|
HC PRO BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 57105
|
| Hospital Charge Code |
9835710501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,197.16
|
| Rate for Payer: Aetna of WY Medicare |
$143.23
|
| Rate for Payer: Beech Street Commercial |
$2,129.90
|
| Rate for Payer: Cash Price |
$1,569.40
|
| Rate for Payer: Cash Price |
$1,569.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,174.74
|
| Rate for Payer: Cigna of WY Commercial |
$2,197.16
|
| Rate for Payer: First Choice Health Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,129.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.23
|
| Rate for Payer: HealthUtah PPO |
$2,242.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,174.74
|
| Rate for Payer: Multiplan Medicare/VA |
$121.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,197.16
|
| Rate for Payer: PacificSource Commercial |
$2,017.80
|
| Rate for Payer: PHCS PPO |
$2,129.90
|
| Rate for Payer: Three Rivers PPO |
$1,681.50
|
| Rate for Payer: TriWest Veterans Administration |
$143.23
|
| Rate for Payer: United Healthcare Commercial |
$1,950.54
|
| Rate for Payer: United Healthcare Medicare |
$143.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,905.70
|
|
|
HC PRO BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 57100
|
| Hospital Charge Code |
9835710001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$1,294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,268.12
|
| Rate for Payer: Aetna of WY Medicare |
$62.47
|
| Rate for Payer: Beech Street Commercial |
$1,229.30
|
| Rate for Payer: Cash Price |
$905.80
|
| Rate for Payer: Cash Price |
$905.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,255.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,268.12
|
| Rate for Payer: First Choice Health Commercial |
$1,164.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,229.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.47
|
| Rate for Payer: HealthUtah PPO |
$1,294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,255.18
|
| Rate for Payer: Multiplan Medicare/VA |
$53.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,268.12
|
| Rate for Payer: PacificSource Commercial |
$1,164.60
|
| Rate for Payer: PHCS PPO |
$1,229.30
|
| Rate for Payer: Three Rivers PPO |
$970.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.47
|
| Rate for Payer: United Healthcare Commercial |
$1,125.78
|
| Rate for Payer: United Healthcare Medicare |
$62.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,099.90
|
|
|
HC PRO BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 57100 NONPBBPAYER
|
| Hospital Charge Code |
9835710001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,584.66
|
| Rate for Payer: Aetna of WY Medicare |
$62.47
|
| Rate for Payer: Beech Street Commercial |
$1,536.15
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,568.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,584.66
|
| Rate for Payer: First Choice Health Commercial |
$1,455.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,536.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.47
|
| Rate for Payer: HealthUtah PPO |
$1,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,568.49
|
| Rate for Payer: Multiplan Medicare/VA |
$53.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,584.66
|
| Rate for Payer: PacificSource Commercial |
$1,455.30
|
| Rate for Payer: PHCS PPO |
$1,536.15
|
| Rate for Payer: Three Rivers PPO |
$1,212.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.47
|
| Rate for Payer: United Healthcare Commercial |
$1,406.79
|
| Rate for Payer: United Healthcare Medicare |
$62.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,374.45
|
|
|
HC PRO BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 40808 NONPBBPAYER
|
| Hospital Charge Code |
9834080801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$86.97
|
| Rate for Payer: Beech Street Commercial |
$422.75
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: First Choice Health Commercial |
$400.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.97
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$73.92
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$422.75
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.97
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$86.97
|
| Rate for Payer: WINHealth Partners Commercial |
$378.25
|
|
|
HC PRO BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
9834080801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$348.88
|
| Rate for Payer: Aetna of WY Medicare |
$86.97
|
| Rate for Payer: Beech Street Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$249.20
|
| Rate for Payer: Cash Price |
$249.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$345.32
|
| Rate for Payer: Cigna of WY Commercial |
$348.88
|
| Rate for Payer: First Choice Health Commercial |
$320.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$338.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.97
|
| Rate for Payer: HealthUtah PPO |
$356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$345.32
|
| Rate for Payer: Multiplan Medicare/VA |
$73.92
|
| Rate for Payer: One Health Plan of WY PPO |
$348.88
|
| Rate for Payer: PacificSource Commercial |
$320.40
|
| Rate for Payer: PHCS PPO |
$338.20
|
| Rate for Payer: Three Rivers PPO |
$267.00
|
| Rate for Payer: TriWest Veterans Administration |
$86.97
|
| Rate for Payer: United Healthcare Commercial |
$309.72
|
| Rate for Payer: United Healthcare Medicare |
$86.97
|
| Rate for Payer: WINHealth Partners Commercial |
$302.60
|
|
|
HC PRO BIOPSY VULVA/PERINEUM,ONE LESN
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
9835660501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$557.62
|
| Rate for Payer: Aetna of WY Medicare |
$56.42
|
| Rate for Payer: Beech Street Commercial |
$540.55
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$551.93
|
| Rate for Payer: Cigna of WY Commercial |
$557.62
|
| Rate for Payer: First Choice Health Commercial |
$512.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$540.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.42
|
| Rate for Payer: HealthUtah PPO |
$569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$551.93
|
| Rate for Payer: Multiplan Medicare/VA |
$47.96
|
| Rate for Payer: One Health Plan of WY PPO |
$557.62
|
| Rate for Payer: PacificSource Commercial |
$512.10
|
| Rate for Payer: PHCS PPO |
$540.55
|
| Rate for Payer: Three Rivers PPO |
$426.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.42
|
| Rate for Payer: United Healthcare Commercial |
$495.03
|
| Rate for Payer: United Healthcare Medicare |
$56.42
|
| Rate for Payer: WINHealth Partners Commercial |
$483.65
|
|
|
HC PRO BIOPSY VULVA/PERINEUM,ONE LESN
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 56605 NONPBBPAYER
|
| Hospital Charge Code |
9835660501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$696.78
|
| Rate for Payer: Aetna of WY Medicare |
$56.42
|
| Rate for Payer: Beech Street Commercial |
$675.45
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$689.67
|
| Rate for Payer: Cigna of WY Commercial |
$696.78
|
| Rate for Payer: First Choice Health Commercial |
$639.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$675.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.42
|
| Rate for Payer: HealthUtah PPO |
$711.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$689.67
|
| Rate for Payer: Multiplan Medicare/VA |
$47.96
|
| Rate for Payer: One Health Plan of WY PPO |
$696.78
|
| Rate for Payer: PacificSource Commercial |
$639.90
|
| Rate for Payer: PHCS PPO |
$675.45
|
| Rate for Payer: Three Rivers PPO |
$533.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.42
|
| Rate for Payer: United Healthcare Commercial |
$618.57
|
| Rate for Payer: United Healthcare Medicare |
$56.42
|
| Rate for Payer: WINHealth Partners Commercial |
$604.35
|
|
|
HC PRO BLADDER IRRIGATION
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
9835170001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.42
|
| Rate for Payer: Aetna of WY Medicare |
$28.46
|
| Rate for Payer: Aetna of WY Medicare |
$28.46
|
| Rate for Payer: Beech Street Commercial |
$122.55
|
| Rate for Payer: Beech Street Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.13
|
| Rate for Payer: Cigna of WY Commercial |
$126.42
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: First Choice Health Commercial |
$116.10
|
| Rate for Payer: First Choice Health Commercial |
$230.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$122.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.46
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: HealthUtah PPO |
$129.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.13
|
| Rate for Payer: Multiplan Medicare/VA |
$24.19
|
| Rate for Payer: Multiplan Medicare/VA |
$24.19
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: One Health Plan of WY PPO |
$126.42
|
| Rate for Payer: PacificSource Commercial |
$116.10
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$243.20
|
| Rate for Payer: PHCS PPO |
$122.55
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: Three Rivers PPO |
$96.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.46
|
| Rate for Payer: TriWest Veterans Administration |
$28.46
|
| Rate for Payer: United Healthcare Commercial |
$112.23
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$28.46
|
| Rate for Payer: United Healthcare Medicare |
$28.46
|
| Rate for Payer: WINHealth Partners Commercial |
$217.60
|
| Rate for Payer: WINHealth Partners Commercial |
$109.65
|
|
|
HC PRO BLADDER IRRIGATION
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 51700 NONPBBPAYER
|
| Hospital Charge Code |
9835170001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$28.46
|
| Rate for Payer: Beech Street Commercial |
$152.95
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: First Choice Health Commercial |
$144.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.46
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$24.19
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$152.95
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.46
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$28.46
|
| Rate for Payer: WINHealth Partners Commercial |
$136.85
|
|
|
HC PRO BONE BIOPSY,TROCAR/NEEDLE DEEP
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
9832022501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$122.62
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.62
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$104.23
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$122.62
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$122.62
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
HC PRO BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
9832090001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$925.12
|
| Rate for Payer: Aetna of WY Medicare |
$172.22
|
| Rate for Payer: Beech Street Commercial |
$896.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$915.68
|
| Rate for Payer: Cigna of WY Commercial |
$925.12
|
| Rate for Payer: First Choice Health Commercial |
$849.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$896.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.22
|
| Rate for Payer: HealthUtah PPO |
$944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$915.68
|
| Rate for Payer: Multiplan Medicare/VA |
$146.39
|
| Rate for Payer: One Health Plan of WY PPO |
$925.12
|
| Rate for Payer: PacificSource Commercial |
$849.60
|
| Rate for Payer: PHCS PPO |
$896.80
|
| Rate for Payer: Three Rivers PPO |
$708.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.22
|
| Rate for Payer: United Healthcare Commercial |
$821.28
|
| Rate for Payer: United Healthcare Medicare |
$172.22
|
| Rate for Payer: WINHealth Partners Commercial |
$802.40
|
|
|
HC PRO BREAST CYST ASPIRATION
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 19000 NONPBBPAYER
|
| Hospital Charge Code |
9831900001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$39.99
|
| Rate for Payer: Beech Street Commercial |
$211.85
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: First Choice Health Commercial |
$200.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.99
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$33.99
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$211.85
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.99
|
| Rate for Payer: United Healthcare Commercial |
$194.01
|
| Rate for Payer: United Healthcare Medicare |
$39.99
|
| Rate for Payer: WINHealth Partners Commercial |
$189.55
|
|
|
HC PRO BREAST CYST ASPIRATION
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
9831900001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$39.99
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.99
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$33.99
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$39.99
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$39.99
|
| Rate for Payer: WINHealth Partners Commercial |
$151.30
|
|
|
HC PRO BREATHING CAPACITY TEST INTERP
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 94010 26
|
| Hospital Charge Code |
9839401001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
HC PRO BREATHING CAPACITY TEST INTERP
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 94010 50,NONPBBPAYER
|
| Hospital Charge Code |
9839401001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$26.68
|
| Rate for Payer: Beech Street Commercial |
$99.75
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: First Choice Health Commercial |
$94.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.68
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$22.68
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$99.75
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.68
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$26.68
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
|
|
HC PRO BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
9833162201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$125.05
|
| Rate for Payer: Beech Street Commercial |
$1,157.10
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: First Choice Health Commercial |
$1,096.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.05
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$106.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,157.10
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.05
|
| Rate for Payer: United Healthcare Commercial |
$1,059.66
|
| Rate for Payer: United Healthcare Medicare |
$125.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,035.30
|
|
|
HC PRO BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$4,012.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
9834510001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$250.05 |
| Max. Negotiated Rate |
$4,012.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,931.76
|
| Rate for Payer: Aetna of WY Medicare |
$294.18
|
| Rate for Payer: Beech Street Commercial |
$3,811.40
|
| Rate for Payer: Cash Price |
$2,808.40
|
| Rate for Payer: Cash Price |
$2,808.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,891.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,931.76
|
| Rate for Payer: First Choice Health Commercial |
$3,610.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,811.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.18
|
| Rate for Payer: HealthUtah PPO |
$4,012.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,891.64
|
| Rate for Payer: Multiplan Medicare/VA |
$250.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,931.76
|
| Rate for Payer: PacificSource Commercial |
$3,610.80
|
| Rate for Payer: PHCS PPO |
$3,811.40
|
| Rate for Payer: Three Rivers PPO |
$3,009.00
|
| Rate for Payer: TriWest Veterans Administration |
$294.18
|
| Rate for Payer: United Healthcare Commercial |
$3,490.44
|
| Rate for Payer: United Healthcare Medicare |
$294.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3,410.20
|
|
|
HC PRO BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
9821910001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Aetna of WY Medicare |
$64.80
|
| Rate for Payer: Beech Street Commercial |
$340.10
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: First Choice Health Commercial |
$322.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.80
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Multiplan Medicare/VA |
$55.08
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$340.10
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$64.80
|
| Rate for Payer: WINHealth Partners Commercial |
$304.30
|
|
|
HC PRO BX,VULVA/PERINEUM,ADDL LESION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 56606 NONPBBPAYER
|
| Hospital Charge Code |
9835660601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| 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: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| 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: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$266.90
|
|
|
HC PRO BX,VULVA/PERINEUM,ADDL LESION
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
9835660601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$238.45
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: First Choice Health Commercial |
$225.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$238.45
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$218.37
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$213.35
|
|
|
HC PRO CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$6,894.00
|
|
|
Service Code
|
HCPCS 25320 50
|
| Hospital Charge Code |
9832532001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$6,894.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,756.12
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$6,549.30
|
| Rate for Payer: Cash Price |
$4,825.80
|
| Rate for Payer: Cash Price |
$4,825.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,687.18
|
| Rate for Payer: Cigna of WY Commercial |
$6,756.12
|
| Rate for Payer: First Choice Health Commercial |
$6,204.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,549.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$6,894.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,687.18
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$6,756.12
|
| Rate for Payer: PacificSource Commercial |
$6,204.60
|
| Rate for Payer: PHCS PPO |
$6,549.30
|
| Rate for Payer: Three Rivers PPO |
$5,170.50
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$5,997.78
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$5,859.90
|
|
|
HC PRO CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
9832532001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,378.06
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$3,274.65
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,343.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,378.06
|
| Rate for Payer: First Choice Health Commercial |
$3,102.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,274.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$3,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,343.59
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,378.06
|
| Rate for Payer: PacificSource Commercial |
$3,102.30
|
| Rate for Payer: PHCS PPO |
$3,274.65
|
| Rate for Payer: Three Rivers PPO |
$2,585.25
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$2,998.89
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,929.95
|
|
|
HC PRO CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
9832302001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$3,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,188.92
|
| Rate for Payer: Aetna of WY Medicare |
$671.56
|
| Rate for Payer: Beech Street Commercial |
$3,091.30
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,156.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,188.92
|
| Rate for Payer: First Choice Health Commercial |
$2,928.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,091.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.56
|
| Rate for Payer: HealthUtah PPO |
$3,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,156.38
|
| Rate for Payer: Multiplan Medicare/VA |
$570.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,188.92
|
| Rate for Payer: PacificSource Commercial |
$2,928.60
|
| Rate for Payer: PHCS PPO |
$3,091.30
|
| Rate for Payer: Three Rivers PPO |
$2,440.50
|
| Rate for Payer: TriWest Veterans Administration |
$671.56
|
| Rate for Payer: United Healthcare Commercial |
$2,830.98
|
| Rate for Payer: United Healthcare Medicare |
$671.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,765.90
|
|
|
HC PRO CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
HCPCS 26516
|
| Hospital Charge Code |
9832651601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$4,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,484.48
|
| Rate for Payer: Aetna of WY Medicare |
$728.47
|
| Rate for Payer: Beech Street Commercial |
$4,347.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,438.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,484.48
|
| Rate for Payer: First Choice Health Commercial |
$4,118.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.47
|
| Rate for Payer: HealthUtah PPO |
$4,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,438.72
|
| Rate for Payer: Multiplan Medicare/VA |
$619.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,484.48
|
| Rate for Payer: PacificSource Commercial |
$4,118.40
|
| Rate for Payer: PHCS PPO |
$4,347.20
|
| Rate for Payer: Three Rivers PPO |
$3,432.00
|
| Rate for Payer: TriWest Veterans Administration |
$728.47
|
| Rate for Payer: United Healthcare Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare Medicare |
$728.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,889.60
|
|
|
HC PRO CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$5,474.00
|
|
|
Service Code
|
HCPCS 23462
|
| Hospital Charge Code |
9832346201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$5,474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,364.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,027.90
|
| Rate for Payer: Beech Street Commercial |
$5,200.30
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,309.78
|
| Rate for Payer: Cigna of WY Commercial |
$5,364.52
|
| Rate for Payer: First Choice Health Commercial |
$4,926.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,200.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,027.90
|
| Rate for Payer: HealthUtah PPO |
$5,474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,309.78
|
| Rate for Payer: Multiplan Medicare/VA |
$873.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,364.52
|
| Rate for Payer: PacificSource Commercial |
$4,926.60
|
| Rate for Payer: PHCS PPO |
$5,200.30
|
| Rate for Payer: Three Rivers PPO |
$4,105.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,027.90
|
| Rate for Payer: United Healthcare Commercial |
$4,762.38
|
| Rate for Payer: United Healthcare Medicare |
$1,027.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,652.90
|
|
