|
HC PRO AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
9831173201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$16.12
|
| Rate for Payer: Beech Street Commercial |
$67.45
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: First Choice Health Commercial |
$63.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.12
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$13.70
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$67.45
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$61.77
|
| Rate for Payer: United Healthcare Medicare |
$16.12
|
| Rate for Payer: WINHealth Partners Commercial |
$60.35
|
|
|
HC PRO AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 11732 NONPBBPAYER
|
| Hospital Charge Code |
9831173201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$16.12
|
| Rate for Payer: Beech Street Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: First Choice Health Commercial |
$80.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.12
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$13.70
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$84.55
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$16.12
|
| Rate for Payer: WINHealth Partners Commercial |
$75.65
|
|
|
HC PRO BIOPSY AUDITORY CANAL
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 69105 NONPBBPAYER
|
| Hospital Charge Code |
9836910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$314.58
|
| Rate for Payer: Aetna of WY Medicare |
$61.84
|
| Rate for Payer: Beech Street Commercial |
$304.95
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$311.37
|
| Rate for Payer: Cigna of WY Commercial |
$314.58
|
| Rate for Payer: First Choice Health Commercial |
$288.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.84
|
| Rate for Payer: HealthUtah PPO |
$321.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$311.37
|
| Rate for Payer: Multiplan Medicare/VA |
$52.56
|
| Rate for Payer: One Health Plan of WY PPO |
$314.58
|
| Rate for Payer: PacificSource Commercial |
$288.90
|
| Rate for Payer: PHCS PPO |
$304.95
|
| Rate for Payer: Three Rivers PPO |
$240.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.84
|
| Rate for Payer: United Healthcare Commercial |
$279.27
|
| Rate for Payer: United Healthcare Medicare |
$61.84
|
| Rate for Payer: WINHealth Partners Commercial |
$272.85
|
|
|
HC PRO BIOPSY AUDITORY CANAL
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
9836910501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.86
|
| Rate for Payer: Aetna of WY Medicare |
$61.84
|
| Rate for Payer: Beech Street Commercial |
$244.15
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$249.29
|
| Rate for Payer: Cigna of WY Commercial |
$251.86
|
| Rate for Payer: First Choice Health Commercial |
$231.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.84
|
| Rate for Payer: HealthUtah PPO |
$257.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.29
|
| Rate for Payer: Multiplan Medicare/VA |
$52.56
|
| Rate for Payer: One Health Plan of WY PPO |
$251.86
|
| Rate for Payer: PacificSource Commercial |
$231.30
|
| Rate for Payer: PHCS PPO |
$244.15
|
| Rate for Payer: Three Rivers PPO |
$192.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.84
|
| Rate for Payer: United Healthcare Commercial |
$223.59
|
| Rate for Payer: United Healthcare Medicare |
$61.84
|
| Rate for Payer: WINHealth Partners Commercial |
$218.45
|
|
|
HC PRO BIOPSY BREAST OPEN INCISIONAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
9831910101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$181.85 |
| Max. Negotiated Rate |
$1,142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,119.16
|
| Rate for Payer: Aetna of WY Medicare |
$213.94
|
| Rate for Payer: Beech Street Commercial |
$1,084.90
|
| Rate for Payer: Cash Price |
$799.40
|
| Rate for Payer: Cash Price |
$799.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,107.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,119.16
|
| Rate for Payer: First Choice Health Commercial |
$1,027.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,084.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.94
|
| Rate for Payer: HealthUtah PPO |
$1,142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,107.74
|
| Rate for Payer: Multiplan Medicare/VA |
$181.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,119.16
|
| Rate for Payer: PacificSource Commercial |
$1,027.80
|
| Rate for Payer: PHCS PPO |
$1,084.90
|
| Rate for Payer: Three Rivers PPO |
$856.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.94
|
| Rate for Payer: United Healthcare Commercial |
$993.54
|
| Rate for Payer: United Healthcare Medicare |
$213.94
|
| Rate for Payer: WINHealth Partners Commercial |
$970.70
|
|
|
HC PRO BIOPSY, EACH ADDED LESION
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 11101
|
| Hospital Charge Code |
9831110101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Beech Street Commercial |
$104.50
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: First Choice Health Commercial |
$99.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$104.50
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$93.50
|
|
|
HC PRO BIOPSY, EACH ADDED LESION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 11101 NONPBBPAYER
|
| Hospital Charge Code |
9831110101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Beech Street Commercial |
$130.15
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: First Choice Health Commercial |
$123.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$130.15
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: WINHealth Partners Commercial |
$116.45
|
|
|
HC PRO BIOPSY,EXCISION LOCAL LESION
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
9835750001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Aetna of WY Medicare |
$72.29
|
| Rate for Payer: Beech Street Commercial |
$286.90
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: First Choice Health Commercial |
$271.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.29
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$286.90
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.29
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: United Healthcare Medicare |
$72.29
|
| Rate for Payer: WINHealth Partners Commercial |
$256.70
|
|
|
HC PRO BIOPSY,EXCISION LOCAL LESION
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 57500 NONPBBPAYER
|
| Hospital Charge Code |
9835750001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$72.29
|
| Rate for Payer: Beech Street Commercial |
$359.10
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: First Choice Health Commercial |
$340.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.29
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$359.10
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.29
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$72.29
|
| Rate for Payer: WINHealth Partners Commercial |
$321.30
|
|
|
HC PRO BIOPSY EXCISION LYMPH NODE OPEN
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
9833852501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$359.59 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,216.76
|
| Rate for Payer: Aetna of WY Medicare |
$423.05
|
| Rate for Payer: Beech Street Commercial |
$2,148.90
|
| Rate for Payer: Cash Price |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,583.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,194.14
|
| Rate for Payer: Cigna of WY Commercial |
$2,216.76
|
| Rate for Payer: First Choice Health Commercial |
$2,035.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,148.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.05
|
| Rate for Payer: HealthUtah PPO |
$2,262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,194.14
|
| Rate for Payer: Multiplan Medicare/VA |
$359.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,216.76
|
| Rate for Payer: PacificSource Commercial |
$2,035.80
|
| Rate for Payer: PHCS PPO |
$2,148.90
|
| Rate for Payer: Three Rivers PPO |
$1,696.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.05
|
| Rate for Payer: United Healthcare Commercial |
$1,967.94
|
| Rate for Payer: United Healthcare Medicare |
$423.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,922.70
|
|
|
HC PRO BIOPSY/EXCISION, LYMPH NODE(S) SUPERFICIAL
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
9833850001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$207.77 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,289.68
|
| Rate for Payer: Aetna of WY Medicare |
$244.44
|
| Rate for Payer: Beech Street Commercial |
$1,250.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,276.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,289.68
|
| Rate for Payer: First Choice Health Commercial |
$1,184.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.44
|
| Rate for Payer: HealthUtah PPO |
$1,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,276.52
|
| Rate for Payer: Multiplan Medicare/VA |
$207.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,289.68
|
| Rate for Payer: PacificSource Commercial |
$1,184.40
|
| Rate for Payer: PHCS PPO |
$1,250.20
|
| Rate for Payer: Three Rivers PPO |
$987.00
|
| Rate for Payer: TriWest Veterans Administration |
$244.44
|
| Rate for Payer: United Healthcare Commercial |
$1,144.92
|
| Rate for Payer: United Healthcare Medicare |
$244.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,118.60
|
|
|
HC PRO BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 69100 NONPBBPAYER
|
| Hospital Charge Code |
9836910001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$44.42
|
| Rate for Payer: Beech Street Commercial |
$233.70
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: First Choice Health Commercial |
$221.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.42
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$37.76
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$233.70
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.42
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$44.42
|
| Rate for Payer: WINHealth Partners Commercial |
$209.10
|
|
|
HC PRO BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
9836910001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$44.42
|
| Rate for Payer: Beech Street Commercial |
$187.15
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: First Choice Health Commercial |
$177.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.42
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$37.76
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$187.15
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$44.42
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$44.42
|
| Rate for Payer: WINHealth Partners Commercial |
$167.45
|
|
|
HC PRO BIOPSY INTRANASAL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
9833010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
|
|
HC PRO BIOPSY INTRANASAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 30100 NONPBBPAYER
|
| Hospital Charge Code |
9833010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Beech Street Commercial |
$466.45
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: First Choice Health Commercial |
$441.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$466.45
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: WINHealth Partners Commercial |
$417.35
|
|
|
HC PRO BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$4,385.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
9834710001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$4,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,297.30
|
| Rate for Payer: Aetna of WY Medicare |
$810.58
|
| Rate for Payer: Beech Street Commercial |
$4,165.75
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,253.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,297.30
|
| Rate for Payer: First Choice Health Commercial |
$3,946.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.58
|
| Rate for Payer: HealthUtah PPO |
$4,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,253.45
|
| Rate for Payer: Multiplan Medicare/VA |
$688.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,297.30
|
| Rate for Payer: PacificSource Commercial |
$3,946.50
|
| Rate for Payer: PHCS PPO |
$4,165.75
|
| Rate for Payer: Three Rivers PPO |
$3,288.75
|
| Rate for Payer: TriWest Veterans Administration |
$810.58
|
| Rate for Payer: United Healthcare Commercial |
$3,814.95
|
| Rate for Payer: United Healthcare Medicare |
$810.58
|
| Rate for Payer: WINHealth Partners Commercial |
$3,727.25
|
|
|
HC PRO BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$7,926.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
9832020501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.91 |
| Max. Negotiated Rate |
$7,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,767.48
|
| Rate for Payer: Aetna of WY Medicare |
$146.95
|
| Rate for Payer: Beech Street Commercial |
$7,529.70
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,688.22
|
| Rate for Payer: Cigna of WY Commercial |
$7,767.48
|
| Rate for Payer: First Choice Health Commercial |
$7,133.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,529.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.95
|
| Rate for Payer: HealthUtah PPO |
$7,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,688.22
|
| Rate for Payer: Multiplan Medicare/VA |
$124.91
|
| Rate for Payer: One Health Plan of WY PPO |
$7,767.48
|
| Rate for Payer: PacificSource Commercial |
$7,133.40
|
| Rate for Payer: PHCS PPO |
$7,529.70
|
| Rate for Payer: Three Rivers PPO |
$5,944.50
|
| Rate for Payer: TriWest Veterans Administration |
$146.95
|
| Rate for Payer: United Healthcare Commercial |
$6,895.62
|
| Rate for Payer: United Healthcare Medicare |
$146.95
|
| Rate for Payer: WINHealth Partners Commercial |
$6,737.10
|
|
|
HC PRO BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 20200
|
| Hospital Charge Code |
9832020001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,053.50
|
| Rate for Payer: Aetna of WY Medicare |
$90.49
|
| Rate for Payer: Beech Street Commercial |
$1,021.25
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,042.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,053.50
|
| Rate for Payer: First Choice Health Commercial |
$967.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,021.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.49
|
| Rate for Payer: HealthUtah PPO |
$1,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,042.75
|
| Rate for Payer: Multiplan Medicare/VA |
$76.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,053.50
|
| Rate for Payer: PacificSource Commercial |
$967.50
|
| Rate for Payer: PHCS PPO |
$1,021.25
|
| Rate for Payer: Three Rivers PPO |
$806.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.49
|
| Rate for Payer: United Healthcare Commercial |
$935.25
|
| Rate for Payer: United Healthcare Medicare |
$90.49
|
| Rate for Payer: WINHealth Partners Commercial |
$913.75
|
|
|
HC PRO BIOPSY OF SKIN LESION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
9831110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Beech Street Commercial |
$111.15
|
| Rate for Payer: Beech Street Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: First Choice Health Commercial |
$105.30
|
| Rate for Payer: First Choice Health Commercial |
$140.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$111.15
|
| Rate for Payer: PHCS PPO |
$148.20
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: WINHealth Partners Commercial |
$99.45
|
| Rate for Payer: WINHealth Partners Commercial |
$132.60
|
|
|
HC PRO BIOPSY OF SKIN LESION
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 11100 NONPBBPAYER
|
| Hospital Charge Code |
9831110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Beech Street Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: First Choice Health Commercial |
$131.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$138.70
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$124.10
|
|
|
HC PRO BIOPSY, SOFT TISSUE OF SHLDR; SUPERFICIA
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 23065 NONPBBPAYER
|
| Hospital Charge Code |
9832306501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.24
|
| Rate for Payer: Aetna of WY Medicare |
$155.16
|
| Rate for Payer: Beech Street Commercial |
$796.10
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.86
|
| Rate for Payer: Cigna of WY Commercial |
$821.24
|
| Rate for Payer: First Choice Health Commercial |
$754.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.16
|
| Rate for Payer: HealthUtah PPO |
$838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.86
|
| Rate for Payer: Multiplan Medicare/VA |
$131.89
|
| Rate for Payer: One Health Plan of WY PPO |
$821.24
|
| Rate for Payer: PacificSource Commercial |
$754.20
|
| Rate for Payer: PHCS PPO |
$796.10
|
| Rate for Payer: Three Rivers PPO |
$628.50
|
| Rate for Payer: TriWest Veterans Administration |
$155.16
|
| Rate for Payer: United Healthcare Commercial |
$729.06
|
| Rate for Payer: United Healthcare Medicare |
$155.16
|
| Rate for Payer: WINHealth Partners Commercial |
$712.30
|
|
|
HC PRO BIOPSY, SOFT TISSUE OF SHLDR; SUPERFICIA
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
9832306501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$656.60
|
| Rate for Payer: Aetna of WY Medicare |
$155.16
|
| Rate for Payer: Beech Street Commercial |
$636.50
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$649.90
|
| Rate for Payer: Cigna of WY Commercial |
$656.60
|
| Rate for Payer: First Choice Health Commercial |
$603.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.16
|
| Rate for Payer: HealthUtah PPO |
$670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$649.90
|
| Rate for Payer: Multiplan Medicare/VA |
$131.89
|
| Rate for Payer: One Health Plan of WY PPO |
$656.60
|
| Rate for Payer: PacificSource Commercial |
$603.00
|
| Rate for Payer: PHCS PPO |
$636.50
|
| Rate for Payer: Three Rivers PPO |
$502.50
|
| Rate for Payer: TriWest Veterans Administration |
$155.16
|
| Rate for Payer: United Healthcare Commercial |
$582.90
|
| Rate for Payer: United Healthcare Medicare |
$155.16
|
| Rate for Payer: WINHealth Partners Commercial |
$569.50
|
|
|
HC PRO BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$1,292.00
|
|
|
Service Code
|
HCPCS 41100 NONPBBPAYER
|
| Hospital Charge Code |
9834110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$1,292.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,266.16
|
| Rate for Payer: Aetna of WY Medicare |
$104.47
|
| Rate for Payer: Beech Street Commercial |
$1,227.40
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,253.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,266.16
|
| Rate for Payer: First Choice Health Commercial |
$1,162.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,227.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.47
|
| Rate for Payer: HealthUtah PPO |
$1,292.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,253.24
|
| Rate for Payer: Multiplan Medicare/VA |
$88.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,266.16
|
| Rate for Payer: PacificSource Commercial |
$1,162.80
|
| Rate for Payer: PHCS PPO |
$1,227.40
|
| Rate for Payer: Three Rivers PPO |
$969.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.47
|
| Rate for Payer: United Healthcare Commercial |
$1,124.04
|
| Rate for Payer: United Healthcare Medicare |
$104.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,098.20
|
|
|
HC PRO BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
9834110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$1,034.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,013.32
|
| Rate for Payer: Aetna of WY Medicare |
$104.47
|
| Rate for Payer: Beech Street Commercial |
$982.30
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,002.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,013.32
|
| Rate for Payer: First Choice Health Commercial |
$930.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$982.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.47
|
| Rate for Payer: HealthUtah PPO |
$1,034.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,002.98
|
| Rate for Payer: Multiplan Medicare/VA |
$88.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,013.32
|
| Rate for Payer: PacificSource Commercial |
$930.60
|
| Rate for Payer: PHCS PPO |
$982.30
|
| Rate for Payer: Three Rivers PPO |
$775.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.47
|
| Rate for Payer: United Healthcare Commercial |
$899.58
|
| Rate for Payer: United Healthcare Medicare |
$104.47
|
| Rate for Payer: WINHealth Partners Commercial |
$878.90
|
|
|
HC PRO BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$2,802.00
|
|
|
Service Code
|
HCPCS 57105 NONPBBPAYER
|
| Hospital Charge Code |
9835710501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$2,802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,745.96
|
| Rate for Payer: Aetna of WY Medicare |
$143.23
|
| Rate for Payer: Beech Street Commercial |
$2,661.90
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,717.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,745.96
|
| Rate for Payer: First Choice Health Commercial |
$2,521.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.23
|
| Rate for Payer: HealthUtah PPO |
$2,802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,717.94
|
| Rate for Payer: Multiplan Medicare/VA |
$121.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,745.96
|
| Rate for Payer: PacificSource Commercial |
$2,521.80
|
| Rate for Payer: PHCS PPO |
$2,661.90
|
| Rate for Payer: Three Rivers PPO |
$2,101.50
|
| Rate for Payer: TriWest Veterans Administration |
$143.23
|
| Rate for Payer: United Healthcare Commercial |
$2,437.74
|
| Rate for Payer: United Healthcare Medicare |
$143.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,381.70
|
|
