|
HC PRO OSTEOPATHIC MANIP,7-8 BODY REGN
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 98928 NONPBBPAYER
|
| Hospital Charge Code |
9839892801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$56.05
|
| Rate for Payer: Beech Street Commercial |
$208.05
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: First Choice Health Commercial |
$197.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.05
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$47.64
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$208.05
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.05
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$56.05
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
|
|
HC PRO OSTEOPATHIC MANIP,7-8 BODY REGN
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
9839892801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$56.05
|
| Rate for Payer: Beech Street Commercial |
$166.25
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: First Choice Health Commercial |
$157.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.05
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.64
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$166.25
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.05
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$56.05
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
|
|
HC PRO OSTEOPATHIC MANIP,9-10 BODY REGN
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
9839892901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.28
|
| Rate for Payer: Aetna of WY Medicare |
$67.10
|
| Rate for Payer: Beech Street Commercial |
$176.70
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.42
|
| Rate for Payer: Cigna of WY Commercial |
$182.28
|
| Rate for Payer: First Choice Health Commercial |
$167.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$186.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.42
|
| Rate for Payer: Multiplan Medicare/VA |
$57.04
|
| Rate for Payer: One Health Plan of WY PPO |
$182.28
|
| Rate for Payer: PacificSource Commercial |
$167.40
|
| Rate for Payer: PHCS PPO |
$176.70
|
| Rate for Payer: Three Rivers PPO |
$139.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$161.82
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$176.70
|
|
|
HC PRO OSTEOPATHIC MANIP,9-10 BODY REGN
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 98929 NONPBBPAYER
|
| Hospital Charge Code |
9839892901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$67.10
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$57.04
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
|
|
HC PRO OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
9832539001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$635.43 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$747.56
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.56
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$635.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$747.56
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$747.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
HC PRO OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
9822539001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$635.43 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$747.56
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.56
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$635.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$747.56
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$747.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
HC PRO OSTEOTOMY CLAVICAL W/ W/O INTERNAL FIX
|
Professional
|
Both
|
$4,841.00
|
|
|
Service Code
|
HCPCS 23485
|
| Hospital Charge Code |
9832348501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$782.56 |
| Max. Negotiated Rate |
$4,841.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,744.18
|
| Rate for Payer: Aetna of WY Medicare |
$920.66
|
| Rate for Payer: Beech Street Commercial |
$4,598.95
|
| Rate for Payer: Cash Price |
$3,388.70
|
| Rate for Payer: Cash Price |
$3,388.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,695.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,744.18
|
| Rate for Payer: First Choice Health Commercial |
$4,356.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,598.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$920.66
|
| Rate for Payer: HealthUtah PPO |
$4,841.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,695.77
|
| Rate for Payer: Multiplan Medicare/VA |
$782.56
|
| Rate for Payer: One Health Plan of WY PPO |
$4,744.18
|
| Rate for Payer: PacificSource Commercial |
$4,356.90
|
| Rate for Payer: PHCS PPO |
$4,598.95
|
| Rate for Payer: Three Rivers PPO |
$3,630.75
|
| Rate for Payer: TriWest Veterans Administration |
$920.66
|
| Rate for Payer: United Healthcare Commercial |
$4,211.67
|
| Rate for Payer: United Healthcare Medicare |
$920.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4,114.85
|
|
|
HC PRO OSTEOTOMY PHALANX OR FINGER EA
|
Professional
|
Both
|
$5,517.00
|
|
|
Service Code
|
HCPCS 26567
|
| Hospital Charge Code |
9832656701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$599.39 |
| Max. Negotiated Rate |
$5,517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,406.66
|
| Rate for Payer: Aetna of WY Medicare |
$705.16
|
| Rate for Payer: Beech Street Commercial |
$5,241.15
|
| Rate for Payer: Cash Price |
$3,861.90
|
| Rate for Payer: Cash Price |
$3,861.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,351.49
|
| Rate for Payer: Cigna of WY Commercial |
$5,406.66
|
| Rate for Payer: First Choice Health Commercial |
$4,965.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,241.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.16
|
| Rate for Payer: HealthUtah PPO |
$5,517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,351.49
|
| Rate for Payer: Multiplan Medicare/VA |
$599.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,406.66
|
| Rate for Payer: PacificSource Commercial |
$4,965.30
|
| Rate for Payer: PHCS PPO |
$5,241.15
|
| Rate for Payer: Three Rivers PPO |
$4,137.75
|
| Rate for Payer: TriWest Veterans Administration |
$705.16
|
| Rate for Payer: United Healthcare Commercial |
$4,799.79
|
| Rate for Payer: United Healthcare Medicare |
$705.16
|
| Rate for Payer: WINHealth Partners Commercial |
$4,689.45
|
|
|
HC PRO OVARIAN CYSTECTOMY UNI/BILAT
|
Professional
|
Both
|
$3,928.00
|
|
|
Service Code
|
HCPCS 58925
|
| Hospital Charge Code |
9835892501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$627.67 |
| Max. Negotiated Rate |
$3,928.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,849.44
|
| Rate for Payer: Aetna of WY Medicare |
$738.44
|
| Rate for Payer: Beech Street Commercial |
$3,731.60
|
| Rate for Payer: Cash Price |
$2,749.60
|
| Rate for Payer: Cash Price |
$2,749.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,810.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,849.44
|
| Rate for Payer: First Choice Health Commercial |
$3,535.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,731.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.44
|
| Rate for Payer: HealthUtah PPO |
$3,928.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,810.16
|
| Rate for Payer: Multiplan Medicare/VA |
$627.67
|
| Rate for Payer: One Health Plan of WY PPO |
$3,849.44
|
| Rate for Payer: PacificSource Commercial |
$3,535.20
|
| Rate for Payer: PHCS PPO |
$3,731.60
|
| Rate for Payer: Three Rivers PPO |
$2,946.00
|
| Rate for Payer: TriWest Veterans Administration |
$738.44
|
| Rate for Payer: United Healthcare Commercial |
$3,417.36
|
| Rate for Payer: United Healthcare Medicare |
$738.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3,338.80
|
|
|
HC PRO PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH
|
Professional
|
Both
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57423
|
| Hospital Charge Code |
9755742301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$758.55 |
| Max. Negotiated Rate |
$3,731.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,656.38
|
| Rate for Payer: Aetna of WY Medicare |
$892.41
|
| Rate for Payer: Beech Street Commercial |
$3,544.45
|
| Rate for Payer: Cash Price |
$2,611.70
|
| Rate for Payer: Cash Price |
$2,611.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,619.07
|
| Rate for Payer: Cigna of WY Commercial |
$3,656.38
|
| Rate for Payer: First Choice Health Commercial |
$3,357.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,544.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$892.41
|
| Rate for Payer: HealthUtah PPO |
$3,731.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,619.07
|
| Rate for Payer: Multiplan Medicare/VA |
$758.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,656.38
|
| Rate for Payer: PacificSource Commercial |
$3,357.90
|
| Rate for Payer: PHCS PPO |
$3,544.45
|
| Rate for Payer: Three Rivers PPO |
$2,798.25
|
| Rate for Payer: TriWest Veterans Administration |
$892.41
|
| Rate for Payer: United Healthcare Commercial |
$3,245.97
|
| Rate for Payer: United Healthcare Medicare |
$892.41
|
| Rate for Payer: WINHealth Partners Commercial |
$3,171.35
|
|
|
HC PRO PARTIAL EXCISION BONE DISTAL PHAL / FINGER
|
Professional
|
Both
|
$1,328.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
9832623601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$369.99 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,301.44
|
| Rate for Payer: Aetna of WY Medicare |
$435.28
|
| Rate for Payer: Beech Street Commercial |
$1,261.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,301.44
|
| Rate for Payer: First Choice Health Commercial |
$1,195.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,261.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.28
|
| Rate for Payer: HealthUtah PPO |
$1,328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.16
|
| Rate for Payer: Multiplan Medicare/VA |
$369.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,301.44
|
| Rate for Payer: PacificSource Commercial |
$1,195.20
|
| Rate for Payer: PHCS PPO |
$1,261.60
|
| Rate for Payer: Three Rivers PPO |
$996.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.28
|
| Rate for Payer: United Healthcare Commercial |
$1,155.36
|
| Rate for Payer: United Healthcare Medicare |
$435.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,128.80
|
|
|
HC PRO PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$2,327.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
9832812001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$2,327.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,280.46
|
| Rate for Payer: Aetna of WY Medicare |
$483.29
|
| Rate for Payer: Beech Street Commercial |
$2,210.65
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,257.19
|
| Rate for Payer: Cigna of WY Commercial |
$2,280.46
|
| Rate for Payer: First Choice Health Commercial |
$2,094.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,210.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.29
|
| Rate for Payer: HealthUtah PPO |
$2,327.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,257.19
|
| Rate for Payer: Multiplan Medicare/VA |
$410.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,280.46
|
| Rate for Payer: PacificSource Commercial |
$2,094.30
|
| Rate for Payer: PHCS PPO |
$2,210.65
|
| Rate for Payer: Three Rivers PPO |
$1,745.25
|
| Rate for Payer: TriWest Veterans Administration |
$483.29
|
| Rate for Payer: United Healthcare Commercial |
$2,024.49
|
| Rate for Payer: United Healthcare Medicare |
$483.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.95
|
|
|
HC PRO PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$2,874.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
9832764001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$684.14 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,816.52
|
| Rate for Payer: Aetna of WY Medicare |
$804.87
|
| Rate for Payer: Beech Street Commercial |
$2,730.30
|
| Rate for Payer: Cash Price |
$2,011.80
|
| Rate for Payer: Cash Price |
$2,011.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,787.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,816.52
|
| Rate for Payer: First Choice Health Commercial |
$2,586.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,730.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$804.87
|
| Rate for Payer: HealthUtah PPO |
$2,874.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,787.78
|
| Rate for Payer: Multiplan Medicare/VA |
$684.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,816.52
|
| Rate for Payer: PacificSource Commercial |
$2,586.60
|
| Rate for Payer: PHCS PPO |
$2,730.30
|
| Rate for Payer: Three Rivers PPO |
$2,155.50
|
| Rate for Payer: TriWest Veterans Administration |
$804.87
|
| Rate for Payer: United Healthcare Commercial |
$2,500.38
|
| Rate for Payer: United Healthcare Medicare |
$804.87
|
| Rate for Payer: WINHealth Partners Commercial |
$2,442.90
|
|
|
HC PRO PARTIAL EXCISION THYROID,UNILAT
|
Professional
|
Both
|
$3,641.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
9836021001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$577.11 |
| Max. Negotiated Rate |
$3,641.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,568.18
|
| Rate for Payer: Aetna of WY Medicare |
$678.95
|
| Rate for Payer: Beech Street Commercial |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,531.77
|
| Rate for Payer: Cigna of WY Commercial |
$3,568.18
|
| Rate for Payer: First Choice Health Commercial |
$3,276.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,458.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.95
|
| Rate for Payer: HealthUtah PPO |
$3,641.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,531.77
|
| Rate for Payer: Multiplan Medicare/VA |
$577.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,568.18
|
| Rate for Payer: PacificSource Commercial |
$3,276.90
|
| Rate for Payer: PHCS PPO |
$3,458.95
|
| Rate for Payer: Three Rivers PPO |
$2,730.75
|
| Rate for Payer: TriWest Veterans Administration |
$678.95
|
| Rate for Payer: United Healthcare Commercial |
$3,167.67
|
| Rate for Payer: United Healthcare Medicare |
$678.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,094.85
|
|
|
HC PRO PARTIAL EXC PHALANX OF TOE BONE
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 28124
|
| Hospital Charge Code |
9832812401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$278.95 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$328.18
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.18
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$278.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$328.18
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$328.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
HC PRO PARTIAL EXC TARS/METAT BONE
|
Professional
|
Both
|
$6,986.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
9832812201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$6,986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,846.28
|
| Rate for Payer: Aetna of WY Medicare |
$429.26
|
| Rate for Payer: Beech Street Commercial |
$6,636.70
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,776.42
|
| Rate for Payer: Cigna of WY Commercial |
$6,846.28
|
| Rate for Payer: First Choice Health Commercial |
$6,287.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,636.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.26
|
| Rate for Payer: HealthUtah PPO |
$6,986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,776.42
|
| Rate for Payer: Multiplan Medicare/VA |
$364.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6,846.28
|
| Rate for Payer: PacificSource Commercial |
$6,287.40
|
| Rate for Payer: PHCS PPO |
$6,636.70
|
| Rate for Payer: Three Rivers PPO |
$5,239.50
|
| Rate for Payer: TriWest Veterans Administration |
$429.26
|
| Rate for Payer: United Healthcare Commercial |
$6,077.82
|
| Rate for Payer: United Healthcare Medicare |
$429.26
|
| Rate for Payer: WINHealth Partners Commercial |
$5,938.10
|
|
|
HC PRO PARTIAL REMOVAL, CLAVICLE
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
9832312001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$576.49
|
| Rate for Payer: Beech Street Commercial |
$2,849.05
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: First Choice Health Commercial |
$2,699.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.49
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$490.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,849.05
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.49
|
| Rate for Payer: United Healthcare Commercial |
$2,609.13
|
| Rate for Payer: United Healthcare Medicare |
$576.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,549.15
|
|
|
HC PRO PARTIAL REMOVAL OF COLON
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
9834414001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$6,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,810.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,269.94
|
| Rate for Payer: Beech Street Commercial |
$6,601.55
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,740.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,810.02
|
| Rate for Payer: First Choice Health Commercial |
$6,254.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,601.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,269.94
|
| Rate for Payer: HealthUtah PPO |
$6,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,740.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.45
|
| Rate for Payer: One Health Plan of WY PPO |
$6,810.02
|
| Rate for Payer: PacificSource Commercial |
$6,254.10
|
| Rate for Payer: PHCS PPO |
$6,601.55
|
| Rate for Payer: Three Rivers PPO |
$5,211.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,269.94
|
| Rate for Payer: United Healthcare Commercial |
$6,045.63
|
| Rate for Payer: United Healthcare Medicare |
$1,269.94
|
| Rate for Payer: WINHealth Partners Commercial |
$5,906.65
|
|
|
HC PRO PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$6,289.00
|
|
|
Service Code
|
HCPCS 28160
|
| Hospital Charge Code |
9832816001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$222.76 |
| Max. Negotiated Rate |
$6,289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,163.22
|
| Rate for Payer: Aetna of WY Medicare |
$262.07
|
| Rate for Payer: Beech Street Commercial |
$5,974.55
|
| Rate for Payer: Cash Price |
$4,402.30
|
| Rate for Payer: Cash Price |
$4,402.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,100.33
|
| Rate for Payer: Cigna of WY Commercial |
$6,163.22
|
| Rate for Payer: First Choice Health Commercial |
$5,660.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,974.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.07
|
| Rate for Payer: HealthUtah PPO |
$6,289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,100.33
|
| Rate for Payer: Multiplan Medicare/VA |
$222.76
|
| Rate for Payer: One Health Plan of WY PPO |
$6,163.22
|
| Rate for Payer: PacificSource Commercial |
$5,660.10
|
| Rate for Payer: PHCS PPO |
$5,974.55
|
| Rate for Payer: Three Rivers PPO |
$4,716.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.07
|
| Rate for Payer: United Healthcare Commercial |
$5,471.43
|
| Rate for Payer: United Healthcare Medicare |
$262.07
|
| Rate for Payer: WINHealth Partners Commercial |
$5,345.65
|
|
|
HC PRO PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE
|
Professional
|
Both
|
$3,143.00
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
9832313001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$514.21 |
| Max. Negotiated Rate |
$3,143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,080.14
|
| Rate for Payer: Aetna of WY Medicare |
$604.95
|
| Rate for Payer: Beech Street Commercial |
$2,985.85
|
| Rate for Payer: Cash Price |
$2,200.10
|
| Rate for Payer: Cash Price |
$2,200.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,048.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,080.14
|
| Rate for Payer: First Choice Health Commercial |
$2,828.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,985.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.95
|
| Rate for Payer: HealthUtah PPO |
$3,143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,048.71
|
| Rate for Payer: Multiplan Medicare/VA |
$514.21
|
| Rate for Payer: One Health Plan of WY PPO |
$3,080.14
|
| Rate for Payer: PacificSource Commercial |
$2,828.70
|
| Rate for Payer: PHCS PPO |
$2,985.85
|
| Rate for Payer: Three Rivers PPO |
$2,357.25
|
| Rate for Payer: TriWest Veterans Administration |
$604.95
|
| Rate for Payer: United Healthcare Commercial |
$2,734.41
|
| Rate for Payer: United Healthcare Medicare |
$604.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,671.55
|
|
|
HC PRO PART PALMAR FASCIECTOM,OPEN 1 DIGIT
|
Professional
|
Both
|
$7,604.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
9832612301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$695.95 |
| Max. Negotiated Rate |
$7,604.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,451.92
|
| Rate for Payer: Aetna of WY Medicare |
$818.77
|
| Rate for Payer: Beech Street Commercial |
$7,223.80
|
| Rate for Payer: Cash Price |
$5,322.80
|
| Rate for Payer: Cash Price |
$5,322.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,375.88
|
| Rate for Payer: Cigna of WY Commercial |
$7,451.92
|
| Rate for Payer: First Choice Health Commercial |
$6,843.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,223.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$818.77
|
| Rate for Payer: HealthUtah PPO |
$7,604.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,375.88
|
| Rate for Payer: Multiplan Medicare/VA |
$695.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7,451.92
|
| Rate for Payer: PacificSource Commercial |
$6,843.60
|
| Rate for Payer: PHCS PPO |
$7,223.80
|
| Rate for Payer: Three Rivers PPO |
$5,703.00
|
| Rate for Payer: TriWest Veterans Administration |
$818.77
|
| Rate for Payer: United Healthcare Commercial |
$6,615.48
|
| Rate for Payer: United Healthcare Medicare |
$818.77
|
| Rate for Payer: WINHealth Partners Commercial |
$6,463.40
|
|
|
HC PRO PART PALMAR FASCIECTOM,,OPEN ADD DIGIT
|
Professional
|
Both
|
$3,614.00
|
|
|
Service Code
|
HCPCS 26125
|
| Hospital Charge Code |
9832612501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$216.34 |
| Max. Negotiated Rate |
$3,614.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,541.72
|
| Rate for Payer: Aetna of WY Medicare |
$254.52
|
| Rate for Payer: Beech Street Commercial |
$3,433.30
|
| Rate for Payer: Cash Price |
$2,529.80
|
| Rate for Payer: Cash Price |
$2,529.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,505.58
|
| Rate for Payer: Cigna of WY Commercial |
$3,541.72
|
| Rate for Payer: First Choice Health Commercial |
$3,252.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,433.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.52
|
| Rate for Payer: HealthUtah PPO |
$3,614.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,505.58
|
| Rate for Payer: Multiplan Medicare/VA |
$216.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,541.72
|
| Rate for Payer: PacificSource Commercial |
$3,252.60
|
| Rate for Payer: PHCS PPO |
$3,433.30
|
| Rate for Payer: Three Rivers PPO |
$2,710.50
|
| Rate for Payer: TriWest Veterans Administration |
$254.52
|
| Rate for Payer: United Healthcare Commercial |
$3,144.18
|
| Rate for Payer: United Healthcare Medicare |
$254.52
|
| Rate for Payer: WINHealth Partners Commercial |
$3,071.90
|
|
|
HC PRO PELVIC EXAMINATION / ANESTHESIA
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
9835741001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.68 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$419.44
|
| Rate for Payer: Aetna of WY Medicare |
$101.98
|
| Rate for Payer: Beech Street Commercial |
$406.60
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$415.16
|
| Rate for Payer: Cigna of WY Commercial |
$419.44
|
| Rate for Payer: First Choice Health Commercial |
$385.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$406.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.98
|
| Rate for Payer: HealthUtah PPO |
$428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$415.16
|
| Rate for Payer: Multiplan Medicare/VA |
$86.68
|
| Rate for Payer: One Health Plan of WY PPO |
$419.44
|
| Rate for Payer: PacificSource Commercial |
$385.20
|
| Rate for Payer: PHCS PPO |
$406.60
|
| Rate for Payer: Three Rivers PPO |
$321.00
|
| Rate for Payer: TriWest Veterans Administration |
$101.98
|
| Rate for Payer: United Healthcare Commercial |
$372.36
|
| Rate for Payer: United Healthcare Medicare |
$101.98
|
| Rate for Payer: WINHealth Partners Commercial |
$363.80
|
|
|
HC PRO PELVIC EXAMINATION / ANESTHESIA
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 57410 NONPBBPAYER
|
| Hospital Charge Code |
9835741001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.68 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.30
|
| Rate for Payer: Aetna of WY Medicare |
$101.98
|
| Rate for Payer: Beech Street Commercial |
$508.25
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.95
|
| Rate for Payer: Cigna of WY Commercial |
$524.30
|
| Rate for Payer: First Choice Health Commercial |
$481.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.98
|
| Rate for Payer: HealthUtah PPO |
$535.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.95
|
| Rate for Payer: Multiplan Medicare/VA |
$86.68
|
| Rate for Payer: One Health Plan of WY PPO |
$524.30
|
| Rate for Payer: PacificSource Commercial |
$481.50
|
| Rate for Payer: PHCS PPO |
$508.25
|
| Rate for Payer: Three Rivers PPO |
$401.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.98
|
| Rate for Payer: United Healthcare Commercial |
$465.45
|
| Rate for Payer: United Healthcare Medicare |
$101.98
|
| Rate for Payer: WINHealth Partners Commercial |
$454.75
|
|
|
HC PRO PELVIS/HIP JOINT SURGERY
|
Professional
|
Both
|
$7,352.00
|
|
|
Service Code
|
HCPCS 27299 NONPBBPAYER
|
| Hospital Charge Code |
9832729901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$5,514.00 |
| Max. Negotiated Rate |
$7,352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,204.96
|
| Rate for Payer: Beech Street Commercial |
$6,984.40
|
| Rate for Payer: Cash Price |
$5,146.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,131.44
|
| Rate for Payer: Cigna of WY Commercial |
$7,204.96
|
| Rate for Payer: First Choice Health Commercial |
$6,616.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,984.40
|
| Rate for Payer: HealthUtah PPO |
$7,352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,131.44
|
| Rate for Payer: One Health Plan of WY PPO |
$7,204.96
|
| Rate for Payer: PacificSource Commercial |
$6,616.80
|
| Rate for Payer: PHCS PPO |
$6,984.40
|
| Rate for Payer: Three Rivers PPO |
$5,514.00
|
| Rate for Payer: United Healthcare Commercial |
$6,396.24
|
| Rate for Payer: WINHealth Partners Commercial |
$6,249.20
|
|
