|
EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$1,661.00
|
|
|
Service Code
|
HCPCS 49000 AS
|
| Hospital Charge Code |
49000
|
| Min. Negotiated Rate |
$621.50 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,627.78
|
| Rate for Payer: Aetna of WY Medicare |
$731.18
|
| Rate for Payer: Beech Street Commercial |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,611.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,627.78
|
| Rate for Payer: First Choice Health Commercial |
$1,494.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,577.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.18
|
| Rate for Payer: HealthUtah PPO |
$1,661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,611.17
|
| Rate for Payer: Multiplan Medicare/VA |
$621.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,627.78
|
| Rate for Payer: PacificSource Commercial |
$1,494.90
|
| Rate for Payer: PHCS PPO |
$1,577.95
|
| Rate for Payer: Three Rivers PPO |
$1,245.75
|
| Rate for Payer: TriWest Veterans Administration |
$731.18
|
| Rate for Payer: United Healthcare Commercial |
$1,445.07
|
| Rate for Payer: United Healthcare Medicare |
$731.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,411.85
|
|
|
EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$1,661.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
49000
|
| Min. Negotiated Rate |
$621.50 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,627.78
|
| Rate for Payer: Aetna of WY Medicare |
$731.18
|
| Rate for Payer: Beech Street Commercial |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,611.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,627.78
|
| Rate for Payer: First Choice Health Commercial |
$1,494.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,577.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.18
|
| Rate for Payer: HealthUtah PPO |
$1,661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,611.17
|
| Rate for Payer: Multiplan Medicare/VA |
$621.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,627.78
|
| Rate for Payer: PacificSource Commercial |
$1,494.90
|
| Rate for Payer: PHCS PPO |
$1,577.95
|
| Rate for Payer: Three Rivers PPO |
$1,245.75
|
| Rate for Payer: TriWest Veterans Administration |
$731.18
|
| Rate for Payer: United Healthcare Commercial |
$1,445.07
|
| Rate for Payer: United Healthcare Medicare |
$731.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,411.85
|
|
|
EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
20102
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,295.56
|
| Rate for Payer: Aetna of WY Medicare |
$244.17
|
| Rate for Payer: Beech Street Commercial |
$1,255.90
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,282.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,295.56
|
| Rate for Payer: First Choice Health Commercial |
$1,189.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,255.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.17
|
| Rate for Payer: HealthUtah PPO |
$1,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,282.34
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,295.56
|
| Rate for Payer: PacificSource Commercial |
$1,189.80
|
| Rate for Payer: PHCS PPO |
$1,255.90
|
| Rate for Payer: Three Rivers PPO |
$991.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.17
|
| Rate for Payer: United Healthcare Commercial |
$1,150.14
|
| Rate for Payer: United Healthcare Medicare |
$244.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,123.70
|
|
|
EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 35840 AS
|
| Hospital Charge Code |
35840
|
| Min. Negotiated Rate |
$970.93 |
| 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 |
$1,142.27
|
| 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 |
$1,142.27
|
| Rate for Payer: HealthUtah PPO |
$4,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,953.72
|
| Rate for Payer: Multiplan Medicare/VA |
$970.93
|
| 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 |
$1,142.27
|
| Rate for Payer: United Healthcare Commercial |
$3,546.12
|
| Rate for Payer: United Healthcare Medicare |
$1,142.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,464.60
|
|
|
EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
35840
|
| Min. Negotiated Rate |
$970.93 |
| 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 |
$1,142.27
|
| 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 |
$1,142.27
|
| Rate for Payer: HealthUtah PPO |
$4,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,953.72
|
| Rate for Payer: Multiplan Medicare/VA |
$970.93
|
| 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 |
$1,142.27
|
| Rate for Payer: United Healthcare Commercial |
$3,546.12
|
| Rate for Payer: United Healthcare Medicare |
$1,142.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,464.60
|
|
|
EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 35840 80
|
| Hospital Charge Code |
35840
|
| Min. Negotiated Rate |
$970.93 |
| 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 |
$1,142.27
|
| 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 |
$1,142.27
|
| Rate for Payer: HealthUtah PPO |
$4,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,953.72
|
| Rate for Payer: Multiplan Medicare/VA |
$970.93
|
| 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 |
$1,142.27
|
| Rate for Payer: United Healthcare Commercial |
$3,546.12
|
| Rate for Payer: United Healthcare Medicare |
$1,142.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,464.60
|
|
|
EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$2,785.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
35860
|
| Min. Negotiated Rate |
$663.22 |
| Max. Negotiated Rate |
$2,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,729.30
|
| Rate for Payer: Aetna of WY Medicare |
$780.26
|
| Rate for Payer: Beech Street Commercial |
$2,645.75
|
| Rate for Payer: Cash Price |
$1,949.50
|
| Rate for Payer: Cash Price |
$1,949.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,701.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,729.30
|
| Rate for Payer: First Choice Health Commercial |
$2,506.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,645.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$780.26
|
| Rate for Payer: HealthUtah PPO |
$2,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,701.45
|
| Rate for Payer: Multiplan Medicare/VA |
$663.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,729.30
|
| Rate for Payer: PacificSource Commercial |
$2,506.50
|
| Rate for Payer: PHCS PPO |
$2,645.75
|
| Rate for Payer: Three Rivers PPO |
$2,088.75
|
| Rate for Payer: TriWest Veterans Administration |
$780.26
|
| Rate for Payer: United Healthcare Commercial |
$2,422.95
|
| Rate for Payer: United Healthcare Medicare |
$780.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,367.25
|
|
|
EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
25248
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,407.28
|
| Rate for Payer: Aetna of WY Medicare |
$416.59
|
| Rate for Payer: Beech Street Commercial |
$1,364.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,392.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,407.28
|
| Rate for Payer: First Choice Health Commercial |
$1,292.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,364.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.59
|
| Rate for Payer: HealthUtah PPO |
$1,436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,392.92
|
| Rate for Payer: Multiplan Medicare/VA |
$354.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,407.28
|
| Rate for Payer: PacificSource Commercial |
$1,292.40
|
| Rate for Payer: PHCS PPO |
$1,364.20
|
| Rate for Payer: Three Rivers PPO |
$1,077.00
|
| Rate for Payer: TriWest Veterans Administration |
$416.59
|
| Rate for Payer: United Healthcare Commercial |
$1,249.32
|
| Rate for Payer: United Healthcare Medicare |
$416.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,220.60
|
|
|
EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 59412 80
|
| Hospital Charge Code |
59412
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$96.74
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.74
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$82.23
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.74
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$96.74
|
| Rate for Payer: WINHealth Partners Commercial |
$263.50
|
|
|
EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
59412
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$96.74
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.74
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$82.23
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.74
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$96.74
|
| Rate for Payer: WINHealth Partners Commercial |
$263.50
|
|
|
EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 26111 AS
|
| Hospital Charge Code |
26111
|
| Min. Negotiated Rate |
$346.13 |
| Max. Negotiated Rate |
$2,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,104.06
|
| Rate for Payer: Aetna of WY Medicare |
$407.21
|
| Rate for Payer: Beech Street Commercial |
$2,039.65
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,082.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,104.06
|
| Rate for Payer: First Choice Health Commercial |
$1,932.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,039.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.21
|
| Rate for Payer: HealthUtah PPO |
$2,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,082.59
|
| Rate for Payer: Multiplan Medicare/VA |
$346.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,104.06
|
| Rate for Payer: PacificSource Commercial |
$1,932.30
|
| Rate for Payer: PHCS PPO |
$2,039.65
|
| Rate for Payer: Three Rivers PPO |
$1,610.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.21
|
| Rate for Payer: United Healthcare Commercial |
$1,867.89
|
| Rate for Payer: United Healthcare Medicare |
$407.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,824.95
|
|
|
EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 26111 80
|
| Hospital Charge Code |
26111
|
| Min. Negotiated Rate |
$346.13 |
| Max. Negotiated Rate |
$2,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,104.06
|
| Rate for Payer: Aetna of WY Medicare |
$407.21
|
| Rate for Payer: Beech Street Commercial |
$2,039.65
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,082.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,104.06
|
| Rate for Payer: First Choice Health Commercial |
$1,932.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,039.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.21
|
| Rate for Payer: HealthUtah PPO |
$2,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,082.59
|
| Rate for Payer: Multiplan Medicare/VA |
$346.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,104.06
|
| Rate for Payer: PacificSource Commercial |
$1,932.30
|
| Rate for Payer: PHCS PPO |
$2,039.65
|
| Rate for Payer: Three Rivers PPO |
$1,610.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.21
|
| Rate for Payer: United Healthcare Commercial |
$1,867.89
|
| Rate for Payer: United Healthcare Medicare |
$407.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,824.95
|
|
|
EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
26111
|
| Min. Negotiated Rate |
$346.13 |
| Max. Negotiated Rate |
$2,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,104.06
|
| Rate for Payer: Aetna of WY Medicare |
$407.21
|
| Rate for Payer: Beech Street Commercial |
$2,039.65
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,082.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,104.06
|
| Rate for Payer: First Choice Health Commercial |
$1,932.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,039.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.21
|
| Rate for Payer: HealthUtah PPO |
$2,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,082.59
|
| Rate for Payer: Multiplan Medicare/VA |
$346.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,104.06
|
| Rate for Payer: PacificSource Commercial |
$1,932.30
|
| Rate for Payer: PHCS PPO |
$2,039.65
|
| Rate for Payer: Three Rivers PPO |
$1,610.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.21
|
| Rate for Payer: United Healthcare Commercial |
$1,867.89
|
| Rate for Payer: United Healthcare Medicare |
$407.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,824.95
|
|
|
EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
26113
|
| Min. Negotiated Rate |
$455.34 |
| Max. Negotiated Rate |
$2,823.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,766.54
|
| Rate for Payer: Aetna of WY Medicare |
$535.70
|
| Rate for Payer: Beech Street Commercial |
$2,681.85
|
| Rate for Payer: Cash Price |
$1,976.10
|
| Rate for Payer: Cash Price |
$1,976.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,738.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,766.54
|
| Rate for Payer: First Choice Health Commercial |
$2,540.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,681.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$535.70
|
| Rate for Payer: HealthUtah PPO |
$2,823.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,738.31
|
| Rate for Payer: Multiplan Medicare/VA |
$455.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,766.54
|
| Rate for Payer: PacificSource Commercial |
$2,540.70
|
| Rate for Payer: PHCS PPO |
$2,681.85
|
| Rate for Payer: Three Rivers PPO |
$2,117.25
|
| Rate for Payer: TriWest Veterans Administration |
$535.70
|
| Rate for Payer: United Healthcare Commercial |
$2,456.01
|
| Rate for Payer: United Healthcare Medicare |
$535.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,399.55
|
|
|
EXUDERM SACRUM 6.4X6.5 MSC5475
|
Facility
|
IP
|
$19.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.78
|
| Rate for Payer: Altius Commercial |
$18.78
|
| Rate for Payer: Beech Street Commercial |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.97
|
| Rate for Payer: Cigna of WY Commercial |
$19.17
|
| Rate for Payer: Entrust Commercial |
$18.58
|
| Rate for Payer: First Choice Health Commercial |
$18.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.91
|
| Rate for Payer: HealthUtah PPO |
$19.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.97
|
| Rate for Payer: Multiplan Medicare/VA |
$12.26
|
| Rate for Payer: One Health Plan of WY PPO |
$19.17
|
| Rate for Payer: PacificSource Commercial |
$17.60
|
| Rate for Payer: PHCS PPO |
$19.17
|
| Rate for Payer: Three Rivers PPO |
$14.67
|
| Rate for Payer: TriWest Veterans Administration |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$17.02
|
| Rate for Payer: United Healthcare Medicare |
$12.91
|
| Rate for Payer: WINHealth Partners Commercial |
$18.58
|
| Rate for Payer: Wise Provider Network Commercial |
$18.58
|
|
|
EXUDERM SACRUM 6.4X6.5 MSC5475
|
Facility
|
OP
|
$19.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.17
|
| Rate for Payer: Aetna of WY Medicare |
$12.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.78
|
| Rate for Payer: Altius Commercial |
$18.78
|
| Rate for Payer: Beech Street Commercial |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.97
|
| Rate for Payer: Cigna of WY Commercial |
$19.17
|
| Rate for Payer: Entrust Commercial |
$18.58
|
| Rate for Payer: First Choice Health Commercial |
$18.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.34
|
| Rate for Payer: HealthUtah PPO |
$19.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$19.17
|
| Rate for Payer: PacificSource Commercial |
$17.60
|
| Rate for Payer: PHCS PPO |
$19.17
|
| Rate for Payer: Three Rivers PPO |
$14.67
|
| Rate for Payer: TriWest Veterans Administration |
$11.34
|
| Rate for Payer: United Healthcare Commercial |
$17.02
|
| Rate for Payer: United Healthcare Medicare |
$11.34
|
| Rate for Payer: WINHealth Partners Commercial |
$19.17
|
| Rate for Payer: Wise Provider Network Commercial |
$18.58
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 5965105290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.05
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
NDC 5965105230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.08
|
| Rate for Payer: Altius Commercial |
$1.08
|
| Rate for Payer: Beech Street Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.10
|
| Rate for Payer: Cigna of WY Commercial |
$1.11
|
| Rate for Payer: Entrust Commercial |
$1.07
|
| Rate for Payer: First Choice Health Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.11
|
| Rate for Payer: PacificSource Commercial |
$1.02
|
| Rate for Payer: PHCS PPO |
$1.11
|
| Rate for Payer: Three Rivers PPO |
$0.85
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1.07
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 5965105290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.05
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.72
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$18.74
|
|
|
Service Code
|
NDC 5026829811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$18.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.99
|
| Rate for Payer: Altius Commercial |
$17.99
|
| Rate for Payer: Beech Street Commercial |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.18
|
| Rate for Payer: Cigna of WY Commercial |
$18.37
|
| Rate for Payer: Entrust Commercial |
$17.80
|
| Rate for Payer: First Choice Health Commercial |
$17.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.37
|
| Rate for Payer: HealthUtah PPO |
$18.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.18
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$18.37
|
| Rate for Payer: PacificSource Commercial |
$16.87
|
| Rate for Payer: PHCS PPO |
$18.37
|
| Rate for Payer: Three Rivers PPO |
$14.06
|
| Rate for Payer: TriWest Veterans Administration |
$12.37
|
| Rate for Payer: United Healthcare Commercial |
$16.30
|
| Rate for Payer: United Healthcare Medicare |
$12.37
|
| Rate for Payer: WINHealth Partners Commercial |
$17.80
|
| Rate for Payer: Wise Provider Network Commercial |
$17.80
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
NDC 5026829811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$18.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.37
|
| Rate for Payer: Aetna of WY Medicare |
$12.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.99
|
| Rate for Payer: Altius Commercial |
$17.99
|
| Rate for Payer: Beech Street Commercial |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.18
|
| Rate for Payer: Cigna of WY Commercial |
$18.37
|
| Rate for Payer: Entrust Commercial |
$17.80
|
| Rate for Payer: First Choice Health Commercial |
$17.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.87
|
| Rate for Payer: HealthUtah PPO |
$18.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.18
|
| Rate for Payer: Multiplan Medicare/VA |
$10.33
|
| Rate for Payer: One Health Plan of WY PPO |
$18.37
|
| Rate for Payer: PacificSource Commercial |
$16.87
|
| Rate for Payer: PHCS PPO |
$18.37
|
| Rate for Payer: Three Rivers PPO |
$14.06
|
| Rate for Payer: TriWest Veterans Administration |
$10.87
|
| Rate for Payer: United Healthcare Commercial |
$16.30
|
| Rate for Payer: United Healthcare Medicare |
$10.87
|
| Rate for Payer: WINHealth Partners Commercial |
$18.37
|
| Rate for Payer: Wise Provider Network Commercial |
$17.80
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
NDC 5965105230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.08
|
| Rate for Payer: Altius Commercial |
$1.08
|
| Rate for Payer: Beech Street Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.10
|
| Rate for Payer: Cigna of WY Commercial |
$1.11
|
| Rate for Payer: Entrust Commercial |
$1.07
|
| Rate for Payer: First Choice Health Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1.11
|
| Rate for Payer: PacificSource Commercial |
$1.02
|
| Rate for Payer: PHCS PPO |
$1.11
|
| Rate for Payer: Three Rivers PPO |
$0.85
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1.07
|
|
|
FALL PROTECTION KIT W/ BLANKET
|
Facility
|
IP
|
$20.29
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.48
|
| Rate for Payer: Altius Commercial |
$19.48
|
| Rate for Payer: Beech Street Commercial |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.66
|
| Rate for Payer: Cash Price |
$14.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.68
|
| Rate for Payer: Cigna of WY Commercial |
$19.88
|
| Rate for Payer: Entrust Commercial |
$19.28
|
| Rate for Payer: First Choice Health Commercial |
$19.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.39
|
| Rate for Payer: HealthUtah PPO |
$20.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.68
|
| Rate for Payer: Multiplan Medicare/VA |
$12.72
|
| Rate for Payer: One Health Plan of WY PPO |
$19.88
|
| Rate for Payer: PacificSource Commercial |
$18.26
|
| Rate for Payer: PHCS PPO |
$19.88
|
| Rate for Payer: Three Rivers PPO |
$15.22
|
| Rate for Payer: TriWest Veterans Administration |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$13.39
|
| Rate for Payer: WINHealth Partners Commercial |
$19.28
|
| Rate for Payer: Wise Provider Network Commercial |
$19.28
|
|
|
FALL PROTECTION KIT W/ BLANKET
|
Facility
|
OP
|
$20.29
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.88
|
| Rate for Payer: Aetna of WY Medicare |
$13.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.48
|
| Rate for Payer: Altius Commercial |
$19.48
|
| Rate for Payer: Beech Street Commercial |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.66
|
| Rate for Payer: Cash Price |
$14.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.68
|
| Rate for Payer: Cigna of WY Commercial |
$19.88
|
| Rate for Payer: Entrust Commercial |
$19.28
|
| Rate for Payer: First Choice Health Commercial |
$19.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.77
|
| Rate for Payer: HealthUtah PPO |
$20.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.68
|
| Rate for Payer: Multiplan Medicare/VA |
$11.18
|
| Rate for Payer: One Health Plan of WY PPO |
$19.88
|
| Rate for Payer: PacificSource Commercial |
$18.26
|
| Rate for Payer: PHCS PPO |
$19.88
|
| Rate for Payer: Three Rivers PPO |
$15.22
|
| Rate for Payer: TriWest Veterans Administration |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$11.77
|
| Rate for Payer: WINHealth Partners Commercial |
$19.88
|
| Rate for Payer: Wise Provider Network Commercial |
$19.28
|
|
|
FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
90846
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$365.54
|
| Rate for Payer: Aetna of WY Medicare |
$95.01
|
| Rate for Payer: Beech Street Commercial |
$354.35
|
| Rate for Payer: Cash Price |
$261.10
|
| Rate for Payer: Cash Price |
$261.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$361.81
|
| Rate for Payer: Cigna of WY Commercial |
$365.54
|
| Rate for Payer: First Choice Health Commercial |
$335.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$354.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.01
|
| Rate for Payer: HealthUtah PPO |
$373.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$361.81
|
| Rate for Payer: Multiplan Medicare/VA |
$80.76
|
| Rate for Payer: One Health Plan of WY PPO |
$365.54
|
| Rate for Payer: PacificSource Commercial |
$335.70
|
| Rate for Payer: PHCS PPO |
$354.35
|
| Rate for Payer: Three Rivers PPO |
$279.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.01
|
| Rate for Payer: United Healthcare Commercial |
$324.51
|
| Rate for Payer: United Healthcare Medicare |
$95.01
|
| Rate for Payer: WINHealth Partners Commercial |
$354.35
|
|
