|
HC PRO ANES VEINS FOREARM WRIST & HAND PHLEBORRHAPHY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01852
|
| Hospital Charge Code |
9640185201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01522
|
| Hospital Charge Code |
9640152201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES VEINS OF UPPER LEG INCLUDING EXPLORATION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01260
|
| Hospital Charge Code |
9640126001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES VENOUS/LYMPHATIC NOS THER IVNTL RAD NOS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01930
|
| Hospital Charge Code |
9640193001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00126
|
| Hospital Charge Code |
9640012601
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LOWER ABD UR TRACT RENAL DON NFRCT
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00862
|
| Hospital Charge Code |
9640086201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LOWER ABD W/URIN TRACT ADRENLECTOMY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00866
|
| Hospital Charge Code |
9640086601
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LWER ABD W/URINARY TRACT TOT CYSTEC
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00864
|
| Hospital Charge Code |
9640086401
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LWR ABD W/URINARY TRACT RAD PRSTECT
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00865
|
| Hospital Charge Code |
9640086501
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LWR ABD W/URIN TRACT CSTOLITHOTOMY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00870
|
| Hospital Charge Code |
9640087001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES XTRPRTL LWR ABD W/URIN TRACT RENAL TRANSPL
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 00868
|
| Hospital Charge Code |
9640086801
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANNUAL ALCOHOL MISUSE SCREENING 15 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
983G044201
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANNUAL ALCOHOL MISUSE SCREENING 15 MIN
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
510G044201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$36.10
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$7.45
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$36.10
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
|
|
HC PRO ANNUAL WELLNESS PPPS, INITIAL VISIT
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
983G043801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$361.62
|
| Rate for Payer: Aetna of WY Medicare |
$161.29
|
| Rate for Payer: Beech Street Commercial |
$350.55
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$357.93
|
| Rate for Payer: Cigna of WY Commercial |
$361.62
|
| Rate for Payer: First Choice Health Commercial |
$332.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$350.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.29
|
| Rate for Payer: HealthUtah PPO |
$369.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$357.93
|
| Rate for Payer: Multiplan Medicare/VA |
$137.10
|
| Rate for Payer: One Health Plan of WY PPO |
$361.62
|
| Rate for Payer: PacificSource Commercial |
$332.10
|
| Rate for Payer: PHCS PPO |
$350.55
|
| Rate for Payer: Three Rivers PPO |
$276.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.29
|
| Rate for Payer: United Healthcare Commercial |
$321.03
|
| Rate for Payer: United Healthcare Medicare |
$161.29
|
| Rate for Payer: WINHealth Partners Commercial |
$350.55
|
|
|
HC PRO ANNUAL WELLNESS PPPS, SUBSEQUENT VISIT
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
983G043901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$126.92
|
| Rate for Payer: Beech Street Commercial |
$316.35
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: First Choice Health Commercial |
$299.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.92
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$107.88
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$316.35
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$126.92
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$126.92
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
|
|
HC PRO ANOSCOPY BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 46606
|
| Hospital Charge Code |
9834660601
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
9834660001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.82
|
| Rate for Payer: Aetna of WY Medicare |
$39.83
|
| Rate for Payer: Aetna of WY Medicare |
$39.83
|
| Rate for Payer: Beech Street Commercial |
$198.55
|
| Rate for Payer: Beech Street Commercial |
$321.10
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.73
|
| Rate for Payer: Cigna of WY Commercial |
$204.82
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: First Choice Health Commercial |
$188.10
|
| Rate for Payer: First Choice Health Commercial |
$304.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| 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: Government Employees Health Association (GEHA) Medicare |
$39.83
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: HealthUtah PPO |
$209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.73
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: One Health Plan of WY PPO |
$204.82
|
| Rate for Payer: PacificSource Commercial |
$188.10
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$321.10
|
| Rate for Payer: PHCS PPO |
$198.55
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: Three Rivers PPO |
$156.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.83
|
| Rate for Payer: TriWest Veterans Administration |
$39.83
|
| Rate for Payer: United Healthcare Commercial |
$181.83
|
| Rate for Payer: United Healthcare Commercial |
$294.06
|
| Rate for Payer: United Healthcare Medicare |
$39.83
|
| Rate for Payer: United Healthcare Medicare |
$39.83
|
| Rate for Payer: WINHealth Partners Commercial |
$287.30
|
| Rate for Payer: WINHealth Partners Commercial |
$177.65
|
|
|
HC PRO ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 59425 NONPBBPAYER
|
| Hospital Charge Code |
9835942501
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
9835942501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$346.77 |
| Max. Negotiated Rate |
$831.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$814.38
|
| Rate for Payer: Aetna of WY Medicare |
$407.96
|
| Rate for Payer: Beech Street Commercial |
$789.45
|
| Rate for Payer: Cash Price |
$581.70
|
| Rate for Payer: Cash Price |
$581.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$806.07
|
| Rate for Payer: Cigna of WY Commercial |
$814.38
|
| Rate for Payer: First Choice Health Commercial |
$747.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$789.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.96
|
| Rate for Payer: HealthUtah PPO |
$831.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$806.07
|
| Rate for Payer: Multiplan Medicare/VA |
$346.77
|
| Rate for Payer: One Health Plan of WY PPO |
$814.38
|
| Rate for Payer: PacificSource Commercial |
$747.90
|
| Rate for Payer: PHCS PPO |
$789.45
|
| Rate for Payer: Three Rivers PPO |
$623.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.96
|
| Rate for Payer: United Healthcare Commercial |
$722.97
|
| Rate for Payer: United Healthcare Medicare |
$407.96
|
| Rate for Payer: WINHealth Partners Commercial |
$706.35
|
|
|
HC PRO ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,830.00
|
|
|
Service Code
|
HCPCS 59426 NONPBBPAYER
|
| Hospital Charge Code |
9835942601
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
9835942601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$1,434.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$748.90
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| 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 |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$636.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$748.90
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$748.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
HC PRO ANTERIOR COLPORRAPHY RCYSTOCELE W/CYSTO
|
Professional
|
Both
|
$3,490.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
9835724001
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$2,849.00
|
|
|
Service Code
|
HCPCS 22846
|
| Hospital Charge Code |
9832284601
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANTICOAGULANT MGMT FOR PT TAKI
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
9839379301
|
|
Hospital Revenue Code
|
983
|
| 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
|
|
|
HC PRO ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$3,531.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
9835184001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$569.68 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,460.38
|
| Rate for Payer: Aetna of WY Medicare |
$670.21
|
| Rate for Payer: Beech Street Commercial |
$3,354.45
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,425.07
|
| Rate for Payer: Cigna of WY Commercial |
$3,460.38
|
| Rate for Payer: First Choice Health Commercial |
$3,177.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,354.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$670.21
|
| Rate for Payer: HealthUtah PPO |
$3,531.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,425.07
|
| Rate for Payer: Multiplan Medicare/VA |
$569.68
|
| Rate for Payer: One Health Plan of WY PPO |
$3,460.38
|
| Rate for Payer: PacificSource Commercial |
$3,177.90
|
| Rate for Payer: PHCS PPO |
$3,354.45
|
| Rate for Payer: Three Rivers PPO |
$2,648.25
|
| Rate for Payer: TriWest Veterans Administration |
$670.21
|
| Rate for Payer: United Healthcare Commercial |
$3,071.97
|
| Rate for Payer: United Healthcare Medicare |
$670.21
|
| Rate for Payer: WINHealth Partners Commercial |
$3,001.35
|
|
