|
HC PRO REMV FB EXT AUDITORY CANAL W/O ANESTH
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
9836920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$344.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.52
|
| Rate for Payer: Aetna of WY Medicare |
$45.56
|
| Rate for Payer: Aetna of WY Medicare |
$45.56
|
| Rate for Payer: Beech Street Commercial |
$212.80
|
| Rate for Payer: Beech Street Commercial |
$334.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$341.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.28
|
| Rate for Payer: Cigna of WY Commercial |
$219.52
|
| Rate for Payer: Cigna of WY Commercial |
$344.96
|
| Rate for Payer: First Choice Health Commercial |
$201.60
|
| Rate for Payer: First Choice Health Commercial |
$316.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.56
|
| Rate for Payer: HealthUtah PPO |
$352.00
|
| Rate for Payer: HealthUtah PPO |
$224.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$341.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.28
|
| Rate for Payer: Multiplan Medicare/VA |
$38.73
|
| Rate for Payer: Multiplan Medicare/VA |
$38.73
|
| Rate for Payer: One Health Plan of WY PPO |
$344.96
|
| Rate for Payer: One Health Plan of WY PPO |
$219.52
|
| Rate for Payer: PacificSource Commercial |
$201.60
|
| Rate for Payer: PacificSource Commercial |
$316.80
|
| Rate for Payer: PHCS PPO |
$334.40
|
| Rate for Payer: PHCS PPO |
$212.80
|
| Rate for Payer: Three Rivers PPO |
$264.00
|
| Rate for Payer: Three Rivers PPO |
$168.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.56
|
| Rate for Payer: TriWest Veterans Administration |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$194.88
|
| Rate for Payer: United Healthcare Commercial |
$306.24
|
| Rate for Payer: United Healthcare Medicare |
$45.56
|
| Rate for Payer: United Healthcare Medicare |
$45.56
|
| Rate for Payer: WINHealth Partners Commercial |
$299.20
|
| Rate for Payer: WINHealth Partners Commercial |
$190.40
|
|
|
HC PRO REMV FB EXT AUDITORY CANAL W/O ANESTH
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 69200 NONPBBPAYER
|
| Hospital Charge Code |
9836920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$45.56
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.56
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$38.73
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$45.56
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
HC PRO REMV FB EXT AUDITORY CANAL W/O ANESTH
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 69200 50,NONPBBPAYER
|
| Hospital Charge Code |
9836920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$45.56
|
| Rate for Payer: Beech Street Commercial |
$532.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: First Choice Health Commercial |
$504.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.56
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$38.73
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$532.00
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$45.56
|
| Rate for Payer: WINHealth Partners Commercial |
$476.00
|
|
|
HC PRO REMV FB EXT AUDITORY CANAL W/O ANESTH
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 69200 50
|
| Hospital Charge Code |
9836920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$439.04
|
| Rate for Payer: Aetna of WY Medicare |
$45.56
|
| Rate for Payer: Beech Street Commercial |
$425.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$434.56
|
| Rate for Payer: Cigna of WY Commercial |
$439.04
|
| Rate for Payer: First Choice Health Commercial |
$403.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$425.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.56
|
| Rate for Payer: HealthUtah PPO |
$448.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$434.56
|
| Rate for Payer: Multiplan Medicare/VA |
$38.73
|
| Rate for Payer: One Health Plan of WY PPO |
$439.04
|
| Rate for Payer: PacificSource Commercial |
$403.20
|
| Rate for Payer: PHCS PPO |
$425.60
|
| Rate for Payer: Three Rivers PPO |
$336.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$389.76
|
| Rate for Payer: United Healthcare Medicare |
$45.56
|
| Rate for Payer: WINHealth Partners Commercial |
$380.80
|
|
|
HC PRO REMV F.B.,EYE,SUPERF CONJUNC
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
9836520501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$27.90
|
| Rate for Payer: Aetna of WY Medicare |
$27.90
|
| Rate for Payer: Beech Street Commercial |
$299.25
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: First Choice Health Commercial |
$283.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.90
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$23.72
|
| Rate for Payer: Multiplan Medicare/VA |
$23.72
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$299.25
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.90
|
| Rate for Payer: TriWest Veterans Administration |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$27.90
|
| Rate for Payer: United Healthcare Medicare |
$27.90
|
| Rate for Payer: WINHealth Partners Commercial |
$267.75
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
HC PRO REMV IMPACTED CERUMEN INSTRUMENTATION UNILAT/BILAT
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
9836921001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$31.08
|
| Rate for Payer: Aetna of WY Medicare |
$31.08
|
| Rate for Payer: Beech Street Commercial |
$175.75
|
| Rate for Payer: Beech Street Commercial |
$127.30
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.98
|
| Rate for Payer: Cigna of WY Commercial |
$131.32
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: First Choice Health Commercial |
$166.50
|
| Rate for Payer: First Choice Health Commercial |
$120.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.08
|
| Rate for Payer: HealthUtah PPO |
$134.00
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.98
|
| Rate for Payer: Multiplan Medicare/VA |
$26.42
|
| Rate for Payer: Multiplan Medicare/VA |
$26.42
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: One Health Plan of WY PPO |
$131.32
|
| Rate for Payer: PacificSource Commercial |
$120.60
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$127.30
|
| Rate for Payer: PHCS PPO |
$175.75
|
| Rate for Payer: Three Rivers PPO |
$100.50
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$31.08
|
| Rate for Payer: TriWest Veterans Administration |
$31.08
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Commercial |
$116.58
|
| Rate for Payer: United Healthcare Medicare |
$31.08
|
| Rate for Payer: United Healthcare Medicare |
$31.08
|
| Rate for Payer: WINHealth Partners Commercial |
$113.90
|
| Rate for Payer: WINHealth Partners Commercial |
$157.25
|
|
|
HC PRO REMV IMPACTED CERUMEN INSTRUMENTATION UNILAT/BILAT
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 69210 NONPBBPAYER
|
| Hospital Charge Code |
9836921001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.66
|
| Rate for Payer: Aetna of WY Medicare |
$31.08
|
| Rate for Payer: Beech Street Commercial |
$158.65
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.99
|
| Rate for Payer: Cigna of WY Commercial |
$163.66
|
| Rate for Payer: First Choice Health Commercial |
$150.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.08
|
| Rate for Payer: HealthUtah PPO |
$167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.99
|
| Rate for Payer: Multiplan Medicare/VA |
$26.42
|
| Rate for Payer: One Health Plan of WY PPO |
$163.66
|
| Rate for Payer: PacificSource Commercial |
$150.30
|
| Rate for Payer: PHCS PPO |
$158.65
|
| Rate for Payer: Three Rivers PPO |
$125.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.08
|
| Rate for Payer: United Healthcare Commercial |
$145.29
|
| Rate for Payer: United Healthcare Medicare |
$31.08
|
| Rate for Payer: WINHealth Partners Commercial |
$141.95
|
|
|
HC PRO REMV IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
9836920901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Aetna of WY Medicare |
$15.63
|
| Rate for Payer: Beech Street Commercial |
$173.85
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: First Choice Health Commercial |
$164.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.63
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$13.29
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$173.85
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.63
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$15.63
|
| Rate for Payer: WINHealth Partners Commercial |
$155.55
|
|
|
HC PRO REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49002
|
| Hospital Charge Code |
9754900201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$838.69 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$986.69
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.69
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$838.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$986.69
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$986.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
HC PRO REPAIR ACHILLES TEND;OPN PERCUT
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
9832765001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,885.12
|
| Rate for Payer: Aetna of WY Medicare |
$640.70
|
| Rate for Payer: Beech Street Commercial |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,855.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,885.12
|
| Rate for Payer: First Choice Health Commercial |
$2,649.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,796.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.70
|
| Rate for Payer: HealthUtah PPO |
$2,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,855.68
|
| Rate for Payer: Multiplan Medicare/VA |
$544.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,885.12
|
| Rate for Payer: PacificSource Commercial |
$2,649.60
|
| Rate for Payer: PHCS PPO |
$2,796.80
|
| Rate for Payer: Three Rivers PPO |
$2,208.00
|
| Rate for Payer: TriWest Veterans Administration |
$640.70
|
| Rate for Payer: United Healthcare Commercial |
$2,561.28
|
| Rate for Payer: United Healthcare Medicare |
$640.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,502.40
|
|
|
HC PRO REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$4,027.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
9833520601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$627.33 |
| Max. Negotiated Rate |
$4,027.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,946.46
|
| Rate for Payer: Aetna of WY Medicare |
$738.04
|
| Rate for Payer: Beech Street Commercial |
$3,825.65
|
| Rate for Payer: Cash Price |
$2,818.90
|
| Rate for Payer: Cash Price |
$2,818.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,906.19
|
| Rate for Payer: Cigna of WY Commercial |
$3,946.46
|
| Rate for Payer: First Choice Health Commercial |
$3,624.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,825.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.04
|
| Rate for Payer: HealthUtah PPO |
$4,027.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,906.19
|
| Rate for Payer: Multiplan Medicare/VA |
$627.33
|
| Rate for Payer: One Health Plan of WY PPO |
$3,946.46
|
| Rate for Payer: PacificSource Commercial |
$3,624.30
|
| Rate for Payer: PHCS PPO |
$3,825.65
|
| Rate for Payer: Three Rivers PPO |
$3,020.25
|
| Rate for Payer: TriWest Veterans Administration |
$738.04
|
| Rate for Payer: United Healthcare Commercial |
$3,503.49
|
| Rate for Payer: United Healthcare Medicare |
$738.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3,422.95
|
|
|
HC PRO REPAIR COMP 5CM OR LESS
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
9831315301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$129.45
|
| Rate for Payer: Beech Street Commercial |
$532.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: First Choice Health Commercial |
$504.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.45
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$110.03
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$532.00
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.45
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$129.45
|
| Rate for Payer: WINHealth Partners Commercial |
$476.00
|
|
|
HC PRO REPAIR COMP 5CM OR LESS
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 13153 NONPBBPAYER
|
| Hospital Charge Code |
9831315301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$129.45
|
| Rate for Payer: Beech Street Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: First Choice Health Commercial |
$630.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.45
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.03
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$665.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.45
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$129.45
|
| Rate for Payer: WINHealth Partners Commercial |
$595.00
|
|
|
HC PRO REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
9831313301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$119.33
|
| Rate for Payer: Aetna of WY Medicare |
$119.33
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Beech Street Commercial |
$665.95
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$490.70
|
| Rate for Payer: Cash Price |
$490.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: Cigna of WY Commercial |
$686.98
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: First Choice Health Commercial |
$630.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.33
|
| Rate for Payer: HealthUtah PPO |
$701.00
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$101.43
|
| Rate for Payer: Multiplan Medicare/VA |
$101.43
|
| Rate for Payer: One Health Plan of WY PPO |
$686.98
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PacificSource Commercial |
$630.90
|
| Rate for Payer: PHCS PPO |
$665.95
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$525.75
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.33
|
| Rate for Payer: TriWest Veterans Administration |
$119.33
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Commercial |
$609.87
|
| Rate for Payer: United Healthcare Medicare |
$119.33
|
| Rate for Payer: United Healthcare Medicare |
$119.33
|
| Rate for Payer: WINHealth Partners Commercial |
$595.85
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
HC PRO REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 13133 NONPBBPAYER
|
| Hospital Charge Code |
9831313301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$629.16
|
| Rate for Payer: Aetna of WY Medicare |
$119.33
|
| Rate for Payer: Beech Street Commercial |
$609.90
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$622.74
|
| Rate for Payer: Cigna of WY Commercial |
$629.16
|
| Rate for Payer: First Choice Health Commercial |
$577.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$609.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.33
|
| Rate for Payer: HealthUtah PPO |
$642.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$622.74
|
| Rate for Payer: Multiplan Medicare/VA |
$101.43
|
| Rate for Payer: One Health Plan of WY PPO |
$629.16
|
| Rate for Payer: PacificSource Commercial |
$577.80
|
| Rate for Payer: PHCS PPO |
$609.90
|
| Rate for Payer: Three Rivers PPO |
$481.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.33
|
| Rate for Payer: United Healthcare Commercial |
$558.54
|
| Rate for Payer: United Healthcare Medicare |
$119.33
|
| Rate for Payer: WINHealth Partners Commercial |
$545.70
|
|
|
HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 1.1-2.5 CM
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
9831313101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$197.33 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$963.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,322.02
|
| Rate for Payer: Aetna of WY Medicare |
$232.15
|
| Rate for Payer: Aetna of WY Medicare |
$232.15
|
| Rate for Payer: Beech Street Commercial |
$1,281.55
|
| Rate for Payer: Beech Street Commercial |
$933.85
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$953.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,308.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,322.02
|
| Rate for Payer: Cigna of WY Commercial |
$963.34
|
| Rate for Payer: First Choice Health Commercial |
$1,214.10
|
| Rate for Payer: First Choice Health Commercial |
$884.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$933.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,281.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.15
|
| Rate for Payer: HealthUtah PPO |
$983.00
|
| Rate for Payer: HealthUtah PPO |
$1,349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$953.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,308.53
|
| Rate for Payer: Multiplan Medicare/VA |
$197.33
|
| Rate for Payer: Multiplan Medicare/VA |
$197.33
|
| Rate for Payer: One Health Plan of WY PPO |
$963.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,322.02
|
| Rate for Payer: PacificSource Commercial |
$1,214.10
|
| Rate for Payer: PacificSource Commercial |
$884.70
|
| Rate for Payer: PHCS PPO |
$933.85
|
| Rate for Payer: PHCS PPO |
$1,281.55
|
| Rate for Payer: Three Rivers PPO |
$737.25
|
| Rate for Payer: Three Rivers PPO |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration |
$232.15
|
| Rate for Payer: TriWest Veterans Administration |
$232.15
|
| Rate for Payer: United Healthcare Commercial |
$1,173.63
|
| Rate for Payer: United Healthcare Commercial |
$855.21
|
| Rate for Payer: United Healthcare Medicare |
$232.15
|
| Rate for Payer: United Healthcare Medicare |
$232.15
|
| Rate for Payer: WINHealth Partners Commercial |
$835.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,146.65
|
|
|
HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 1.1-2.5 CM
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 13131 NONPBBPAYER
|
| Hospital Charge Code |
9831313101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$197.33 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,204.42
|
| Rate for Payer: Aetna of WY Medicare |
$232.15
|
| Rate for Payer: Beech Street Commercial |
$1,167.55
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,192.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,204.42
|
| Rate for Payer: First Choice Health Commercial |
$1,106.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,167.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.15
|
| Rate for Payer: HealthUtah PPO |
$1,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,192.13
|
| Rate for Payer: Multiplan Medicare/VA |
$197.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,204.42
|
| Rate for Payer: PacificSource Commercial |
$1,106.10
|
| Rate for Payer: PHCS PPO |
$1,167.55
|
| Rate for Payer: Three Rivers PPO |
$921.75
|
| Rate for Payer: TriWest Veterans Administration |
$232.15
|
| Rate for Payer: United Healthcare Commercial |
$1,069.23
|
| Rate for Payer: United Healthcare Medicare |
$232.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,044.65
|
|
|
HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 2.6-7.5 CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
9831313201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,646.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,205.40
|
| Rate for Payer: Aetna of WY Medicare |
$290.00
|
| Rate for Payer: Aetna of WY Medicare |
$290.00
|
| Rate for Payer: Beech Street Commercial |
$1,168.50
|
| Rate for Payer: Beech Street Commercial |
$1,596.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,629.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,193.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,205.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,646.40
|
| Rate for Payer: First Choice Health Commercial |
$1,107.00
|
| Rate for Payer: First Choice Health Commercial |
$1,512.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,596.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$1,680.00
|
| Rate for Payer: HealthUtah PPO |
$1,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,629.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,193.10
|
| Rate for Payer: Multiplan Medicare/VA |
$246.50
|
| Rate for Payer: Multiplan Medicare/VA |
$246.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,646.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,205.40
|
| Rate for Payer: PacificSource Commercial |
$1,107.00
|
| Rate for Payer: PacificSource Commercial |
$1,512.00
|
| Rate for Payer: PHCS PPO |
$1,596.00
|
| Rate for Payer: PHCS PPO |
$1,168.50
|
| Rate for Payer: Three Rivers PPO |
$1,260.00
|
| Rate for Payer: Three Rivers PPO |
$922.50
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Commercial |
$1,461.60
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,428.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.50
|
|
|
HC PRO REPAIR COMPLEX WND HEAD,FAC,HAND 2.6-7.5 CM
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 13132 NONPBBPAYER
|
| Hospital Charge Code |
9831313201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$1,537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,506.26
|
| Rate for Payer: Aetna of WY Medicare |
$290.00
|
| Rate for Payer: Beech Street Commercial |
$1,460.15
|
| Rate for Payer: Cash Price |
$1,075.90
|
| Rate for Payer: Cash Price |
$1,075.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,490.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,506.26
|
| Rate for Payer: First Choice Health Commercial |
$1,383.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,460.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$1,537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,490.89
|
| Rate for Payer: Multiplan Medicare/VA |
$246.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,506.26
|
| Rate for Payer: PacificSource Commercial |
$1,383.30
|
| Rate for Payer: PHCS PPO |
$1,460.15
|
| Rate for Payer: Three Rivers PPO |
$1,152.75
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,306.45
|
|
|
HC PRO REPAIR COMPLEX WND LID,NOS,EAR 1.1-2.5 CM
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
9831315101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$226.53 |
| Max. Negotiated Rate |
$1,549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,518.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,106.42
|
| Rate for Payer: Aetna of WY Medicare |
$266.51
|
| Rate for Payer: Aetna of WY Medicare |
$266.51
|
| Rate for Payer: Beech Street Commercial |
$1,072.55
|
| Rate for Payer: Beech Street Commercial |
$1,471.55
|
| Rate for Payer: Cash Price |
$790.30
|
| Rate for Payer: Cash Price |
$790.30
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,502.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,095.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,106.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,518.02
|
| Rate for Payer: First Choice Health Commercial |
$1,016.10
|
| Rate for Payer: First Choice Health Commercial |
$1,394.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,471.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,072.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.51
|
| Rate for Payer: HealthUtah PPO |
$1,549.00
|
| Rate for Payer: HealthUtah PPO |
$1,129.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,502.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,095.13
|
| Rate for Payer: Multiplan Medicare/VA |
$226.53
|
| Rate for Payer: Multiplan Medicare/VA |
$226.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,518.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,106.42
|
| Rate for Payer: PacificSource Commercial |
$1,016.10
|
| Rate for Payer: PacificSource Commercial |
$1,394.10
|
| Rate for Payer: PHCS PPO |
$1,471.55
|
| Rate for Payer: PHCS PPO |
$1,072.55
|
| Rate for Payer: Three Rivers PPO |
$1,161.75
|
| Rate for Payer: Three Rivers PPO |
$846.75
|
| Rate for Payer: TriWest Veterans Administration |
$266.51
|
| Rate for Payer: TriWest Veterans Administration |
$266.51
|
| Rate for Payer: United Healthcare Commercial |
$982.23
|
| Rate for Payer: United Healthcare Commercial |
$1,347.63
|
| Rate for Payer: United Healthcare Medicare |
$266.51
|
| Rate for Payer: United Healthcare Medicare |
$266.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,316.65
|
| Rate for Payer: WINHealth Partners Commercial |
$959.65
|
|
|
HC PRO REPAIR COMPLEX WND LID,NOS,EAR 1.1-2.5 CM
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 13151 NONPBBPAYER
|
| Hospital Charge Code |
9831315101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$226.53 |
| Max. Negotiated Rate |
$1,411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,382.78
|
| Rate for Payer: Aetna of WY Medicare |
$266.51
|
| Rate for Payer: Beech Street Commercial |
$1,340.45
|
| Rate for Payer: Cash Price |
$987.70
|
| Rate for Payer: Cash Price |
$987.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,368.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,382.78
|
| Rate for Payer: First Choice Health Commercial |
$1,269.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,340.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.51
|
| Rate for Payer: HealthUtah PPO |
$1,411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,368.67
|
| Rate for Payer: Multiplan Medicare/VA |
$226.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,382.78
|
| Rate for Payer: PacificSource Commercial |
$1,269.90
|
| Rate for Payer: PHCS PPO |
$1,340.45
|
| Rate for Payer: Three Rivers PPO |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration |
$266.51
|
| Rate for Payer: United Healthcare Commercial |
$1,227.57
|
| Rate for Payer: United Healthcare Medicare |
$266.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,199.35
|
|
|
HC PRO REPAIR COMPLEX WND LID,NOS,EAR 2.5-7.5 CM
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
9831315201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.98 |
| Max. Negotiated Rate |
$1,867.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,829.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,333.78
|
| Rate for Payer: Aetna of WY Medicare |
$321.15
|
| Rate for Payer: Aetna of WY Medicare |
$321.15
|
| Rate for Payer: Beech Street Commercial |
$1,292.95
|
| Rate for Payer: Beech Street Commercial |
$1,773.65
|
| Rate for Payer: Cash Price |
$952.70
|
| Rate for Payer: Cash Price |
$952.70
|
| 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: ChoiceCare Network Commercial |
$1,320.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,333.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,829.66
|
| Rate for Payer: First Choice Health Commercial |
$1,224.90
|
| 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) Commercial |
$1,292.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.15
|
| Rate for Payer: HealthUtah PPO |
$1,867.00
|
| Rate for Payer: HealthUtah PPO |
$1,361.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,810.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,320.17
|
| Rate for Payer: Multiplan Medicare/VA |
$272.98
|
| Rate for Payer: Multiplan Medicare/VA |
$272.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,829.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,333.78
|
| Rate for Payer: PacificSource Commercial |
$1,224.90
|
| Rate for Payer: PacificSource Commercial |
$1,680.30
|
| Rate for Payer: PHCS PPO |
$1,773.65
|
| Rate for Payer: PHCS PPO |
$1,292.95
|
| Rate for Payer: Three Rivers PPO |
$1,400.25
|
| Rate for Payer: Three Rivers PPO |
$1,020.75
|
| Rate for Payer: TriWest Veterans Administration |
$321.15
|
| Rate for Payer: TriWest Veterans Administration |
$321.15
|
| Rate for Payer: United Healthcare Commercial |
$1,184.07
|
| Rate for Payer: United Healthcare Commercial |
$1,624.29
|
| Rate for Payer: United Healthcare Medicare |
$321.15
|
| Rate for Payer: United Healthcare Medicare |
$321.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,586.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.85
|
|
|
HC PRO REPAIR COMPLEX WND LID,NOS,EAR 2.5-7.5 CM
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 13152 NONPBBPAYER
|
| Hospital Charge Code |
9831315201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.98 |
| Max. Negotiated Rate |
$1,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.98
|
| Rate for Payer: Aetna of WY Medicare |
$321.15
|
| Rate for Payer: Beech Street Commercial |
$1,615.95
|
| Rate for Payer: Cash Price |
$1,190.70
|
| Rate for Payer: Cash Price |
$1,190.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.97
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.98
|
| Rate for Payer: First Choice Health Commercial |
$1,530.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.15
|
| Rate for Payer: HealthUtah PPO |
$1,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.97
|
| Rate for Payer: Multiplan Medicare/VA |
$272.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.98
|
| Rate for Payer: PacificSource Commercial |
$1,530.90
|
| Rate for Payer: PHCS PPO |
$1,615.95
|
| Rate for Payer: Three Rivers PPO |
$1,275.75
|
| Rate for Payer: TriWest Veterans Administration |
$321.15
|
| Rate for Payer: United Healthcare Commercial |
$1,479.87
|
| Rate for Payer: United Healthcare Medicare |
$321.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,445.85
|
|
|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
9831312001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$913.36
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,278.90
|
| Rate for Payer: Aetna of WY Medicare |
$222.84
|
| Rate for Payer: Aetna of WY Medicare |
$222.84
|
| Rate for Payer: Beech Street Commercial |
$1,239.75
|
| Rate for Payer: Beech Street Commercial |
$885.40
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$904.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,265.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,278.90
|
| Rate for Payer: Cigna of WY Commercial |
$913.36
|
| Rate for Payer: First Choice Health Commercial |
$1,174.50
|
| Rate for Payer: First Choice Health Commercial |
$838.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$885.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,239.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.84
|
| Rate for Payer: HealthUtah PPO |
$932.00
|
| Rate for Payer: HealthUtah PPO |
$1,305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$904.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,265.85
|
| Rate for Payer: Multiplan Medicare/VA |
$189.41
|
| Rate for Payer: Multiplan Medicare/VA |
$189.41
|
| Rate for Payer: One Health Plan of WY PPO |
$913.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,278.90
|
| Rate for Payer: PacificSource Commercial |
$1,174.50
|
| Rate for Payer: PacificSource Commercial |
$838.80
|
| Rate for Payer: PHCS PPO |
$885.40
|
| Rate for Payer: PHCS PPO |
$1,239.75
|
| Rate for Payer: Three Rivers PPO |
$699.00
|
| Rate for Payer: Three Rivers PPO |
$978.75
|
| Rate for Payer: TriWest Veterans Administration |
$222.84
|
| Rate for Payer: TriWest Veterans Administration |
$222.84
|
| Rate for Payer: United Healthcare Commercial |
$1,135.35
|
| Rate for Payer: United Healthcare Commercial |
$810.84
|
| Rate for Payer: United Healthcare Medicare |
$222.84
|
| Rate for Payer: United Healthcare Medicare |
$222.84
|
| Rate for Payer: WINHealth Partners Commercial |
$792.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,109.25
|
|
|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 13120 NONPBBPAYER
|
| Hospital Charge Code |
9831312001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.70
|
| Rate for Payer: Aetna of WY Medicare |
$222.84
|
| Rate for Payer: Beech Street Commercial |
$1,106.75
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.70
|
| Rate for Payer: First Choice Health Commercial |
$1,048.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.84
|
| Rate for Payer: HealthUtah PPO |
$1,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.05
|
| Rate for Payer: Multiplan Medicare/VA |
$189.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.70
|
| Rate for Payer: PacificSource Commercial |
$1,048.50
|
| Rate for Payer: PHCS PPO |
$1,106.75
|
| Rate for Payer: Three Rivers PPO |
$873.75
|
| Rate for Payer: TriWest Veterans Administration |
$222.84
|
| Rate for Payer: United Healthcare Commercial |
$1,013.55
|
| Rate for Payer: United Healthcare Medicare |
$222.84
|
| Rate for Payer: WINHealth Partners Commercial |
$990.25
|
|
