|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 0.9 MG SOLUTION FOR INJECTION [89023]
|
Facility
|
OP
|
$5,885.44
|
|
|
Service Code
|
HCPCS J0775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,186.97 |
| Max. Negotiated Rate |
$5,885.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,767.73
|
| Rate for Payer: Aetna of WY Medicare |
$3,884.39
|
| Rate for Payer: Altius Commercial |
$5,650.02
|
| Rate for Payer: Beech Street Commercial |
$5,767.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,708.88
|
| Rate for Payer: Cash Price |
$4,119.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,708.88
|
| Rate for Payer: Cigna of WY Commercial |
$5,767.73
|
| Rate for Payer: Entrust Commercial |
$5,591.17
|
| Rate for Payer: First Choice Health Commercial |
$5,591.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,591.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,354.70
|
| Rate for Payer: HealthUtah PPO |
$5,885.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,708.88
|
| Rate for Payer: Multiplan Medicare/VA |
$3,186.97
|
| Rate for Payer: One Health Plan of WY PPO |
$5,767.73
|
| Rate for Payer: PacificSource Commercial |
$5,296.90
|
| Rate for Payer: PHCS PPO |
$5,767.73
|
| Rate for Payer: Three Rivers PPO |
$4,414.08
|
| Rate for Payer: TriWest Veterans Administration |
$3,354.70
|
| Rate for Payer: United Healthcare Commercial |
$5,620.60
|
| Rate for Payer: United Healthcare Medicare |
$3,354.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,767.73
|
| Rate for Payer: Wise Provider Network Commercial |
$5,591.17
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 0.9 MG SOLUTION FOR INJECTION [89023]
|
Facility
|
IP
|
$5,885.44
|
|
|
Service Code
|
HCPCS J0775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,410.61 |
| Max. Negotiated Rate |
$5,885.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,767.73
|
| Rate for Payer: Aetna of WY Medicare |
$3,766.68
|
| Rate for Payer: Altius Commercial |
$5,650.02
|
| Rate for Payer: Beech Street Commercial |
$5,767.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,708.88
|
| Rate for Payer: Cash Price |
$4,119.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,708.88
|
| Rate for Payer: Cigna of WY Commercial |
$5,767.73
|
| Rate for Payer: Entrust Commercial |
$5,591.17
|
| Rate for Payer: First Choice Health Commercial |
$5,591.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,591.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,590.12
|
| Rate for Payer: HealthUtah PPO |
$5,885.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,708.88
|
| Rate for Payer: Multiplan Medicare/VA |
$3,410.61
|
| Rate for Payer: One Health Plan of WY PPO |
$5,767.73
|
| Rate for Payer: PacificSource Commercial |
$5,296.90
|
| Rate for Payer: PHCS PPO |
$5,767.73
|
| Rate for Payer: Three Rivers PPO |
$4,414.08
|
| Rate for Payer: TriWest Veterans Administration |
$3,590.12
|
| Rate for Payer: United Healthcare Commercial |
$5,620.60
|
| Rate for Payer: United Healthcare Medicare |
$3,590.12
|
| Rate for Payer: WINHealth Partners Commercial |
$5,591.17
|
| Rate for Payer: Wise Provider Network Commercial |
$5,591.17
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [17020]
|
Facility
|
IP
|
$45.23
|
|
|
Service Code
|
NDC 5048401030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$45.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.33
|
| Rate for Payer: Aetna of WY Medicare |
$28.95
|
| Rate for Payer: Altius Commercial |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$44.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.87
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.87
|
| Rate for Payer: Cigna of WY Commercial |
$44.33
|
| Rate for Payer: Entrust Commercial |
$42.97
|
| Rate for Payer: First Choice Health Commercial |
$42.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.59
|
| Rate for Payer: HealthUtah PPO |
$45.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.87
|
| Rate for Payer: Multiplan Medicare/VA |
$26.21
|
| Rate for Payer: One Health Plan of WY PPO |
$44.33
|
| Rate for Payer: PacificSource Commercial |
$40.71
|
| Rate for Payer: PHCS PPO |
$44.33
|
| Rate for Payer: Three Rivers PPO |
$33.92
|
| Rate for Payer: TriWest Veterans Administration |
$27.59
|
| Rate for Payer: United Healthcare Commercial |
$43.19
|
| Rate for Payer: United Healthcare Medicare |
$27.59
|
| Rate for Payer: WINHealth Partners Commercial |
$42.97
|
| Rate for Payer: Wise Provider Network Commercial |
$42.97
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [17020]
|
Facility
|
OP
|
$45.23
|
|
|
Service Code
|
NDC 5048401030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$45.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.33
|
| Rate for Payer: Aetna of WY Medicare |
$29.85
|
| Rate for Payer: Altius Commercial |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$44.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.87
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.87
|
| Rate for Payer: Cigna of WY Commercial |
$44.33
|
| Rate for Payer: Entrust Commercial |
$42.97
|
| Rate for Payer: First Choice Health Commercial |
$42.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$45.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.87
|
| Rate for Payer: Multiplan Medicare/VA |
$24.49
|
| Rate for Payer: One Health Plan of WY PPO |
$44.33
|
| Rate for Payer: PacificSource Commercial |
$40.71
|
| Rate for Payer: PHCS PPO |
$44.33
|
| Rate for Payer: Three Rivers PPO |
$33.92
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$43.19
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$44.33
|
| Rate for Payer: Wise Provider Network Commercial |
$42.97
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 36591
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Aetna of WY Medicare |
$27.09
|
| Rate for Payer: Beech Street Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: First Choice Health Commercial |
$18.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.09
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$23.03
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.00
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.09
|
| Rate for Payer: United Healthcare Commercial |
$19.00
|
| Rate for Payer: WINHealth Partners Commercial |
$17.00
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 36415
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$8.83
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.83
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$7.51
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.83
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: WINHealth Partners Commercial |
$25.50
|
|
|
COLON CA SCRN NOT HI RSK IND
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
HCPCS G0121
|
| Min. Negotiated Rate |
$148.84 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,546.44
|
| Rate for Payer: Aetna of WY Medicare |
$175.11
|
| Rate for Payer: Beech Street Commercial |
$1,499.10
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,530.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,546.44
|
| Rate for Payer: First Choice Health Commercial |
$1,420.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,499.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.11
|
| Rate for Payer: HealthUtah PPO |
$1,578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,530.66
|
| Rate for Payer: Multiplan Medicare/VA |
$148.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,546.44
|
| Rate for Payer: PacificSource Commercial |
$1,420.20
|
| Rate for Payer: PHCS PPO |
$1,499.10
|
| Rate for Payer: Three Rivers PPO |
$1,183.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.11
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,499.10
|
|
|
COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES
|
Professional
|
Both
|
$3,209.00
|
|
|
Service Code
|
HCPCS 45388
|
| Min. Negotiated Rate |
$217.25 |
| Max. Negotiated Rate |
$3,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,144.82
|
| Rate for Payer: Aetna of WY Medicare |
$255.59
|
| Rate for Payer: Beech Street Commercial |
$3,048.55
|
| Rate for Payer: Cash Price |
$2,246.30
|
| Rate for Payer: Cash Price |
$2,246.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,112.73
|
| Rate for Payer: Cigna of WY Commercial |
$3,144.82
|
| Rate for Payer: First Choice Health Commercial |
$2,888.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,048.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.59
|
| Rate for Payer: HealthUtah PPO |
$3,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,112.73
|
| Rate for Payer: Multiplan Medicare/VA |
$217.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,144.82
|
| Rate for Payer: PacificSource Commercial |
$2,888.10
|
| Rate for Payer: PHCS PPO |
$3,048.55
|
| Rate for Payer: Three Rivers PPO |
$2,406.75
|
| Rate for Payer: TriWest Veterans Administration |
$255.59
|
| Rate for Payer: United Healthcare Commercial |
$3,048.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,727.65
|
|
|
COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 45378
|
| Min. Negotiated Rate |
$148.64 |
| Max. Negotiated Rate |
$1,389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,361.22
|
| Rate for Payer: Aetna of WY Medicare |
$174.87
|
| Rate for Payer: Beech Street Commercial |
$1,319.55
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,347.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,361.22
|
| Rate for Payer: First Choice Health Commercial |
$1,250.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,319.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.87
|
| Rate for Payer: HealthUtah PPO |
$1,389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,347.33
|
| Rate for Payer: Multiplan Medicare/VA |
$148.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,361.22
|
| Rate for Payer: PacificSource Commercial |
$1,250.10
|
| Rate for Payer: PHCS PPO |
$1,319.55
|
| Rate for Payer: Three Rivers PPO |
$1,041.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.87
|
| Rate for Payer: United Healthcare Commercial |
$1,319.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,180.65
|
|
|
COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 45380
|
| Min. Negotiated Rate |
$161.58 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
| Rate for Payer: Aetna of WY Medicare |
$190.09
|
| Rate for Payer: Beech Street Commercial |
$1,501.00
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
| Rate for Payer: First Choice Health Commercial |
$1,422.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.09
|
| Rate for Payer: HealthUtah PPO |
$1,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
| Rate for Payer: Multiplan Medicare/VA |
$161.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
| Rate for Payer: PacificSource Commercial |
$1,422.00
|
| Rate for Payer: PHCS PPO |
$1,501.00
|
| Rate for Payer: Three Rivers PPO |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.09
|
| Rate for Payer: United Healthcare Commercial |
$1,501.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,343.00
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$2,027.00
|
|
|
Service Code
|
HCPCS G0105
|
| Min. Negotiated Rate |
$148.64 |
| Max. Negotiated Rate |
$2,027.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,986.46
|
| Rate for Payer: Aetna of WY Medicare |
$174.87
|
| Rate for Payer: Beech Street Commercial |
$1,925.65
|
| Rate for Payer: Cash Price |
$1,418.90
|
| Rate for Payer: Cash Price |
$1,418.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,966.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,986.46
|
| Rate for Payer: First Choice Health Commercial |
$1,824.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,925.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.87
|
| Rate for Payer: HealthUtah PPO |
$2,027.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,966.19
|
| Rate for Payer: Multiplan Medicare/VA |
$148.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,986.46
|
| Rate for Payer: PacificSource Commercial |
$1,824.30
|
| Rate for Payer: PHCS PPO |
$1,925.65
|
| Rate for Payer: Three Rivers PPO |
$1,520.25
|
| Rate for Payer: TriWest Veterans Administration |
$174.87
|
| Rate for Payer: United Healthcare Commercial |
$1,925.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,925.65
|
|
|
COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$6,884.00
|
|
|
Service Code
|
HCPCS 57120
|
| Min. Negotiated Rate |
$437.05 |
| Max. Negotiated Rate |
$6,884.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,746.32
|
| Rate for Payer: Aetna of WY Medicare |
$514.18
|
| Rate for Payer: Beech Street Commercial |
$6,539.80
|
| Rate for Payer: Cash Price |
$4,818.80
|
| Rate for Payer: Cash Price |
$4,818.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,677.48
|
| Rate for Payer: Cigna of WY Commercial |
$6,746.32
|
| Rate for Payer: First Choice Health Commercial |
$6,195.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,539.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.18
|
| Rate for Payer: HealthUtah PPO |
$6,884.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,677.48
|
| Rate for Payer: Multiplan Medicare/VA |
$437.05
|
| Rate for Payer: One Health Plan of WY PPO |
$6,746.32
|
| Rate for Payer: PacificSource Commercial |
$6,195.60
|
| Rate for Payer: PHCS PPO |
$6,539.80
|
| Rate for Payer: Three Rivers PPO |
$5,163.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.18
|
| Rate for Payer: United Healthcare Commercial |
$6,539.80
|
| Rate for Payer: WINHealth Partners Commercial |
$5,851.40
|
|
|
COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,278.00
|
|
|
Service Code
|
HCPCS 57280 80
|
| Min. Negotiated Rate |
$2,458.50 |
| Max. Negotiated Rate |
$3,278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,212.44
|
| Rate for Payer: Beech Street Commercial |
$3,114.10
|
| Rate for Payer: Cash Price |
$2,294.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,179.66
|
| Rate for Payer: Cigna of WY Commercial |
$3,212.44
|
| Rate for Payer: First Choice Health Commercial |
$2,950.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,179.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,212.44
|
| Rate for Payer: PacificSource Commercial |
$2,950.20
|
| Rate for Payer: PHCS PPO |
$3,114.10
|
| Rate for Payer: Three Rivers PPO |
$2,458.50
|
| Rate for Payer: United Healthcare Commercial |
$3,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,786.30
|
|
|
COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$8,189.00
|
|
|
Service Code
|
HCPCS 57280
|
| Min. Negotiated Rate |
$789.15 |
| Max. Negotiated Rate |
$8,189.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,025.22
|
| Rate for Payer: Aetna of WY Medicare |
$928.41
|
| Rate for Payer: Beech Street Commercial |
$7,779.55
|
| Rate for Payer: Cash Price |
$5,732.30
|
| Rate for Payer: Cash Price |
$5,732.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,943.33
|
| Rate for Payer: Cigna of WY Commercial |
$8,025.22
|
| Rate for Payer: First Choice Health Commercial |
$7,370.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,779.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.41
|
| Rate for Payer: HealthUtah PPO |
$8,189.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,943.33
|
| Rate for Payer: Multiplan Medicare/VA |
$789.15
|
| Rate for Payer: One Health Plan of WY PPO |
$8,025.22
|
| Rate for Payer: PacificSource Commercial |
$7,370.10
|
| Rate for Payer: PHCS PPO |
$7,779.55
|
| Rate for Payer: Three Rivers PPO |
$6,141.75
|
| Rate for Payer: TriWest Veterans Administration |
$928.41
|
| Rate for Payer: United Healthcare Commercial |
$7,779.55
|
| Rate for Payer: WINHealth Partners Commercial |
$6,960.65
|
|
|
COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$1,324.00
|
|
|
Service Code
|
HCPCS 57200
|
| Min. Negotiated Rate |
$275.45 |
| Max. Negotiated Rate |
$1,324.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,297.52
|
| Rate for Payer: Aetna of WY Medicare |
$324.06
|
| Rate for Payer: Beech Street Commercial |
$1,257.80
|
| Rate for Payer: Cash Price |
$926.80
|
| Rate for Payer: Cash Price |
$926.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,284.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,297.52
|
| Rate for Payer: First Choice Health Commercial |
$1,191.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,257.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.06
|
| Rate for Payer: HealthUtah PPO |
$1,324.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,284.28
|
| Rate for Payer: Multiplan Medicare/VA |
$275.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,297.52
|
| Rate for Payer: PacificSource Commercial |
$1,191.60
|
| Rate for Payer: PHCS PPO |
$1,257.80
|
| Rate for Payer: Three Rivers PPO |
$993.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.06
|
| Rate for Payer: United Healthcare Commercial |
$1,257.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,125.40
|
|
|
COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 57454
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$566.44
|
| Rate for Payer: Aetna of WY Medicare |
$127.97
|
| Rate for Payer: Beech Street Commercial |
$549.10
|
| Rate for Payer: Cash Price |
$404.60
|
| Rate for Payer: Cash Price |
$404.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$560.66
|
| Rate for Payer: Cigna of WY Commercial |
$566.44
|
| Rate for Payer: First Choice Health Commercial |
$520.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$549.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.97
|
| Rate for Payer: HealthUtah PPO |
$578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$560.66
|
| Rate for Payer: Multiplan Medicare/VA |
$108.77
|
| Rate for Payer: One Health Plan of WY PPO |
$566.44
|
| Rate for Payer: PacificSource Commercial |
$520.20
|
| Rate for Payer: PHCS PPO |
$549.10
|
| Rate for Payer: Three Rivers PPO |
$433.50
|
| Rate for Payer: TriWest Veterans Administration |
$127.97
|
| Rate for Payer: United Healthcare Commercial |
$549.10
|
| Rate for Payer: WINHealth Partners Commercial |
$491.30
|
|
|
COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 57456
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Aetna of WY Medicare |
$96.57
|
| Rate for Payer: Beech Street Commercial |
$416.10
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: First Choice Health Commercial |
$394.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.57
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$82.08
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$416.10
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.57
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: WINHealth Partners Commercial |
$372.30
|
|
|
COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 57452
|
| Min. Negotiated Rate |
$74.24 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$87.34
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.34
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$74.24
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.34
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
|
|
COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 57455
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$464.52
|
| Rate for Payer: Aetna of WY Medicare |
$103.60
|
| Rate for Payer: Beech Street Commercial |
$450.30
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$459.78
|
| Rate for Payer: Cigna of WY Commercial |
$464.52
|
| Rate for Payer: First Choice Health Commercial |
$426.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$450.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.60
|
| Rate for Payer: HealthUtah PPO |
$474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$459.78
|
| Rate for Payer: Multiplan Medicare/VA |
$88.06
|
| Rate for Payer: One Health Plan of WY PPO |
$464.52
|
| Rate for Payer: PacificSource Commercial |
$426.60
|
| Rate for Payer: PHCS PPO |
$450.30
|
| Rate for Payer: Three Rivers PPO |
$355.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.60
|
| Rate for Payer: United Healthcare Commercial |
$450.30
|
| Rate for Payer: WINHealth Partners Commercial |
$402.90
|
|
|
COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 57461
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Aetna of WY Medicare |
$174.24
|
| Rate for Payer: Beech Street Commercial |
$760.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: First Choice Health Commercial |
$720.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.24
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$148.10
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$760.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.24
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
| Rate for Payer: WINHealth Partners Commercial |
$680.00
|
|
|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 57460
|
| Min. Negotiated Rate |
$129.62 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$677.18
|
| Rate for Payer: Aetna of WY Medicare |
$152.50
|
| Rate for Payer: Beech Street Commercial |
$656.45
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$670.27
|
| Rate for Payer: Cigna of WY Commercial |
$677.18
|
| Rate for Payer: First Choice Health Commercial |
$621.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$656.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.50
|
| Rate for Payer: HealthUtah PPO |
$691.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$670.27
|
| Rate for Payer: Multiplan Medicare/VA |
$129.62
|
| Rate for Payer: One Health Plan of WY PPO |
$677.18
|
| Rate for Payer: PacificSource Commercial |
$621.90
|
| Rate for Payer: PHCS PPO |
$656.45
|
| Rate for Payer: Three Rivers PPO |
$518.25
|
| Rate for Payer: TriWest Veterans Administration |
$152.50
|
| Rate for Payer: United Healthcare Commercial |
$656.45
|
| Rate for Payer: WINHealth Partners Commercial |
$587.35
|
|
|
COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 57420
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$85.86
|
| Rate for Payer: Beech Street Commercial |
$370.50
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: First Choice Health Commercial |
$351.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.86
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$72.98
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$370.50
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.86
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
| Rate for Payer: WINHealth Partners Commercial |
$331.50
|
|
|
COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 57421
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$517.44
|
| Rate for Payer: Aetna of WY Medicare |
$116.27
|
| Rate for Payer: Beech Street Commercial |
$501.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$512.16
|
| Rate for Payer: Cigna of WY Commercial |
$517.44
|
| Rate for Payer: First Choice Health Commercial |
$475.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$501.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.27
|
| Rate for Payer: HealthUtah PPO |
$528.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$512.16
|
| Rate for Payer: Multiplan Medicare/VA |
$98.83
|
| Rate for Payer: One Health Plan of WY PPO |
$517.44
|
| Rate for Payer: PacificSource Commercial |
$475.20
|
| Rate for Payer: PHCS PPO |
$501.60
|
| Rate for Payer: Three Rivers PPO |
$396.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$501.60
|
| Rate for Payer: WINHealth Partners Commercial |
$448.80
|
|
|
COLPOSCOPY VULVA
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 56820
|
| Min. Negotiated Rate |
$68.39 |
| Max. Negotiated Rate |
$446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.08
|
| Rate for Payer: Aetna of WY Medicare |
$80.46
|
| Rate for Payer: Beech Street Commercial |
$423.70
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$432.62
|
| Rate for Payer: Cigna of WY Commercial |
$437.08
|
| Rate for Payer: First Choice Health Commercial |
$401.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$423.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.46
|
| Rate for Payer: HealthUtah PPO |
$446.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$432.62
|
| Rate for Payer: Multiplan Medicare/VA |
$68.39
|
| Rate for Payer: One Health Plan of WY PPO |
$437.08
|
| Rate for Payer: PacificSource Commercial |
$401.40
|
| Rate for Payer: PHCS PPO |
$423.70
|
| Rate for Payer: Three Rivers PPO |
$334.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.46
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: WINHealth Partners Commercial |
$379.10
|
|
|
COLPOSCOPY VULVA W/BIOPSY
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 56821
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$108.34
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: First Choice Health Commercial |
$441.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.34
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$92.09
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$108.34
|
| Rate for Payer: United Healthcare Commercial |
$465.50
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
|
