|
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
|
|
|
HC PRO REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
9752713701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,190.43 |
| Max. Negotiated Rate |
$7,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,446.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,400.51
|
| Rate for Payer: Beech Street Commercial |
$7,218.10
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,370.06
|
| Rate for Payer: Cigna of WY Commercial |
$7,446.04
|
| Rate for Payer: First Choice Health Commercial |
$6,838.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,218.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,400.51
|
| Rate for Payer: HealthUtah PPO |
$7,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,370.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,190.43
|
| Rate for Payer: One Health Plan of WY PPO |
$7,446.04
|
| Rate for Payer: PacificSource Commercial |
$6,838.20
|
| Rate for Payer: PHCS PPO |
$7,218.10
|
| Rate for Payer: Three Rivers PPO |
$5,698.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,400.51
|
| Rate for Payer: United Healthcare Commercial |
$6,610.26
|
| Rate for Payer: United Healthcare Medicare |
$1,400.51
|
| Rate for Payer: WINHealth Partners Commercial |
$6,458.30
|
|
|
HC PRO REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$9,883.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
9752713401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,542.24 |
| Max. Negotiated Rate |
$9,883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,685.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,814.40
|
| Rate for Payer: Beech Street Commercial |
$9,388.85
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,586.51
|
| Rate for Payer: Cigna of WY Commercial |
$9,685.34
|
| Rate for Payer: First Choice Health Commercial |
$8,894.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,388.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,814.40
|
| Rate for Payer: HealthUtah PPO |
$9,883.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,586.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.24
|
| Rate for Payer: One Health Plan of WY PPO |
$9,685.34
|
| Rate for Payer: PacificSource Commercial |
$8,894.70
|
| Rate for Payer: PHCS PPO |
$9,388.85
|
| Rate for Payer: Three Rivers PPO |
$7,412.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$8,598.21
|
| Rate for Payer: United Healthcare Medicare |
$1,814.40
|
| Rate for Payer: WINHealth Partners Commercial |
$8,400.55
|
|
|
HC PRO RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
9833042001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,200.91 |
| Max. Negotiated Rate |
$5,171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,067.58
|
| Rate for Payer: Aetna of WY Medicare |
$1,412.83
|
| Rate for Payer: Beech Street Commercial |
$4,912.45
|
| Rate for Payer: Cash Price |
$3,619.70
|
| Rate for Payer: Cash Price |
$3,619.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,015.87
|
| Rate for Payer: Cigna of WY Commercial |
$5,067.58
|
| Rate for Payer: First Choice Health Commercial |
$4,653.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,912.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,412.83
|
| Rate for Payer: HealthUtah PPO |
$5,171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,015.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1,200.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,067.58
|
| Rate for Payer: PacificSource Commercial |
$4,653.90
|
| Rate for Payer: PHCS PPO |
$4,912.45
|
| Rate for Payer: Three Rivers PPO |
$3,878.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,412.83
|
| Rate for Payer: United Healthcare Commercial |
$4,498.77
|
| Rate for Payer: United Healthcare Medicare |
$1,412.83
|
| Rate for Payer: WINHealth Partners Commercial |
$4,395.35
|
|
|
HC PRO RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$3,656.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
9832434301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$594.02 |
| Max. Negotiated Rate |
$3,656.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,582.88
|
| Rate for Payer: Aetna of WY Medicare |
$698.85
|
| Rate for Payer: Beech Street Commercial |
$3,473.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,546.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,582.88
|
| Rate for Payer: First Choice Health Commercial |
$3,290.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,473.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.85
|
| Rate for Payer: HealthUtah PPO |
$3,656.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,546.32
|
| Rate for Payer: Multiplan Medicare/VA |
$594.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,582.88
|
| Rate for Payer: PacificSource Commercial |
$3,290.40
|
| Rate for Payer: PHCS PPO |
$3,473.20
|
| Rate for Payer: Three Rivers PPO |
$2,742.00
|
| Rate for Payer: TriWest Veterans Administration |
$698.85
|
| Rate for Payer: United Healthcare Commercial |
$3,180.72
|
| Rate for Payer: United Healthcare Medicare |
$698.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,107.60
|
|
|
HC PRO RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
9832434201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$638.94 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$751.70
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$751.70
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$638.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$751.70
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$751.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
HC PRO RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
9834080501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$866.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$848.68
|
| Rate for Payer: Aetna of WY Medicare |
$192.28
|
| Rate for Payer: Beech Street Commercial |
$822.70
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$840.02
|
| Rate for Payer: Cigna of WY Commercial |
$848.68
|
| Rate for Payer: First Choice Health Commercial |
$779.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$822.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.28
|
| Rate for Payer: HealthUtah PPO |
$866.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$840.02
|
| Rate for Payer: Multiplan Medicare/VA |
$163.44
|
| Rate for Payer: One Health Plan of WY PPO |
$848.68
|
| Rate for Payer: PacificSource Commercial |
$779.40
|
| Rate for Payer: PHCS PPO |
$822.70
|
| Rate for Payer: Three Rivers PPO |
$649.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.28
|
| Rate for Payer: United Healthcare Commercial |
$753.42
|
| Rate for Payer: United Healthcare Medicare |
$192.28
|
| Rate for Payer: WINHealth Partners Commercial |
$736.10
|
|
|
HC PRO RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 40805 NONPBBPAYER
|
| Hospital Charge Code |
9834080501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,060.36
|
| Rate for Payer: Aetna of WY Medicare |
$192.28
|
| Rate for Payer: Beech Street Commercial |
$1,027.90
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,049.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,060.36
|
| Rate for Payer: First Choice Health Commercial |
$973.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,027.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.28
|
| Rate for Payer: HealthUtah PPO |
$1,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,049.54
|
| Rate for Payer: Multiplan Medicare/VA |
$163.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,060.36
|
| Rate for Payer: PacificSource Commercial |
$973.80
|
| Rate for Payer: PHCS PPO |
$1,027.90
|
| Rate for Payer: Three Rivers PPO |
$811.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.28
|
| Rate for Payer: United Healthcare Commercial |
$941.34
|
| Rate for Payer: United Healthcare Medicare |
$192.28
|
| Rate for Payer: WINHealth Partners Commercial |
$919.70
|
|
|
HC PRO RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 32552 NONPBBPAYER
|
| Hospital Charge Code |
9833255201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Aetna of WY Medicare |
$149.43
|
| Rate for Payer: Beech Street Commercial |
$774.25
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: First Choice Health Commercial |
$733.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.43
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$127.02
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$774.25
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$149.43
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$149.43
|
| Rate for Payer: WINHealth Partners Commercial |
$692.75
|
|
|
HC PRO RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
9833255201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$638.96
|
| Rate for Payer: Aetna of WY Medicare |
$149.43
|
| Rate for Payer: Beech Street Commercial |
$619.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$632.44
|
| Rate for Payer: Cigna of WY Commercial |
$638.96
|
| Rate for Payer: First Choice Health Commercial |
$586.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$619.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.43
|
| Rate for Payer: HealthUtah PPO |
$652.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$632.44
|
| Rate for Payer: Multiplan Medicare/VA |
$127.02
|
| Rate for Payer: One Health Plan of WY PPO |
$638.96
|
| Rate for Payer: PacificSource Commercial |
$586.80
|
| Rate for Payer: PHCS PPO |
$619.40
|
| Rate for Payer: Three Rivers PPO |
$489.00
|
| Rate for Payer: TriWest Veterans Administration |
$149.43
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
| Rate for Payer: United Healthcare Medicare |
$149.43
|
| Rate for Payer: WINHealth Partners Commercial |
$554.20
|
|
|
HC PRO RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$6,197.00
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
9752748801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$981.60 |
| Max. Negotiated Rate |
$6,197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,073.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.82
|
| Rate for Payer: Beech Street Commercial |
$5,887.15
|
| Rate for Payer: Cash Price |
$4,337.90
|
| Rate for Payer: Cash Price |
$4,337.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,011.09
|
| Rate for Payer: Cigna of WY Commercial |
$6,073.06
|
| Rate for Payer: First Choice Health Commercial |
$5,577.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,887.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.82
|
| Rate for Payer: HealthUtah PPO |
$6,197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,011.09
|
| Rate for Payer: Multiplan Medicare/VA |
$981.60
|
| Rate for Payer: One Health Plan of WY PPO |
$6,073.06
|
| Rate for Payer: PacificSource Commercial |
$5,577.30
|
| Rate for Payer: PHCS PPO |
$5,887.15
|
| Rate for Payer: Three Rivers PPO |
$4,647.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.82
|
| Rate for Payer: United Healthcare Commercial |
$5,391.39
|
| Rate for Payer: United Healthcare Medicare |
$1,154.82
|
| Rate for Payer: WINHealth Partners Commercial |
$5,267.45
|
|
|
HC PRO RMVL/REVJ SLING STRESS INCONTINENCE
|
Professional
|
Both
|
$4,320.00
|
|
|
Service Code
|
HCPCS 57287
|
| Hospital Charge Code |
9825728701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,233.60
|
| Rate for Payer: Aetna of WY Medicare |
$719.44
|
| Rate for Payer: Beech Street Commercial |
$4,104.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,190.40
|
| Rate for Payer: Cigna of WY Commercial |
$4,233.60
|
| Rate for Payer: First Choice Health Commercial |
$3,888.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,104.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$719.44
|
| Rate for Payer: HealthUtah PPO |
$4,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,190.40
|
| Rate for Payer: Multiplan Medicare/VA |
$611.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,233.60
|
| Rate for Payer: PacificSource Commercial |
$3,888.00
|
| Rate for Payer: PHCS PPO |
$4,104.00
|
| Rate for Payer: Three Rivers PPO |
$3,240.00
|
| Rate for Payer: TriWest Veterans Administration |
$719.44
|
| Rate for Payer: United Healthcare Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare Medicare |
$719.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3,672.00
|
|
|
HC PRO RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
9836366101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$269.53 |
| Max. Negotiated Rate |
$1,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,634.64
|
| Rate for Payer: Aetna of WY Medicare |
$317.09
|
| Rate for Payer: Beech Street Commercial |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,617.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,634.64
|
| Rate for Payer: First Choice Health Commercial |
$1,501.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,584.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.09
|
| Rate for Payer: HealthUtah PPO |
$1,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,617.96
|
| Rate for Payer: Multiplan Medicare/VA |
$269.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,634.64
|
| Rate for Payer: PacificSource Commercial |
$1,501.20
|
| Rate for Payer: PHCS PPO |
$1,584.60
|
| Rate for Payer: Three Rivers PPO |
$1,251.00
|
| Rate for Payer: TriWest Veterans Administration |
$317.09
|
| Rate for Payer: United Healthcare Commercial |
$1,451.16
|
| Rate for Payer: United Healthcare Medicare |
$317.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,417.80
|
|
|
HC PRO RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
9831198301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$97.95
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.95
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$83.26
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$97.95
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$97.95
|
| Rate for Payer: WINHealth Partners Commercial |
$443.70
|
|
|
HC PRO ROUTINE OB ANTEPARTUM CARE
|
Professional
|
Both
|
$6,379.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
9835940001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,957.68 |
| Max. Negotiated Rate |
$6,251.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,251.42
|
| Rate for Payer: Aetna of WY Medicare |
$2,303.15
|
| Rate for Payer: Beech Street Commercial |
$6,060.05
|
| Rate for Payer: Cash Price |
$4,465.30
|
| Rate for Payer: Cash Price |
$4,465.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,187.63
|
| Rate for Payer: Cigna of WY Commercial |
$6,251.42
|
| Rate for Payer: First Choice Health Commercial |
$5,741.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,060.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,303.15
|
| Rate for Payer: HealthUtah PPO |
$2,213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,187.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,957.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,251.42
|
| Rate for Payer: PacificSource Commercial |
$5,741.10
|
| Rate for Payer: PHCS PPO |
$6,060.05
|
| Rate for Payer: Three Rivers PPO |
$4,784.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,303.15
|
| Rate for Payer: United Healthcare Commercial |
$5,549.73
|
| Rate for Payer: United Healthcare Medicare |
$2,303.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,422.15
|
|
|
HC PRO RPLC GASTRO TUBE NO REV/GUID PRO FEE
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
9834376201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.70
|
| Rate for Payer: Aetna of WY Medicare |
$35.15
|
| Rate for Payer: Beech Street Commercial |
$1,106.75
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.70
|
| Rate for Payer: First Choice Health Commercial |
$1,048.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.15
|
| Rate for Payer: HealthUtah PPO |
$1,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.05
|
| Rate for Payer: Multiplan Medicare/VA |
$29.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.70
|
| Rate for Payer: PacificSource Commercial |
$1,048.50
|
| Rate for Payer: PHCS PPO |
$1,106.75
|
| Rate for Payer: Three Rivers PPO |
$873.75
|
| Rate for Payer: TriWest Veterans Administration |
$35.15
|
| Rate for Payer: United Healthcare Commercial |
$1,013.55
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
| Rate for Payer: WINHealth Partners Commercial |
$990.25
|
|
|
HC PRO RP NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$5,199.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
9752654601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$5,199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,095.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,014.58
|
| Rate for Payer: Beech Street Commercial |
$4,939.05
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,043.03
|
| Rate for Payer: Cigna of WY Commercial |
$5,095.02
|
| Rate for Payer: First Choice Health Commercial |
$4,679.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,939.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,014.58
|
| Rate for Payer: HealthUtah PPO |
$5,199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,043.03
|
| Rate for Payer: Multiplan Medicare/VA |
$862.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,095.02
|
| Rate for Payer: PacificSource Commercial |
$4,679.10
|
| Rate for Payer: PHCS PPO |
$4,939.05
|
| Rate for Payer: Three Rivers PPO |
$3,899.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,014.58
|
| Rate for Payer: United Healthcare Commercial |
$4,523.13
|
| Rate for Payer: United Healthcare Medicare |
$1,014.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4,419.15
|
|
|
HC PRO RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$3,270.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
9834955301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$513.59 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,204.60
|
| Rate for Payer: Aetna of WY Medicare |
$604.22
|
| Rate for Payer: Beech Street Commercial |
$3,106.50
|
| Rate for Payer: Cash Price |
$2,289.00
|
| Rate for Payer: Cash Price |
$2,289.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,171.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,204.60
|
| Rate for Payer: First Choice Health Commercial |
$2,943.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,106.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.22
|
| Rate for Payer: HealthUtah PPO |
$3,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,171.90
|
| Rate for Payer: Multiplan Medicare/VA |
$513.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,204.60
|
| Rate for Payer: PacificSource Commercial |
$2,943.00
|
| Rate for Payer: PHCS PPO |
$3,106.50
|
| Rate for Payer: Three Rivers PPO |
$2,452.50
|
| Rate for Payer: TriWest Veterans Administration |
$604.22
|
| Rate for Payer: United Healthcare Commercial |
$2,844.90
|
| Rate for Payer: United Healthcare Medicare |
$604.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,779.50
|
|
|
HC PRO RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
9834955001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$469.82 |
| Max. Negotiated Rate |
$1,973.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,933.54
|
| Rate for Payer: Aetna of WY Medicare |
$552.73
|
| Rate for Payer: Beech Street Commercial |
$1,874.35
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,913.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,933.54
|
| Rate for Payer: First Choice Health Commercial |
$1,775.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,874.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.73
|
| Rate for Payer: HealthUtah PPO |
$1,973.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,913.81
|
| Rate for Payer: Multiplan Medicare/VA |
$469.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,933.54
|
| Rate for Payer: PacificSource Commercial |
$1,775.70
|
| Rate for Payer: PHCS PPO |
$1,874.35
|
| Rate for Payer: Three Rivers PPO |
$1,479.75
|
| Rate for Payer: TriWest Veterans Administration |
$552.73
|
| Rate for Payer: United Healthcare Commercial |
$1,716.51
|
| Rate for Payer: United Healthcare Medicare |
$552.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,677.05
|
|
|
HC PRO RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$3,035.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
9834950701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$3,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,974.30
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$2,883.25
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,943.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,974.30
|
| Rate for Payer: First Choice Health Commercial |
$2,731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,883.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$3,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,943.95
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,974.30
|
| Rate for Payer: PacificSource Commercial |
$2,731.50
|
| Rate for Payer: PHCS PPO |
$2,883.25
|
| Rate for Payer: Three Rivers PPO |
$2,276.25
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$2,640.45
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,579.75
|
|
|
HC PRO RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$6,070.00
|
|
|
Service Code
|
HCPCS 49507 50
|
| Hospital Charge Code |
9834950701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$6,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,948.60
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$5,766.50
|
| Rate for Payer: Cash Price |
$4,249.00
|
| Rate for Payer: Cash Price |
$4,249.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,887.90
|
| Rate for Payer: Cigna of WY Commercial |
$5,948.60
|
| Rate for Payer: First Choice Health Commercial |
$5,463.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,766.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$6,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,887.90
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$5,948.60
|
| Rate for Payer: PacificSource Commercial |
$5,463.00
|
| Rate for Payer: PHCS PPO |
$5,766.50
|
| Rate for Payer: Three Rivers PPO |
$4,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$5,280.90
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$5,159.50
|
|
|
HC PRO RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,565.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
9824959401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,513.70
|
| Rate for Payer: Aetna of WY Medicare |
$701.96
|
| Rate for Payer: Beech Street Commercial |
$2,436.75
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,488.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,513.70
|
| Rate for Payer: First Choice Health Commercial |
$2,308.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$701.96
|
| Rate for Payer: HealthUtah PPO |
$2,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,488.05
|
| Rate for Payer: Multiplan Medicare/VA |
$596.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,513.70
|
| Rate for Payer: PacificSource Commercial |
$2,308.50
|
| Rate for Payer: PHCS PPO |
$2,436.75
|
| Rate for Payer: Three Rivers PPO |
$1,923.75
|
| Rate for Payer: TriWest Veterans Administration |
$701.96
|
| Rate for Payer: United Healthcare Commercial |
$2,231.55
|
| Rate for Payer: United Healthcare Medicare |
$701.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,180.25
|
|
|
HC PRO RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,565.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
9754959401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,513.70
|
| Rate for Payer: Aetna of WY Medicare |
$701.96
|
| Rate for Payer: Beech Street Commercial |
$2,436.75
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,488.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,513.70
|
| Rate for Payer: First Choice Health Commercial |
$2,308.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$701.96
|
| Rate for Payer: HealthUtah PPO |
$2,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,488.05
|
| Rate for Payer: Multiplan Medicare/VA |
$596.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,513.70
|
| Rate for Payer: PacificSource Commercial |
$2,308.50
|
| Rate for Payer: PHCS PPO |
$2,436.75
|
| Rate for Payer: Three Rivers PPO |
$1,923.75
|
| Rate for Payer: TriWest Veterans Administration |
$701.96
|
| Rate for Payer: United Healthcare Commercial |
$2,231.55
|
| Rate for Payer: United Healthcare Medicare |
$701.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,180.25
|
|
|
HC PRO RPR AA HERNIA 1ST 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
9834959301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$458.73 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$539.68
|
| Rate for Payer: Beech Street Commercial |
$1,871.50
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: First Choice Health Commercial |
$1,773.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.68
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$458.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,871.50
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.68
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$539.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,674.50
|
|
|
HC PRO RPR AA HERNIA 1ST < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
9834959101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$1,354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,326.92
|
| Rate for Payer: Aetna of WY Medicare |
$322.89
|
| Rate for Payer: Beech Street Commercial |
$1,286.30
|
| Rate for Payer: Cash Price |
$947.80
|
| Rate for Payer: Cash Price |
$947.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,313.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,326.92
|
| Rate for Payer: First Choice Health Commercial |
$1,218.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,286.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.89
|
| Rate for Payer: HealthUtah PPO |
$1,354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,313.38
|
| Rate for Payer: Multiplan Medicare/VA |
$274.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,326.92
|
| Rate for Payer: PacificSource Commercial |
$1,218.60
|
| Rate for Payer: PHCS PPO |
$1,286.30
|
| Rate for Payer: Three Rivers PPO |
$1,015.50
|
| Rate for Payer: TriWest Veterans Administration |
$322.89
|
| Rate for Payer: United Healthcare Commercial |
$1,177.98
|
| Rate for Payer: United Healthcare Medicare |
$322.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,150.90
|
|
