|
ANKLE KOOLAIR STIRRUP 11186
|
Facility
|
IP
|
$41.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$41.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.29
|
| Rate for Payer: Altius Commercial |
$40.29
|
| Rate for Payer: Beech Street Commercial |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.46
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.71
|
| Rate for Payer: Cigna of WY Commercial |
$41.13
|
| Rate for Payer: Entrust Commercial |
$39.87
|
| Rate for Payer: First Choice Health Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.70
|
| Rate for Payer: HealthUtah PPO |
$41.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.71
|
| Rate for Payer: Multiplan Medicare/VA |
$26.32
|
| Rate for Payer: One Health Plan of WY PPO |
$41.13
|
| Rate for Payer: PacificSource Commercial |
$37.77
|
| Rate for Payer: PHCS PPO |
$41.13
|
| Rate for Payer: Three Rivers PPO |
$31.48
|
| Rate for Payer: TriWest Veterans Administration |
$27.70
|
| Rate for Payer: United Healthcare Commercial |
$36.51
|
| Rate for Payer: United Healthcare Medicare |
$27.70
|
| Rate for Payer: WINHealth Partners Commercial |
$39.87
|
| Rate for Payer: Wise Provider Network Commercial |
$39.87
|
|
|
ANKLE KOOLAIR STIRRUP 11186
|
Facility
|
OP
|
$41.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$41.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.13
|
| Rate for Payer: Aetna of WY Medicare |
$27.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.29
|
| Rate for Payer: Altius Commercial |
$40.29
|
| Rate for Payer: Beech Street Commercial |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.46
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.71
|
| Rate for Payer: Cigna of WY Commercial |
$41.13
|
| Rate for Payer: Entrust Commercial |
$39.87
|
| Rate for Payer: First Choice Health Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.34
|
| Rate for Payer: HealthUtah PPO |
$41.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.13
|
| Rate for Payer: One Health Plan of WY PPO |
$41.13
|
| Rate for Payer: PacificSource Commercial |
$37.77
|
| Rate for Payer: PHCS PPO |
$41.13
|
| Rate for Payer: Three Rivers PPO |
$31.48
|
| Rate for Payer: TriWest Veterans Administration |
$24.34
|
| Rate for Payer: United Healthcare Commercial |
$36.51
|
| Rate for Payer: United Healthcare Medicare |
$24.34
|
| Rate for Payer: WINHealth Partners Commercial |
$41.13
|
| Rate for Payer: Wise Provider Network Commercial |
$39.87
|
|
|
ANKLE STIRRUP PLUS BLK 97007
|
Facility
|
IP
|
$31.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.79
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$19.75
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$20.79
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$20.79
|
| Rate for Payer: WINHealth Partners Commercial |
$29.92
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
ANKLE STIRRUP PLUS BLK 97007
|
Facility
|
OP
|
$31.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Aetna of WY Medicare |
$20.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.27
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$17.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$30.87
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
ANNUAL ALCOHOL SCREEN 15 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
G0442
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$7.45
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
ANOSCOPY ABLATION LESION
|
Professional
|
Both
|
$3,805.00
|
|
|
Service Code
|
HCPCS 46615
|
| Hospital Charge Code |
46615
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$3,805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,728.90
|
| Rate for Payer: Aetna of WY Medicare |
$86.94
|
| Rate for Payer: Beech Street Commercial |
$3,614.75
|
| Rate for Payer: Cash Price |
$2,663.50
|
| Rate for Payer: Cash Price |
$2,663.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,690.85
|
| Rate for Payer: Cigna of WY Commercial |
$3,728.90
|
| Rate for Payer: First Choice Health Commercial |
$3,424.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,614.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.94
|
| Rate for Payer: HealthUtah PPO |
$3,805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,690.85
|
| Rate for Payer: Multiplan Medicare/VA |
$73.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,728.90
|
| Rate for Payer: PacificSource Commercial |
$3,424.50
|
| Rate for Payer: PHCS PPO |
$3,614.75
|
| Rate for Payer: Three Rivers PPO |
$2,853.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.94
|
| Rate for Payer: United Healthcare Commercial |
$3,310.35
|
| Rate for Payer: United Healthcare Medicare |
$86.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3,234.25
|
|
|
ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
46600
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.82
|
| Rate for Payer: Aetna of WY Medicare |
$39.83
|
| Rate for Payer: Beech Street Commercial |
$198.55
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.73
|
| Rate for Payer: Cigna of WY Commercial |
$204.82
|
| Rate for Payer: First Choice Health Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.83
|
| Rate for Payer: HealthUtah PPO |
$209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.73
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$204.82
|
| Rate for Payer: PacificSource Commercial |
$188.10
|
| Rate for Payer: PHCS PPO |
$198.55
|
| Rate for Payer: Three Rivers PPO |
$156.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.83
|
| Rate for Payer: United Healthcare Commercial |
$181.83
|
| Rate for Payer: United Healthcare Medicare |
$39.83
|
| Rate for Payer: WINHealth Partners Commercial |
$177.65
|
|
|
ANOSCOPY W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 46606
|
| Hospital Charge Code |
46606
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$2,936.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,877.28
|
| Rate for Payer: Aetna of WY Medicare |
$72.21
|
| Rate for Payer: Beech Street Commercial |
$2,789.20
|
| Rate for Payer: Cash Price |
$2,055.20
|
| Rate for Payer: Cash Price |
$2,055.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,847.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,877.28
|
| Rate for Payer: First Choice Health Commercial |
$2,642.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,789.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.21
|
| Rate for Payer: HealthUtah PPO |
$2,936.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,847.92
|
| Rate for Payer: Multiplan Medicare/VA |
$61.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,877.28
|
| Rate for Payer: PacificSource Commercial |
$2,642.40
|
| Rate for Payer: PHCS PPO |
$2,789.20
|
| Rate for Payer: Three Rivers PPO |
$2,202.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.21
|
| Rate for Payer: United Healthcare Commercial |
$2,554.32
|
| Rate for Payer: United Healthcare Medicare |
$72.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2,495.60
|
|
|
ANOSCOPY W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$4,302.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
46610
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$4,302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,215.96
|
| Rate for Payer: Aetna of WY Medicare |
$76.53
|
| Rate for Payer: Beech Street Commercial |
$4,086.90
|
| Rate for Payer: Cash Price |
$3,011.40
|
| Rate for Payer: Cash Price |
$3,011.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,172.94
|
| Rate for Payer: Cigna of WY Commercial |
$4,215.96
|
| Rate for Payer: First Choice Health Commercial |
$3,871.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,086.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.53
|
| Rate for Payer: HealthUtah PPO |
$4,302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,172.94
|
| Rate for Payer: Multiplan Medicare/VA |
$65.05
|
| Rate for Payer: One Health Plan of WY PPO |
$4,215.96
|
| Rate for Payer: PacificSource Commercial |
$3,871.80
|
| Rate for Payer: PHCS PPO |
$4,086.90
|
| Rate for Payer: Three Rivers PPO |
$3,226.50
|
| Rate for Payer: TriWest Veterans Administration |
$76.53
|
| Rate for Payer: United Healthcare Commercial |
$3,742.74
|
| Rate for Payer: United Healthcare Medicare |
$76.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,656.70
|
|
|
ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$5,621.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$5,621.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,508.58
|
| Rate for Payer: Aetna of WY Medicare |
$100.74
|
| Rate for Payer: Beech Street Commercial |
$5,339.95
|
| Rate for Payer: Cash Price |
$3,934.70
|
| Rate for Payer: Cash Price |
$3,934.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,452.37
|
| Rate for Payer: Cigna of WY Commercial |
$5,508.58
|
| Rate for Payer: First Choice Health Commercial |
$5,058.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,339.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.74
|
| Rate for Payer: HealthUtah PPO |
$5,621.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,452.37
|
| Rate for Payer: Multiplan Medicare/VA |
$85.63
|
| Rate for Payer: One Health Plan of WY PPO |
$5,508.58
|
| Rate for Payer: PacificSource Commercial |
$5,058.90
|
| Rate for Payer: PHCS PPO |
$5,339.95
|
| Rate for Payer: Three Rivers PPO |
$4,215.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.74
|
| Rate for Payer: United Healthcare Commercial |
$4,890.27
|
| Rate for Payer: United Healthcare Medicare |
$100.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4,777.85
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
59425
|
| Min. Negotiated Rate |
$346.77 |
| Max. Negotiated Rate |
$1,039.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,018.22
|
| Rate for Payer: Aetna of WY Medicare |
$407.96
|
| Rate for Payer: Beech Street Commercial |
$987.05
|
| Rate for Payer: Cash Price |
$727.30
|
| Rate for Payer: Cash Price |
$727.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,007.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,018.22
|
| Rate for Payer: First Choice Health Commercial |
$935.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$987.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.96
|
| Rate for Payer: HealthUtah PPO |
$1,039.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,007.83
|
| Rate for Payer: Multiplan Medicare/VA |
$346.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,018.22
|
| Rate for Payer: PacificSource Commercial |
$935.10
|
| Rate for Payer: PHCS PPO |
$987.05
|
| Rate for Payer: Three Rivers PPO |
$779.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.96
|
| Rate for Payer: United Healthcare Commercial |
$903.93
|
| Rate for Payer: United Healthcare Medicare |
$407.96
|
| Rate for Payer: WINHealth Partners Commercial |
$883.15
|
|
|
ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,830.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
59426
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$1,793.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,793.40
|
| Rate for Payer: Aetna of WY Medicare |
$748.90
|
| Rate for Payer: Beech Street Commercial |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,775.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,793.40
|
| Rate for Payer: First Choice Health Commercial |
$1,647.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,738.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$748.90
|
| Rate for Payer: HealthUtah PPO |
$1,137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,775.10
|
| Rate for Payer: Multiplan Medicare/VA |
$636.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,793.40
|
| Rate for Payer: PacificSource Commercial |
$1,647.00
|
| Rate for Payer: PHCS PPO |
$1,738.50
|
| Rate for Payer: Three Rivers PPO |
$1,372.50
|
| Rate for Payer: TriWest Veterans Administration |
$748.90
|
| Rate for Payer: United Healthcare Commercial |
$1,592.10
|
| Rate for Payer: United Healthcare Medicare |
$748.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,555.50
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$3,490.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
57240
|
| Min. Negotiated Rate |
$503.78 |
| Max. Negotiated Rate |
$3,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,420.20
|
| Rate for Payer: Aetna of WY Medicare |
$592.68
|
| Rate for Payer: Beech Street Commercial |
$3,315.50
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,385.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,420.20
|
| Rate for Payer: First Choice Health Commercial |
$3,141.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$592.68
|
| Rate for Payer: HealthUtah PPO |
$3,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,385.30
|
| Rate for Payer: Multiplan Medicare/VA |
$503.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,420.20
|
| Rate for Payer: PacificSource Commercial |
$3,141.00
|
| Rate for Payer: PHCS PPO |
$3,315.50
|
| Rate for Payer: Three Rivers PPO |
$2,617.50
|
| Rate for Payer: TriWest Veterans Administration |
$592.68
|
| Rate for Payer: United Healthcare Commercial |
$3,036.30
|
| Rate for Payer: United Healthcare Medicare |
$592.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,966.50
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$3,490.00
|
|
|
Service Code
|
HCPCS 57240 80
|
| Hospital Charge Code |
57240
|
| Min. Negotiated Rate |
$503.78 |
| Max. Negotiated Rate |
$3,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,420.20
|
| Rate for Payer: Aetna of WY Medicare |
$592.68
|
| Rate for Payer: Beech Street Commercial |
$3,315.50
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,385.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,420.20
|
| Rate for Payer: First Choice Health Commercial |
$3,141.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$592.68
|
| Rate for Payer: HealthUtah PPO |
$3,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,385.30
|
| Rate for Payer: Multiplan Medicare/VA |
$503.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,420.20
|
| Rate for Payer: PacificSource Commercial |
$3,141.00
|
| Rate for Payer: PHCS PPO |
$3,315.50
|
| Rate for Payer: Three Rivers PPO |
$2,617.50
|
| Rate for Payer: TriWest Veterans Administration |
$592.68
|
| Rate for Payer: United Healthcare Commercial |
$3,036.30
|
| Rate for Payer: United Healthcare Medicare |
$592.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,966.50
|
|
|
ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 22845 80
|
| Hospital Charge Code |
22845
|
| Min. Negotiated Rate |
$576.33 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Aetna of WY Medicare |
$678.04
|
| Rate for Payer: Beech Street Commercial |
$2,299.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: First Choice Health Commercial |
$2,178.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.04
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$576.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,299.00
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$678.04
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$678.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,057.00
|
|
|
ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 22845 AS
|
| Hospital Charge Code |
22845
|
| Min. Negotiated Rate |
$576.33 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Aetna of WY Medicare |
$678.04
|
| Rate for Payer: Beech Street Commercial |
$2,299.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: First Choice Health Commercial |
$2,178.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.04
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$576.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,299.00
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$678.04
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$678.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,057.00
|
|
|
ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$2,849.00
|
|
|
Service Code
|
HCPCS 22846
|
| Hospital Charge Code |
22846
|
| Min. Negotiated Rate |
$599.73 |
| Max. Negotiated Rate |
$2,849.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,792.02
|
| Rate for Payer: Aetna of WY Medicare |
$705.56
|
| Rate for Payer: Beech Street Commercial |
$2,706.55
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: Cash Price |
$1,994.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,763.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,792.02
|
| Rate for Payer: First Choice Health Commercial |
$2,564.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,706.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.56
|
| Rate for Payer: HealthUtah PPO |
$2,849.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,763.53
|
| Rate for Payer: Multiplan Medicare/VA |
$599.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2,792.02
|
| Rate for Payer: PacificSource Commercial |
$2,564.10
|
| Rate for Payer: PHCS PPO |
$2,706.55
|
| Rate for Payer: Three Rivers PPO |
$2,136.75
|
| Rate for Payer: TriWest Veterans Administration |
$705.56
|
| Rate for Payer: United Healthcare Commercial |
$2,478.63
|
| Rate for Payer: United Healthcare Medicare |
$705.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,421.65
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,847.00
|
|
|
Service Code
|
HCPCS 27418 AS
|
| Hospital Charge Code |
27418
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,790.06
|
| Rate for Payer: Aetna of WY Medicare |
$797.68
|
| Rate for Payer: Beech Street Commercial |
$2,704.65
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,761.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,790.06
|
| Rate for Payer: First Choice Health Commercial |
$2,562.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,704.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$797.68
|
| Rate for Payer: HealthUtah PPO |
$2,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,761.59
|
| Rate for Payer: Multiplan Medicare/VA |
$678.03
|
| Rate for Payer: One Health Plan of WY PPO |
$2,790.06
|
| Rate for Payer: PacificSource Commercial |
$2,562.30
|
| Rate for Payer: PHCS PPO |
$2,704.65
|
| Rate for Payer: Three Rivers PPO |
$2,135.25
|
| Rate for Payer: TriWest Veterans Administration |
$797.68
|
| Rate for Payer: United Healthcare Commercial |
$2,476.89
|
| Rate for Payer: United Healthcare Medicare |
$797.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,419.95
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,847.00
|
|
|
Service Code
|
HCPCS 27418 80
|
| Hospital Charge Code |
27418
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,790.06
|
| Rate for Payer: Aetna of WY Medicare |
$797.68
|
| Rate for Payer: Beech Street Commercial |
$2,704.65
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,761.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,790.06
|
| Rate for Payer: First Choice Health Commercial |
$2,562.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,704.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$797.68
|
| Rate for Payer: HealthUtah PPO |
$2,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,761.59
|
| Rate for Payer: Multiplan Medicare/VA |
$678.03
|
| Rate for Payer: One Health Plan of WY PPO |
$2,790.06
|
| Rate for Payer: PacificSource Commercial |
$2,562.30
|
| Rate for Payer: PHCS PPO |
$2,704.65
|
| Rate for Payer: Three Rivers PPO |
$2,135.25
|
| Rate for Payer: TriWest Veterans Administration |
$797.68
|
| Rate for Payer: United Healthcare Commercial |
$2,476.89
|
| Rate for Payer: United Healthcare Medicare |
$797.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,419.95
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,847.00
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
27418
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,790.06
|
| Rate for Payer: Aetna of WY Medicare |
$797.68
|
| Rate for Payer: Beech Street Commercial |
$2,704.65
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: Cash Price |
$1,992.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,761.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,790.06
|
| Rate for Payer: First Choice Health Commercial |
$2,562.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,704.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$797.68
|
| Rate for Payer: HealthUtah PPO |
$2,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,761.59
|
| Rate for Payer: Multiplan Medicare/VA |
$678.03
|
| Rate for Payer: One Health Plan of WY PPO |
$2,790.06
|
| Rate for Payer: PacificSource Commercial |
$2,562.30
|
| Rate for Payer: PHCS PPO |
$2,704.65
|
| Rate for Payer: Three Rivers PPO |
$2,135.25
|
| Rate for Payer: TriWest Veterans Administration |
$797.68
|
| Rate for Payer: United Healthcare Commercial |
$2,476.89
|
| Rate for Payer: United Healthcare Medicare |
$797.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,419.95
|
|
|
ANTIBODY HELICOBACTER PYLORI
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
86677
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Medicare |
$16.85
|
| Rate for Payer: Beech Street Commercial |
$111.15
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: First Choice Health Commercial |
$105.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.85
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$14.32
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$111.15
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$16.85
|
| Rate for Payer: WINHealth Partners Commercial |
$111.15
|
|
|
ANTICOAG CLINIC PER SESSION
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS S9401
|
| Hospital Charge Code |
S9401
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
|
|
ANTICOAGULANT MGMT FOR PT TAKING WARFARIN
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
93793
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.05
|
| Rate for Payer: Beech Street Commercial |
$40.85
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: First Choice Health Commercial |
$38.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.05
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$9.39
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$40.85
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.05
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
|
|
ANTIFOGGER KIT
|
Facility
|
IP
|
$2.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.84
|
| Rate for Payer: Altius Commercial |
$2.84
|
| Rate for Payer: Beech Street Commercial |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.87
|
| Rate for Payer: Cigna of WY Commercial |
$2.90
|
| Rate for Payer: Entrust Commercial |
$2.81
|
| Rate for Payer: First Choice Health Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.95
|
| Rate for Payer: HealthUtah PPO |
$2.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2.90
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.90
|
| Rate for Payer: Three Rivers PPO |
$2.22
|
| Rate for Payer: TriWest Veterans Administration |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2.81
|
| Rate for Payer: Wise Provider Network Commercial |
$2.81
|
|
|
ANTIFOGGER KIT
|
Facility
|
OP
|
$2.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.90
|
| Rate for Payer: Aetna of WY Medicare |
$1.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.84
|
| Rate for Payer: Altius Commercial |
$2.84
|
| Rate for Payer: Beech Street Commercial |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.87
|
| Rate for Payer: Cigna of WY Commercial |
$2.90
|
| Rate for Payer: Entrust Commercial |
$2.81
|
| Rate for Payer: First Choice Health Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.72
|
| Rate for Payer: HealthUtah PPO |
$2.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2.90
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.90
|
| Rate for Payer: Three Rivers PPO |
$2.22
|
| Rate for Payer: TriWest Veterans Administration |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicare |
$1.72
|
| Rate for Payer: WINHealth Partners Commercial |
$2.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2.81
|
|
