|
CLOSED TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
27200
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$949.62
|
| Rate for Payer: Aetna of WY Medicare |
$192.56
|
| Rate for Payer: Beech Street Commercial |
$920.55
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$939.93
|
| Rate for Payer: Cigna of WY Commercial |
$949.62
|
| Rate for Payer: First Choice Health Commercial |
$872.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$920.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.56
|
| Rate for Payer: HealthUtah PPO |
$969.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$939.93
|
| Rate for Payer: Multiplan Medicare/VA |
$163.68
|
| Rate for Payer: One Health Plan of WY PPO |
$949.62
|
| Rate for Payer: PacificSource Commercial |
$872.10
|
| Rate for Payer: PHCS PPO |
$920.55
|
| Rate for Payer: Three Rivers PPO |
$726.75
|
| Rate for Payer: TriWest Veterans Administration |
$192.56
|
| Rate for Payer: United Healthcare Commercial |
$843.03
|
| Rate for Payer: United Healthcare Medicare |
$192.56
|
| Rate for Payer: WINHealth Partners Commercial |
$823.65
|
|
|
CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
27767
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$432.18
|
| Rate for Payer: Aetna of WY Medicare |
$292.56
|
| Rate for Payer: Beech Street Commercial |
$418.95
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$427.77
|
| Rate for Payer: Cigna of WY Commercial |
$432.18
|
| Rate for Payer: First Choice Health Commercial |
$396.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.56
|
| Rate for Payer: HealthUtah PPO |
$441.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$427.77
|
| Rate for Payer: Multiplan Medicare/VA |
$248.68
|
| Rate for Payer: One Health Plan of WY PPO |
$432.18
|
| Rate for Payer: PacificSource Commercial |
$396.90
|
| Rate for Payer: PHCS PPO |
$418.95
|
| Rate for Payer: Three Rivers PPO |
$330.75
|
| Rate for Payer: TriWest Veterans Administration |
$292.56
|
| Rate for Payer: United Healthcare Commercial |
$383.67
|
| Rate for Payer: United Healthcare Medicare |
$292.56
|
| Rate for Payer: WINHealth Partners Commercial |
$374.85
|
|
|
CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
25650
|
| Min. Negotiated Rate |
$262.06 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$488.04
|
| Rate for Payer: Aetna of WY Medicare |
$308.31
|
| Rate for Payer: Beech Street Commercial |
$473.10
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$483.06
|
| Rate for Payer: Cigna of WY Commercial |
$488.04
|
| Rate for Payer: First Choice Health Commercial |
$448.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$473.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.31
|
| Rate for Payer: HealthUtah PPO |
$498.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$483.06
|
| Rate for Payer: Multiplan Medicare/VA |
$262.06
|
| Rate for Payer: One Health Plan of WY PPO |
$488.04
|
| Rate for Payer: PacificSource Commercial |
$448.20
|
| Rate for Payer: PHCS PPO |
$473.10
|
| Rate for Payer: Three Rivers PPO |
$373.50
|
| Rate for Payer: TriWest Veterans Administration |
$308.31
|
| Rate for Payer: United Healthcare Commercial |
$433.26
|
| Rate for Payer: United Healthcare Medicare |
$308.31
|
| Rate for Payer: WINHealth Partners Commercial |
$423.30
|
|
|
CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 22305
|
| Hospital Charge Code |
22305
|
| Min. Negotiated Rate |
$683.25 |
| Max. Negotiated Rate |
$911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.78
|
| Rate for Payer: Beech Street Commercial |
$865.45
|
| Rate for Payer: Cash Price |
$637.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.67
|
| Rate for Payer: Cigna of WY Commercial |
$892.78
|
| Rate for Payer: First Choice Health Commercial |
$819.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$865.45
|
| Rate for Payer: HealthUtah PPO |
$911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.67
|
| Rate for Payer: One Health Plan of WY PPO |
$892.78
|
| Rate for Payer: PacificSource Commercial |
$819.90
|
| Rate for Payer: PHCS PPO |
$865.45
|
| Rate for Payer: Three Rivers PPO |
$683.25
|
| Rate for Payer: United Healthcare Commercial |
$792.57
|
| Rate for Payer: WINHealth Partners Commercial |
$774.35
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
27840
|
| Min. Negotiated Rate |
$326.94 |
| Max. Negotiated Rate |
$1,940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,901.20
|
| Rate for Payer: Aetna of WY Medicare |
$384.64
|
| Rate for Payer: Beech Street Commercial |
$1,843.00
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,881.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,901.20
|
| Rate for Payer: First Choice Health Commercial |
$1,746.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,843.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.64
|
| Rate for Payer: HealthUtah PPO |
$1,940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,881.80
|
| Rate for Payer: Multiplan Medicare/VA |
$326.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,901.20
|
| Rate for Payer: PacificSource Commercial |
$1,746.00
|
| Rate for Payer: PHCS PPO |
$1,843.00
|
| Rate for Payer: Three Rivers PPO |
$1,455.00
|
| Rate for Payer: TriWest Veterans Administration |
$384.64
|
| Rate for Payer: United Healthcare Commercial |
$1,687.80
|
| Rate for Payer: United Healthcare Medicare |
$384.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,649.00
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$2,183.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
27810
|
| Min. Negotiated Rate |
$361.34 |
| Max. Negotiated Rate |
$2,183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,139.34
|
| Rate for Payer: Aetna of WY Medicare |
$425.11
|
| Rate for Payer: Beech Street Commercial |
$2,073.85
|
| Rate for Payer: Cash Price |
$1,528.10
|
| Rate for Payer: Cash Price |
$1,528.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,117.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,139.34
|
| Rate for Payer: First Choice Health Commercial |
$1,964.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,073.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.11
|
| Rate for Payer: HealthUtah PPO |
$2,183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,117.51
|
| Rate for Payer: Multiplan Medicare/VA |
$361.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,139.34
|
| Rate for Payer: PacificSource Commercial |
$1,964.70
|
| Rate for Payer: PHCS PPO |
$2,073.85
|
| Rate for Payer: Three Rivers PPO |
$1,637.25
|
| Rate for Payer: TriWest Veterans Administration |
$425.11
|
| Rate for Payer: United Healthcare Commercial |
$1,899.21
|
| Rate for Payer: United Healthcare Medicare |
$425.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,855.55
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
27808
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,529.78
|
| Rate for Payer: Aetna of WY Medicare |
$308.49
|
| Rate for Payer: Beech Street Commercial |
$1,482.95
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,514.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,529.78
|
| Rate for Payer: First Choice Health Commercial |
$1,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.49
|
| Rate for Payer: HealthUtah PPO |
$1,561.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,514.17
|
| Rate for Payer: Multiplan Medicare/VA |
$262.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,529.78
|
| Rate for Payer: PacificSource Commercial |
$1,404.90
|
| Rate for Payer: PHCS PPO |
$1,482.95
|
| Rate for Payer: Three Rivers PPO |
$1,170.75
|
| Rate for Payer: TriWest Veterans Administration |
$308.49
|
| Rate for Payer: United Healthcare Commercial |
$1,358.07
|
| Rate for Payer: United Healthcare Medicare |
$308.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.85
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
28400
|
| Min. Negotiated Rate |
$196.38 |
| Max. Negotiated Rate |
$1,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,153.46
|
| Rate for Payer: Aetna of WY Medicare |
$231.04
|
| Rate for Payer: Beech Street Commercial |
$1,118.15
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,141.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,153.46
|
| Rate for Payer: First Choice Health Commercial |
$1,059.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,118.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.04
|
| Rate for Payer: HealthUtah PPO |
$1,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,141.69
|
| Rate for Payer: Multiplan Medicare/VA |
$196.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,153.46
|
| Rate for Payer: PacificSource Commercial |
$1,059.30
|
| Rate for Payer: PHCS PPO |
$1,118.15
|
| Rate for Payer: Three Rivers PPO |
$882.75
|
| Rate for Payer: TriWest Veterans Administration |
$231.04
|
| Rate for Payer: United Healthcare Commercial |
$1,023.99
|
| Rate for Payer: United Healthcare Medicare |
$231.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,000.45
|
|
|
CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$1,447.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
25622
|
| Min. Negotiated Rate |
$244.42 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,418.06
|
| Rate for Payer: Aetna of WY Medicare |
$287.55
|
| Rate for Payer: Beech Street Commercial |
$1,374.65
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,403.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,418.06
|
| Rate for Payer: First Choice Health Commercial |
$1,302.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,374.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.55
|
| Rate for Payer: HealthUtah PPO |
$1,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,403.59
|
| Rate for Payer: Multiplan Medicare/VA |
$244.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,418.06
|
| Rate for Payer: PacificSource Commercial |
$1,302.30
|
| Rate for Payer: PHCS PPO |
$1,374.65
|
| Rate for Payer: Three Rivers PPO |
$1,085.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.55
|
| Rate for Payer: United Healthcare Commercial |
$1,258.89
|
| Rate for Payer: United Healthcare Medicare |
$287.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,229.95
|
|
|
CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
25675
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,077.60
|
| Rate for Payer: Aetna of WY Medicare |
$411.96
|
| Rate for Payer: Beech Street Commercial |
$2,014.00
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,056.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,077.60
|
| Rate for Payer: First Choice Health Commercial |
$1,908.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.96
|
| Rate for Payer: HealthUtah PPO |
$2,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,056.40
|
| Rate for Payer: Multiplan Medicare/VA |
$350.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,077.60
|
| Rate for Payer: PacificSource Commercial |
$1,908.00
|
| Rate for Payer: PHCS PPO |
$2,014.00
|
| Rate for Payer: Three Rivers PPO |
$1,590.00
|
| Rate for Payer: TriWest Veterans Administration |
$411.96
|
| Rate for Payer: United Healthcare Commercial |
$1,844.40
|
| Rate for Payer: United Healthcare Medicare |
$411.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,802.00
|
|
|
CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
27500
|
| Min. Negotiated Rate |
$400.88 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,428.44
|
| Rate for Payer: Aetna of WY Medicare |
$471.62
|
| Rate for Payer: Beech Street Commercial |
$2,354.10
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,403.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,428.44
|
| Rate for Payer: First Choice Health Commercial |
$2,230.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.62
|
| Rate for Payer: HealthUtah PPO |
$2,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,403.66
|
| Rate for Payer: Multiplan Medicare/VA |
$400.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,428.44
|
| Rate for Payer: PacificSource Commercial |
$2,230.20
|
| Rate for Payer: PHCS PPO |
$2,354.10
|
| Rate for Payer: Three Rivers PPO |
$1,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.62
|
| Rate for Payer: United Healthcare Commercial |
$2,155.86
|
| Rate for Payer: United Healthcare Medicare |
$471.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,106.30
|
|
|
CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$3,246.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
27552
|
| Min. Negotiated Rate |
$528.10 |
| Max. Negotiated Rate |
$3,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,181.08
|
| Rate for Payer: Aetna of WY Medicare |
$621.29
|
| Rate for Payer: Beech Street Commercial |
$3,083.70
|
| Rate for Payer: Cash Price |
$2,272.20
|
| Rate for Payer: Cash Price |
$2,272.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,148.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,181.08
|
| Rate for Payer: First Choice Health Commercial |
$2,921.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,083.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$621.29
|
| Rate for Payer: HealthUtah PPO |
$3,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,148.62
|
| Rate for Payer: Multiplan Medicare/VA |
$528.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,181.08
|
| Rate for Payer: PacificSource Commercial |
$2,921.40
|
| Rate for Payer: PHCS PPO |
$3,083.70
|
| Rate for Payer: Three Rivers PPO |
$2,434.50
|
| Rate for Payer: TriWest Veterans Administration |
$621.29
|
| Rate for Payer: United Healthcare Commercial |
$2,824.02
|
| Rate for Payer: United Healthcare Medicare |
$621.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,759.10
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
28470
|
| Min. Negotiated Rate |
$175.47 |
| Max. Negotiated Rate |
$1,051.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,029.98
|
| Rate for Payer: Aetna of WY Medicare |
$206.43
|
| Rate for Payer: Beech Street Commercial |
$998.45
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,019.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,029.98
|
| Rate for Payer: First Choice Health Commercial |
$945.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$998.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.43
|
| Rate for Payer: HealthUtah PPO |
$1,051.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,019.47
|
| Rate for Payer: Multiplan Medicare/VA |
$175.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,029.98
|
| Rate for Payer: PacificSource Commercial |
$945.90
|
| Rate for Payer: PHCS PPO |
$998.45
|
| Rate for Payer: Three Rivers PPO |
$788.25
|
| Rate for Payer: TriWest Veterans Administration |
$206.43
|
| Rate for Payer: United Healthcare Commercial |
$914.37
|
| Rate for Payer: United Healthcare Medicare |
$206.43
|
| Rate for Payer: WINHealth Partners Commercial |
$893.35
|
|
|
CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
24620
|
| Min. Negotiated Rate |
$492.59 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$995.68
|
| Rate for Payer: Aetna of WY Medicare |
$579.52
|
| Rate for Payer: Beech Street Commercial |
$965.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$985.52
|
| Rate for Payer: Cigna of WY Commercial |
$995.68
|
| Rate for Payer: First Choice Health Commercial |
$914.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$965.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$579.52
|
| Rate for Payer: HealthUtah PPO |
$1,016.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$985.52
|
| Rate for Payer: Multiplan Medicare/VA |
$492.59
|
| Rate for Payer: One Health Plan of WY PPO |
$995.68
|
| Rate for Payer: PacificSource Commercial |
$914.40
|
| Rate for Payer: PHCS PPO |
$965.20
|
| Rate for Payer: Three Rivers PPO |
$762.00
|
| Rate for Payer: TriWest Veterans Administration |
$579.52
|
| Rate for Payer: United Healthcare Commercial |
$883.92
|
| Rate for Payer: United Healthcare Medicare |
$579.52
|
| Rate for Payer: WINHealth Partners Commercial |
$863.60
|
|
|
CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
21315
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$756.56
|
| Rate for Payer: Aetna of WY Medicare |
$57.24
|
| Rate for Payer: Beech Street Commercial |
$733.40
|
| Rate for Payer: Cash Price |
$540.40
|
| Rate for Payer: Cash Price |
$540.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$748.84
|
| Rate for Payer: Cigna of WY Commercial |
$756.56
|
| Rate for Payer: First Choice Health Commercial |
$694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$733.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.24
|
| Rate for Payer: HealthUtah PPO |
$772.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$748.84
|
| Rate for Payer: Multiplan Medicare/VA |
$48.65
|
| Rate for Payer: One Health Plan of WY PPO |
$756.56
|
| Rate for Payer: PacificSource Commercial |
$694.80
|
| Rate for Payer: PHCS PPO |
$733.40
|
| Rate for Payer: Three Rivers PPO |
$579.00
|
| Rate for Payer: TriWest Veterans Administration |
$57.24
|
| Rate for Payer: United Healthcare Commercial |
$671.64
|
| Rate for Payer: United Healthcare Medicare |
$57.24
|
| Rate for Payer: WINHealth Partners Commercial |
$656.20
|
|
|
CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
21320
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$670.32
|
| Rate for Payer: Aetna of WY Medicare |
$91.27
|
| Rate for Payer: Beech Street Commercial |
$649.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$663.48
|
| Rate for Payer: Cigna of WY Commercial |
$670.32
|
| Rate for Payer: First Choice Health Commercial |
$615.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$649.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.27
|
| Rate for Payer: HealthUtah PPO |
$684.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$663.48
|
| Rate for Payer: Multiplan Medicare/VA |
$77.58
|
| Rate for Payer: One Health Plan of WY PPO |
$670.32
|
| Rate for Payer: PacificSource Commercial |
$615.60
|
| Rate for Payer: PHCS PPO |
$649.80
|
| Rate for Payer: Three Rivers PPO |
$513.00
|
| Rate for Payer: TriWest Veterans Administration |
$91.27
|
| Rate for Payer: United Healthcare Commercial |
$595.08
|
| Rate for Payer: United Healthcare Medicare |
$91.27
|
| Rate for Payer: WINHealth Partners Commercial |
$581.40
|
|
|
CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
21337
|
| Min. Negotiated Rate |
$250.61 |
| Max. Negotiated Rate |
$1,509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,478.82
|
| Rate for Payer: Aetna of WY Medicare |
$294.84
|
| Rate for Payer: Beech Street Commercial |
$1,433.55
|
| Rate for Payer: Cash Price |
$1,056.30
|
| Rate for Payer: Cash Price |
$1,056.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,463.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,478.82
|
| Rate for Payer: First Choice Health Commercial |
$1,358.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,433.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.84
|
| Rate for Payer: HealthUtah PPO |
$1,509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,463.73
|
| Rate for Payer: Multiplan Medicare/VA |
$250.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,478.82
|
| Rate for Payer: PacificSource Commercial |
$1,358.10
|
| Rate for Payer: PHCS PPO |
$1,433.55
|
| Rate for Payer: Three Rivers PPO |
$1,131.75
|
| Rate for Payer: TriWest Veterans Administration |
$294.84
|
| Rate for Payer: United Healthcare Commercial |
$1,312.83
|
| Rate for Payer: United Healthcare Medicare |
$294.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,282.65
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$2,508.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
27562
|
| Min. Negotiated Rate |
$411.34 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,457.84
|
| Rate for Payer: Aetna of WY Medicare |
$483.93
|
| Rate for Payer: Beech Street Commercial |
$2,382.60
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: Cash Price |
$1,755.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,432.76
|
| Rate for Payer: Cigna of WY Commercial |
$2,457.84
|
| Rate for Payer: First Choice Health Commercial |
$2,257.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,382.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.93
|
| Rate for Payer: HealthUtah PPO |
$2,508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,432.76
|
| Rate for Payer: Multiplan Medicare/VA |
$411.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,457.84
|
| Rate for Payer: PacificSource Commercial |
$2,257.20
|
| Rate for Payer: PHCS PPO |
$2,382.60
|
| Rate for Payer: Three Rivers PPO |
$1,881.00
|
| Rate for Payer: TriWest Veterans Administration |
$483.93
|
| Rate for Payer: United Healthcare Commercial |
$2,181.96
|
| Rate for Payer: United Healthcare Medicare |
$483.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,131.80
|
|
|
CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
27560
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$1,770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,734.60
|
| Rate for Payer: Aetna of WY Medicare |
$341.39
|
| Rate for Payer: Beech Street Commercial |
$1,681.50
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,716.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,734.60
|
| Rate for Payer: First Choice Health Commercial |
$1,593.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,681.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.39
|
| Rate for Payer: HealthUtah PPO |
$1,770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,716.90
|
| Rate for Payer: Multiplan Medicare/VA |
$290.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,734.60
|
| Rate for Payer: PacificSource Commercial |
$1,593.00
|
| Rate for Payer: PHCS PPO |
$1,681.50
|
| Rate for Payer: Three Rivers PPO |
$1,327.50
|
| Rate for Payer: TriWest Veterans Administration |
$341.39
|
| Rate for Payer: United Healthcare Commercial |
$1,539.90
|
| Rate for Payer: United Healthcare Medicare |
$341.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,504.50
|
|
|
CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
27520
|
| Min. Negotiated Rate |
$257.82 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Aetna of WY Medicare |
$303.32
|
| Rate for Payer: Beech Street Commercial |
$1,456.35
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: First Choice Health Commercial |
$1,379.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.32
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$257.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,456.35
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$303.32
|
| Rate for Payer: United Healthcare Commercial |
$1,333.71
|
| Rate for Payer: United Healthcare Medicare |
$303.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,303.05
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
24655
|
| Min. Negotiated Rate |
$345.46 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,014.88
|
| Rate for Payer: Aetna of WY Medicare |
$406.42
|
| Rate for Payer: Beech Street Commercial |
$1,953.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,994.32
|
| Rate for Payer: Cigna of WY Commercial |
$2,014.88
|
| Rate for Payer: First Choice Health Commercial |
$1,850.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,953.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.42
|
| Rate for Payer: HealthUtah PPO |
$2,056.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,994.32
|
| Rate for Payer: Multiplan Medicare/VA |
$345.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,014.88
|
| Rate for Payer: PacificSource Commercial |
$1,850.40
|
| Rate for Payer: PHCS PPO |
$1,953.20
|
| Rate for Payer: Three Rivers PPO |
$1,542.00
|
| Rate for Payer: TriWest Veterans Administration |
$406.42
|
| Rate for Payer: United Healthcare Commercial |
$1,788.72
|
| Rate for Payer: United Healthcare Medicare |
$406.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,747.60
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
24650
|
| Min. Negotiated Rate |
$212.15 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$937.86
|
| Rate for Payer: Aetna of WY Medicare |
$249.59
|
| Rate for Payer: Beech Street Commercial |
$909.15
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$928.29
|
| Rate for Payer: Cigna of WY Commercial |
$937.86
|
| Rate for Payer: First Choice Health Commercial |
$861.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$909.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.59
|
| Rate for Payer: HealthUtah PPO |
$957.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$928.29
|
| Rate for Payer: Multiplan Medicare/VA |
$212.15
|
| Rate for Payer: One Health Plan of WY PPO |
$937.86
|
| Rate for Payer: PacificSource Commercial |
$861.30
|
| Rate for Payer: PHCS PPO |
$909.15
|
| Rate for Payer: Three Rivers PPO |
$717.75
|
| Rate for Payer: TriWest Veterans Administration |
$249.59
|
| Rate for Payer: United Healthcare Commercial |
$832.59
|
| Rate for Payer: United Healthcare Medicare |
$249.59
|
| Rate for Payer: WINHealth Partners Commercial |
$813.45
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
25505
|
| Min. Negotiated Rate |
$390.63 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,731.66
|
| Rate for Payer: Aetna of WY Medicare |
$459.57
|
| Rate for Payer: Beech Street Commercial |
$1,678.65
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,713.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,731.66
|
| Rate for Payer: First Choice Health Commercial |
$1,590.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.57
|
| Rate for Payer: HealthUtah PPO |
$1,767.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,713.99
|
| Rate for Payer: Multiplan Medicare/VA |
$390.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,731.66
|
| Rate for Payer: PacificSource Commercial |
$1,590.30
|
| Rate for Payer: PHCS PPO |
$1,678.65
|
| Rate for Payer: Three Rivers PPO |
$1,325.25
|
| Rate for Payer: TriWest Veterans Administration |
$459.57
|
| Rate for Payer: United Healthcare Commercial |
$1,537.29
|
| Rate for Payer: United Healthcare Medicare |
$459.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,501.95
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
25500
|
| Min. Negotiated Rate |
$222.09 |
| Max. Negotiated Rate |
$904.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$885.92
|
| Rate for Payer: Aetna of WY Medicare |
$261.28
|
| Rate for Payer: Beech Street Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$876.88
|
| Rate for Payer: Cigna of WY Commercial |
$885.92
|
| Rate for Payer: First Choice Health Commercial |
$813.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$858.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.28
|
| Rate for Payer: HealthUtah PPO |
$904.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$876.88
|
| Rate for Payer: Multiplan Medicare/VA |
$222.09
|
| Rate for Payer: One Health Plan of WY PPO |
$885.92
|
| Rate for Payer: PacificSource Commercial |
$813.60
|
| Rate for Payer: PHCS PPO |
$858.80
|
| Rate for Payer: Three Rivers PPO |
$678.00
|
| Rate for Payer: TriWest Veterans Administration |
$261.28
|
| Rate for Payer: United Healthcare Commercial |
$786.48
|
| Rate for Payer: United Healthcare Medicare |
$261.28
|
| Rate for Payer: WINHealth Partners Commercial |
$768.40
|
|
|
CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
25565
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$461.50
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.50
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$392.28
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$461.50
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$461.50
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
