|
HC PRO OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$6,505.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
9752557401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.12 |
| Max. Negotiated Rate |
$6,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,374.90
|
| Rate for Payer: Aetna of WY Medicare |
$660.14
|
| Rate for Payer: Beech Street Commercial |
$6,179.75
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,309.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,374.90
|
| Rate for Payer: First Choice Health Commercial |
$5,854.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,179.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.14
|
| Rate for Payer: HealthUtah PPO |
$6,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,309.85
|
| Rate for Payer: Multiplan Medicare/VA |
$561.12
|
| Rate for Payer: One Health Plan of WY PPO |
$6,374.90
|
| Rate for Payer: PacificSource Commercial |
$5,854.50
|
| Rate for Payer: PHCS PPO |
$6,179.75
|
| Rate for Payer: Three Rivers PPO |
$4,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.14
|
| Rate for Payer: United Healthcare Commercial |
$5,659.35
|
| Rate for Payer: United Healthcare Medicare |
$660.14
|
| Rate for Payer: WINHealth Partners Commercial |
$5,529.25
|
|
|
HC PRO OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
|
Professional
|
Both
|
$3,064.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
9832181101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$472.78 |
| Max. Negotiated Rate |
$3,064.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,002.72
|
| Rate for Payer: Aetna of WY Medicare |
$556.21
|
| Rate for Payer: Beech Street Commercial |
$2,910.80
|
| Rate for Payer: Cash Price |
$2,144.80
|
| Rate for Payer: Cash Price |
$2,144.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,972.08
|
| Rate for Payer: Cigna of WY Commercial |
$3,002.72
|
| Rate for Payer: First Choice Health Commercial |
$2,757.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,910.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$556.21
|
| Rate for Payer: HealthUtah PPO |
$3,064.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,972.08
|
| Rate for Payer: Multiplan Medicare/VA |
$472.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,002.72
|
| Rate for Payer: PacificSource Commercial |
$2,757.60
|
| Rate for Payer: PHCS PPO |
$2,910.80
|
| Rate for Payer: Three Rivers PPO |
$2,298.00
|
| Rate for Payer: TriWest Veterans Administration |
$556.21
|
| Rate for Payer: United Healthcare Commercial |
$2,665.68
|
| Rate for Payer: United Healthcare Medicare |
$556.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2,604.40
|
|
|
HC PRO OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD
|
Professional
|
Both
|
$3,361.00
|
|
|
Service Code
|
HCPCS 23585
|
| Hospital Charge Code |
9832358501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$800.72 |
| Max. Negotiated Rate |
$3,361.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,293.78
|
| Rate for Payer: Aetna of WY Medicare |
$942.02
|
| Rate for Payer: Beech Street Commercial |
$3,192.95
|
| Rate for Payer: Cash Price |
$2,352.70
|
| Rate for Payer: Cash Price |
$2,352.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,260.17
|
| Rate for Payer: Cigna of WY Commercial |
$3,293.78
|
| Rate for Payer: First Choice Health Commercial |
$3,024.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,192.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$942.02
|
| Rate for Payer: HealthUtah PPO |
$3,361.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,260.17
|
| Rate for Payer: Multiplan Medicare/VA |
$800.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,293.78
|
| Rate for Payer: PacificSource Commercial |
$3,024.90
|
| Rate for Payer: PHCS PPO |
$3,192.95
|
| Rate for Payer: Three Rivers PPO |
$2,520.75
|
| Rate for Payer: TriWest Veterans Administration |
$942.02
|
| Rate for Payer: United Healthcare Commercial |
$2,924.07
|
| Rate for Payer: United Healthcare Medicare |
$942.02
|
| Rate for Payer: WINHealth Partners Commercial |
$2,856.85
|
|
|
HC PRO OPEN TX TBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$3,076.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
9832753501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$732.69 |
| Max. Negotiated Rate |
$3,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,014.48
|
| Rate for Payer: Aetna of WY Medicare |
$861.99
|
| Rate for Payer: Beech Street Commercial |
$2,922.20
|
| Rate for Payer: Cash Price |
$2,153.20
|
| Rate for Payer: Cash Price |
$2,153.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,983.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,014.48
|
| Rate for Payer: First Choice Health Commercial |
$2,768.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,922.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$861.99
|
| Rate for Payer: HealthUtah PPO |
$3,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,983.72
|
| Rate for Payer: Multiplan Medicare/VA |
$732.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,014.48
|
| Rate for Payer: PacificSource Commercial |
$2,768.40
|
| Rate for Payer: PHCS PPO |
$2,922.20
|
| Rate for Payer: Three Rivers PPO |
$2,307.00
|
| Rate for Payer: TriWest Veterans Administration |
$861.99
|
| Rate for Payer: United Healthcare Commercial |
$2,676.12
|
| Rate for Payer: United Healthcare Medicare |
$861.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,614.60
|
|
|
HC PRO OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
9832782301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,956.50 |
| Max. Negotiated Rate |
$3,942.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,863.16
|
| Rate for Payer: Beech Street Commercial |
$3,744.90
|
| Rate for Payer: Cash Price |
$2,759.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,823.74
|
| Rate for Payer: Cigna of WY Commercial |
$3,863.16
|
| Rate for Payer: First Choice Health Commercial |
$3,547.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,744.90
|
| Rate for Payer: HealthUtah PPO |
$3,942.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,823.74
|
| Rate for Payer: One Health Plan of WY PPO |
$3,863.16
|
| Rate for Payer: PacificSource Commercial |
$3,547.80
|
| Rate for Payer: PHCS PPO |
$3,744.90
|
| Rate for Payer: Three Rivers PPO |
$2,956.50
|
| Rate for Payer: United Healthcare Commercial |
$3,429.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,350.70
|
|
|
HC PRO OPEN TX TRIMALL FX
|
Professional
|
Both
|
$4,473.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
9832782201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$721.46 |
| Max. Negotiated Rate |
$4,473.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,383.54
|
| Rate for Payer: Aetna of WY Medicare |
$848.78
|
| Rate for Payer: Beech Street Commercial |
$4,249.35
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,338.81
|
| Rate for Payer: Cigna of WY Commercial |
$4,383.54
|
| Rate for Payer: First Choice Health Commercial |
$4,025.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,249.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$848.78
|
| Rate for Payer: HealthUtah PPO |
$4,473.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,338.81
|
| Rate for Payer: Multiplan Medicare/VA |
$721.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,383.54
|
| Rate for Payer: PacificSource Commercial |
$4,025.70
|
| Rate for Payer: PHCS PPO |
$4,249.35
|
| Rate for Payer: Three Rivers PPO |
$3,354.75
|
| Rate for Payer: TriWest Veterans Administration |
$848.78
|
| Rate for Payer: United Healthcare Commercial |
$3,891.51
|
| Rate for Payer: United Healthcare Medicare |
$848.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.05
|
|
|
HC PRO OPEN TX ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,283.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
9832468501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$543.69 |
| Max. Negotiated Rate |
$2,283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,237.34
|
| Rate for Payer: Aetna of WY Medicare |
$639.63
|
| Rate for Payer: Beech Street Commercial |
$2,168.85
|
| Rate for Payer: Cash Price |
$1,598.10
|
| Rate for Payer: Cash Price |
$1,598.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,214.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,237.34
|
| Rate for Payer: First Choice Health Commercial |
$2,054.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,168.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$639.63
|
| Rate for Payer: HealthUtah PPO |
$2,283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,214.51
|
| Rate for Payer: Multiplan Medicare/VA |
$543.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,237.34
|
| Rate for Payer: PacificSource Commercial |
$2,054.70
|
| Rate for Payer: PHCS PPO |
$2,168.85
|
| Rate for Payer: Three Rivers PPO |
$1,712.25
|
| Rate for Payer: TriWest Veterans Administration |
$639.63
|
| Rate for Payer: United Healthcare Commercial |
$1,986.21
|
| Rate for Payer: United Healthcare Medicare |
$639.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1,940.55
|
|
|
HC PRO OPEN TX ULNA STYLOID FRACTURE
|
Professional
|
Both
|
$8,004.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
9832565201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$518.94 |
| Max. Negotiated Rate |
$8,004.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,843.92
|
| Rate for Payer: Aetna of WY Medicare |
$610.52
|
| Rate for Payer: Beech Street Commercial |
$7,603.80
|
| Rate for Payer: Cash Price |
$5,602.80
|
| Rate for Payer: Cash Price |
$5,602.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,763.88
|
| Rate for Payer: Cigna of WY Commercial |
$7,843.92
|
| Rate for Payer: First Choice Health Commercial |
$7,203.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,603.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.52
|
| Rate for Payer: HealthUtah PPO |
$8,004.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,763.88
|
| Rate for Payer: Multiplan Medicare/VA |
$518.94
|
| Rate for Payer: One Health Plan of WY PPO |
$7,843.92
|
| Rate for Payer: PacificSource Commercial |
$7,203.60
|
| Rate for Payer: PHCS PPO |
$7,603.80
|
| Rate for Payer: Three Rivers PPO |
$6,003.00
|
| Rate for Payer: TriWest Veterans Administration |
$610.52
|
| Rate for Payer: United Healthcare Commercial |
$6,963.48
|
| Rate for Payer: United Healthcare Medicare |
$610.52
|
| Rate for Payer: WINHealth Partners Commercial |
$6,803.40
|
|
|
HC PRO OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
9752355201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,157.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,093.86
|
| Rate for Payer: Aetna of WY Medicare |
$633.39
|
| Rate for Payer: Beech Street Commercial |
$2,999.15
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,062.29
|
| Rate for Payer: Cigna of WY Commercial |
$3,093.86
|
| Rate for Payer: First Choice Health Commercial |
$2,841.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,999.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.39
|
| Rate for Payer: HealthUtah PPO |
$3,157.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,062.29
|
| Rate for Payer: Multiplan Medicare/VA |
$538.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,093.86
|
| Rate for Payer: PacificSource Commercial |
$2,841.30
|
| Rate for Payer: PHCS PPO |
$2,999.15
|
| Rate for Payer: Three Rivers PPO |
$2,367.75
|
| Rate for Payer: TriWest Veterans Administration |
$633.39
|
| Rate for Payer: United Healthcare Commercial |
$2,746.59
|
| Rate for Payer: United Healthcare Medicare |
$633.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,683.45
|
|
|
HC PRO OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,882.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
9752560801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$686.38 |
| Max. Negotiated Rate |
$2,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,824.36
|
| Rate for Payer: Aetna of WY Medicare |
$807.51
|
| Rate for Payer: Beech Street Commercial |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,795.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,824.36
|
| Rate for Payer: First Choice Health Commercial |
$2,593.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,737.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.51
|
| Rate for Payer: HealthUtah PPO |
$2,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,795.54
|
| Rate for Payer: Multiplan Medicare/VA |
$686.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,824.36
|
| Rate for Payer: PacificSource Commercial |
$2,593.80
|
| Rate for Payer: PHCS PPO |
$2,737.90
|
| Rate for Payer: Three Rivers PPO |
$2,161.50
|
| Rate for Payer: TriWest Veterans Administration |
$807.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.34
|
| Rate for Payer: United Healthcare Medicare |
$807.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.70
|
|
|
HC PRO OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
9752723601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$975.54 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,013.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,147.70
|
| Rate for Payer: Beech Street Commercial |
$3,890.25
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,972.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,013.10
|
| Rate for Payer: First Choice Health Commercial |
$3,685.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,890.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,147.70
|
| Rate for Payer: HealthUtah PPO |
$4,095.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,972.15
|
| Rate for Payer: Multiplan Medicare/VA |
$975.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,013.10
|
| Rate for Payer: PacificSource Commercial |
$3,685.50
|
| Rate for Payer: PHCS PPO |
$3,890.25
|
| Rate for Payer: Three Rivers PPO |
$3,071.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,147.70
|
| Rate for Payer: United Healthcare Commercial |
$3,562.65
|
| Rate for Payer: United Healthcare Medicare |
$1,147.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,480.75
|
|
|
HC PRO OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$6,901.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
9752750601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,093.57 |
| Max. Negotiated Rate |
$6,901.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,762.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,286.55
|
| Rate for Payer: Beech Street Commercial |
$6,555.95
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,693.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,762.98
|
| Rate for Payer: First Choice Health Commercial |
$6,210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,555.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,286.55
|
| Rate for Payer: HealthUtah PPO |
$6,901.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,693.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,093.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,762.98
|
| Rate for Payer: PacificSource Commercial |
$6,210.90
|
| Rate for Payer: PHCS PPO |
$6,555.95
|
| Rate for Payer: Three Rivers PPO |
$5,175.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,286.55
|
| Rate for Payer: United Healthcare Commercial |
$6,003.87
|
| Rate for Payer: United Healthcare Medicare |
$1,286.55
|
| Rate for Payer: WINHealth Partners Commercial |
$5,865.85
|
|
|
HC PRO OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
9832756601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$734.04 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,020.36
|
| Rate for Payer: Aetna of WY Medicare |
$863.58
|
| Rate for Payer: Beech Street Commercial |
$2,927.90
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,989.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,020.36
|
| Rate for Payer: First Choice Health Commercial |
$2,773.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$863.58
|
| Rate for Payer: HealthUtah PPO |
$3,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,989.54
|
| Rate for Payer: Multiplan Medicare/VA |
$734.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,020.36
|
| Rate for Payer: PacificSource Commercial |
$2,773.80
|
| Rate for Payer: PHCS PPO |
$2,927.90
|
| Rate for Payer: Three Rivers PPO |
$2,311.50
|
| Rate for Payer: TriWest Veterans Administration |
$863.58
|
| Rate for Payer: United Healthcare Commercial |
$2,681.34
|
| Rate for Payer: United Healthcare Medicare |
$863.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,619.70
|
|
|
HC PRO OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
9752775801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$867.78
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.78
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$737.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$867.78
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$867.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
HC PRO ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$1,639.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
9835452001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$270.04 |
| Max. Negotiated Rate |
$1,639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,606.22
|
| Rate for Payer: Aetna of WY Medicare |
$317.69
|
| Rate for Payer: Beech Street Commercial |
$1,557.05
|
| Rate for Payer: Cash Price |
$1,147.30
|
| Rate for Payer: Cash Price |
$1,147.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,589.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,606.22
|
| Rate for Payer: First Choice Health Commercial |
$1,475.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,557.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.69
|
| Rate for Payer: HealthUtah PPO |
$1,639.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,589.83
|
| Rate for Payer: Multiplan Medicare/VA |
$270.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,606.22
|
| Rate for Payer: PacificSource Commercial |
$1,475.10
|
| Rate for Payer: PHCS PPO |
$1,557.05
|
| Rate for Payer: Three Rivers PPO |
$1,229.25
|
| Rate for Payer: TriWest Veterans Administration |
$317.69
|
| Rate for Payer: United Healthcare Commercial |
$1,425.93
|
| Rate for Payer: United Healthcare Medicare |
$317.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,393.15
|
|
|
HC PRO ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
9835464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$352.19 |
| Max. Negotiated Rate |
$2,186.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,142.28
|
| Rate for Payer: Aetna of WY Medicare |
$414.34
|
| Rate for Payer: Beech Street Commercial |
$2,076.70
|
| Rate for Payer: Cash Price |
$1,530.20
|
| Rate for Payer: Cash Price |
$1,530.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,120.42
|
| Rate for Payer: Cigna of WY Commercial |
$2,142.28
|
| Rate for Payer: First Choice Health Commercial |
$1,967.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,076.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.34
|
| Rate for Payer: HealthUtah PPO |
$2,186.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,120.42
|
| Rate for Payer: Multiplan Medicare/VA |
$352.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,142.28
|
| Rate for Payer: PacificSource Commercial |
$1,967.40
|
| Rate for Payer: PHCS PPO |
$2,076.70
|
| Rate for Payer: Three Rivers PPO |
$1,639.50
|
| Rate for Payer: TriWest Veterans Administration |
$414.34
|
| Rate for Payer: United Healthcare Commercial |
$1,901.82
|
| Rate for Payer: United Healthcare Medicare |
$414.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,858.10
|
|
|
HC PRO OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
9832828801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$362.87 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,196.18
|
| Rate for Payer: Aetna of WY Medicare |
$426.91
|
| Rate for Payer: Beech Street Commercial |
$2,128.95
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,173.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,196.18
|
| Rate for Payer: First Choice Health Commercial |
$2,016.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.91
|
| Rate for Payer: HealthUtah PPO |
$2,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,173.77
|
| Rate for Payer: Multiplan Medicare/VA |
$362.87
|
| Rate for Payer: One Health Plan of WY PPO |
$2,196.18
|
| Rate for Payer: PacificSource Commercial |
$2,016.90
|
| Rate for Payer: PHCS PPO |
$2,128.95
|
| Rate for Payer: Three Rivers PPO |
$1,680.75
|
| Rate for Payer: TriWest Veterans Administration |
$426.91
|
| Rate for Payer: United Healthcare Commercial |
$1,949.67
|
| Rate for Payer: United Healthcare Medicare |
$426.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,904.85
|
|
|
HC PRO OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
9822811901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$303.41 |
| Max. Negotiated Rate |
$1,867.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,829.66
|
| Rate for Payer: Aetna of WY Medicare |
$356.95
|
| Rate for Payer: Beech Street Commercial |
$1,773.65
|
| Rate for Payer: Cash Price |
$1,306.90
|
| Rate for Payer: Cash Price |
$1,306.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,810.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,829.66
|
| Rate for Payer: First Choice Health Commercial |
$1,680.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,773.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.95
|
| Rate for Payer: HealthUtah PPO |
$1,867.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,810.99
|
| Rate for Payer: Multiplan Medicare/VA |
$303.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,829.66
|
| Rate for Payer: PacificSource Commercial |
$1,680.30
|
| Rate for Payer: PHCS PPO |
$1,773.65
|
| Rate for Payer: Three Rivers PPO |
$1,400.25
|
| Rate for Payer: TriWest Veterans Administration |
$356.95
|
| Rate for Payer: United Healthcare Commercial |
$1,624.29
|
| Rate for Payer: United Healthcare Medicare |
$356.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,586.95
|
|
|
HC PRO OSTECTOMY PRTL 5TH METAR HEAD SPX
|
Professional
|
Both
|
$5,848.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
9832811001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$244.79 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,731.04
|
| Rate for Payer: Aetna of WY Medicare |
$287.99
|
| Rate for Payer: Beech Street Commercial |
$5,555.60
|
| Rate for Payer: Cash Price |
$4,093.60
|
| Rate for Payer: Cash Price |
$4,093.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,672.56
|
| Rate for Payer: Cigna of WY Commercial |
$5,731.04
|
| Rate for Payer: First Choice Health Commercial |
$5,263.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,555.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.99
|
| Rate for Payer: HealthUtah PPO |
$5,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,672.56
|
| Rate for Payer: Multiplan Medicare/VA |
$244.79
|
| Rate for Payer: One Health Plan of WY PPO |
$5,731.04
|
| Rate for Payer: PacificSource Commercial |
$5,263.20
|
| Rate for Payer: PHCS PPO |
$5,555.60
|
| Rate for Payer: Three Rivers PPO |
$4,386.00
|
| Rate for Payer: TriWest Veterans Administration |
$287.99
|
| Rate for Payer: United Healthcare Commercial |
$5,087.76
|
| Rate for Payer: United Healthcare Medicare |
$287.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,970.80
|
|
|
HC PRO OSTEOPATHIC MANIP,1-2 BODY REGN
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
9839892501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.58
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$22.01
|
| Rate for Payer: Aetna of WY Medicare |
$22.01
|
| Rate for Payer: Beech Street Commercial |
$95.95
|
| Rate for Payer: Beech Street Commercial |
$114.95
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Cigna of WY Commercial |
$118.58
|
| Rate for Payer: First Choice Health Commercial |
$90.90
|
| Rate for Payer: First Choice Health Commercial |
$108.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.01
|
| Rate for Payer: HealthUtah PPO |
$121.00
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$18.71
|
| Rate for Payer: Multiplan Medicare/VA |
$18.71
|
| Rate for Payer: One Health Plan of WY PPO |
$118.58
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PacificSource Commercial |
$108.90
|
| Rate for Payer: PHCS PPO |
$114.95
|
| Rate for Payer: PHCS PPO |
$95.95
|
| Rate for Payer: Three Rivers PPO |
$90.75
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$22.01
|
| Rate for Payer: TriWest Veterans Administration |
$22.01
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Commercial |
$105.27
|
| Rate for Payer: United Healthcare Medicare |
$22.01
|
| Rate for Payer: United Healthcare Medicare |
$22.01
|
| Rate for Payer: WINHealth Partners Commercial |
$114.95
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
|
|
HC PRO OSTEOPATHIC MANIP,1-2 BODY REGN
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 98925 NONPBBPAYER
|
| Hospital Charge Code |
9839892501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$22.01
|
| Rate for Payer: Beech Street Commercial |
$119.70
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: First Choice Health Commercial |
$113.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.01
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$18.71
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$119.70
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.01
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Medicare |
$22.01
|
| Rate for Payer: WINHealth Partners Commercial |
$119.70
|
|
|
HC PRO OSTEOPATHIC MANIP,3-4 BODY REGN
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
9839892601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$194.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$33.38
|
| Rate for Payer: Aetna of WY Medicare |
$33.38
|
| Rate for Payer: Beech Street Commercial |
$104.50
|
| Rate for Payer: Beech Street Commercial |
$188.10
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$192.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Cigna of WY Commercial |
$194.04
|
| Rate for Payer: First Choice Health Commercial |
$99.00
|
| Rate for Payer: First Choice Health Commercial |
$178.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.38
|
| Rate for Payer: HealthUtah PPO |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$192.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$28.37
|
| Rate for Payer: Multiplan Medicare/VA |
$28.37
|
| Rate for Payer: One Health Plan of WY PPO |
$194.04
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PacificSource Commercial |
$178.20
|
| Rate for Payer: PHCS PPO |
$188.10
|
| Rate for Payer: PHCS PPO |
$104.50
|
| Rate for Payer: Three Rivers PPO |
$148.50
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.38
|
| Rate for Payer: TriWest Veterans Administration |
$33.38
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$172.26
|
| Rate for Payer: United Healthcare Medicare |
$33.38
|
| Rate for Payer: United Healthcare Medicare |
$33.38
|
| Rate for Payer: WINHealth Partners Commercial |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
|
|
HC PRO OSTEOPATHIC MANIP,3-4 BODY REGN
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 98926 NONPBBPAYER
|
| Hospital Charge Code |
9839892601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$33.38
|
| Rate for Payer: Beech Street Commercial |
$130.15
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: First Choice Health Commercial |
$123.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.38
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$28.37
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$130.15
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.38
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: United Healthcare Medicare |
$33.38
|
| Rate for Payer: WINHealth Partners Commercial |
$130.15
|
|
|
HC PRO OSTEOPATHIC MANIP,5-6 BODY REGN
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 98927 NONPBBPAYER
|
| Hospital Charge Code |
9839892701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$44.43
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.43
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$37.77
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.43
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
|
|
HC PRO OSTEOPATHIC MANIP,5-6 BODY REGN
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
9839892701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$275.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$44.43
|
| Rate for Payer: Aetna of WY Medicare |
$44.43
|
| Rate for Payer: Beech Street Commercial |
$147.25
|
| Rate for Payer: Beech Street Commercial |
$266.95
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Cigna of WY Commercial |
$275.38
|
| Rate for Payer: First Choice Health Commercial |
$139.50
|
| Rate for Payer: First Choice Health Commercial |
$252.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.43
|
| Rate for Payer: HealthUtah PPO |
$281.00
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$37.77
|
| Rate for Payer: Multiplan Medicare/VA |
$37.77
|
| Rate for Payer: One Health Plan of WY PPO |
$275.38
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PacificSource Commercial |
$252.90
|
| Rate for Payer: PHCS PPO |
$266.95
|
| Rate for Payer: PHCS PPO |
$147.25
|
| Rate for Payer: Three Rivers PPO |
$210.75
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$44.43
|
| Rate for Payer: TriWest Veterans Administration |
$44.43
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Commercial |
$244.47
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
| Rate for Payer: WINHealth Partners Commercial |
$266.95
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
|
