57
|
| Rate for Payer: United Healthcare Medicare |
$701.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,154.35
|
|
