|
HC PRO TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
5109940601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$11.29
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.29
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$9.60
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.29
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$11.29
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
HC PRO TONSILLECTOMY ADENOIDECTOMY 11 YRS
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS 42820
|
| Hospital Charge Code |
9834282001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,452.36
|
| Rate for Payer: Aetna of WY Medicare |
$284.57
|
| Rate for Payer: Beech Street Commercial |
$1,407.90
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,437.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,452.36
|
| Rate for Payer: First Choice Health Commercial |
$1,333.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,407.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.57
|
| Rate for Payer: HealthUtah PPO |
$1,482.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,437.54
|
| Rate for Payer: Multiplan Medicare/VA |
$241.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,452.36
|
| Rate for Payer: PacificSource Commercial |
$1,333.80
|
| Rate for Payer: PHCS PPO |
$1,407.90
|
| Rate for Payer: Three Rivers PPO |
$1,111.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.57
|
| Rate for Payer: United Healthcare Commercial |
$1,289.34
|
| Rate for Payer: United Healthcare Medicare |
$284.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,259.70
|
|
|
HC PRO TONSILLECTOMY & ADENOIDECTOMY 12 YR
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 42821
|
| Hospital Charge Code |
9834282101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$252.59 |
| Max. Negotiated Rate |
$1,546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,515.08
|
| Rate for Payer: Aetna of WY Medicare |
$297.17
|
| Rate for Payer: Beech Street Commercial |
$1,468.70
|
| Rate for Payer: Cash Price |
$1,082.20
|
| Rate for Payer: Cash Price |
$1,082.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,499.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,515.08
|
| Rate for Payer: First Choice Health Commercial |
$1,391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,468.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.17
|
| Rate for Payer: HealthUtah PPO |
$1,546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,499.62
|
| Rate for Payer: Multiplan Medicare/VA |
$252.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,515.08
|
| Rate for Payer: PacificSource Commercial |
$1,391.40
|
| Rate for Payer: PHCS PPO |
$1,468.70
|
| Rate for Payer: Three Rivers PPO |
$1,159.50
|
| Rate for Payer: TriWest Veterans Administration |
$297.17
|
| Rate for Payer: United Healthcare Commercial |
$1,345.02
|
| Rate for Payer: United Healthcare Medicare |
$297.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,314.10
|
|
|
HC PRO TONSILLECTOMY AGE 12 OLDER
|
Professional
|
Both
|
$1,291.00
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
9834282601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$212.91 |
| Max. Negotiated Rate |
$1,291.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,265.18
|
| Rate for Payer: Aetna of WY Medicare |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$1,226.45
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,252.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,265.18
|
| Rate for Payer: First Choice Health Commercial |
$1,161.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,226.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.48
|
| Rate for Payer: HealthUtah PPO |
$1,291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,252.27
|
| Rate for Payer: Multiplan Medicare/VA |
$212.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,265.18
|
| Rate for Payer: PacificSource Commercial |
$1,161.90
|
| Rate for Payer: PHCS PPO |
$1,226.45
|
| Rate for Payer: Three Rivers PPO |
$968.25
|
| Rate for Payer: TriWest Veterans Administration |
$250.48
|
| Rate for Payer: United Healthcare Commercial |
$1,123.17
|
| Rate for Payer: United Healthcare Medicare |
$250.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.35
|
|
|
HC PRO TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 42825
|
| Hospital Charge Code |
9834282501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$223.76 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,322.02
|
| Rate for Payer: Aetna of WY Medicare |
$263.25
|
| Rate for Payer: Beech Street Commercial |
$1,281.55
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,308.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,322.02
|
| Rate for Payer: First Choice Health Commercial |
$1,214.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,281.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.25
|
| Rate for Payer: HealthUtah PPO |
$1,349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,308.53
|
| Rate for Payer: Multiplan Medicare/VA |
$223.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,322.02
|
| Rate for Payer: PacificSource Commercial |
$1,214.10
|
| Rate for Payer: PHCS PPO |
$1,281.55
|
| Rate for Payer: Three Rivers PPO |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$1,173.63
|
| Rate for Payer: United Healthcare Medicare |
$263.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,146.65
|
|
|
HC PRO TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$5,229.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
9835815001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$831.10 |
| Max. Negotiated Rate |
$5,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,124.42
|
| Rate for Payer: Aetna of WY Medicare |
$977.76
|
| Rate for Payer: Beech Street Commercial |
$4,967.55
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,072.13
|
| Rate for Payer: Cigna of WY Commercial |
$5,124.42
|
| Rate for Payer: First Choice Health Commercial |
$4,706.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,967.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.76
|
| Rate for Payer: HealthUtah PPO |
$5,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,072.13
|
| Rate for Payer: Multiplan Medicare/VA |
$831.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,124.42
|
| Rate for Payer: PacificSource Commercial |
$4,706.10
|
| Rate for Payer: PHCS PPO |
$4,967.55
|
| Rate for Payer: Three Rivers PPO |
$3,921.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.76
|
| Rate for Payer: United Healthcare Commercial |
$4,549.23
|
| Rate for Payer: United Healthcare Medicare |
$977.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4,444.65
|
|
|
HC PRO TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$6,991.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
9832744701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$6,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,851.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$6,641.45
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,781.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,851.18
|
| Rate for Payer: First Choice Health Commercial |
$6,291.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,641.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$6,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,781.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$6,851.18
|
| Rate for Payer: PacificSource Commercial |
$6,291.90
|
| Rate for Payer: PHCS PPO |
$6,641.45
|
| Rate for Payer: Three Rivers PPO |
$5,243.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$6,082.17
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$5,942.35
|
|
|
HC PRO TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$13,982.00
|
|
|
Service Code
|
HCPCS 27447 50
|
| Hospital Charge Code |
9832744701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$13,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,702.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$13,282.90
|
| Rate for Payer: Cash Price |
$9,787.40
|
| Rate for Payer: Cash Price |
$9,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,562.54
|
| Rate for Payer: Cigna of WY Commercial |
$13,702.36
|
| Rate for Payer: First Choice Health Commercial |
$12,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,282.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$13,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,562.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$13,702.36
|
| Rate for Payer: PacificSource Commercial |
$12,583.80
|
| Rate for Payer: PHCS PPO |
$13,282.90
|
| Rate for Payer: Three Rivers PPO |
$10,486.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$12,164.34
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$11,884.70
|
|
|
HC PRO TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,633.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
9836022001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$577.57 |
| Max. Negotiated Rate |
$3,633.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,560.34
|
| Rate for Payer: Aetna of WY Medicare |
$679.49
|
| Rate for Payer: Beech Street Commercial |
$3,451.35
|
| Rate for Payer: Cash Price |
$2,543.10
|
| Rate for Payer: Cash Price |
$2,543.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,524.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,560.34
|
| Rate for Payer: First Choice Health Commercial |
$3,269.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,451.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.49
|
| Rate for Payer: HealthUtah PPO |
$3,633.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,524.01
|
| Rate for Payer: Multiplan Medicare/VA |
$577.57
|
| Rate for Payer: One Health Plan of WY PPO |
$3,560.34
|
| Rate for Payer: PacificSource Commercial |
$3,269.70
|
| Rate for Payer: PHCS PPO |
$3,451.35
|
| Rate for Payer: Three Rivers PPO |
$2,724.75
|
| Rate for Payer: TriWest Veterans Administration |
$679.49
|
| Rate for Payer: United Healthcare Commercial |
$3,160.71
|
| Rate for Payer: United Healthcare Medicare |
$679.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,088.05
|
|
|
HC PRO TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC
|
Professional
|
Both
|
$4,798.00
|
|
|
Service Code
|
HCPCS 60225
|
| Hospital Charge Code |
9826022501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$765.92 |
| Max. Negotiated Rate |
$4,798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,702.04
|
| Rate for Payer: Aetna of WY Medicare |
$901.08
|
| Rate for Payer: Beech Street Commercial |
$4,558.10
|
| Rate for Payer: Cash Price |
$3,358.60
|
| Rate for Payer: Cash Price |
$3,358.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,654.06
|
| Rate for Payer: Cigna of WY Commercial |
$4,702.04
|
| Rate for Payer: First Choice Health Commercial |
$4,318.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,558.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.08
|
| Rate for Payer: HealthUtah PPO |
$4,798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,654.06
|
| Rate for Payer: Multiplan Medicare/VA |
$765.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4,702.04
|
| Rate for Payer: PacificSource Commercial |
$4,318.20
|
| Rate for Payer: PHCS PPO |
$4,558.10
|
| Rate for Payer: Three Rivers PPO |
$3,598.50
|
| Rate for Payer: TriWest Veterans Administration |
$901.08
|
| Rate for Payer: United Healthcare Commercial |
$4,174.26
|
| Rate for Payer: United Healthcare Medicare |
$901.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,078.30
|
|
|
HC PRO TOT DISC ARTHRP ANT APDISC 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 22858
|
| Hospital Charge Code |
9832285801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$402.10 |
| Max. Negotiated Rate |
$2,032.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,991.36
|
| Rate for Payer: Aetna of WY Medicare |
$473.06
|
| Rate for Payer: Beech Street Commercial |
$1,930.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,971.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,991.36
|
| Rate for Payer: First Choice Health Commercial |
$1,828.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,930.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$473.06
|
| Rate for Payer: HealthUtah PPO |
$2,032.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,971.04
|
| Rate for Payer: Multiplan Medicare/VA |
$402.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,991.36
|
| Rate for Payer: PacificSource Commercial |
$1,828.80
|
| Rate for Payer: PHCS PPO |
$1,930.40
|
| Rate for Payer: Three Rivers PPO |
$1,524.00
|
| Rate for Payer: TriWest Veterans Administration |
$473.06
|
| Rate for Payer: United Healthcare Commercial |
$1,767.84
|
| Rate for Payer: United Healthcare Medicare |
$473.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,727.20
|
|
|
HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGG
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
3028675301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.39
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.39
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.53
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$12.39
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGM
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
3028675302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.39
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.39
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.53
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$12.39
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HC PRO TRANSECTION/AVULSION OTH SPINAL NRV XDRL
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
9836477201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$460.16 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,850.82
|
| Rate for Payer: Aetna of WY Medicare |
$541.37
|
| Rate for Payer: Beech Street Commercial |
$2,763.55
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,821.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,850.82
|
| Rate for Payer: First Choice Health Commercial |
$2,618.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,763.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.37
|
| Rate for Payer: HealthUtah PPO |
$2,909.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,821.73
|
| Rate for Payer: Multiplan Medicare/VA |
$460.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,850.82
|
| Rate for Payer: PacificSource Commercial |
$2,618.10
|
| Rate for Payer: PHCS PPO |
$2,763.55
|
| Rate for Payer: Three Rivers PPO |
$2,181.75
|
| Rate for Payer: TriWest Veterans Administration |
$541.37
|
| Rate for Payer: United Healthcare Commercial |
$2,530.83
|
| Rate for Payer: United Healthcare Medicare |
$541.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,472.65
|
|
|
HC PRO TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 99495 NONPBBPAYER
|
| Hospital Charge Code |
9839949501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Aetna of WY Medicare |
$134.68
|
| Rate for Payer: Beech Street Commercial |
$579.50
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: First Choice Health Commercial |
$549.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.68
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$114.48
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$579.50
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$134.68
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$134.68
|
| Rate for Payer: WINHealth Partners Commercial |
$579.50
|
|
|
HC PRO TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 99496 NONPBBPAYER
|
| Hospital Charge Code |
9839949601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$155.51 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$787.92
|
| Rate for Payer: Aetna of WY Medicare |
$182.95
|
| Rate for Payer: Beech Street Commercial |
$763.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$779.88
|
| Rate for Payer: Cigna of WY Commercial |
$787.92
|
| Rate for Payer: First Choice Health Commercial |
$723.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$763.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.95
|
| Rate for Payer: HealthUtah PPO |
$804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$779.88
|
| Rate for Payer: Multiplan Medicare/VA |
$155.51
|
| Rate for Payer: One Health Plan of WY PPO |
$787.92
|
| Rate for Payer: PacificSource Commercial |
$723.60
|
| Rate for Payer: PHCS PPO |
$763.80
|
| Rate for Payer: Three Rivers PPO |
$603.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.95
|
| Rate for Payer: United Healthcare Commercial |
$699.48
|
| Rate for Payer: United Healthcare Medicare |
$182.95
|
| Rate for Payer: WINHealth Partners Commercial |
$763.80
|
|
|
HC PRO TRANSPOSITION/NEUROPLASTY ULNA NERVE
|
Professional
|
Both
|
$3,068.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
9836471801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$501.64 |
| Max. Negotiated Rate |
$3,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,006.64
|
| Rate for Payer: Aetna of WY Medicare |
$590.17
|
| Rate for Payer: Beech Street Commercial |
$2,914.60
|
| Rate for Payer: Cash Price |
$2,147.60
|
| Rate for Payer: Cash Price |
$2,147.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,975.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,006.64
|
| Rate for Payer: First Choice Health Commercial |
$2,761.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,914.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$590.17
|
| Rate for Payer: HealthUtah PPO |
$3,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,975.96
|
| Rate for Payer: Multiplan Medicare/VA |
$501.64
|
| Rate for Payer: One Health Plan of WY PPO |
$3,006.64
|
| Rate for Payer: PacificSource Commercial |
$2,761.20
|
| Rate for Payer: PHCS PPO |
$2,914.60
|
| Rate for Payer: Three Rivers PPO |
$2,301.00
|
| Rate for Payer: TriWest Veterans Administration |
$590.17
|
| Rate for Payer: United Healthcare Commercial |
$2,669.16
|
| Rate for Payer: United Healthcare Medicare |
$590.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,607.80
|
|
|
HC PRO TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
9832849601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$1,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,221.08
|
| Rate for Payer: Aetna of WY Medicare |
$271.76
|
| Rate for Payer: Beech Street Commercial |
$1,183.70
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,208.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,221.08
|
| Rate for Payer: First Choice Health Commercial |
$1,121.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,183.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$271.76
|
| Rate for Payer: HealthUtah PPO |
$1,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,208.62
|
| Rate for Payer: Multiplan Medicare/VA |
$231.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,221.08
|
| Rate for Payer: PacificSource Commercial |
$1,121.40
|
| Rate for Payer: PHCS PPO |
$1,183.70
|
| Rate for Payer: Three Rivers PPO |
$934.50
|
| Rate for Payer: TriWest Veterans Administration |
$271.76
|
| Rate for Payer: United Healthcare Commercial |
$1,084.02
|
| Rate for Payer: United Healthcare Medicare |
$271.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,059.10
|
|
|
HC PRO TREAT ECTOPIC PREGNANCY
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
9835915101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$627.11 |
| Max. Negotiated Rate |
$2,303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,256.94
|
| Rate for Payer: Aetna of WY Medicare |
$737.78
|
| Rate for Payer: Beech Street Commercial |
$2,187.85
|
| Rate for Payer: Cash Price |
$1,612.10
|
| Rate for Payer: Cash Price |
$1,612.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,233.91
|
| Rate for Payer: Cigna of WY Commercial |
$2,256.94
|
| Rate for Payer: First Choice Health Commercial |
$2,072.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,187.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$737.78
|
| Rate for Payer: HealthUtah PPO |
$2,303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,233.91
|
| Rate for Payer: Multiplan Medicare/VA |
$627.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,256.94
|
| Rate for Payer: PacificSource Commercial |
$2,072.70
|
| Rate for Payer: PHCS PPO |
$2,187.85
|
| Rate for Payer: Three Rivers PPO |
$1,727.25
|
| Rate for Payer: TriWest Veterans Administration |
$737.78
|
| Rate for Payer: United Healthcare Commercial |
$2,003.61
|
| Rate for Payer: United Healthcare Medicare |
$737.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,957.55
|
|
|
HC PRO TREAT KNEECAP FRACTURE
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
9832752401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$621.76 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,557.80
|
| Rate for Payer: Aetna of WY Medicare |
$731.48
|
| Rate for Payer: Beech Street Commercial |
$2,479.50
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,531.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,557.80
|
| Rate for Payer: First Choice Health Commercial |
$2,349.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,479.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.48
|
| Rate for Payer: HealthUtah PPO |
$2,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,531.70
|
| Rate for Payer: Multiplan Medicare/VA |
$621.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,557.80
|
| Rate for Payer: PacificSource Commercial |
$2,349.00
|
| Rate for Payer: PHCS PPO |
$2,479.50
|
| Rate for Payer: Three Rivers PPO |
$1,957.50
|
| Rate for Payer: TriWest Veterans Administration |
$731.48
|
| Rate for Payer: United Healthcare Commercial |
$2,270.70
|
| Rate for Payer: United Healthcare Medicare |
$731.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,218.50
|
|
|
HC PRO TREAT LOWER LEG FRACTURE
|
Professional
|
Both
|
$5,096.00
|
|
|
Service Code
|
HCPCS 27825 50,NONPBBPAYER
|
| Hospital Charge Code |
9832782501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$5,096.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,994.08
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$4,841.20
|
| Rate for Payer: Cash Price |
$3,567.20
|
| Rate for Payer: Cash Price |
$3,567.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,943.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,994.08
|
| Rate for Payer: First Choice Health Commercial |
$4,586.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,841.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$5,096.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,943.12
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,994.08
|
| Rate for Payer: PacificSource Commercial |
$4,586.40
|
| Rate for Payer: PHCS PPO |
$4,841.20
|
| Rate for Payer: Three Rivers PPO |
$3,822.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$4,433.52
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,331.60
|
|
|
HC PRO TREAT LOWER LEG FRACTURE
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 27825 50
|
| Hospital Charge Code |
9832782501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$4,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,994.48
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$3,872.20
|
| Rate for Payer: Cash Price |
$2,853.20
|
| Rate for Payer: Cash Price |
$2,853.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,953.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,994.48
|
| Rate for Payer: First Choice Health Commercial |
$3,668.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,872.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$4,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,953.72
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$3,994.48
|
| Rate for Payer: PacificSource Commercial |
$3,668.40
|
| Rate for Payer: PHCS PPO |
$3,872.20
|
| Rate for Payer: Three Rivers PPO |
$3,057.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$3,546.12
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3,464.60
|
|
|
HC PRO TREAT LOWER LEG FRACTURE
|
Professional
|
Both
|
$2,038.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
9832782501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,997.24
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$1,936.10
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,976.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,997.24
|
| Rate for Payer: First Choice Health Commercial |
$1,834.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,936.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,976.86
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,997.24
|
| Rate for Payer: PacificSource Commercial |
$1,834.20
|
| Rate for Payer: PHCS PPO |
$1,936.10
|
| Rate for Payer: Three Rivers PPO |
$1,528.50
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$1,773.06
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,732.30
|
|
|
HC PRO TREAT LOWER LEG FRACTURE
|
Professional
|
Both
|
$2,548.00
|
|
|
Service Code
|
HCPCS 27825 NONPBBPAYER
|
| Hospital Charge Code |
9832782501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,497.04
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,471.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,497.04
|
| Rate for Payer: First Choice Health Commercial |
$2,293.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,420.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,471.56
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,497.04
|
| Rate for Payer: PacificSource Commercial |
$2,293.20
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,911.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$2,216.76
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,165.80
|
|
|
HC PRO TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$7,170.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
9832847601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$325.82 |
| Max. Negotiated Rate |
$7,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,026.60
|
| Rate for Payer: Aetna of WY Medicare |
$383.32
|
| Rate for Payer: Beech Street Commercial |
$6,811.50
|
| Rate for Payer: Cash Price |
$5,019.00
|
| Rate for Payer: Cash Price |
$5,019.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,954.90
|
| Rate for Payer: Cigna of WY Commercial |
$7,026.60
|
| Rate for Payer: First Choice Health Commercial |
$6,453.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,811.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.32
|
| Rate for Payer: HealthUtah PPO |
$7,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,954.90
|
| Rate for Payer: Multiplan Medicare/VA |
$325.82
|
| Rate for Payer: One Health Plan of WY PPO |
$7,026.60
|
| Rate for Payer: PacificSource Commercial |
$6,453.00
|
| Rate for Payer: PHCS PPO |
$6,811.50
|
| Rate for Payer: Three Rivers PPO |
$5,377.50
|
| Rate for Payer: TriWest Veterans Administration |
$383.32
|
| Rate for Payer: United Healthcare Commercial |
$6,237.90
|
| Rate for Payer: United Healthcare Medicare |
$383.32
|
| Rate for Payer: WINHealth Partners Commercial |
$6,094.50
|
|
