|
HC PRO REPAIR SUPERFICIAL WND FACE 5.1-7.5 CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 12014 NONPBBPAYER
|
| Hospital Charge Code |
9831201401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$379.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.42
|
| Rate for Payer: Aetna of WY Medicare |
$70.61
|
| Rate for Payer: Beech Street Commercial |
$360.05
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.63
|
| Rate for Payer: Cigna of WY Commercial |
$371.42
|
| Rate for Payer: First Choice Health Commercial |
$341.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.61
|
| Rate for Payer: HealthUtah PPO |
$379.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.63
|
| Rate for Payer: Multiplan Medicare/VA |
$60.02
|
| Rate for Payer: One Health Plan of WY PPO |
$371.42
|
| Rate for Payer: PacificSource Commercial |
$341.10
|
| Rate for Payer: PHCS PPO |
$360.05
|
| Rate for Payer: Three Rivers PPO |
$284.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.61
|
| Rate for Payer: United Healthcare Commercial |
$329.73
|
| Rate for Payer: United Healthcare Medicare |
$70.61
|
| Rate for Payer: WINHealth Partners Commercial |
$322.15
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 7.6-12.5 CM
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
9831201501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$647.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$634.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$88.59
|
| Rate for Payer: Aetna of WY Medicare |
$88.59
|
| Rate for Payer: Beech Street Commercial |
$365.75
|
| Rate for Payer: Beech Street Commercial |
$614.65
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$452.90
|
| Rate for Payer: Cash Price |
$452.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$627.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Cigna of WY Commercial |
$634.06
|
| Rate for Payer: First Choice Health Commercial |
$346.50
|
| Rate for Payer: First Choice Health Commercial |
$582.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$614.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.59
|
| Rate for Payer: HealthUtah PPO |
$647.00
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$627.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$75.30
|
| Rate for Payer: Multiplan Medicare/VA |
$75.30
|
| Rate for Payer: One Health Plan of WY PPO |
$634.06
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PacificSource Commercial |
$582.30
|
| Rate for Payer: PHCS PPO |
$614.65
|
| Rate for Payer: PHCS PPO |
$365.75
|
| Rate for Payer: Three Rivers PPO |
$485.25
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.59
|
| Rate for Payer: TriWest Veterans Administration |
$88.59
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Commercial |
$562.89
|
| Rate for Payer: United Healthcare Medicare |
$88.59
|
| Rate for Payer: United Healthcare Medicare |
$88.59
|
| Rate for Payer: WINHealth Partners Commercial |
$549.95
|
| Rate for Payer: WINHealth Partners Commercial |
$327.25
|
|
|
HC PRO REPAIR SUPERFICIAL WND FACE 7.6-12.5 CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 12015 NONPBBPAYER
|
| Hospital Charge Code |
9831201501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$88.59
|
| Rate for Payer: Beech Street Commercial |
$456.95
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$466.57
|
| Rate for Payer: Cigna of WY Commercial |
$471.38
|
| Rate for Payer: First Choice Health Commercial |
$432.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.59
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$75.30
|
| Rate for Payer: One Health Plan of WY PPO |
$471.38
|
| Rate for Payer: PacificSource Commercial |
$432.90
|
| Rate for Payer: PHCS PPO |
$456.95
|
| Rate for Payer: Three Rivers PPO |
$360.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.59
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Medicare |
$88.59
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
HC PRO REPAIR SUPERFICIAL WOUND BODY 12.6-20 CM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
9831200501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.86 |
| 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 |
$378.28
|
| Rate for Payer: Aetna of WY Medicare |
$89.25
|
| Rate for Payer: Aetna of WY Medicare |
$89.25
|
| Rate for Payer: Beech Street Commercial |
$366.70
|
| Rate for Payer: Beech Street Commercial |
$760.00
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: Cash Price |
$270.20
|
| 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 |
$374.42
|
| Rate for Payer: Cigna of WY Commercial |
$378.28
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: First Choice Health Commercial |
$347.40
|
| 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 |
$366.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.25
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: HealthUtah PPO |
$386.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$374.42
|
| Rate for Payer: Multiplan Medicare/VA |
$75.86
|
| Rate for Payer: Multiplan Medicare/VA |
$75.86
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: One Health Plan of WY PPO |
$378.28
|
| Rate for Payer: PacificSource Commercial |
$347.40
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$760.00
|
| Rate for Payer: PHCS PPO |
$366.70
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: Three Rivers PPO |
$289.50
|
| Rate for Payer: TriWest Veterans Administration |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$335.82
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$89.25
|
| Rate for Payer: United Healthcare Medicare |
$89.25
|
| Rate for Payer: WINHealth Partners Commercial |
$680.00
|
| Rate for Payer: WINHealth Partners Commercial |
$328.10
|
|
|
HC PRO REPAIR SUPERFICIAL WOUND BODY 12.6-20 CM
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 12005 NONPBBPAYER
|
| Hospital Charge Code |
9831200501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.86 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$473.34
|
| Rate for Payer: Aetna of WY Medicare |
$89.25
|
| Rate for Payer: Beech Street Commercial |
$458.85
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$468.51
|
| Rate for Payer: Cigna of WY Commercial |
$473.34
|
| Rate for Payer: First Choice Health Commercial |
$434.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$458.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.25
|
| Rate for Payer: HealthUtah PPO |
$483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$468.51
|
| Rate for Payer: Multiplan Medicare/VA |
$75.86
|
| Rate for Payer: One Health Plan of WY PPO |
$473.34
|
| Rate for Payer: PacificSource Commercial |
$434.70
|
| Rate for Payer: PHCS PPO |
$458.85
|
| Rate for Payer: Three Rivers PPO |
$362.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$420.21
|
| Rate for Payer: United Healthcare Medicare |
$89.25
|
| Rate for Payer: WINHealth Partners Commercial |
$410.55
|
|
|
HC PRO REPAIR SUPERFICIAL WOUND BODY 7.6-12.5 CM
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 12004 NONPBBPAYER
|
| Hospital Charge Code |
9831200401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$69.56
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.56
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$59.13
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.56
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$69.56
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
HC PRO REPAIR SUPERFICIAL WOUND BODY 7.6-12.5 CM
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
9831200401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$537.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$69.56
|
| Rate for Payer: Aetna of WY Medicare |
$69.56
|
| Rate for Payer: Beech Street Commercial |
$349.60
|
| Rate for Payer: Beech Street Commercial |
$520.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$383.60
|
| Rate for Payer: Cash Price |
$383.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$531.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: Cigna of WY Commercial |
$537.04
|
| Rate for Payer: First Choice Health Commercial |
$331.20
|
| Rate for Payer: First Choice Health Commercial |
$493.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$520.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.56
|
| Rate for Payer: HealthUtah PPO |
$548.00
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$531.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$59.13
|
| Rate for Payer: Multiplan Medicare/VA |
$59.13
|
| Rate for Payer: One Health Plan of WY PPO |
$537.04
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PacificSource Commercial |
$493.20
|
| Rate for Payer: PHCS PPO |
$520.60
|
| Rate for Payer: PHCS PPO |
$349.60
|
| Rate for Payer: Three Rivers PPO |
$411.00
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.56
|
| Rate for Payer: TriWest Veterans Administration |
$69.56
|
| Rate for Payer: United Healthcare Commercial |
$320.16
|
| Rate for Payer: United Healthcare Commercial |
$476.76
|
| Rate for Payer: United Healthcare Medicare |
$69.56
|
| Rate for Payer: United Healthcare Medicare |
$69.56
|
| Rate for Payer: WINHealth Partners Commercial |
$465.80
|
| Rate for Payer: WINHealth Partners Commercial |
$312.80
|
|
|
HC PRO REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
9832434101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$623.37 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,564.66
|
| Rate for Payer: Aetna of WY Medicare |
$733.38
|
| Rate for Payer: Beech Street Commercial |
$2,486.15
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,538.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,564.66
|
| Rate for Payer: First Choice Health Commercial |
$2,355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,486.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.38
|
| Rate for Payer: HealthUtah PPO |
$2,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,538.49
|
| Rate for Payer: Multiplan Medicare/VA |
$623.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,564.66
|
| Rate for Payer: PacificSource Commercial |
$2,355.30
|
| Rate for Payer: PHCS PPO |
$2,486.15
|
| Rate for Payer: Three Rivers PPO |
$1,962.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.38
|
| Rate for Payer: United Healthcare Commercial |
$2,276.79
|
| Rate for Payer: United Healthcare Medicare |
$733.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.45
|
|
|
HC PRO REPAIR TENODESIS OF LONG TENDO OF BICEPS
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
9832343001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$723.82
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.82
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$615.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$723.82
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$723.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
HC PRO REPAIR TONGUE LACER <2.5CM,POST 1/3
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
9834125101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$150.64 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$520.38
|
| Rate for Payer: Aetna of WY Medicare |
$177.22
|
| Rate for Payer: Beech Street Commercial |
$504.45
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$515.07
|
| Rate for Payer: Cigna of WY Commercial |
$520.38
|
| Rate for Payer: First Choice Health Commercial |
$477.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$504.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.22
|
| Rate for Payer: HealthUtah PPO |
$531.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$515.07
|
| Rate for Payer: Multiplan Medicare/VA |
$150.64
|
| Rate for Payer: One Health Plan of WY PPO |
$520.38
|
| Rate for Payer: PacificSource Commercial |
$477.90
|
| Rate for Payer: PHCS PPO |
$504.45
|
| Rate for Payer: Three Rivers PPO |
$398.25
|
| Rate for Payer: TriWest Veterans Administration |
$177.22
|
| Rate for Payer: United Healthcare Commercial |
$461.97
|
| Rate for Payer: United Healthcare Medicare |
$177.22
|
| Rate for Payer: WINHealth Partners Commercial |
$451.35
|
|
|
HC PRO REPAIR TONGUE LACER,2.6 CM+/COMPLX
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
9834125201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$171.44 |
| Max. Negotiated Rate |
$1,599.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,567.02
|
| Rate for Payer: Aetna of WY Medicare |
$201.69
|
| Rate for Payer: Beech Street Commercial |
$1,519.05
|
| Rate for Payer: Cash Price |
$1,119.30
|
| Rate for Payer: Cash Price |
$1,119.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,551.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,567.02
|
| Rate for Payer: First Choice Health Commercial |
$1,439.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,519.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.69
|
| Rate for Payer: HealthUtah PPO |
$1,599.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,551.03
|
| Rate for Payer: Multiplan Medicare/VA |
$171.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,567.02
|
| Rate for Payer: PacificSource Commercial |
$1,439.10
|
| Rate for Payer: PHCS PPO |
$1,519.05
|
| Rate for Payer: Three Rivers PPO |
$1,199.25
|
| Rate for Payer: TriWest Veterans Administration |
$201.69
|
| Rate for Payer: United Healthcare Commercial |
$1,391.13
|
| Rate for Payer: United Healthcare Medicare |
$201.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,359.15
|
|
|
HC PRO REPAIR TONGUE LACERATION <2.5CM
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
9834125001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$126.39 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$773.22
|
| Rate for Payer: Aetna of WY Medicare |
$148.69
|
| Rate for Payer: Beech Street Commercial |
$749.55
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$765.33
|
| Rate for Payer: Cigna of WY Commercial |
$773.22
|
| Rate for Payer: First Choice Health Commercial |
$710.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$749.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.69
|
| Rate for Payer: HealthUtah PPO |
$789.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$765.33
|
| Rate for Payer: Multiplan Medicare/VA |
$126.39
|
| Rate for Payer: One Health Plan of WY PPO |
$773.22
|
| Rate for Payer: PacificSource Commercial |
$710.10
|
| Rate for Payer: PHCS PPO |
$749.55
|
| Rate for Payer: Three Rivers PPO |
$591.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.69
|
| Rate for Payer: United Healthcare Commercial |
$686.43
|
| Rate for Payer: United Healthcare Medicare |
$148.69
|
| Rate for Payer: WINHealth Partners Commercial |
$670.65
|
|
|
HC PRO REPAIR TONGUE LACERATION <2.5CM
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 41250 NONPBBPAYER
|
| Hospital Charge Code |
9834125001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$126.39 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$966.28
|
| Rate for Payer: Aetna of WY Medicare |
$148.69
|
| Rate for Payer: Beech Street Commercial |
$936.70
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$956.42
|
| Rate for Payer: Cigna of WY Commercial |
$966.28
|
| Rate for Payer: First Choice Health Commercial |
$887.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$936.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.69
|
| Rate for Payer: HealthUtah PPO |
$986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$956.42
|
| Rate for Payer: Multiplan Medicare/VA |
$126.39
|
| Rate for Payer: One Health Plan of WY PPO |
$966.28
|
| Rate for Payer: PacificSource Commercial |
$887.40
|
| Rate for Payer: PHCS PPO |
$936.70
|
| Rate for Payer: Three Rivers PPO |
$739.50
|
| Rate for Payer: TriWest Veterans Administration |
$148.69
|
| Rate for Payer: United Healthcare Commercial |
$857.82
|
| Rate for Payer: United Healthcare Medicare |
$148.69
|
| Rate for Payer: WINHealth Partners Commercial |
$838.10
|
|
|
HC PRO REP FOREARM TENDON / MUSCLE
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
9832527001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$413.23 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,700.30
|
| Rate for Payer: Aetna of WY Medicare |
$486.15
|
| Rate for Payer: Beech Street Commercial |
$1,648.25
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,682.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,700.30
|
| Rate for Payer: First Choice Health Commercial |
$1,561.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,648.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.15
|
| Rate for Payer: HealthUtah PPO |
$1,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,682.95
|
| Rate for Payer: Multiplan Medicare/VA |
$413.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,700.30
|
| Rate for Payer: PacificSource Commercial |
$1,561.50
|
| Rate for Payer: PHCS PPO |
$1,648.25
|
| Rate for Payer: Three Rivers PPO |
$1,301.25
|
| Rate for Payer: TriWest Veterans Administration |
$486.15
|
| Rate for Payer: United Healthcare Commercial |
$1,509.45
|
| Rate for Payer: United Healthcare Medicare |
$486.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,474.75
|
|
|
HC PRO REPOSITION GASTROSTOMY TUBE - GASTROSTOMY TUBE, CHANGE / REPOSITION
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
9834376101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$83.38 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$776.16
|
| Rate for Payer: Aetna of WY Medicare |
$98.10
|
| Rate for Payer: Beech Street Commercial |
$752.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$768.24
|
| Rate for Payer: Cigna of WY Commercial |
$776.16
|
| Rate for Payer: First Choice Health Commercial |
$712.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$752.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.10
|
| Rate for Payer: HealthUtah PPO |
$792.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$768.24
|
| Rate for Payer: Multiplan Medicare/VA |
$83.38
|
| Rate for Payer: One Health Plan of WY PPO |
$776.16
|
| Rate for Payer: PacificSource Commercial |
$712.80
|
| Rate for Payer: PHCS PPO |
$752.40
|
| Rate for Payer: Three Rivers PPO |
$594.00
|
| Rate for Payer: TriWest Veterans Administration |
$98.10
|
| Rate for Payer: United Healthcare Commercial |
$689.04
|
| Rate for Payer: United Healthcare Medicare |
$98.10
|
| Rate for Payer: WINHealth Partners Commercial |
$673.20
|
|
|
HC PRO RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 28153
|
| Hospital Charge Code |
9832815301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$1,374.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,346.52
|
| Rate for Payer: Aetna of WY Medicare |
$259.29
|
| Rate for Payer: Beech Street Commercial |
$1,305.30
|
| Rate for Payer: Cash Price |
$961.80
|
| Rate for Payer: Cash Price |
$961.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,332.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,346.52
|
| Rate for Payer: First Choice Health Commercial |
$1,236.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,305.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.29
|
| Rate for Payer: HealthUtah PPO |
$1,374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,332.78
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,346.52
|
| Rate for Payer: PacificSource Commercial |
$1,236.60
|
| Rate for Payer: PHCS PPO |
$1,305.30
|
| Rate for Payer: Three Rivers PPO |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration |
$259.29
|
| Rate for Payer: United Healthcare Commercial |
$1,195.38
|
| Rate for Payer: United Healthcare Medicare |
$259.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,167.90
|
|
|
HC PRO RESECT SMALL INTEST,SINGL RESEC/ANAS
|
Professional
|
Both
|
$6,333.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
9834412001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,206.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.87
|
| Rate for Payer: Beech Street Commercial |
$6,016.35
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,143.01
|
| Rate for Payer: Cigna of WY Commercial |
$6,206.34
|
| Rate for Payer: First Choice Health Commercial |
$5,699.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,016.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.87
|
| Rate for Payer: HealthUtah PPO |
$6,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,143.01
|
| Rate for Payer: Multiplan Medicare/VA |
$981.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,206.34
|
| Rate for Payer: PacificSource Commercial |
$5,699.70
|
| Rate for Payer: PHCS PPO |
$6,016.35
|
| Rate for Payer: Three Rivers PPO |
$4,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.87
|
| Rate for Payer: United Healthcare Commercial |
$5,509.71
|
| Rate for Payer: United Healthcare Medicare |
$1,154.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,383.05
|
|
|
HC PRO REVISION OF TOTAL KNEE ARTHROP
|
Professional
|
Both
|
$9,080.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
9832748701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,423.73 |
| Max. Negotiated Rate |
$9,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,898.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.98
|
| Rate for Payer: Beech Street Commercial |
$8,626.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,807.60
|
| Rate for Payer: Cigna of WY Commercial |
$8,898.40
|
| Rate for Payer: First Choice Health Commercial |
$8,172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,626.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.98
|
| Rate for Payer: HealthUtah PPO |
$9,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,807.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,423.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8,898.40
|
| Rate for Payer: PacificSource Commercial |
$8,172.00
|
| Rate for Payer: PHCS PPO |
$8,626.00
|
| Rate for Payer: Three Rivers PPO |
$6,810.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.98
|
| Rate for Payer: United Healthcare Commercial |
$7,899.60
|
| Rate for Payer: United Healthcare Medicare |
$1,674.98
|
| Rate for Payer: WINHealth Partners Commercial |
$7,718.00
|
|
|
HC PRO REVISION/RMVL PERIPHERAL/GASTRIC NPGR
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
9836459501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$1,078.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,056.44
|
| Rate for Payer: Aetna of WY Medicare |
$220.82
|
| Rate for Payer: Beech Street Commercial |
$1,024.10
|
| Rate for Payer: Cash Price |
$754.60
|
| Rate for Payer: Cash Price |
$754.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,045.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,056.44
|
| Rate for Payer: First Choice Health Commercial |
$970.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,024.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.82
|
| Rate for Payer: HealthUtah PPO |
$1,078.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,045.66
|
| Rate for Payer: Multiplan Medicare/VA |
$187.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,056.44
|
| Rate for Payer: PacificSource Commercial |
$970.20
|
| Rate for Payer: PHCS PPO |
$1,024.10
|
| Rate for Payer: Three Rivers PPO |
$808.50
|
| Rate for Payer: TriWest Veterans Administration |
$220.82
|
| Rate for Payer: United Healthcare Commercial |
$937.86
|
| Rate for Payer: United Healthcare Medicare |
$220.82
|
| Rate for Payer: WINHealth Partners Commercial |
$916.30
|
|
|
HC PRO REVISION TOTAL SHOULDER ARTHROPLASTY
|
Professional
|
Both
|
$5,926.00
|
|
|
Service Code
|
HCPCS 23474
|
| Hospital Charge Code |
9832347401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,411.55 |
| Max. Negotiated Rate |
$5,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,807.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,660.65
|
| Rate for Payer: Beech Street Commercial |
$5,629.70
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,748.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,807.48
|
| Rate for Payer: First Choice Health Commercial |
$5,333.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,629.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,660.65
|
| Rate for Payer: HealthUtah PPO |
$5,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,748.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,411.55
|
| Rate for Payer: One Health Plan of WY PPO |
$5,807.48
|
| Rate for Payer: PacificSource Commercial |
$5,333.40
|
| Rate for Payer: PHCS PPO |
$5,629.70
|
| Rate for Payer: Three Rivers PPO |
$4,444.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,660.65
|
| Rate for Payer: United Healthcare Commercial |
$5,155.62
|
| Rate for Payer: United Healthcare Medicare |
$1,660.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,037.10
|
|
|
HC PRO REVISION TOTAL SHOULDER ARTHROPLASTY
|
Professional
|
Both
|
$5,492.00
|
|
|
Service Code
|
HCPCS 23473
|
| Hospital Charge Code |
9832347301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,308.29 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,382.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,539.17
|
| Rate for Payer: Beech Street Commercial |
$5,217.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,327.24
|
| Rate for Payer: Cigna of WY Commercial |
$5,382.16
|
| Rate for Payer: First Choice Health Commercial |
$4,942.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,217.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,539.17
|
| Rate for Payer: HealthUtah PPO |
$5,492.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,327.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,308.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5,382.16
|
| Rate for Payer: PacificSource Commercial |
$4,942.80
|
| Rate for Payer: PHCS PPO |
$5,217.40
|
| Rate for Payer: Three Rivers PPO |
$4,119.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,539.17
|
| Rate for Payer: United Healthcare Commercial |
$4,778.04
|
| Rate for Payer: United Healthcare Medicare |
$1,539.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4,668.20
|
|
|
HC PRO REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
9836366301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$369.13 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,282.42
|
| Rate for Payer: Aetna of WY Medicare |
$434.27
|
| Rate for Payer: Beech Street Commercial |
$2,212.55
|
| Rate for Payer: Cash Price |
$1,630.30
|
| Rate for Payer: Cash Price |
$1,630.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,259.13
|
| Rate for Payer: Cigna of WY Commercial |
$2,282.42
|
| Rate for Payer: First Choice Health Commercial |
$2,096.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,212.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$434.27
|
| Rate for Payer: HealthUtah PPO |
$2,329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,259.13
|
| Rate for Payer: Multiplan Medicare/VA |
$369.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,282.42
|
| Rate for Payer: PacificSource Commercial |
$2,096.10
|
| Rate for Payer: PHCS PPO |
$2,212.55
|
| Rate for Payer: Three Rivers PPO |
$1,746.75
|
| Rate for Payer: TriWest Veterans Administration |
$434.27
|
| Rate for Payer: United Healthcare Commercial |
$2,026.23
|
| Rate for Payer: United Healthcare Medicare |
$434.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,979.65
|
|
|
HC PRO REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
9836368801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,872.78
|
| Rate for Payer: Aetna of WY Medicare |
$289.01
|
| Rate for Payer: Beech Street Commercial |
$1,815.45
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,853.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,872.78
|
| Rate for Payer: First Choice Health Commercial |
$1,719.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,815.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.01
|
| Rate for Payer: HealthUtah PPO |
$1,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,853.67
|
| Rate for Payer: Multiplan Medicare/VA |
$245.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,872.78
|
| Rate for Payer: PacificSource Commercial |
$1,719.90
|
| Rate for Payer: PHCS PPO |
$1,815.45
|
| Rate for Payer: Three Rivers PPO |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration |
$289.01
|
| Rate for Payer: United Healthcare Commercial |
$1,662.57
|
| Rate for Payer: United Healthcare Medicare |
$289.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.35
|
|
|
HC PRO REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
9836458501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$118.34 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$728.14
|
| Rate for Payer: Aetna of WY Medicare |
$139.22
|
| Rate for Payer: Beech Street Commercial |
$705.85
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$720.71
|
| Rate for Payer: Cigna of WY Commercial |
$728.14
|
| Rate for Payer: First Choice Health Commercial |
$668.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$705.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.22
|
| Rate for Payer: HealthUtah PPO |
$743.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$720.71
|
| Rate for Payer: Multiplan Medicare/VA |
$118.34
|
| Rate for Payer: One Health Plan of WY PPO |
$728.14
|
| Rate for Payer: PacificSource Commercial |
$668.70
|
| Rate for Payer: PHCS PPO |
$705.85
|
| Rate for Payer: Three Rivers PPO |
$557.25
|
| Rate for Payer: TriWest Veterans Administration |
$139.22
|
| Rate for Payer: United Healthcare Commercial |
$646.41
|
| Rate for Payer: United Healthcare Medicare |
$139.22
|
| Rate for Payer: WINHealth Partners Commercial |
$631.55
|
|
|
HC PRO REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27486
|
| Hospital Charge Code |
9752748601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,144.19 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,117.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,346.11
|
| Rate for Payer: Beech Street Commercial |
$6,899.85
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,045.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,117.74
|
| Rate for Payer: First Choice Health Commercial |
$6,536.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,899.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,346.11
|
| Rate for Payer: HealthUtah PPO |
$7,263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,045.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.19
|
| Rate for Payer: One Health Plan of WY PPO |
$7,117.74
|
| Rate for Payer: PacificSource Commercial |
$6,536.70
|
| Rate for Payer: PHCS PPO |
$6,899.85
|
| Rate for Payer: Three Rivers PPO |
$5,447.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,346.11
|
| Rate for Payer: United Healthcare Commercial |
$6,318.81
|
| Rate for Payer: United Healthcare Medicare |
$1,346.11
|
| Rate for Payer: WINHealth Partners Commercial |
$6,173.55
|
|
