|
EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$768.32
|
| Rate for Payer: Aetna of WY Medicare |
$167.51
|
| Rate for Payer: Beech Street Commercial |
$744.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$760.48
|
| Rate for Payer: Cigna of WY Commercial |
$768.32
|
| Rate for Payer: First Choice Health Commercial |
$705.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.51
|
| Rate for Payer: HealthUtah PPO |
$784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$760.48
|
| Rate for Payer: Multiplan Medicare/VA |
$142.38
|
| Rate for Payer: One Health Plan of WY PPO |
$768.32
|
| Rate for Payer: PacificSource Commercial |
$705.60
|
| Rate for Payer: PHCS PPO |
$744.80
|
| Rate for Payer: Three Rivers PPO |
$588.00
|
| Rate for Payer: TriWest Veterans Administration |
$167.51
|
| Rate for Payer: United Healthcare Commercial |
$744.80
|
| Rate for Payer: WINHealth Partners Commercial |
$666.40
|
|
|
EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$718.34
|
| Rate for Payer: Aetna of WY Medicare |
$157.70
|
| Rate for Payer: Beech Street Commercial |
$696.35
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: Cash Price |
$513.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$711.01
|
| Rate for Payer: Cigna of WY Commercial |
$718.34
|
| Rate for Payer: First Choice Health Commercial |
$659.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$696.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.70
|
| Rate for Payer: HealthUtah PPO |
$733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$711.01
|
| Rate for Payer: Multiplan Medicare/VA |
$134.04
|
| Rate for Payer: One Health Plan of WY PPO |
$718.34
|
| Rate for Payer: PacificSource Commercial |
$659.70
|
| Rate for Payer: PHCS PPO |
$696.35
|
| Rate for Payer: Three Rivers PPO |
$549.75
|
| Rate for Payer: TriWest Veterans Administration |
$157.70
|
| Rate for Payer: United Healthcare Commercial |
$696.35
|
| Rate for Payer: WINHealth Partners Commercial |
$623.05
|
|
|
EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$615.44
|
| Rate for Payer: Aetna of WY Medicare |
$135.03
|
| Rate for Payer: Beech Street Commercial |
$596.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.16
|
| Rate for Payer: Cigna of WY Commercial |
$615.44
|
| Rate for Payer: First Choice Health Commercial |
$565.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$596.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.03
|
| Rate for Payer: HealthUtah PPO |
$628.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.16
|
| Rate for Payer: Multiplan Medicare/VA |
$114.78
|
| Rate for Payer: One Health Plan of WY PPO |
$615.44
|
| Rate for Payer: PacificSource Commercial |
$565.20
|
| Rate for Payer: PHCS PPO |
$596.60
|
| Rate for Payer: Three Rivers PPO |
$471.00
|
| Rate for Payer: TriWest Veterans Administration |
$135.03
|
| Rate for Payer: United Healthcare Commercial |
$596.60
|
| Rate for Payer: WINHealth Partners Commercial |
$533.80
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Aetna of WY Medicare |
$189.15
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.15
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: Multiplan Medicare/VA |
$160.78
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: TriWest Veterans Administration |
$189.15
|
| Rate for Payer: United Healthcare Commercial |
$842.65
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 43246 80
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: United Healthcare Commercial |
$842.65
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 43246 AS
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: United Healthcare Commercial |
$842.65
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$849.66
|
| Rate for Payer: Aetna of WY Medicare |
$185.67
|
| Rate for Payer: Beech Street Commercial |
$823.65
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$840.99
|
| Rate for Payer: Cigna of WY Commercial |
$849.66
|
| Rate for Payer: First Choice Health Commercial |
$780.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$823.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.67
|
| Rate for Payer: HealthUtah PPO |
$867.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$840.99
|
| Rate for Payer: Multiplan Medicare/VA |
$157.82
|
| Rate for Payer: One Health Plan of WY PPO |
$849.66
|
| Rate for Payer: PacificSource Commercial |
$780.30
|
| Rate for Payer: PHCS PPO |
$823.65
|
| Rate for Payer: Three Rivers PPO |
$650.25
|
| Rate for Payer: TriWest Veterans Administration |
$185.67
|
| Rate for Payer: United Healthcare Commercial |
$823.65
|
| Rate for Payer: WINHealth Partners Commercial |
$736.95
|
|
|
EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$111.94 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$599.76
|
| Rate for Payer: Aetna of WY Medicare |
$131.69
|
| Rate for Payer: Beech Street Commercial |
$581.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$593.64
|
| Rate for Payer: Cigna of WY Commercial |
$599.76
|
| Rate for Payer: First Choice Health Commercial |
$550.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.69
|
| Rate for Payer: HealthUtah PPO |
$612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$593.64
|
| Rate for Payer: Multiplan Medicare/VA |
$111.94
|
| Rate for Payer: One Health Plan of WY PPO |
$599.76
|
| Rate for Payer: PacificSource Commercial |
$550.80
|
| Rate for Payer: PHCS PPO |
$581.40
|
| Rate for Payer: Three Rivers PPO |
$459.00
|
| Rate for Payer: TriWest Veterans Administration |
$131.69
|
| Rate for Payer: United Healthcare Commercial |
$581.40
|
| Rate for Payer: WINHealth Partners Commercial |
$520.20
|
|
|
EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$13.91
|
| Rate for Payer: Beech Street Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: First Choice Health Commercial |
$122.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.91
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$11.82
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$129.20
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.91
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Beech Street Commercial |
$52.25
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: First Choice Health Commercial |
$49.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$52.25
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: United Healthcare Commercial |
$52.25
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
|
|
EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$115.90
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: First Choice Health Commercial |
$109.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$5.22
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$115.90
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
|
|
ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Beech Street Commercial |
$88.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: First Choice Health Commercial |
$83.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$88.35
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
| Rate for Payer: WINHealth Partners Commercial |
$88.35
|
|
|
ELBOW ADAPTER SUCTION PORT
|
Facility
|
IP
|
$1.05
|
|
| Hospital Charge Code |
2500247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.67
|
| Rate for Payer: Altius Commercial |
$1.01
|
| Rate for Payer: Beech Street Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.02
|
| Rate for Payer: Cigna of WY Commercial |
$1.03
|
| Rate for Payer: Entrust Commercial |
$1.00
|
| Rate for Payer: First Choice Health Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.64
|
| Rate for Payer: HealthUtah PPO |
$1.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1.03
|
| Rate for Payer: PacificSource Commercial |
$0.95
|
| Rate for Payer: PHCS PPO |
$1.03
|
| Rate for Payer: Three Rivers PPO |
$0.79
|
| Rate for Payer: TriWest Veterans Administration |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1.00
|
|
|
ELBOW ADAPTER SUCTION PORT
|
Facility
|
OP
|
$1.05
|
|
| Hospital Charge Code |
2500247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Commercial |
$1.01
|
| Rate for Payer: Beech Street Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.02
|
| Rate for Payer: Cigna of WY Commercial |
$1.03
|
| Rate for Payer: Entrust Commercial |
$1.00
|
| Rate for Payer: First Choice Health Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.03
|
| Rate for Payer: PacificSource Commercial |
$0.95
|
| Rate for Payer: PHCS PPO |
$1.03
|
| Rate for Payer: Three Rivers PPO |
$0.79
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.00
|
|
|
ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.60
|
| Rate for Payer: Aetna of WY Medicare |
$38.28
|
| Rate for Payer: Beech Street Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.40
|
| Rate for Payer: Cigna of WY Commercial |
$901.60
|
| Rate for Payer: First Choice Health Commercial |
$828.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$920.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.40
|
| Rate for Payer: Multiplan Medicare/VA |
$32.54
|
| Rate for Payer: One Health Plan of WY PPO |
$901.60
|
| Rate for Payer: PacificSource Commercial |
$828.00
|
| Rate for Payer: PHCS PPO |
$874.00
|
| Rate for Payer: Three Rivers PPO |
$690.00
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$874.00
|
| Rate for Payer: WINHealth Partners Commercial |
$874.00
|
|
|
ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$75.05
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: First Choice Health Commercial |
$71.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$75.05
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: WINHealth Partners Commercial |
$75.05
|
|
|
ELECT INFANT/PED ECG 2330-003
|
Facility
|
OP
|
$2.02
|
|
| Hospital Charge Code |
2450068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.98
|
| Rate for Payer: Aetna of WY Medicare |
$1.33
|
| Rate for Payer: Altius Commercial |
$1.94
|
| Rate for Payer: Beech Street Commercial |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.96
|
| Rate for Payer: Cigna of WY Commercial |
$1.98
|
| Rate for Payer: Entrust Commercial |
$1.92
|
| Rate for Payer: First Choice Health Commercial |
$1.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.15
|
| Rate for Payer: HealthUtah PPO |
$2.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1.98
|
| Rate for Payer: PacificSource Commercial |
$1.82
|
| Rate for Payer: PHCS PPO |
$1.98
|
| Rate for Payer: Three Rivers PPO |
$1.52
|
| Rate for Payer: TriWest Veterans Administration |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$1.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.98
|
| Rate for Payer: Wise Provider Network Commercial |
$1.92
|
|
|
ELECT INFANT/PED ECG 2330-003
|
Facility
|
IP
|
$2.02
|
|
| Hospital Charge Code |
2450068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.98
|
| Rate for Payer: Aetna of WY Medicare |
$1.29
|
| Rate for Payer: Altius Commercial |
$1.94
|
| Rate for Payer: Beech Street Commercial |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.96
|
| Rate for Payer: Cigna of WY Commercial |
$1.98
|
| Rate for Payer: Entrust Commercial |
$1.92
|
| Rate for Payer: First Choice Health Commercial |
$1.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.23
|
| Rate for Payer: HealthUtah PPO |
$2.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1.98
|
| Rate for Payer: PacificSource Commercial |
$1.82
|
| Rate for Payer: PHCS PPO |
$1.98
|
| Rate for Payer: Three Rivers PPO |
$1.52
|
| Rate for Payer: TriWest Veterans Administration |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$1.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1.92
|
|
|
ELECTRODE FETAL LEG PAD 246AAO
|
Facility
|
IP
|
$6.39
|
|
| Hospital Charge Code |
2450027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.26
|
| Rate for Payer: Aetna of WY Medicare |
$4.09
|
| Rate for Payer: Altius Commercial |
$6.13
|
| Rate for Payer: Beech Street Commercial |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.20
|
| Rate for Payer: Cigna of WY Commercial |
$6.26
|
| Rate for Payer: Entrust Commercial |
$6.07
|
| Rate for Payer: First Choice Health Commercial |
$6.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.90
|
| Rate for Payer: HealthUtah PPO |
$6.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.20
|
| Rate for Payer: Multiplan Medicare/VA |
$3.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6.26
|
| Rate for Payer: PacificSource Commercial |
$5.75
|
| Rate for Payer: PHCS PPO |
$6.26
|
| Rate for Payer: Three Rivers PPO |
$4.79
|
| Rate for Payer: TriWest Veterans Administration |
$3.90
|
| Rate for Payer: United Healthcare Commercial |
$6.10
|
| Rate for Payer: United Healthcare Medicare |
$3.90
|
| Rate for Payer: WINHealth Partners Commercial |
$6.07
|
| Rate for Payer: Wise Provider Network Commercial |
$6.07
|
|
|
ELECTRODE FETAL LEG PAD 246AAO
|
Facility
|
OP
|
$6.39
|
|
| Hospital Charge Code |
2450027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.26
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Commercial |
$6.13
|
| Rate for Payer: Beech Street Commercial |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.20
|
| Rate for Payer: Cigna of WY Commercial |
$6.26
|
| Rate for Payer: Entrust Commercial |
$6.07
|
| Rate for Payer: First Choice Health Commercial |
$6.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.64
|
| Rate for Payer: HealthUtah PPO |
$6.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.20
|
| Rate for Payer: Multiplan Medicare/VA |
$3.46
|
| Rate for Payer: One Health Plan of WY PPO |
$6.26
|
| Rate for Payer: PacificSource Commercial |
$5.75
|
| Rate for Payer: PHCS PPO |
$6.26
|
| Rate for Payer: Three Rivers PPO |
$4.79
|
| Rate for Payer: TriWest Veterans Administration |
$3.64
|
| Rate for Payer: United Healthcare Commercial |
$6.10
|
| Rate for Payer: United Healthcare Medicare |
$3.64
|
| Rate for Payer: WINHealth Partners Commercial |
$6.26
|
| Rate for Payer: Wise Provider Network Commercial |
$6.07
|
|
|
ELECTRODE FETAL SPIRAL 7000AAO
|
Facility
|
OP
|
$22.44
|
|
| Hospital Charge Code |
2450019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.99
|
| Rate for Payer: Aetna of WY Medicare |
$14.81
|
| Rate for Payer: Altius Commercial |
$21.54
|
| Rate for Payer: Beech Street Commercial |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.77
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.77
|
| Rate for Payer: Cigna of WY Commercial |
$21.99
|
| Rate for Payer: Entrust Commercial |
$21.32
|
| Rate for Payer: First Choice Health Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.79
|
| Rate for Payer: HealthUtah PPO |
$22.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.77
|
| Rate for Payer: Multiplan Medicare/VA |
$12.15
|
| Rate for Payer: One Health Plan of WY PPO |
$21.99
|
| Rate for Payer: PacificSource Commercial |
$20.20
|
| Rate for Payer: PHCS PPO |
$21.99
|
| Rate for Payer: Three Rivers PPO |
$16.83
|
| Rate for Payer: TriWest Veterans Administration |
$12.79
|
| Rate for Payer: United Healthcare Commercial |
$21.43
|
| Rate for Payer: United Healthcare Medicare |
$12.79
|
| Rate for Payer: WINHealth Partners Commercial |
$21.99
|
| Rate for Payer: Wise Provider Network Commercial |
$21.32
|
|
|
ELECTRODE FETAL SPIRAL 7000AAO
|
Facility
|
IP
|
$22.44
|
|
| Hospital Charge Code |
2450019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.99
|
| Rate for Payer: Aetna of WY Medicare |
$14.36
|
| Rate for Payer: Altius Commercial |
$21.54
|
| Rate for Payer: Beech Street Commercial |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.77
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.77
|
| Rate for Payer: Cigna of WY Commercial |
$21.99
|
| Rate for Payer: Entrust Commercial |
$21.32
|
| Rate for Payer: First Choice Health Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.69
|
| Rate for Payer: HealthUtah PPO |
$22.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.77
|
| Rate for Payer: Multiplan Medicare/VA |
$13.00
|
| Rate for Payer: One Health Plan of WY PPO |
$21.99
|
| Rate for Payer: PacificSource Commercial |
$20.20
|
| Rate for Payer: PHCS PPO |
$21.99
|
| Rate for Payer: Three Rivers PPO |
$16.83
|
| Rate for Payer: TriWest Veterans Administration |
$13.69
|
| Rate for Payer: United Healthcare Commercial |
$21.43
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WINHealth Partners Commercial |
$21.32
|
| Rate for Payer: Wise Provider Network Commercial |
$21.32
|
|
|
ELECTRODE LEEP BALL 5MM X 12CM
|
Facility
|
IP
|
$92.44
|
|
| Hospital Charge Code |
2650988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Aetna of WY Medicare |
$59.16
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.67
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.39
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$53.57
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$56.39
|
| Rate for Payer: United Healthcare Commercial |
$88.28
|
| Rate for Payer: United Healthcare Medicare |
$56.39
|
| Rate for Payer: WINHealth Partners Commercial |
$87.82
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
|
ELECTRODE LEEP BALL 5MM X 12CM
|
Facility
|
OP
|
$92.44
|
|
| Hospital Charge Code |
2650988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Aetna of WY Medicare |
$61.01
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.67
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.69
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$50.06
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$52.69
|
| Rate for Payer: United Healthcare Commercial |
$88.28
|
| Rate for Payer: United Healthcare Medicare |
$52.69
|
| Rate for Payer: WINHealth Partners Commercial |
$90.59
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
|
ELECTRODE LEEP LOOP 2CM X 2CM
|
Facility
|
IP
|
$92.44
|
|
| Hospital Charge Code |
2650986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Aetna of WY Medicare |
$59.16
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.67
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.39
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$53.57
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$56.39
|
| Rate for Payer: United Healthcare Commercial |
$88.28
|
| Rate for Payer: United Healthcare Medicare |
$56.39
|
| Rate for Payer: WINHealth Partners Commercial |
$87.82
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
