|
HC PRO STOMACH SURGERY PROCEDURE UNLISTED
|
Professional
|
Both
|
$2,728.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
9834399901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,046.00 |
| Max. Negotiated Rate |
$2,728.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,673.44
|
| Rate for Payer: Beech Street Commercial |
$2,591.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,646.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,673.44
|
| Rate for Payer: First Choice Health Commercial |
$2,455.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,591.60
|
| Rate for Payer: HealthUtah PPO |
$2,728.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,646.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,673.44
|
| Rate for Payer: PacificSource Commercial |
$2,455.20
|
| Rate for Payer: PHCS PPO |
$2,591.60
|
| Rate for Payer: Three Rivers PPO |
$2,046.00
|
| Rate for Payer: United Healthcare Commercial |
$2,373.36
|
| Rate for Payer: WINHealth Partners Commercial |
$2,318.80
|
|
|
HC PRO STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 59525
|
| Hospital Charge Code |
9755952501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.87 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,424.92
|
| Rate for Payer: Aetna of WY Medicare |
$450.44
|
| Rate for Payer: Beech Street Commercial |
$1,381.30
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,410.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,424.92
|
| Rate for Payer: First Choice Health Commercial |
$1,308.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,381.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.44
|
| Rate for Payer: HealthUtah PPO |
$1,454.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,410.38
|
| Rate for Payer: Multiplan Medicare/VA |
$382.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,424.92
|
| Rate for Payer: PacificSource Commercial |
$1,308.60
|
| Rate for Payer: PHCS PPO |
$1,381.30
|
| Rate for Payer: Three Rivers PPO |
$1,090.50
|
| Rate for Payer: TriWest Veterans Administration |
$450.44
|
| Rate for Payer: United Healthcare Commercial |
$1,264.98
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.90
|
|
|
HC PRO STRAPPING ANKLE/FOOT
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
9832954001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$16.44
|
| Rate for Payer: Aetna of WY Medicare |
$16.44
|
| Rate for Payer: Beech Street Commercial |
$129.20
|
| Rate for Payer: Beech Street Commercial |
$74.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: First Choice Health Commercial |
$122.40
|
| Rate for Payer: First Choice Health Commercial |
$70.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.44
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$13.97
|
| Rate for Payer: Multiplan Medicare/VA |
$13.97
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$74.10
|
| Rate for Payer: PHCS PPO |
$129.20
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$16.44
|
| Rate for Payer: TriWest Veterans Administration |
$16.44
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Commercial |
$67.86
|
| Rate for Payer: United Healthcare Medicare |
$16.44
|
| Rate for Payer: United Healthcare Medicare |
$16.44
|
| Rate for Payer: WINHealth Partners Commercial |
$66.30
|
| Rate for Payer: WINHealth Partners Commercial |
$115.60
|
|
|
HC PRO STRAPPING ANKLE/FOOT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 29540 NONPBBPAYER
|
| Hospital Charge Code |
9832954001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$16.44
|
| Rate for Payer: Beech Street Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: First Choice Health Commercial |
$87.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.44
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$13.97
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$92.15
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.44
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$16.44
|
| Rate for Payer: WINHealth Partners Commercial |
$82.45
|
|
|
HC PRO STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
9832926001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$18.08
|
| Rate for Payer: Aetna of WY Medicare |
$18.08
|
| Rate for Payer: Beech Street Commercial |
$128.25
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$121.50
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.08
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$15.37
|
| Rate for Payer: Multiplan Medicare/VA |
$15.37
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: PHCS PPO |
$128.25
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$18.08
|
| Rate for Payer: TriWest Veterans Administration |
$18.08
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$18.08
|
| Rate for Payer: WINHealth Partners Commercial |
$69.70
|
| Rate for Payer: WINHealth Partners Commercial |
$114.75
|
|
|
HC PRO STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 29260 NONPBBPAYER
|
| Hospital Charge Code |
9832926001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$18.08
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.08
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$15.37
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$18.08
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$18.08
|
| Rate for Payer: WINHealth Partners Commercial |
$86.70
|
|
|
HC PRO STRAPPING HAND/FINGER
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
9832928001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$19.22
|
| Rate for Payer: Aetna of WY Medicare |
$19.22
|
| Rate for Payer: Beech Street Commercial |
$142.50
|
| Rate for Payer: Beech Street Commercial |
$78.85
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Cigna of WY Commercial |
$81.34
|
| Rate for Payer: First Choice Health Commercial |
$135.00
|
| Rate for Payer: First Choice Health Commercial |
$74.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$83.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$16.34
|
| Rate for Payer: Multiplan Medicare/VA |
$16.34
|
| Rate for Payer: One Health Plan of WY PPO |
$81.34
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PacificSource Commercial |
$74.70
|
| Rate for Payer: PHCS PPO |
$78.85
|
| Rate for Payer: PHCS PPO |
$142.50
|
| Rate for Payer: Three Rivers PPO |
$62.25
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.22
|
| Rate for Payer: TriWest Veterans Administration |
$19.22
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$72.21
|
| Rate for Payer: United Healthcare Medicare |
$19.22
|
| Rate for Payer: United Healthcare Medicare |
$19.22
|
| Rate for Payer: WINHealth Partners Commercial |
$70.55
|
| Rate for Payer: WINHealth Partners Commercial |
$127.50
|
|
|
HC PRO STRAPPING HAND/FINGER
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 29280 NONPBBPAYER
|
| Hospital Charge Code |
9832928001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$19.22
|
| Rate for Payer: Beech Street Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: First Choice Health Commercial |
$93.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$16.34
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$98.80
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$19.22
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$19.22
|
| Rate for Payer: WINHealth Partners Commercial |
$88.40
|
|
|
HC PRO STRAPPING HIP
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
9832952001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: First Choice Health Commercial |
$87.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$92.15
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$82.45
|
|
|
HC PRO STRAPPING HIP
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 29520 NONPBBPAYER
|
| Hospital Charge Code |
9832952001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.58
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$114.95
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.37
|
| Rate for Payer: Cigna of WY Commercial |
$118.58
|
| Rate for Payer: First Choice Health Commercial |
$108.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.37
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$118.58
|
| Rate for Payer: PacificSource Commercial |
$108.90
|
| Rate for Payer: PHCS PPO |
$114.95
|
| Rate for Payer: Three Rivers PPO |
$90.75
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$105.27
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$102.85
|
|
|
HC PRO STRAPPING KNEE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
9832953001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$69.70
|
|
|
HC PRO STRAPPING KNEE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 29530 NONPBBPAYER
|
| Hospital Charge Code |
9832953001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$86.70
|
|
|
HC PRO STRAPPING SHOULDER
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29240 NONPBBPAYER
|
| Hospital Charge Code |
9832924001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$99.75
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: First Choice Health Commercial |
$94.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$99.75
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$89.25
|
|
|
HC PRO STRAPPING SHOULDER
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
9832924001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.16
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$134.90
|
| Rate for Payer: Beech Street Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.74
|
| Rate for Payer: Cigna of WY Commercial |
$139.16
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: First Choice Health Commercial |
$127.80
|
| Rate for Payer: First Choice Health Commercial |
$75.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: HealthUtah PPO |
$142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.74
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: One Health Plan of WY PPO |
$139.16
|
| Rate for Payer: PacificSource Commercial |
$127.80
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$79.80
|
| Rate for Payer: PHCS PPO |
$134.90
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: Three Rivers PPO |
$106.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$123.54
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$71.40
|
| Rate for Payer: WINHealth Partners Commercial |
$120.70
|
|
|
HC PRO STRAPPING UNNA BOOT
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 29580 50
|
| Hospital Charge Code |
9832958001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$380.24
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$368.60
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.36
|
| Rate for Payer: Cigna of WY Commercial |
$380.24
|
| Rate for Payer: First Choice Health Commercial |
$349.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.36
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$380.24
|
| Rate for Payer: PacificSource Commercial |
$349.20
|
| Rate for Payer: PHCS PPO |
$368.60
|
| Rate for Payer: Three Rivers PPO |
$291.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$337.56
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$329.80
|
|
|
HC PRO STRAPPING UNNA BOOT
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 29580 NONPBBPAYER
|
| Hospital Charge Code |
9832958001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$230.85
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: First Choice Health Commercial |
$218.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$230.85
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$211.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$206.55
|
|
|
HC PRO STRAPPING UNNA BOOT
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 29580 50,NONPBBPAYER
|
| Hospital Charge Code |
9832958001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$476.28
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$461.70
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$471.42
|
| Rate for Payer: Cigna of WY Commercial |
$476.28
|
| Rate for Payer: First Choice Health Commercial |
$437.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$461.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$486.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$471.42
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$476.28
|
| Rate for Payer: PacificSource Commercial |
$437.40
|
| Rate for Payer: PHCS PPO |
$461.70
|
| Rate for Payer: Three Rivers PPO |
$364.50
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$422.82
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$413.10
|
|
|
HC PRO STRAPPING UNNA BOOT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
9832958001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Beech Street Commercial |
$209.00
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: First Choice Health Commercial |
$198.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$209.00
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$187.00
|
| Rate for Payer: WINHealth Partners Commercial |
$164.90
|
|
|
HC PRO SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
9831527501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$89.08
|
| 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 |
$89.08
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$75.72
|
| 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 |
$89.08
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Medicare |
$89.08
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
HC PRO SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
9833014001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,422.96
|
| Rate for Payer: Aetna of WY Medicare |
$170.85
|
| Rate for Payer: Beech Street Commercial |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,422.96
|
| Rate for Payer: First Choice Health Commercial |
$1,306.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.85
|
| Rate for Payer: HealthUtah PPO |
$1,452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.44
|
| Rate for Payer: Multiplan Medicare/VA |
$145.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,422.96
|
| Rate for Payer: PacificSource Commercial |
$1,306.80
|
| Rate for Payer: PHCS PPO |
$1,379.40
|
| Rate for Payer: Three Rivers PPO |
$1,089.00
|
| Rate for Payer: TriWest Veterans Administration |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$1,263.24
|
| Rate for Payer: United Healthcare Medicare |
$170.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.20
|
|
|
HC PRO SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 30140 50
|
| Hospital Charge Code |
9833014001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,845.92
|
| Rate for Payer: Aetna of WY Medicare |
$170.85
|
| Rate for Payer: Beech Street Commercial |
$2,758.80
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,816.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,845.92
|
| Rate for Payer: First Choice Health Commercial |
$2,613.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,758.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.85
|
| Rate for Payer: HealthUtah PPO |
$2,904.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,816.88
|
| Rate for Payer: Multiplan Medicare/VA |
$145.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,845.92
|
| Rate for Payer: PacificSource Commercial |
$2,613.60
|
| Rate for Payer: PHCS PPO |
$2,758.80
|
| Rate for Payer: Three Rivers PPO |
$2,178.00
|
| Rate for Payer: TriWest Veterans Administration |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$2,526.48
|
| Rate for Payer: United Healthcare Medicare |
$170.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,468.40
|
|
|
HC PRO SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
9839946201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$39.11
|
| Rate for Payer: Beech Street Commercial |
$137.75
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: First Choice Health Commercial |
$130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.11
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$33.24
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$137.75
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.11
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$39.11
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
|
|
HC PRO SUPRACERVICAL ABDOMINAL HYSTERECTOMY
|
Professional
|
Both
|
$4,978.00
|
|
|
Service Code
|
HCPCS 58180
|
| Hospital Charge Code |
9835818001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$785.54 |
| Max. Negotiated Rate |
$4,978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,878.44
|
| Rate for Payer: Aetna of WY Medicare |
$924.17
|
| Rate for Payer: Beech Street Commercial |
$4,729.10
|
| Rate for Payer: Cash Price |
$3,484.60
|
| Rate for Payer: Cash Price |
$3,484.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,828.66
|
| Rate for Payer: Cigna of WY Commercial |
$4,878.44
|
| Rate for Payer: First Choice Health Commercial |
$4,480.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,729.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$924.17
|
| Rate for Payer: HealthUtah PPO |
$4,978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,828.66
|
| Rate for Payer: Multiplan Medicare/VA |
$785.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,878.44
|
| Rate for Payer: PacificSource Commercial |
$4,480.20
|
| Rate for Payer: PHCS PPO |
$4,729.10
|
| Rate for Payer: Three Rivers PPO |
$3,733.50
|
| Rate for Payer: TriWest Veterans Administration |
$924.17
|
| Rate for Payer: United Healthcare Commercial |
$4,330.86
|
| Rate for Payer: United Healthcare Medicare |
$924.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4,231.30
|
|
|
HC PRO SURG DIAGNOSTIC EXAM, ANORECTAL
|
Professional
|
Both
|
$5,621.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
9834599001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$5,621.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,508.58
|
| Rate for Payer: Aetna of WY Medicare |
$100.74
|
| Rate for Payer: Beech Street Commercial |
$5,339.95
|
| Rate for Payer: Cash Price |
$3,934.70
|
| Rate for Payer: Cash Price |
$3,934.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,452.37
|
| Rate for Payer: Cigna of WY Commercial |
$5,508.58
|
| Rate for Payer: First Choice Health Commercial |
$5,058.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,339.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.74
|
| Rate for Payer: HealthUtah PPO |
$5,621.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,452.37
|
| Rate for Payer: Multiplan Medicare/VA |
$85.63
|
| Rate for Payer: One Health Plan of WY PPO |
$5,508.58
|
| Rate for Payer: PacificSource Commercial |
$5,058.90
|
| Rate for Payer: PHCS PPO |
$5,339.95
|
| Rate for Payer: Three Rivers PPO |
$4,215.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.74
|
| Rate for Payer: United Healthcare Commercial |
$4,890.27
|
| Rate for Payer: United Healthcare Medicare |
$100.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4,777.85
|
|
|
HC PRO SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$5,459.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
9832980601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$869.26 |
| Max. Negotiated Rate |
$5,459.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,349.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,022.66
|
| Rate for Payer: Beech Street Commercial |
$5,186.05
|
| Rate for Payer: Cash Price |
$3,821.30
|
| Rate for Payer: Cash Price |
$3,821.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,295.23
|
| Rate for Payer: Cigna of WY Commercial |
$5,349.82
|
| Rate for Payer: First Choice Health Commercial |
$4,913.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,186.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,022.66
|
| Rate for Payer: HealthUtah PPO |
$5,459.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,295.23
|
| Rate for Payer: Multiplan Medicare/VA |
$869.26
|
| Rate for Payer: One Health Plan of WY PPO |
$5,349.82
|
| Rate for Payer: PacificSource Commercial |
$4,913.10
|
| Rate for Payer: PHCS PPO |
$5,186.05
|
| Rate for Payer: Three Rivers PPO |
$4,094.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,022.66
|
| Rate for Payer: United Healthcare Commercial |
$4,749.33
|
| Rate for Payer: United Healthcare Medicare |
$1,022.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4,640.15
|
|
