|
HC PRO REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,623.00
|
|
|
Service Code
|
HCPCS 24345
|
| Hospital Charge Code |
9832434501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$591.17 |
| Max. Negotiated Rate |
$3,623.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,550.54
|
| Rate for Payer: Aetna of WY Medicare |
$695.49
|
| Rate for Payer: Beech Street Commercial |
$3,441.85
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,514.31
|
| Rate for Payer: Cigna of WY Commercial |
$3,550.54
|
| Rate for Payer: First Choice Health Commercial |
$3,260.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,441.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.49
|
| Rate for Payer: HealthUtah PPO |
$3,623.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,514.31
|
| Rate for Payer: Multiplan Medicare/VA |
$591.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,550.54
|
| Rate for Payer: PacificSource Commercial |
$3,260.70
|
| Rate for Payer: PHCS PPO |
$3,441.85
|
| Rate for Payer: Three Rivers PPO |
$2,717.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.49
|
| Rate for Payer: United Healthcare Commercial |
$3,152.01
|
| Rate for Payer: United Healthcare Medicare |
$695.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,079.55
|
|
|
HC PRO REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
9833063001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$555.42 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,285.36
|
| Rate for Payer: Aetna of WY Medicare |
$653.43
|
| Rate for Payer: Beech Street Commercial |
$2,215.40
|
| Rate for Payer: Cash Price |
$1,632.40
|
| Rate for Payer: Cash Price |
$1,632.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,262.04
|
| Rate for Payer: Cigna of WY Commercial |
$2,285.36
|
| Rate for Payer: First Choice Health Commercial |
$2,098.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,215.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.43
|
| Rate for Payer: HealthUtah PPO |
$2,332.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,262.04
|
| Rate for Payer: Multiplan Medicare/VA |
$555.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,285.36
|
| Rate for Payer: PacificSource Commercial |
$2,098.80
|
| Rate for Payer: PHCS PPO |
$2,215.40
|
| Rate for Payer: Three Rivers PPO |
$1,749.00
|
| Rate for Payer: TriWest Veterans Administration |
$653.43
|
| Rate for Payer: United Healthcare Commercial |
$2,028.84
|
| Rate for Payer: United Healthcare Medicare |
$653.43
|
| Rate for Payer: WINHealth Partners Commercial |
$1,982.20
|
|
|
HC PRO REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 24435
|
| Hospital Charge Code |
9822443501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$889.15 |
| Max. Negotiated Rate |
$3,732.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,657.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,046.06
|
| Rate for Payer: Beech Street Commercial |
$3,545.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,620.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,657.36
|
| Rate for Payer: First Choice Health Commercial |
$3,358.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,046.06
|
| Rate for Payer: HealthUtah PPO |
$3,732.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,620.04
|
| Rate for Payer: Multiplan Medicare/VA |
$889.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,657.36
|
| Rate for Payer: PacificSource Commercial |
$3,358.80
|
| Rate for Payer: PHCS PPO |
$3,545.40
|
| Rate for Payer: Three Rivers PPO |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,046.06
|
| Rate for Payer: United Healthcare Commercial |
$3,246.84
|
| Rate for Payer: United Healthcare Medicare |
$1,046.06
|
| Rate for Payer: WINHealth Partners Commercial |
$3,172.20
|
|
|
HC PRO REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
9832443001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$865.91 |
| Max. Negotiated Rate |
$3,635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,562.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,018.72
|
| Rate for Payer: Beech Street Commercial |
$3,453.25
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,525.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,562.30
|
| Rate for Payer: First Choice Health Commercial |
$3,271.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,453.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,018.72
|
| Rate for Payer: HealthUtah PPO |
$3,635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,525.95
|
| Rate for Payer: Multiplan Medicare/VA |
$865.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,562.30
|
| Rate for Payer: PacificSource Commercial |
$3,271.50
|
| Rate for Payer: PHCS PPO |
$3,453.25
|
| Rate for Payer: Three Rivers PPO |
$2,726.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,018.72
|
| Rate for Payer: United Healthcare Commercial |
$3,162.45
|
| Rate for Payer: United Healthcare Medicare |
$1,018.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,089.75
|
|
|
HC PRO REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 27704
|
| Hospital Charge Code |
9832770401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$469.40 |
| Max. Negotiated Rate |
$2,959.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,899.82
|
| Rate for Payer: Aetna of WY Medicare |
$552.23
|
| Rate for Payer: Beech Street Commercial |
$2,811.05
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,870.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,899.82
|
| Rate for Payer: First Choice Health Commercial |
$2,663.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,811.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.23
|
| Rate for Payer: HealthUtah PPO |
$2,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,870.23
|
| Rate for Payer: Multiplan Medicare/VA |
$469.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,899.82
|
| Rate for Payer: PacificSource Commercial |
$2,663.10
|
| Rate for Payer: PHCS PPO |
$2,811.05
|
| Rate for Payer: Three Rivers PPO |
$2,219.25
|
| Rate for Payer: TriWest Veterans Administration |
$552.23
|
| Rate for Payer: United Healthcare Commercial |
$2,574.33
|
| Rate for Payer: United Healthcare Medicare |
$552.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,515.15
|
|
|
HC PRO REPAIR OF NAIL BED
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
9831176001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$106.10
|
| Rate for Payer: Aetna of WY Medicare |
$106.10
|
| Rate for Payer: Beech Street Commercial |
$489.25
|
| Rate for Payer: Beech Street Commercial |
$662.15
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$487.90
|
| Rate for Payer: Cash Price |
$487.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: Cigna of WY Commercial |
$683.06
|
| Rate for Payer: First Choice Health Commercial |
$463.50
|
| Rate for Payer: First Choice Health Commercial |
$627.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$662.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.10
|
| Rate for Payer: HealthUtah PPO |
$697.00
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$90.18
|
| Rate for Payer: Multiplan Medicare/VA |
$90.18
|
| Rate for Payer: One Health Plan of WY PPO |
$683.06
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PacificSource Commercial |
$627.30
|
| Rate for Payer: PHCS PPO |
$662.15
|
| Rate for Payer: PHCS PPO |
$489.25
|
| Rate for Payer: Three Rivers PPO |
$522.75
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.10
|
| Rate for Payer: TriWest Veterans Administration |
$106.10
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Commercial |
$606.39
|
| Rate for Payer: United Healthcare Medicare |
$106.10
|
| Rate for Payer: United Healthcare Medicare |
$106.10
|
| Rate for Payer: WINHealth Partners Commercial |
$592.45
|
| Rate for Payer: WINHealth Partners Commercial |
$437.75
|
|
|
HC PRO REPAIR OF NAIL BED
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11760 NONPBBPAYER
|
| Hospital Charge Code |
9831176001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Medicare |
$106.10
|
| Rate for Payer: Beech Street Commercial |
$611.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: First Choice Health Commercial |
$579.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.10
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$90.18
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$611.80
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$106.10
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$106.10
|
| Rate for Payer: WINHealth Partners Commercial |
$547.40
|
|
|
HC PRO REPAIR OF NASAL SEPTUM
|
Professional
|
Both
|
$4,969.00
|
|
|
Service Code
|
HCPCS 30520
|
| Hospital Charge Code |
9833052001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$561.07 |
| Max. Negotiated Rate |
$4,969.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,869.62
|
| Rate for Payer: Aetna of WY Medicare |
$660.08
|
| Rate for Payer: Beech Street Commercial |
$4,720.55
|
| Rate for Payer: Cash Price |
$3,478.30
|
| Rate for Payer: Cash Price |
$3,478.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,819.93
|
| Rate for Payer: Cigna of WY Commercial |
$4,869.62
|
| Rate for Payer: First Choice Health Commercial |
$4,472.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,720.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.08
|
| Rate for Payer: HealthUtah PPO |
$4,969.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,819.93
|
| Rate for Payer: Multiplan Medicare/VA |
$561.07
|
| Rate for Payer: One Health Plan of WY PPO |
$4,869.62
|
| Rate for Payer: PacificSource Commercial |
$4,472.10
|
| Rate for Payer: PHCS PPO |
$4,720.55
|
| Rate for Payer: Three Rivers PPO |
$3,726.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.08
|
| Rate for Payer: United Healthcare Commercial |
$4,323.03
|
| Rate for Payer: United Healthcare Medicare |
$660.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,223.65
|
|
|
HC PRO REPAIR & RECONSTRUCT FINGER VOLAR PLATE INTERPHALANGEAL
|
Professional
|
Both
|
$3,990.00
|
|
|
Service Code
|
HCPCS 26548
|
| Hospital Charge Code |
9832654801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,910.20
|
| Rate for Payer: Aetna of WY Medicare |
$782.68
|
| Rate for Payer: Beech Street Commercial |
$3,790.50
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,870.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,910.20
|
| Rate for Payer: First Choice Health Commercial |
$3,591.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,790.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$782.68
|
| Rate for Payer: HealthUtah PPO |
$3,990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,870.30
|
| Rate for Payer: Multiplan Medicare/VA |
$665.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,910.20
|
| Rate for Payer: PacificSource Commercial |
$3,591.00
|
| Rate for Payer: PHCS PPO |
$3,790.50
|
| Rate for Payer: Three Rivers PPO |
$2,992.50
|
| Rate for Payer: TriWest Veterans Administration |
$782.68
|
| Rate for Payer: United Healthcare Commercial |
$3,471.30
|
| Rate for Payer: United Healthcare Medicare |
$782.68
|
| Rate for Payer: WINHealth Partners Commercial |
$3,391.50
|
|
|
HC PRO REPAIR ROTATOR CUFF OPEN, ACUTE
|
Professional
|
Both
|
$4,201.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
9832341001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$4,201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.98
|
| Rate for Payer: Aetna of WY Medicare |
$794.54
|
| Rate for Payer: Beech Street Commercial |
$3,990.95
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.98
|
| Rate for Payer: First Choice Health Commercial |
$3,780.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.54
|
| Rate for Payer: HealthUtah PPO |
$4,201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.97
|
| Rate for Payer: Multiplan Medicare/VA |
$675.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.98
|
| Rate for Payer: PacificSource Commercial |
$3,780.90
|
| Rate for Payer: PHCS PPO |
$3,990.95
|
| Rate for Payer: Three Rivers PPO |
$3,150.75
|
| Rate for Payer: TriWest Veterans Administration |
$794.54
|
| Rate for Payer: United Healthcare Commercial |
$3,654.87
|
| Rate for Payer: United Healthcare Medicare |
$794.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,570.85
|
|
|
HC PRO REPAIR ROTATOR CUFF OPEN, CHRONIC
|
Professional
|
Both
|
$4,368.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
9832341201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$701.76 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,280.64
|
| Rate for Payer: Aetna of WY Medicare |
$825.60
|
| Rate for Payer: Beech Street Commercial |
$4,149.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,236.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,280.64
|
| Rate for Payer: First Choice Health Commercial |
$3,931.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,149.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$825.60
|
| Rate for Payer: HealthUtah PPO |
$4,368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,236.96
|
| Rate for Payer: Multiplan Medicare/VA |
$701.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,280.64
|
| Rate for Payer: PacificSource Commercial |
$3,931.20
|
| Rate for Payer: PHCS PPO |
$4,149.60
|
| Rate for Payer: Three Rivers PPO |
$3,276.00
|
| Rate for Payer: TriWest Veterans Administration |
$825.60
|
| Rate for Payer: United Healthcare Commercial |
$3,800.16
|
| Rate for Payer: United Healthcare Medicare |
$825.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,712.80
|
|
|
HC PRO REPAIR SUPERFICAL WND BODY <2.5CM
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 12001 NONPBBPAYER
|
| Hospital Charge Code |
9831200101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$42.51
|
| Rate for Payer: Beech Street Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$36.13
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$361.00
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
|
|
HC PRO REPAIR SUPERFICAL WND BODY <2.5CM
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
9831200101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Aetna of WY Medicare |
$42.51
|
| Rate for Payer: Aetna of WY Medicare |
$42.51
|
| Rate for Payer: Beech Street Commercial |
$288.80
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: Multiplan Medicare/VA |
$36.13
|
| Rate for Payer: Multiplan Medicare/VA |
$36.13
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: PHCS PPO |
$288.80
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
| Rate for Payer: WINHealth Partners Commercial |
$258.40
|
|
|
HC PRO REPAIR SUPERFICAL WND BODY 2.6-7.5 CM
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
9831200201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$479.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.68
|
| Rate for Payer: Aetna of WY Medicare |
$55.75
|
| Rate for Payer: Aetna of WY Medicare |
$55.75
|
| Rate for Payer: Beech Street Commercial |
$300.20
|
| Rate for Payer: Beech Street Commercial |
$464.55
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$474.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.52
|
| Rate for Payer: Cigna of WY Commercial |
$309.68
|
| Rate for Payer: Cigna of WY Commercial |
$479.22
|
| Rate for Payer: First Choice Health Commercial |
$284.40
|
| Rate for Payer: First Choice Health Commercial |
$440.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$464.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.75
|
| Rate for Payer: HealthUtah PPO |
$489.00
|
| Rate for Payer: HealthUtah PPO |
$316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$474.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.52
|
| Rate for Payer: Multiplan Medicare/VA |
$47.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.39
|
| Rate for Payer: One Health Plan of WY PPO |
$479.22
|
| Rate for Payer: One Health Plan of WY PPO |
$309.68
|
| Rate for Payer: PacificSource Commercial |
$284.40
|
| Rate for Payer: PacificSource Commercial |
$440.10
|
| Rate for Payer: PHCS PPO |
$464.55
|
| Rate for Payer: PHCS PPO |
$300.20
|
| Rate for Payer: Three Rivers PPO |
$366.75
|
| Rate for Payer: Three Rivers PPO |
$237.00
|
| Rate for Payer: TriWest Veterans Administration |
$55.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.75
|
| Rate for Payer: United Healthcare Commercial |
$274.92
|
| Rate for Payer: United Healthcare Commercial |
$425.43
|
| Rate for Payer: United Healthcare Medicare |
$55.75
|
| Rate for Payer: United Healthcare Medicare |
$55.75
|
| Rate for Payer: WINHealth Partners Commercial |
$415.65
|
| Rate for Payer: WINHealth Partners Commercial |
$268.60
|
|
|
HC PRO REPAIR SUPERFICAL WND BODY 2.6-7.5 CM
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 12002 NONPBBPAYER
|
| Hospital Charge Code |
9831200201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$55.75
|
| Rate for Payer: Beech Street Commercial |
$375.25
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: First Choice Health Commercial |
$355.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.75
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$47.39
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$375.25
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.75
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$55.75
|
| Rate for Payer: WINHealth Partners Commercial |
$335.75
|
|
|
HC PRO REPAIR SUPERFICAL WOUND BODY 20.1-30 CM
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
9831200601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Aetna of WY Medicare |
$109.28
|
| Rate for Payer: Aetna of WY Medicare |
$109.28
|
| Rate for Payer: Beech Street Commercial |
$536.75
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$508.50
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.28
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$92.89
|
| Rate for Payer: Multiplan Medicare/VA |
$92.89
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: PHCS PPO |
$536.75
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$109.28
|
| Rate for Payer: TriWest Veterans Administration |
$109.28
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Commercial |
$771.69
|
| Rate for Payer: United Healthcare Medicare |
$109.28
|
| Rate for Payer: United Healthcare Medicare |
$109.28
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
| Rate for Payer: WINHealth Partners Commercial |
$480.25
|
|
|
HC PRO REPAIR SUPERFICAL WOUND BODY 20.1-30 CM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 12006 NONPBBPAYER
|
| Hospital Charge Code |
9831200601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$706.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$691.88
|
| Rate for Payer: Aetna of WY Medicare |
$109.28
|
| Rate for Payer: Beech Street Commercial |
$670.70
|
| Rate for Payer: Cash Price |
$494.20
|
| Rate for Payer: Cash Price |
$494.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$684.82
|
| Rate for Payer: Cigna of WY Commercial |
$691.88
|
| Rate for Payer: First Choice Health Commercial |
$635.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$670.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.28
|
| Rate for Payer: HealthUtah PPO |
$706.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$684.82
|
| Rate for Payer: Multiplan Medicare/VA |
$92.89
|
| Rate for Payer: One Health Plan of WY PPO |
$691.88
|
| Rate for Payer: PacificSource Commercial |
$635.40
|
| Rate for Payer: PHCS PPO |
$670.70
|
| Rate for Payer: Three Rivers PPO |
$529.50
|
| Rate for Payer: TriWest Veterans Administration |
$109.28
|
| Rate for Payer: United Healthcare Commercial |
$614.22
|
| Rate for Payer: United Healthcare Medicare |
$109.28
|
| Rate for Payer: WINHealth Partners Commercial |
$600.10
|
|
|
HC PRO REPAIR SUPERFICAL WOUND BODY >30 CM
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
9831200701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$626.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Aetna of WY Medicare |
$135.84
|
| Rate for Payer: Aetna of WY Medicare |
$135.84
|
| Rate for Payer: Beech Street Commercial |
$1,054.50
|
| Rate for Payer: Beech Street Commercial |
$607.05
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$619.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Cigna of WY Commercial |
$626.22
|
| Rate for Payer: First Choice Health Commercial |
$999.00
|
| Rate for Payer: First Choice Health Commercial |
$575.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$607.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.84
|
| Rate for Payer: HealthUtah PPO |
$639.00
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$619.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.46
|
| Rate for Payer: Multiplan Medicare/VA |
$115.46
|
| Rate for Payer: One Health Plan of WY PPO |
$626.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PacificSource Commercial |
$575.10
|
| Rate for Payer: PHCS PPO |
$607.05
|
| Rate for Payer: PHCS PPO |
$1,054.50
|
| Rate for Payer: Three Rivers PPO |
$479.25
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.84
|
| Rate for Payer: TriWest Veterans Administration |
$135.84
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Commercial |
$555.93
|
| Rate for Payer: United Healthcare Medicare |
$135.84
|
| Rate for Payer: United Healthcare Medicare |
$135.84
|
| Rate for Payer: WINHealth Partners Commercial |
$543.15
|
| Rate for Payer: WINHealth Partners Commercial |
$943.50
|
|
|
HC PRO REPAIR SUPERFICAL WOUND BODY >30 CM
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 12007 NONPBBPAYER
|
| Hospital Charge Code |
9831200701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$783.02
|
| Rate for Payer: Aetna of WY Medicare |
$135.84
|
| Rate for Payer: Beech Street Commercial |
$759.05
|
| Rate for Payer: Cash Price |
$559.30
|
| Rate for Payer: Cash Price |
$559.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$775.03
|
| Rate for Payer: Cigna of WY Commercial |
$783.02
|
| Rate for Payer: First Choice Health Commercial |
$719.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$759.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.84
|
| Rate for Payer: HealthUtah PPO |
$799.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$775.03
|
| Rate for Payer: Multiplan Medicare/VA |
$115.46
|
| Rate for Payer: One Health Plan of WY PPO |
$783.02
|
| Rate for Payer: PacificSource Commercial |
$719.10
|
| Rate for Payer: PHCS PPO |
$759.05
|
| Rate for Payer: Three Rivers PPO |
$599.25
|
| Rate for Payer: TriWest Veterans Administration |
$135.84
|
| Rate for Payer: United Healthcare Commercial |
$695.13
|
| Rate for Payer: United Healthcare Medicare |
$135.84
|
| Rate for Payer: WINHealth Partners Commercial |
$679.15
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 12.6-20 CM
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
9831201601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$733.50 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$958.44
|
| Rate for Payer: Beech Street Commercial |
$929.10
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$948.66
|
| Rate for Payer: Cigna of WY Commercial |
$958.44
|
| Rate for Payer: First Choice Health Commercial |
$880.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$929.10
|
| Rate for Payer: HealthUtah PPO |
$978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$948.66
|
| Rate for Payer: One Health Plan of WY PPO |
$958.44
|
| Rate for Payer: PacificSource Commercial |
$880.20
|
| Rate for Payer: PHCS PPO |
$929.10
|
| Rate for Payer: Three Rivers PPO |
$733.50
|
| Rate for Payer: United Healthcare Commercial |
$850.86
|
| Rate for Payer: WINHealth Partners Commercial |
$831.30
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE <2.5CM
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
9831201101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.68 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.52
|
| Rate for Payer: Aetna of WY Medicare |
$52.56
|
| Rate for Payer: Aetna of WY Medicare |
$52.56
|
| Rate for Payer: Beech Street Commercial |
$212.80
|
| Rate for Payer: Beech Street Commercial |
$483.55
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.28
|
| Rate for Payer: Cigna of WY Commercial |
$219.52
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: First Choice Health Commercial |
$201.60
|
| Rate for Payer: First Choice Health Commercial |
$458.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.56
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: HealthUtah PPO |
$224.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.28
|
| Rate for Payer: Multiplan Medicare/VA |
$44.68
|
| Rate for Payer: Multiplan Medicare/VA |
$44.68
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: One Health Plan of WY PPO |
$219.52
|
| Rate for Payer: PacificSource Commercial |
$201.60
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$483.55
|
| Rate for Payer: PHCS PPO |
$212.80
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: Three Rivers PPO |
$168.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.56
|
| Rate for Payer: TriWest Veterans Administration |
$52.56
|
| Rate for Payer: United Healthcare Commercial |
$194.88
|
| Rate for Payer: United Healthcare Commercial |
$442.83
|
| Rate for Payer: United Healthcare Medicare |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$52.56
|
| Rate for Payer: WINHealth Partners Commercial |
$432.65
|
| Rate for Payer: WINHealth Partners Commercial |
$190.40
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE <2.5CM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 12011 NONPBBPAYER
|
| Hospital Charge Code |
9831201101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.68 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.56
|
| 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 |
$52.56
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.68
|
| 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 |
$52.56
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$52.56
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 2.6-5 CM
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
9831201301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$233.24
|
| Rate for Payer: Aetna of WY Medicare |
$54.60
|
| Rate for Payer: Aetna of WY Medicare |
$54.60
|
| Rate for Payer: Beech Street Commercial |
$226.10
|
| Rate for Payer: Beech Street Commercial |
$507.30
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.86
|
| Rate for Payer: Cigna of WY Commercial |
$233.24
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: First Choice Health Commercial |
$214.20
|
| Rate for Payer: First Choice Health Commercial |
$480.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.60
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: HealthUtah PPO |
$238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.86
|
| Rate for Payer: Multiplan Medicare/VA |
$46.41
|
| Rate for Payer: Multiplan Medicare/VA |
$46.41
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: One Health Plan of WY PPO |
$233.24
|
| Rate for Payer: PacificSource Commercial |
$214.20
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$507.30
|
| Rate for Payer: PHCS PPO |
$226.10
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$178.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.60
|
| Rate for Payer: TriWest Veterans Administration |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$207.06
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$54.60
|
| Rate for Payer: United Healthcare Medicare |
$54.60
|
| Rate for Payer: WINHealth Partners Commercial |
$453.90
|
| Rate for Payer: WINHealth Partners Commercial |
$202.30
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 2.6-5 CM
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 12013 NONPBBPAYER
|
| Hospital Charge Code |
9831201301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.06
|
| Rate for Payer: Aetna of WY Medicare |
$54.60
|
| Rate for Payer: Beech Street Commercial |
$282.15
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.09
|
| Rate for Payer: Cigna of WY Commercial |
$291.06
|
| Rate for Payer: First Choice Health Commercial |
$267.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.60
|
| Rate for Payer: HealthUtah PPO |
$297.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.09
|
| Rate for Payer: Multiplan Medicare/VA |
$46.41
|
| Rate for Payer: One Health Plan of WY PPO |
$291.06
|
| Rate for Payer: PacificSource Commercial |
$267.30
|
| Rate for Payer: PHCS PPO |
$282.15
|
| Rate for Payer: Three Rivers PPO |
$222.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$258.39
|
| Rate for Payer: United Healthcare Medicare |
$54.60
|
| Rate for Payer: WINHealth Partners Commercial |
$252.45
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 5.1-7.5 CM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
9831201401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.94
|
| Rate for Payer: Aetna of WY Medicare |
$70.61
|
| Rate for Payer: Aetna of WY Medicare |
$70.61
|
| Rate for Payer: Beech Street Commercial |
$287.85
|
| Rate for Payer: Beech Street Commercial |
$760.00
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.91
|
| Rate for Payer: Cigna of WY Commercial |
$296.94
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: First Choice Health Commercial |
$272.70
|
| Rate for Payer: First Choice Health Commercial |
$720.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.61
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: HealthUtah PPO |
$303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.91
|
| Rate for Payer: Multiplan Medicare/VA |
$60.02
|
| Rate for Payer: Multiplan Medicare/VA |
$60.02
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: One Health Plan of WY PPO |
$296.94
|
| Rate for Payer: PacificSource Commercial |
$272.70
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$760.00
|
| Rate for Payer: PHCS PPO |
$287.85
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: Three Rivers PPO |
$227.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.61
|
| Rate for Payer: TriWest Veterans Administration |
$70.61
|
| Rate for Payer: United Healthcare Commercial |
$263.61
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$70.61
|
| Rate for Payer: United Healthcare Medicare |
$70.61
|
| Rate for Payer: WINHealth Partners Commercial |
$680.00
|
| Rate for Payer: WINHealth Partners Commercial |
$257.55
|
|
