|
HC PRO RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
9834961301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$338.31 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,369.06
|
| Rate for Payer: Aetna of WY Medicare |
$398.01
|
| Rate for Payer: Beech Street Commercial |
$1,327.15
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,355.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,369.06
|
| Rate for Payer: First Choice Health Commercial |
$1,257.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,327.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$398.01
|
| Rate for Payer: HealthUtah PPO |
$1,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,355.09
|
| Rate for Payer: Multiplan Medicare/VA |
$338.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,369.06
|
| Rate for Payer: PacificSource Commercial |
$1,257.30
|
| Rate for Payer: PHCS PPO |
$1,327.15
|
| Rate for Payer: Three Rivers PPO |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration |
$398.01
|
| Rate for Payer: United Healthcare Commercial |
$1,215.39
|
| Rate for Payer: United Healthcare Medicare |
$398.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,187.45
|
|
|
HC PRO RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,738.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
9832637001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$2,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,683.24
|
| Rate for Payer: Aetna of WY Medicare |
$767.28
|
| Rate for Payer: Beech Street Commercial |
$2,601.10
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,655.86
|
| Rate for Payer: Cigna of WY Commercial |
$2,683.24
|
| Rate for Payer: First Choice Health Commercial |
$2,464.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,601.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$767.28
|
| Rate for Payer: HealthUtah PPO |
$2,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,655.86
|
| Rate for Payer: Multiplan Medicare/VA |
$652.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,683.24
|
| Rate for Payer: PacificSource Commercial |
$2,464.20
|
| Rate for Payer: PHCS PPO |
$2,601.10
|
| Rate for Payer: Three Rivers PPO |
$2,053.50
|
| Rate for Payer: TriWest Veterans Administration |
$767.28
|
| Rate for Payer: United Healthcare Commercial |
$2,382.06
|
| Rate for Payer: United Healthcare Medicare |
$767.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,327.30
|
|
|
HC PRO RPR NASAL VSTIBULAR STENOSIS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
9833046501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$849.59 |
| Max. Negotiated Rate |
$3,566.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,494.68
|
| Rate for Payer: Aetna of WY Medicare |
$999.52
|
| Rate for Payer: Beech Street Commercial |
$3,387.70
|
| Rate for Payer: Cash Price |
$2,496.20
|
| Rate for Payer: Cash Price |
$2,496.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,459.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,494.68
|
| Rate for Payer: First Choice Health Commercial |
$3,209.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,387.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$999.52
|
| Rate for Payer: HealthUtah PPO |
$3,566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,459.02
|
| Rate for Payer: Multiplan Medicare/VA |
$849.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,494.68
|
| Rate for Payer: PacificSource Commercial |
$3,209.40
|
| Rate for Payer: PHCS PPO |
$3,387.70
|
| Rate for Payer: Three Rivers PPO |
$2,674.50
|
| Rate for Payer: TriWest Veterans Administration |
$999.52
|
| Rate for Payer: United Healthcare Commercial |
$3,102.42
|
| Rate for Payer: United Healthcare Medicare |
$999.52
|
| Rate for Payer: WINHealth Partners Commercial |
$3,031.10
|
|
|
HC PRO RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
9832832201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$562.81
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.81
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$478.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$562.81
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$562.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
HC PRO RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC
|
Professional
|
Both
|
$2,669.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
9822544001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$635.63 |
| Max. Negotiated Rate |
$2,669.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,615.62
|
| Rate for Payer: Aetna of WY Medicare |
$747.80
|
| Rate for Payer: Beech Street Commercial |
$2,535.55
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,588.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,615.62
|
| Rate for Payer: First Choice Health Commercial |
$2,402.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,535.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.80
|
| Rate for Payer: HealthUtah PPO |
$2,669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,588.93
|
| Rate for Payer: Multiplan Medicare/VA |
$635.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,615.62
|
| Rate for Payer: PacificSource Commercial |
$2,402.10
|
| Rate for Payer: PHCS PPO |
$2,535.55
|
| Rate for Payer: Three Rivers PPO |
$2,001.75
|
| Rate for Payer: TriWest Veterans Administration |
$747.80
|
| Rate for Payer: United Healthcare Commercial |
$2,322.03
|
| Rate for Payer: United Healthcare Medicare |
$747.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,268.65
|
|
|
HC PRO RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$6,545.00
|
|
|
Service Code
|
HCPCS 49520 50
|
| Hospital Charge Code |
9834952001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$6,545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,414.10
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$6,217.75
|
| Rate for Payer: Cash Price |
$4,581.50
|
| Rate for Payer: Cash Price |
$4,581.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,348.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,414.10
|
| Rate for Payer: First Choice Health Commercial |
$5,890.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,217.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$6,545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,348.65
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$6,414.10
|
| Rate for Payer: PacificSource Commercial |
$5,890.50
|
| Rate for Payer: PHCS PPO |
$6,217.75
|
| Rate for Payer: Three Rivers PPO |
$4,908.75
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$5,694.15
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$5,563.25
|
|
|
HC PRO RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
9834952001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$3,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,206.56
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$3,108.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,173.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,206.56
|
| Rate for Payer: First Choice Health Commercial |
$2,944.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$3,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,173.84
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,206.56
|
| Rate for Payer: PacificSource Commercial |
$2,944.80
|
| Rate for Payer: PHCS PPO |
$3,108.40
|
| Rate for Payer: Three Rivers PPO |
$2,454.00
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,781.20
|
|
|
HC PRO RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
9834952101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$580.82 |
| Max. Negotiated Rate |
$1,956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,916.88
|
| Rate for Payer: Aetna of WY Medicare |
$683.32
|
| Rate for Payer: Beech Street Commercial |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,897.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,916.88
|
| Rate for Payer: First Choice Health Commercial |
$1,760.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$683.32
|
| Rate for Payer: HealthUtah PPO |
$1,956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,897.32
|
| Rate for Payer: Multiplan Medicare/VA |
$580.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,916.88
|
| Rate for Payer: PacificSource Commercial |
$1,760.40
|
| Rate for Payer: PHCS PPO |
$1,858.20
|
| Rate for Payer: Three Rivers PPO |
$1,467.00
|
| Rate for Payer: TriWest Veterans Administration |
$683.32
|
| Rate for Payer: United Healthcare Commercial |
$1,701.72
|
| Rate for Payer: United Healthcare Medicare |
$683.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.60
|
|
|
HC PRO RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
9832820001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$319.88
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.88
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$271.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$319.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
HC PRO RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$3,173.00
|
|
|
Service Code
|
HCPCS 25275
|
| Hospital Charge Code |
9832527501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$558.42 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,109.54
|
| Rate for Payer: Aetna of WY Medicare |
$656.97
|
| Rate for Payer: Beech Street Commercial |
$3,014.35
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,077.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,109.54
|
| Rate for Payer: First Choice Health Commercial |
$2,855.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,014.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.97
|
| Rate for Payer: HealthUtah PPO |
$3,173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,077.81
|
| Rate for Payer: Multiplan Medicare/VA |
$558.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,109.54
|
| Rate for Payer: PacificSource Commercial |
$2,855.70
|
| Rate for Payer: PHCS PPO |
$3,014.35
|
| Rate for Payer: Three Rivers PPO |
$2,379.75
|
| Rate for Payer: TriWest Veterans Administration |
$656.97
|
| Rate for Payer: United Healthcare Commercial |
$2,760.51
|
| Rate for Payer: United Healthcare Medicare |
$656.97
|
| Rate for Payer: WINHealth Partners Commercial |
$2,697.05
|
|
|
HC PRO RRECRT INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$4,860.00
|
|
|
Service Code
|
HCPCS 49566
|
| Hospital Charge Code |
9834956601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3,645.00 |
| Max. Negotiated Rate |
$4,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,762.80
|
| Rate for Payer: Beech Street Commercial |
$4,617.00
|
| Rate for Payer: Cash Price |
$3,402.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,714.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,762.80
|
| Rate for Payer: First Choice Health Commercial |
$4,374.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,617.00
|
| Rate for Payer: HealthUtah PPO |
$4,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,714.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,762.80
|
| Rate for Payer: PacificSource Commercial |
$4,374.00
|
| Rate for Payer: PHCS PPO |
$4,617.00
|
| Rate for Payer: Three Rivers PPO |
$3,645.00
|
| Rate for Payer: United Healthcare Commercial |
$4,228.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,131.00
|
|
|
HC PRO RRECRT INCAL/VNT HERNIA REDUCIBLE
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 49565
|
| Hospital Charge Code |
9834956501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,986.50 |
| Max. Negotiated Rate |
$3,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,902.36
|
| Rate for Payer: Beech Street Commercial |
$3,782.90
|
| Rate for Payer: Cash Price |
$2,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,862.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,902.36
|
| Rate for Payer: First Choice Health Commercial |
$3,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,782.90
|
| Rate for Payer: HealthUtah PPO |
$3,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,862.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,902.36
|
| Rate for Payer: PacificSource Commercial |
$3,583.80
|
| Rate for Payer: PHCS PPO |
$3,782.90
|
| Rate for Payer: Three Rivers PPO |
$2,986.50
|
| Rate for Payer: United Healthcare Commercial |
$3,464.34
|
| Rate for Payer: WINHealth Partners Commercial |
$3,384.70
|
|
|
HC PRO SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$4,091.00
|
|
|
Service Code
|
HCPCS 58700
|
| Hospital Charge Code |
9755870001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$655.49 |
| Max. Negotiated Rate |
$4,091.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,009.18
|
| Rate for Payer: Aetna of WY Medicare |
$771.16
|
| Rate for Payer: Beech Street Commercial |
$3,886.45
|
| Rate for Payer: Cash Price |
$2,863.70
|
| Rate for Payer: Cash Price |
$2,863.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,968.27
|
| Rate for Payer: Cigna of WY Commercial |
$4,009.18
|
| Rate for Payer: First Choice Health Commercial |
$3,681.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,886.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$771.16
|
| Rate for Payer: HealthUtah PPO |
$4,091.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,968.27
|
| Rate for Payer: Multiplan Medicare/VA |
$655.49
|
| Rate for Payer: One Health Plan of WY PPO |
$4,009.18
|
| Rate for Payer: PacificSource Commercial |
$3,681.90
|
| Rate for Payer: PHCS PPO |
$3,886.45
|
| Rate for Payer: Three Rivers PPO |
$3,068.25
|
| Rate for Payer: TriWest Veterans Administration |
$771.16
|
| Rate for Payer: United Healthcare Commercial |
$3,559.17
|
| Rate for Payer: United Healthcare Medicare |
$771.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3,477.35
|
|
|
HC PRO SAME DAY NB DISCHARGE
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 99463
|
| Hospital Charge Code |
9839946301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$103.83
|
| Rate for Payer: Beech Street Commercial |
$470.25
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: First Choice Health Commercial |
$445.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.83
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$470.25
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.83
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$103.83
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
|
|
HC PRO SBSQ HOSPITAL CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 99231
|
| Hospital Charge Code |
9839923101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$161.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$47.36
|
| Rate for Payer: Beech Street Commercial |
$156.75
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: First Choice Health Commercial |
$148.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.36
|
| Rate for Payer: HealthUtah PPO |
$41.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.26
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$156.75
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$47.36
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$47.36
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
|
|
HC PRO SBSQ HOSPITAL CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
9839923202
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$229.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$75.60
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.60
|
| Rate for Payer: HealthUtah PPO |
$68.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$64.26
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$75.60
|
| Rate for Payer: WINHealth Partners Commercial |
$222.30
|
|
|
HC PRO SBSQ HOSPITAL CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
9839923201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$229.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$75.60
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.60
|
| Rate for Payer: HealthUtah PPO |
$68.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$64.26
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$75.60
|
| Rate for Payer: WINHealth Partners Commercial |
$222.30
|
|
|
HC PRO SBSQ HOSPITAL CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
9839923301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$96.66 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$113.72
|
| Rate for Payer: Beech Street Commercial |
$312.55
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: First Choice Health Commercial |
$296.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.72
|
| Rate for Payer: HealthUtah PPO |
$97.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$96.66
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$312.55
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$113.72
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$113.72
|
| Rate for Payer: WINHealth Partners Commercial |
$312.55
|
|
|
HC PRO SBSQ HOSPITAL CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
9839923302
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$96.66 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$113.72
|
| Rate for Payer: Beech Street Commercial |
$312.55
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: First Choice Health Commercial |
$296.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.72
|
| Rate for Payer: HealthUtah PPO |
$97.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$96.66
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$312.55
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$113.72
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$113.72
|
| Rate for Payer: WINHealth Partners Commercial |
$312.55
|
|
|
HC PRO SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
9839930902
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$104.00
|
| Rate for Payer: Beech Street Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.00
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$88.40
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$180.50
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$104.00
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
|
|
HC PRO SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
9839930901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$104.00
|
| Rate for Payer: Beech Street Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.00
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$88.40
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$180.50
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$104.00
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
|
|
HC PRO SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99224
|
| Hospital Charge Code |
9839922401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Beech Street Commercial |
$168.15
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: First Choice Health Commercial |
$159.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$168.15
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: WINHealth Partners Commercial |
$168.15
|
|
|
HC PRO SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99225
|
| Hospital Charge Code |
9839922501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: First Choice Health Commercial |
$216.90
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
|
|
HC PRO SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 99226
|
| Hospital Charge Code |
9839922601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$554.68
|
| Rate for Payer: Beech Street Commercial |
$537.70
|
| Rate for Payer: Beech Street Commercial |
$273.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.02
|
| Rate for Payer: Cigna of WY Commercial |
$554.68
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: First Choice Health Commercial |
$509.40
|
| Rate for Payer: First Choice Health Commercial |
$259.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$537.70
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: HealthUtah PPO |
$566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: One Health Plan of WY PPO |
$554.68
|
| Rate for Payer: PacificSource Commercial |
$509.40
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$537.70
|
| Rate for Payer: PHCS PPO |
$273.60
|
| Rate for Payer: Three Rivers PPO |
$424.50
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$250.56
|
| Rate for Payer: United Healthcare Commercial |
$492.42
|
| Rate for Payer: WINHealth Partners Commercial |
$537.70
|
| Rate for Payer: WINHealth Partners Commercial |
$273.60
|
|
|
HC PRO SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$3,862.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
9754990001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$670.21 |
| Max. Negotiated Rate |
$3,862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,784.76
|
| Rate for Payer: Aetna of WY Medicare |
$788.48
|
| Rate for Payer: Beech Street Commercial |
$3,668.90
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,746.14
|
| Rate for Payer: Cigna of WY Commercial |
$3,784.76
|
| Rate for Payer: First Choice Health Commercial |
$3,475.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,668.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.48
|
| Rate for Payer: HealthUtah PPO |
$3,862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,746.14
|
| Rate for Payer: Multiplan Medicare/VA |
$670.21
|
| Rate for Payer: One Health Plan of WY PPO |
$3,784.76
|
| Rate for Payer: PacificSource Commercial |
$3,475.80
|
| Rate for Payer: PHCS PPO |
$3,668.90
|
| Rate for Payer: Three Rivers PPO |
$2,896.50
|
| Rate for Payer: TriWest Veterans Administration |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$3,359.94
|
| Rate for Payer: United Healthcare Medicare |
$788.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3,282.70
|
|
