|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY 2.6-7.5 CM
|
Professional
|
Both
|
$1,310.00
|
|
|
Service Code
|
HCPCS 13121 NONPBBPAYER
|
| Hospital Charge Code |
9831312101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$210.34 |
| Max. Negotiated Rate |
$1,310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,283.80
|
| Rate for Payer: Aetna of WY Medicare |
$247.46
|
| Rate for Payer: Beech Street Commercial |
$1,244.50
|
| Rate for Payer: Cash Price |
$917.00
|
| Rate for Payer: Cash Price |
$917.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,270.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,283.80
|
| Rate for Payer: First Choice Health Commercial |
$1,179.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,244.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.46
|
| Rate for Payer: HealthUtah PPO |
$1,310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,270.70
|
| Rate for Payer: Multiplan Medicare/VA |
$210.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,283.80
|
| Rate for Payer: PacificSource Commercial |
$1,179.00
|
| Rate for Payer: PHCS PPO |
$1,244.50
|
| Rate for Payer: Three Rivers PPO |
$982.50
|
| Rate for Payer: TriWest Veterans Administration |
$247.46
|
| Rate for Payer: United Healthcare Commercial |
$1,139.70
|
| Rate for Payer: United Healthcare Medicare |
$247.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,113.50
|
|
|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY 2.6-7.5 CM
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
9831312101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$210.34 |
| Max. Negotiated Rate |
$1,434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,405.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,027.04
|
| Rate for Payer: Aetna of WY Medicare |
$247.46
|
| Rate for Payer: Aetna of WY Medicare |
$247.46
|
| Rate for Payer: Beech Street Commercial |
$995.60
|
| Rate for Payer: Beech Street Commercial |
$1,362.30
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,390.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,016.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,027.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,405.32
|
| Rate for Payer: First Choice Health Commercial |
$943.20
|
| Rate for Payer: First Choice Health Commercial |
$1,290.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,362.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$995.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.46
|
| Rate for Payer: HealthUtah PPO |
$1,434.00
|
| Rate for Payer: HealthUtah PPO |
$1,048.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,390.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,016.56
|
| Rate for Payer: Multiplan Medicare/VA |
$210.34
|
| Rate for Payer: Multiplan Medicare/VA |
$210.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,405.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,027.04
|
| Rate for Payer: PacificSource Commercial |
$943.20
|
| Rate for Payer: PacificSource Commercial |
$1,290.60
|
| Rate for Payer: PHCS PPO |
$1,362.30
|
| Rate for Payer: PHCS PPO |
$995.60
|
| Rate for Payer: Three Rivers PPO |
$1,075.50
|
| Rate for Payer: Three Rivers PPO |
$786.00
|
| Rate for Payer: TriWest Veterans Administration |
$247.46
|
| Rate for Payer: TriWest Veterans Administration |
$247.46
|
| Rate for Payer: United Healthcare Commercial |
$911.76
|
| Rate for Payer: United Healthcare Commercial |
$1,247.58
|
| Rate for Payer: United Healthcare Medicare |
$247.46
|
| Rate for Payer: United Healthcare Medicare |
$247.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,218.90
|
| Rate for Payer: WINHealth Partners Commercial |
$890.80
|
|
|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY EA ADDL <5 CM
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
9831312201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.59 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$451.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$330.26
|
| Rate for Payer: Aetna of WY Medicare |
$78.34
|
| Rate for Payer: Aetna of WY Medicare |
$78.34
|
| Rate for Payer: Beech Street Commercial |
$320.15
|
| Rate for Payer: Beech Street Commercial |
$437.95
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$447.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$326.89
|
| Rate for Payer: Cigna of WY Commercial |
$330.26
|
| Rate for Payer: Cigna of WY Commercial |
$451.78
|
| Rate for Payer: First Choice Health Commercial |
$303.30
|
| Rate for Payer: First Choice Health Commercial |
$414.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.34
|
| Rate for Payer: HealthUtah PPO |
$461.00
|
| Rate for Payer: HealthUtah PPO |
$337.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$447.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$326.89
|
| Rate for Payer: Multiplan Medicare/VA |
$66.59
|
| Rate for Payer: Multiplan Medicare/VA |
$66.59
|
| Rate for Payer: One Health Plan of WY PPO |
$451.78
|
| Rate for Payer: One Health Plan of WY PPO |
$330.26
|
| Rate for Payer: PacificSource Commercial |
$303.30
|
| Rate for Payer: PacificSource Commercial |
$414.90
|
| Rate for Payer: PHCS PPO |
$437.95
|
| Rate for Payer: PHCS PPO |
$320.15
|
| Rate for Payer: Three Rivers PPO |
$345.75
|
| Rate for Payer: Three Rivers PPO |
$252.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.34
|
| Rate for Payer: TriWest Veterans Administration |
$78.34
|
| Rate for Payer: United Healthcare Commercial |
$293.19
|
| Rate for Payer: United Healthcare Commercial |
$401.07
|
| Rate for Payer: United Healthcare Medicare |
$78.34
|
| Rate for Payer: United Healthcare Medicare |
$78.34
|
| Rate for Payer: WINHealth Partners Commercial |
$391.85
|
| Rate for Payer: WINHealth Partners Commercial |
$286.45
|
|
|
HC PRO REPAIR COMPLEX WND SCALP/EXTREMITY EA ADDL <5 CM
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 13122 NONPBBPAYER
|
| Hospital Charge Code |
9831312201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.59 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$412.58
|
| Rate for Payer: Aetna of WY Medicare |
$78.34
|
| Rate for Payer: Beech Street Commercial |
$399.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$408.37
|
| Rate for Payer: Cigna of WY Commercial |
$412.58
|
| Rate for Payer: First Choice Health Commercial |
$378.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.34
|
| Rate for Payer: HealthUtah PPO |
$421.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$408.37
|
| Rate for Payer: Multiplan Medicare/VA |
$66.59
|
| Rate for Payer: One Health Plan of WY PPO |
$412.58
|
| Rate for Payer: PacificSource Commercial |
$378.90
|
| Rate for Payer: PHCS PPO |
$399.95
|
| Rate for Payer: Three Rivers PPO |
$315.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.34
|
| Rate for Payer: United Healthcare Commercial |
$366.27
|
| Rate for Payer: United Healthcare Medicare |
$78.34
|
| Rate for Payer: WINHealth Partners Commercial |
$357.85
|
|
|
HC PRO REPAIR COMPLEX WND TRUNK 1.1-2.5CM
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
9831310001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,096.62
|
| Rate for Payer: Aetna of WY Medicare |
$192.56
|
| Rate for Payer: Beech Street Commercial |
$1,063.05
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,085.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,096.62
|
| Rate for Payer: First Choice Health Commercial |
$1,007.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.56
|
| Rate for Payer: HealthUtah PPO |
$1,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,085.43
|
| Rate for Payer: Multiplan Medicare/VA |
$163.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,096.62
|
| Rate for Payer: PacificSource Commercial |
$1,007.10
|
| Rate for Payer: PHCS PPO |
$1,063.05
|
| Rate for Payer: Three Rivers PPO |
$839.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.56
|
| Rate for Payer: United Healthcare Commercial |
$973.53
|
| Rate for Payer: United Healthcare Medicare |
$192.56
|
| Rate for Payer: WINHealth Partners Commercial |
$951.15
|
|
|
HC PRO REPAIR COMPLEX WND TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
9831310101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$997.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$977.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,920.40
|
| Rate for Payer: Aetna of WY Medicare |
$237.41
|
| Rate for Payer: Aetna of WY Medicare |
$237.41
|
| Rate for Payer: Beech Street Commercial |
$2,831.00
|
| Rate for Payer: Beech Street Commercial |
$947.15
|
| Rate for Payer: Cash Price |
$2,086.00
|
| Rate for Payer: Cash Price |
$2,086.00
|
| Rate for Payer: Cash Price |
$697.90
|
| Rate for Payer: Cash Price |
$697.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$967.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,890.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,920.40
|
| Rate for Payer: Cigna of WY Commercial |
$977.06
|
| Rate for Payer: First Choice Health Commercial |
$2,682.00
|
| Rate for Payer: First Choice Health Commercial |
$897.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$947.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,831.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.41
|
| Rate for Payer: HealthUtah PPO |
$997.00
|
| Rate for Payer: HealthUtah PPO |
$2,980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$967.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,890.60
|
| Rate for Payer: Multiplan Medicare/VA |
$201.80
|
| Rate for Payer: Multiplan Medicare/VA |
$201.80
|
| Rate for Payer: One Health Plan of WY PPO |
$977.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,920.40
|
| Rate for Payer: PacificSource Commercial |
$2,682.00
|
| Rate for Payer: PacificSource Commercial |
$897.30
|
| Rate for Payer: PHCS PPO |
$947.15
|
| Rate for Payer: PHCS PPO |
$2,831.00
|
| Rate for Payer: Three Rivers PPO |
$747.75
|
| Rate for Payer: Three Rivers PPO |
$2,235.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.41
|
| Rate for Payer: TriWest Veterans Administration |
$237.41
|
| Rate for Payer: United Healthcare Commercial |
$2,592.60
|
| Rate for Payer: United Healthcare Commercial |
$867.39
|
| Rate for Payer: United Healthcare Medicare |
$237.41
|
| Rate for Payer: United Healthcare Medicare |
$237.41
|
| Rate for Payer: WINHealth Partners Commercial |
$847.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2,533.00
|
|
|
HC PRO REPAIR COMPLEX WND TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 13101 NONPBBPAYER
|
| Hospital Charge Code |
9831310101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$1,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,221.08
|
| Rate for Payer: Aetna of WY Medicare |
$237.41
|
| Rate for Payer: Beech Street Commercial |
$1,183.70
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,208.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,221.08
|
| Rate for Payer: First Choice Health Commercial |
$1,121.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,183.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.41
|
| Rate for Payer: HealthUtah PPO |
$1,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,208.62
|
| Rate for Payer: Multiplan Medicare/VA |
$201.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,221.08
|
| Rate for Payer: PacificSource Commercial |
$1,121.40
|
| Rate for Payer: PHCS PPO |
$1,183.70
|
| Rate for Payer: Three Rivers PPO |
$934.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.41
|
| Rate for Payer: United Healthcare Commercial |
$1,084.02
|
| Rate for Payer: United Healthcare Medicare |
$237.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,059.10
|
|
|
HC PRO REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$3,545.00
|
|
|
Service Code
|
HCPCS 26433
|
| Hospital Charge Code |
9752643301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$478.10 |
| Max. Negotiated Rate |
$3,545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,474.10
|
| Rate for Payer: Aetna of WY Medicare |
$562.47
|
| Rate for Payer: Beech Street Commercial |
$3,367.75
|
| Rate for Payer: Cash Price |
$2,481.50
|
| Rate for Payer: Cash Price |
$2,481.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,438.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,474.10
|
| Rate for Payer: First Choice Health Commercial |
$3,190.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,367.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.47
|
| Rate for Payer: HealthUtah PPO |
$3,545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,438.65
|
| Rate for Payer: Multiplan Medicare/VA |
$478.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,474.10
|
| Rate for Payer: PacificSource Commercial |
$3,190.50
|
| Rate for Payer: PHCS PPO |
$3,367.75
|
| Rate for Payer: Three Rivers PPO |
$2,658.75
|
| Rate for Payer: TriWest Veterans Administration |
$562.47
|
| Rate for Payer: United Healthcare Commercial |
$3,084.15
|
| Rate for Payer: United Healthcare Medicare |
$562.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,013.25
|
|
|
HC PRO REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$4,554.00
|
|
|
Service Code
|
HCPCS 26420
|
| Hospital Charge Code |
9832642001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$618.87 |
| Max. Negotiated Rate |
$4,554.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,462.92
|
| Rate for Payer: Aetna of WY Medicare |
$728.08
|
| Rate for Payer: Beech Street Commercial |
$4,326.30
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,417.38
|
| Rate for Payer: Cigna of WY Commercial |
$4,462.92
|
| Rate for Payer: First Choice Health Commercial |
$4,098.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,326.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.08
|
| Rate for Payer: HealthUtah PPO |
$4,554.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,417.38
|
| Rate for Payer: Multiplan Medicare/VA |
$618.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,462.92
|
| Rate for Payer: PacificSource Commercial |
$4,098.60
|
| Rate for Payer: PHCS PPO |
$4,326.30
|
| Rate for Payer: Three Rivers PPO |
$3,415.50
|
| Rate for Payer: TriWest Veterans Administration |
$728.08
|
| Rate for Payer: United Healthcare Commercial |
$3,961.98
|
| Rate for Payer: United Healthcare Medicare |
$728.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,870.90
|
|
|
HC PRO REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$2,112.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
9832641001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$502.93 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,069.76
|
| Rate for Payer: Aetna of WY Medicare |
$591.68
|
| Rate for Payer: Beech Street Commercial |
$2,006.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,048.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,069.76
|
| Rate for Payer: First Choice Health Commercial |
$1,900.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,006.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.68
|
| Rate for Payer: HealthUtah PPO |
$2,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,048.64
|
| Rate for Payer: Multiplan Medicare/VA |
$502.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,069.76
|
| Rate for Payer: PacificSource Commercial |
$1,900.80
|
| Rate for Payer: PHCS PPO |
$2,006.40
|
| Rate for Payer: Three Rivers PPO |
$1,584.00
|
| Rate for Payer: TriWest Veterans Administration |
$591.68
|
| Rate for Payer: United Healthcare Commercial |
$1,837.44
|
| Rate for Payer: United Healthcare Medicare |
$591.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,795.20
|
|
|
HC PRO REPAIR EXTEN TENDON CENTRAL SLIP W GRAFT EA FINGER
|
Professional
|
Both
|
$2,783.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
9832642801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$662.99 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,727.34
|
| Rate for Payer: Aetna of WY Medicare |
$779.99
|
| Rate for Payer: Beech Street Commercial |
$2,643.85
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,699.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,727.34
|
| Rate for Payer: First Choice Health Commercial |
$2,504.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,643.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$779.99
|
| Rate for Payer: HealthUtah PPO |
$2,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,699.51
|
| Rate for Payer: Multiplan Medicare/VA |
$662.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,727.34
|
| Rate for Payer: PacificSource Commercial |
$2,504.70
|
| Rate for Payer: PHCS PPO |
$2,643.85
|
| Rate for Payer: Three Rivers PPO |
$2,087.25
|
| Rate for Payer: TriWest Veterans Administration |
$779.99
|
| Rate for Payer: United Healthcare Commercial |
$2,421.21
|
| Rate for Payer: United Healthcare Medicare |
$779.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,365.55
|
|
|
HC PRO REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Professional
|
Both
|
$4,219.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
9832641801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$523.68 |
| Max. Negotiated Rate |
$4,219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,134.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,154.04
|
| Rate for Payer: Aetna of WY Medicare |
$616.10
|
| Rate for Payer: Aetna of WY Medicare |
$616.10
|
| Rate for Payer: Beech Street Commercial |
$2,088.10
|
| Rate for Payer: Beech Street Commercial |
$4,008.05
|
| Rate for Payer: Cash Price |
$1,538.60
|
| Rate for Payer: Cash Price |
$1,538.60
|
| Rate for Payer: Cash Price |
$2,953.30
|
| Rate for Payer: Cash Price |
$2,953.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,092.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,132.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,154.04
|
| Rate for Payer: Cigna of WY Commercial |
$4,134.62
|
| Rate for Payer: First Choice Health Commercial |
$1,978.20
|
| Rate for Payer: First Choice Health Commercial |
$3,797.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,008.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,088.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$616.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$616.10
|
| Rate for Payer: HealthUtah PPO |
$4,219.00
|
| Rate for Payer: HealthUtah PPO |
$2,198.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,092.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,132.06
|
| Rate for Payer: Multiplan Medicare/VA |
$523.68
|
| Rate for Payer: Multiplan Medicare/VA |
$523.68
|
| Rate for Payer: One Health Plan of WY PPO |
$4,134.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,154.04
|
| Rate for Payer: PacificSource Commercial |
$1,978.20
|
| Rate for Payer: PacificSource Commercial |
$3,797.10
|
| Rate for Payer: PHCS PPO |
$4,008.05
|
| Rate for Payer: PHCS PPO |
$2,088.10
|
| Rate for Payer: Three Rivers PPO |
$3,164.25
|
| Rate for Payer: Three Rivers PPO |
$1,648.50
|
| Rate for Payer: TriWest Veterans Administration |
$616.10
|
| Rate for Payer: TriWest Veterans Administration |
$616.10
|
| Rate for Payer: United Healthcare Commercial |
$1,912.26
|
| Rate for Payer: United Healthcare Commercial |
$3,670.53
|
| Rate for Payer: United Healthcare Medicare |
$616.10
|
| Rate for Payer: United Healthcare Medicare |
$616.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,586.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,868.30
|
|
|
HC PRO REPAIR FINGER/ TENDON
|
Professional
|
Both
|
$6,031.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
9832635001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$623.64 |
| Max. Negotiated Rate |
$6,031.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,910.38
|
| Rate for Payer: Aetna of WY Medicare |
$733.69
|
| Rate for Payer: Beech Street Commercial |
$5,729.45
|
| Rate for Payer: Cash Price |
$4,221.70
|
| Rate for Payer: Cash Price |
$4,221.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,850.07
|
| Rate for Payer: Cigna of WY Commercial |
$5,910.38
|
| Rate for Payer: First Choice Health Commercial |
$5,427.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,729.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.69
|
| Rate for Payer: HealthUtah PPO |
$6,031.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,850.07
|
| Rate for Payer: Multiplan Medicare/VA |
$623.64
|
| Rate for Payer: One Health Plan of WY PPO |
$5,910.38
|
| Rate for Payer: PacificSource Commercial |
$5,427.90
|
| Rate for Payer: PHCS PPO |
$5,729.45
|
| Rate for Payer: Three Rivers PPO |
$4,523.25
|
| Rate for Payer: TriWest Veterans Administration |
$733.69
|
| Rate for Payer: United Healthcare Commercial |
$5,246.97
|
| Rate for Payer: United Healthcare Medicare |
$733.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,126.35
|
|
|
HC PRO REPAIR FLEX TENDON,ZONE 2,HAND
|
Professional
|
Both
|
$6,966.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
9832635601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$661.94 |
| Max. Negotiated Rate |
$6,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,826.68
|
| Rate for Payer: Aetna of WY Medicare |
$778.75
|
| Rate for Payer: Beech Street Commercial |
$6,617.70
|
| Rate for Payer: Cash Price |
$4,876.20
|
| Rate for Payer: Cash Price |
$4,876.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,757.02
|
| Rate for Payer: Cigna of WY Commercial |
$6,826.68
|
| Rate for Payer: First Choice Health Commercial |
$6,269.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,617.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.75
|
| Rate for Payer: HealthUtah PPO |
$6,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,757.02
|
| Rate for Payer: Multiplan Medicare/VA |
$661.94
|
| Rate for Payer: One Health Plan of WY PPO |
$6,826.68
|
| Rate for Payer: PacificSource Commercial |
$6,269.40
|
| Rate for Payer: PHCS PPO |
$6,617.70
|
| Rate for Payer: Three Rivers PPO |
$5,224.50
|
| Rate for Payer: TriWest Veterans Administration |
$778.75
|
| Rate for Payer: United Healthcare Commercial |
$6,060.42
|
| Rate for Payer: United Healthcare Medicare |
$778.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,921.10
|
|
|
HC PRO REPAIR FOOT EA TEND,EXTENS;PR/SEC
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
9832820801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
| Rate for Payer: Aetna of WY Medicare |
$314.64
|
| Rate for Payer: Beech Street Commercial |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
| Rate for Payer: First Choice Health Commercial |
$1,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.64
|
| Rate for Payer: HealthUtah PPO |
$1,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
| Rate for Payer: Multiplan Medicare/VA |
$267.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
| Rate for Payer: PacificSource Commercial |
$1,474.20
|
| Rate for Payer: PHCS PPO |
$1,556.10
|
| Rate for Payer: Three Rivers PPO |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration |
$314.64
|
| Rate for Payer: United Healthcare Commercial |
$1,425.06
|
| Rate for Payer: United Healthcare Medicare |
$314.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,392.30
|
|
|
HC PRO REPAIR FOREARM/WRIST TEND/MUSC,FLEX,PRIM,EA
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
9832526001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$528.77 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,509.96
|
| Rate for Payer: Aetna of WY Medicare |
$622.08
|
| Rate for Payer: Beech Street Commercial |
$4,371.90
|
| Rate for Payer: Cash Price |
$3,221.40
|
| Rate for Payer: Cash Price |
$3,221.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,463.94
|
| Rate for Payer: Cigna of WY Commercial |
$4,509.96
|
| Rate for Payer: First Choice Health Commercial |
$4,141.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,371.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$622.08
|
| Rate for Payer: HealthUtah PPO |
$4,602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,463.94
|
| Rate for Payer: Multiplan Medicare/VA |
$528.77
|
| Rate for Payer: One Health Plan of WY PPO |
$4,509.96
|
| Rate for Payer: PacificSource Commercial |
$4,141.80
|
| Rate for Payer: PHCS PPO |
$4,371.90
|
| Rate for Payer: Three Rivers PPO |
$3,451.50
|
| Rate for Payer: TriWest Veterans Administration |
$622.08
|
| Rate for Payer: United Healthcare Commercial |
$4,003.74
|
| Rate for Payer: United Healthcare Medicare |
$622.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,911.70
|
|
|
HC PRO REPAIR INCISIONAL/VENTRAL HERNIA,INCARCERATED
|
Professional
|
Both
|
$4,816.00
|
|
|
Service Code
|
HCPCS 49561
|
| Hospital Charge Code |
9834956101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3,612.00 |
| Max. Negotiated Rate |
$4,816.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,719.68
|
| Rate for Payer: Beech Street Commercial |
$4,575.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,671.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,719.68
|
| Rate for Payer: First Choice Health Commercial |
$4,334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,575.20
|
| Rate for Payer: HealthUtah PPO |
$4,816.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,671.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,719.68
|
| Rate for Payer: PacificSource Commercial |
$4,334.40
|
| Rate for Payer: PHCS PPO |
$4,575.20
|
| Rate for Payer: Three Rivers PPO |
$3,612.00
|
| Rate for Payer: United Healthcare Commercial |
$4,189.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,093.60
|
|
|
HC PRO REPAIR INCISIONAL/VENTRAL HERNIA,REDUCIBLE
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
HCPCS 49560
|
| Hospital Charge Code |
9834956001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,868.00 |
| Max. Negotiated Rate |
$3,824.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,747.52
|
| Rate for Payer: Beech Street Commercial |
$3,632.80
|
| Rate for Payer: Cash Price |
$2,676.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,709.28
|
| Rate for Payer: Cigna of WY Commercial |
$3,747.52
|
| Rate for Payer: First Choice Health Commercial |
$3,441.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,632.80
|
| Rate for Payer: HealthUtah PPO |
$3,824.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,709.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,747.52
|
| Rate for Payer: PacificSource Commercial |
$3,441.60
|
| Rate for Payer: PHCS PPO |
$3,632.80
|
| Rate for Payer: Three Rivers PPO |
$2,868.00
|
| Rate for Payer: United Healthcare Commercial |
$3,326.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.40
|
|
|
HC PRO REPAIR ING HERNIA,5+Y/O,REDUCIBL
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
9834950501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$2,565.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: First Choice Health Commercial |
$2,430.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,565.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,295.00
|
|
|
HC PRO REPAIR ING HERNIA,5+Y/O,REDUCIBL
|
Professional
|
Both
|
$5,401.00
|
|
|
Service Code
|
HCPCS 49505 50
|
| Hospital Charge Code |
9834950501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$5,401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,292.98
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$5,130.95
|
| Rate for Payer: Cash Price |
$3,780.70
|
| Rate for Payer: Cash Price |
$3,780.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,238.97
|
| Rate for Payer: Cigna of WY Commercial |
$5,292.98
|
| Rate for Payer: First Choice Health Commercial |
$4,860.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,130.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$5,401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,238.97
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,292.98
|
| Rate for Payer: PacificSource Commercial |
$4,860.90
|
| Rate for Payer: PHCS PPO |
$5,130.95
|
| Rate for Payer: Three Rivers PPO |
$4,050.75
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$4,698.87
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4,590.85
|
|
|
HC PRO REPAIR / INTER EXTR 12.6-20CM
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 12045 NONPBBPAYER
|
| Hospital Charge Code |
9831204501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.77 |
| Max. Negotiated Rate |
$1,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,653.26
|
| Rate for Payer: Aetna of WY Medicare |
$263.26
|
| Rate for Payer: Beech Street Commercial |
$1,602.65
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,636.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,653.26
|
| Rate for Payer: First Choice Health Commercial |
$1,518.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,602.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.26
|
| Rate for Payer: HealthUtah PPO |
$1,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,636.39
|
| Rate for Payer: Multiplan Medicare/VA |
$223.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,653.26
|
| Rate for Payer: PacificSource Commercial |
$1,518.30
|
| Rate for Payer: PHCS PPO |
$1,602.65
|
| Rate for Payer: Three Rivers PPO |
$1,265.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.26
|
| Rate for Payer: United Healthcare Commercial |
$1,467.69
|
| Rate for Payer: United Healthcare Medicare |
$263.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,433.95
|
|
|
HC PRO REPAIR / INTER EXTR 12.6-20CM
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
9831204501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.77 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,323.00
|
| Rate for Payer: Aetna of WY Medicare |
$263.26
|
| Rate for Payer: Beech Street Commercial |
$1,282.50
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,309.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,323.00
|
| Rate for Payer: First Choice Health Commercial |
$1,215.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,282.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.26
|
| Rate for Payer: HealthUtah PPO |
$1,350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,309.50
|
| Rate for Payer: Multiplan Medicare/VA |
$223.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,323.00
|
| Rate for Payer: PacificSource Commercial |
$1,215.00
|
| Rate for Payer: PHCS PPO |
$1,282.50
|
| Rate for Payer: Three Rivers PPO |
$1,012.50
|
| Rate for Payer: TriWest Veterans Administration |
$263.26
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
| Rate for Payer: United Healthcare Medicare |
$263.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,147.50
|
|
|
HC PRO REPAIR LEG TENDON
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 27658
|
| Hospital Charge Code |
9832765801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$307.54 |
| Max. Negotiated Rate |
$1,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,900.22
|
| Rate for Payer: Aetna of WY Medicare |
$361.81
|
| Rate for Payer: Beech Street Commercial |
$1,842.05
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,880.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,900.22
|
| Rate for Payer: First Choice Health Commercial |
$1,745.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,842.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.81
|
| Rate for Payer: HealthUtah PPO |
$1,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,880.83
|
| Rate for Payer: Multiplan Medicare/VA |
$307.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,900.22
|
| Rate for Payer: PacificSource Commercial |
$1,745.10
|
| Rate for Payer: PHCS PPO |
$1,842.05
|
| Rate for Payer: Three Rivers PPO |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration |
$361.81
|
| Rate for Payer: United Healthcare Commercial |
$1,686.93
|
| Rate for Payer: United Healthcare Medicare |
$361.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,648.15
|
|
|
HC PRO REPAIR LIP,FULL THICK,OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 40654
|
| Hospital Charge Code |
9834065401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.35 |
| Max. Negotiated Rate |
$2,203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,158.94
|
| Rate for Payer: Aetna of WY Medicare |
$415.71
|
| Rate for Payer: Beech Street Commercial |
$2,092.85
|
| Rate for Payer: Cash Price |
$1,542.10
|
| Rate for Payer: Cash Price |
$1,542.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,136.91
|
| Rate for Payer: Cigna of WY Commercial |
$2,158.94
|
| Rate for Payer: First Choice Health Commercial |
$1,982.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,092.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.71
|
| Rate for Payer: HealthUtah PPO |
$2,203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,136.91
|
| Rate for Payer: Multiplan Medicare/VA |
$353.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,158.94
|
| Rate for Payer: PacificSource Commercial |
$1,982.70
|
| Rate for Payer: PHCS PPO |
$2,092.85
|
| Rate for Payer: Three Rivers PPO |
$1,652.25
|
| Rate for Payer: TriWest Veterans Administration |
$415.71
|
| Rate for Payer: United Healthcare Commercial |
$1,916.61
|
| Rate for Payer: United Healthcare Medicare |
$415.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,872.55
|
|
|
HC PRO REPAIR LIP,FULL THICK,VERMILION
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
9834065001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.37 |
| Max. Negotiated Rate |
$1,677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,643.46
|
| Rate for Payer: Aetna of WY Medicare |
$308.67
|
| Rate for Payer: Beech Street Commercial |
$1,593.15
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,626.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,643.46
|
| Rate for Payer: First Choice Health Commercial |
$1,509.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,593.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.67
|
| Rate for Payer: HealthUtah PPO |
$1,677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,626.69
|
| Rate for Payer: Multiplan Medicare/VA |
$262.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,643.46
|
| Rate for Payer: PacificSource Commercial |
$1,509.30
|
| Rate for Payer: PHCS PPO |
$1,593.15
|
| Rate for Payer: Three Rivers PPO |
$1,257.75
|
| Rate for Payer: TriWest Veterans Administration |
$308.67
|
| Rate for Payer: United Healthcare Commercial |
$1,458.99
|
| Rate for Payer: United Healthcare Medicare |
$308.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.45
|
|
