|
HC PRO CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
9752098501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$136.44
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.44
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Multiplan Medicare/VA |
$115.97
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$136.44
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
HC PRO CRICOPHARYNGEAL MYOTOMY
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 43030
|
| Hospital Charge Code |
9834303001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$508.40
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$508.40
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$432.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$508.40
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$508.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
HC PRO CRITICAL CARE, ADDL 30 MIN
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
9839929201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.84 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.98
|
| Rate for Payer: Aetna of WY Medicare |
$102.16
|
| Rate for Payer: Beech Street Commercial |
$1,235.95
|
| Rate for Payer: Cash Price |
$910.70
|
| Rate for Payer: Cash Price |
$910.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.97
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.98
|
| Rate for Payer: First Choice Health Commercial |
$1,170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.16
|
| Rate for Payer: HealthUtah PPO |
$1,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.97
|
| Rate for Payer: Multiplan Medicare/VA |
$86.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.98
|
| Rate for Payer: PacificSource Commercial |
$1,170.90
|
| Rate for Payer: PHCS PPO |
$1,235.95
|
| Rate for Payer: Three Rivers PPO |
$975.75
|
| Rate for Payer: TriWest Veterans Administration |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$1,131.87
|
| Rate for Payer: United Healthcare Medicare |
$102.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.95
|
|
|
HC PRO CRITICAL CARE, E/M 30-74 MINUTES
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
9839929101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$1,814.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,777.72
|
| Rate for Payer: Aetna of WY Medicare |
$203.03
|
| Rate for Payer: Beech Street Commercial |
$1,723.30
|
| Rate for Payer: Cash Price |
$1,269.80
|
| Rate for Payer: Cash Price |
$1,269.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,759.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,777.72
|
| Rate for Payer: First Choice Health Commercial |
$1,632.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,723.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.03
|
| Rate for Payer: HealthUtah PPO |
$1,814.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,759.58
|
| Rate for Payer: Multiplan Medicare/VA |
$172.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,777.72
|
| Rate for Payer: PacificSource Commercial |
$1,632.60
|
| Rate for Payer: PHCS PPO |
$1,723.30
|
| Rate for Payer: Three Rivers PPO |
$1,360.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.03
|
| Rate for Payer: United Healthcare Commercial |
$1,578.18
|
| Rate for Payer: United Healthcare Medicare |
$203.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,723.30
|
|
|
HC PRO CRYOCAUTERY
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
9835751101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.02 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$554.68
|
| Rate for Payer: Aetna of WY Medicare |
$143.55
|
| Rate for Payer: Beech Street Commercial |
$537.70
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.02
|
| Rate for Payer: Cigna of WY Commercial |
$554.68
|
| Rate for Payer: First Choice Health Commercial |
$509.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$537.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.55
|
| Rate for Payer: HealthUtah PPO |
$566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.02
|
| Rate for Payer: Multiplan Medicare/VA |
$122.02
|
| Rate for Payer: One Health Plan of WY PPO |
$554.68
|
| Rate for Payer: PacificSource Commercial |
$509.40
|
| Rate for Payer: PHCS PPO |
$537.70
|
| Rate for Payer: Three Rivers PPO |
$424.50
|
| Rate for Payer: TriWest Veterans Administration |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$492.42
|
| Rate for Payer: United Healthcare Medicare |
$143.55
|
| Rate for Payer: WINHealth Partners Commercial |
$481.10
|
|
|
HC PRO CRYOCAUTERY
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
HCPCS 57511 NONPBBPAYER
|
| Hospital Charge Code |
9835751101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.02 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$693.84
|
| Rate for Payer: Aetna of WY Medicare |
$143.55
|
| Rate for Payer: Beech Street Commercial |
$672.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$686.76
|
| Rate for Payer: Cigna of WY Commercial |
$693.84
|
| Rate for Payer: First Choice Health Commercial |
$637.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$672.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.55
|
| Rate for Payer: HealthUtah PPO |
$708.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$686.76
|
| Rate for Payer: Multiplan Medicare/VA |
$122.02
|
| Rate for Payer: One Health Plan of WY PPO |
$693.84
|
| Rate for Payer: PacificSource Commercial |
$637.20
|
| Rate for Payer: PHCS PPO |
$672.60
|
| Rate for Payer: Three Rivers PPO |
$531.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$615.96
|
| Rate for Payer: United Healthcare Medicare |
$143.55
|
| Rate for Payer: WINHealth Partners Commercial |
$601.80
|
|
|
HC PRO CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Hospital Charge Code |
9727557101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.68
|
| Rate for Payer: Aetna of WY Medicare |
$26.27
|
| Rate for Payer: Beech Street Commercial |
$347.70
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.02
|
| Rate for Payer: Cigna of WY Commercial |
$358.68
|
| Rate for Payer: First Choice Health Commercial |
$329.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.27
|
| Rate for Payer: HealthUtah PPO |
$366.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.02
|
| Rate for Payer: Multiplan Medicare/VA |
$22.33
|
| Rate for Payer: One Health Plan of WY PPO |
$358.68
|
| Rate for Payer: PacificSource Commercial |
$329.40
|
| Rate for Payer: PHCS PPO |
$347.70
|
| Rate for Payer: Three Rivers PPO |
$274.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.27
|
| Rate for Payer: United Healthcare Commercial |
$318.42
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WINHealth Partners Commercial |
$347.70
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 30903 NONPBBPAYER
|
| Hospital Charge Code |
9833090301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$830.06
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$804.65
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$821.59
|
| Rate for Payer: Cigna of WY Commercial |
$830.06
|
| Rate for Payer: First Choice Health Commercial |
$762.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$821.59
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$830.06
|
| Rate for Payer: PacificSource Commercial |
$762.30
|
| Rate for Payer: PHCS PPO |
$804.65
|
| Rate for Payer: Three Rivers PPO |
$635.25
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$736.89
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$719.95
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
Both
|
$1,356.00
|
|
|
Service Code
|
HCPCS 30903 50
|
| Hospital Charge Code |
9833090301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,328.88
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$1,288.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: Cash Price |
$949.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,315.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,328.88
|
| Rate for Payer: First Choice Health Commercial |
$1,220.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,288.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$1,356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,315.32
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,328.88
|
| Rate for Payer: PacificSource Commercial |
$1,220.40
|
| Rate for Payer: PHCS PPO |
$1,288.20
|
| Rate for Payer: Three Rivers PPO |
$1,017.00
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$1,179.72
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,152.60
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
9833090301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$678.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$664.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$569.38
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$551.95
|
| Rate for Payer: Beech Street Commercial |
$644.10
|
| Rate for Payer: Cash Price |
$406.70
|
| Rate for Payer: Cash Price |
$406.70
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$657.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$563.57
|
| Rate for Payer: Cigna of WY Commercial |
$569.38
|
| Rate for Payer: Cigna of WY Commercial |
$664.44
|
| Rate for Payer: First Choice Health Commercial |
$522.90
|
| Rate for Payer: First Choice Health Commercial |
$610.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$644.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$678.00
|
| Rate for Payer: HealthUtah PPO |
$581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$657.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$563.57
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$664.44
|
| Rate for Payer: One Health Plan of WY PPO |
$569.38
|
| Rate for Payer: PacificSource Commercial |
$522.90
|
| Rate for Payer: PacificSource Commercial |
$610.20
|
| Rate for Payer: PHCS PPO |
$644.10
|
| Rate for Payer: PHCS PPO |
$551.95
|
| Rate for Payer: Three Rivers PPO |
$508.50
|
| Rate for Payer: Three Rivers PPO |
$435.75
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$505.47
|
| Rate for Payer: United Healthcare Commercial |
$589.86
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$576.30
|
| Rate for Payer: WINHealth Partners Commercial |
$493.85
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 30903 50,NONPBBPAYER
|
| Hospital Charge Code |
9833090301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,660.12
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$1,609.30
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,643.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,660.12
|
| Rate for Payer: First Choice Health Commercial |
$1,524.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,609.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$1,694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,643.18
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,660.12
|
| Rate for Payer: PacificSource Commercial |
$1,524.60
|
| Rate for Payer: PHCS PPO |
$1,609.30
|
| Rate for Payer: Three Rivers PPO |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$1,473.78
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,439.90
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 30901 NONPBBPAYER
|
| Hospital Charge Code |
9833090101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$532.14
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$515.85
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.71
|
| Rate for Payer: Cigna of WY Commercial |
$532.14
|
| Rate for Payer: First Choice Health Commercial |
$488.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.71
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$532.14
|
| Rate for Payer: PacificSource Commercial |
$488.70
|
| Rate for Payer: PHCS PPO |
$515.85
|
| Rate for Payer: Three Rivers PPO |
$407.25
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$472.41
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$461.55
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
9833090101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$425.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$489.25
|
| Rate for Payer: Beech Street Commercial |
$412.30
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.98
|
| Rate for Payer: Cigna of WY Commercial |
$425.32
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: First Choice Health Commercial |
$463.50
|
| Rate for Payer: First Choice Health Commercial |
$390.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$412.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$434.00
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.98
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: One Health Plan of WY PPO |
$425.32
|
| Rate for Payer: PacificSource Commercial |
$390.60
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$412.30
|
| Rate for Payer: PHCS PPO |
$489.25
|
| Rate for Payer: Three Rivers PPO |
$325.50
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Commercial |
$377.58
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$368.90
|
| Rate for Payer: WINHealth Partners Commercial |
$437.75
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
9833090101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$850.64
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$824.60
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$841.96
|
| Rate for Payer: Cigna of WY Commercial |
$850.64
|
| Rate for Payer: First Choice Health Commercial |
$781.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$824.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$868.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$841.96
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$850.64
|
| Rate for Payer: PacificSource Commercial |
$781.20
|
| Rate for Payer: PHCS PPO |
$824.60
|
| Rate for Payer: Three Rivers PPO |
$651.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$755.16
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$737.80
|
|
|
HC PRO CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
HCPCS 30901 50,NONPBBPAYER
|
| Hospital Charge Code |
9833090101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$1,086.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,064.28
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$1,031.70
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,053.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,064.28
|
| Rate for Payer: First Choice Health Commercial |
$977.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$1,086.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,053.42
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,064.28
|
| Rate for Payer: PacificSource Commercial |
$977.40
|
| Rate for Payer: PHCS PPO |
$1,031.70
|
| Rate for Payer: Three Rivers PPO |
$814.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$944.82
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$923.10
|
|
|
HC PRO CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
9833090501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$974.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$954.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$708.54
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$686.85
|
| Rate for Payer: Beech Street Commercial |
$925.30
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$681.80
|
| Rate for Payer: Cash Price |
$681.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$944.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$701.31
|
| Rate for Payer: Cigna of WY Commercial |
$708.54
|
| Rate for Payer: Cigna of WY Commercial |
$954.52
|
| Rate for Payer: First Choice Health Commercial |
$650.70
|
| Rate for Payer: First Choice Health Commercial |
$876.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$925.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$686.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$974.00
|
| Rate for Payer: HealthUtah PPO |
$723.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$944.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$701.31
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$954.52
|
| Rate for Payer: One Health Plan of WY PPO |
$708.54
|
| Rate for Payer: PacificSource Commercial |
$650.70
|
| Rate for Payer: PacificSource Commercial |
$876.60
|
| Rate for Payer: PHCS PPO |
$925.30
|
| Rate for Payer: PHCS PPO |
$686.85
|
| Rate for Payer: Three Rivers PPO |
$730.50
|
| Rate for Payer: Three Rivers PPO |
$542.25
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$629.01
|
| Rate for Payer: United Healthcare Commercial |
$847.38
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$827.90
|
| Rate for Payer: WINHealth Partners Commercial |
$614.55
|
|
|
HC PRO CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
Both
|
$2,434.00
|
|
|
Service Code
|
HCPCS 30905 50,NONPBBPAYER
|
| Hospital Charge Code |
9833090501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$2,434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,385.32
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$2,312.30
|
| Rate for Payer: Cash Price |
$1,703.80
|
| Rate for Payer: Cash Price |
$1,703.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,360.98
|
| Rate for Payer: Cigna of WY Commercial |
$2,385.32
|
| Rate for Payer: First Choice Health Commercial |
$2,190.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,312.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$2,434.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,360.98
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,385.32
|
| Rate for Payer: PacificSource Commercial |
$2,190.60
|
| Rate for Payer: PHCS PPO |
$2,312.30
|
| Rate for Payer: Three Rivers PPO |
$1,825.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$2,117.58
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,068.90
|
|
|
HC PRO CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 30905 NONPBBPAYER
|
| Hospital Charge Code |
9833090501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$1,217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,192.66
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$1,156.15
|
| Rate for Payer: Cash Price |
$851.90
|
| Rate for Payer: Cash Price |
$851.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,180.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,192.66
|
| Rate for Payer: First Choice Health Commercial |
$1,095.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,156.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$1,217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,180.49
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,192.66
|
| Rate for Payer: PacificSource Commercial |
$1,095.30
|
| Rate for Payer: PHCS PPO |
$1,156.15
|
| Rate for Payer: Three Rivers PPO |
$912.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$1,058.79
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,034.45
|
|
|
HC PRO CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
HCPCS 30905 50
|
| Hospital Charge Code |
9833090501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$1,948.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,909.04
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$1,850.60
|
| Rate for Payer: Cash Price |
$1,363.60
|
| Rate for Payer: Cash Price |
$1,363.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,889.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,909.04
|
| Rate for Payer: First Choice Health Commercial |
$1,753.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,850.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$1,948.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,889.56
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,909.04
|
| Rate for Payer: PacificSource Commercial |
$1,753.20
|
| Rate for Payer: PHCS PPO |
$1,850.60
|
| Rate for Payer: Three Rivers PPO |
$1,461.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$1,694.76
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,655.80
|
|
|
HC PRO CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
9835916001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,395.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$430.22
|
| Rate for Payer: Aetna of WY Medicare |
$180.03
|
| Rate for Payer: Aetna of WY Medicare |
$180.03
|
| Rate for Payer: Beech Street Commercial |
$417.05
|
| Rate for Payer: Beech Street Commercial |
$1,352.80
|
| Rate for Payer: Cash Price |
$307.30
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$307.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$425.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,381.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,395.52
|
| Rate for Payer: Cigna of WY Commercial |
$430.22
|
| Rate for Payer: First Choice Health Commercial |
$395.10
|
| Rate for Payer: First Choice Health Commercial |
$1,281.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,352.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$417.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.03
|
| Rate for Payer: HealthUtah PPO |
$1,424.00
|
| Rate for Payer: HealthUtah PPO |
$439.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$425.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,381.28
|
| Rate for Payer: Multiplan Medicare/VA |
$153.03
|
| Rate for Payer: Multiplan Medicare/VA |
$153.03
|
| Rate for Payer: One Health Plan of WY PPO |
$430.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,395.52
|
| Rate for Payer: PacificSource Commercial |
$1,281.60
|
| Rate for Payer: PacificSource Commercial |
$395.10
|
| Rate for Payer: PHCS PPO |
$1,352.80
|
| Rate for Payer: PHCS PPO |
$417.05
|
| Rate for Payer: Three Rivers PPO |
$1,068.00
|
| Rate for Payer: Three Rivers PPO |
$329.25
|
| Rate for Payer: TriWest Veterans Administration |
$180.03
|
| Rate for Payer: TriWest Veterans Administration |
$180.03
|
| Rate for Payer: United Healthcare Commercial |
$381.93
|
| Rate for Payer: United Healthcare Commercial |
$1,238.88
|
| Rate for Payer: United Healthcare Medicare |
$180.03
|
| Rate for Payer: United Healthcare Medicare |
$180.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,210.40
|
| Rate for Payer: WINHealth Partners Commercial |
$373.15
|
|
|
HC PRO CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 59160 NONPBBPAYER
|
| Hospital Charge Code |
9835916001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$538.02
|
| Rate for Payer: Aetna of WY Medicare |
$180.03
|
| Rate for Payer: Beech Street Commercial |
$521.55
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$532.53
|
| Rate for Payer: Cigna of WY Commercial |
$538.02
|
| Rate for Payer: First Choice Health Commercial |
$494.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$521.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.03
|
| Rate for Payer: HealthUtah PPO |
$549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$532.53
|
| Rate for Payer: Multiplan Medicare/VA |
$153.03
|
| Rate for Payer: One Health Plan of WY PPO |
$538.02
|
| Rate for Payer: PacificSource Commercial |
$494.10
|
| Rate for Payer: PHCS PPO |
$521.55
|
| Rate for Payer: Three Rivers PPO |
$411.75
|
| Rate for Payer: TriWest Veterans Administration |
$180.03
|
| Rate for Payer: United Healthcare Commercial |
$477.63
|
| Rate for Payer: United Healthcare Medicare |
$180.03
|
| Rate for Payer: WINHealth Partners Commercial |
$466.65
|
|
|
HC PRO CYST / COMPLEX PILONIDAL ID
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
9831008101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.93 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$673.26
|
| Rate for Payer: Aetna of WY Medicare |
$164.62
|
| Rate for Payer: Beech Street Commercial |
$652.65
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$666.39
|
| Rate for Payer: Cigna of WY Commercial |
$673.26
|
| Rate for Payer: First Choice Health Commercial |
$618.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$652.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.62
|
| Rate for Payer: HealthUtah PPO |
$687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$666.39
|
| Rate for Payer: Multiplan Medicare/VA |
$139.93
|
| Rate for Payer: One Health Plan of WY PPO |
$673.26
|
| Rate for Payer: PacificSource Commercial |
$618.30
|
| Rate for Payer: PHCS PPO |
$652.65
|
| Rate for Payer: Three Rivers PPO |
$515.25
|
| Rate for Payer: TriWest Veterans Administration |
$164.62
|
| Rate for Payer: United Healthcare Commercial |
$597.69
|
| Rate for Payer: United Healthcare Medicare |
$164.62
|
| Rate for Payer: WINHealth Partners Commercial |
$583.95
|
|
|
HC PRO CYST / COMPLEX PILONIDAL ID
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 10081 NONPBBPAYER
|
| Hospital Charge Code |
9831008101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.93 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$164.62
|
| Rate for Payer: Beech Street Commercial |
$816.05
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$833.23
|
| Rate for Payer: Cigna of WY Commercial |
$841.82
|
| Rate for Payer: First Choice Health Commercial |
$773.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$816.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.62
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$139.93
|
| Rate for Payer: One Health Plan of WY PPO |
$841.82
|
| Rate for Payer: PacificSource Commercial |
$773.10
|
| Rate for Payer: PHCS PPO |
$816.05
|
| Rate for Payer: Three Rivers PPO |
$644.25
|
| Rate for Payer: TriWest Veterans Administration |
$164.62
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$164.62
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
HC PRO CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
9835231001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,002.14
|
| Rate for Payer: Aetna of WY Medicare |
$143.70
|
| Rate for Payer: Beech Street Commercial |
$1,940.85
|
| Rate for Payer: Cash Price |
$1,430.10
|
| Rate for Payer: Cash Price |
$1,430.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,981.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,002.14
|
| Rate for Payer: First Choice Health Commercial |
$1,838.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,940.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.70
|
| Rate for Payer: HealthUtah PPO |
$2,043.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,981.71
|
| Rate for Payer: Multiplan Medicare/VA |
$122.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,002.14
|
| Rate for Payer: PacificSource Commercial |
$1,838.70
|
| Rate for Payer: PHCS PPO |
$1,940.85
|
| Rate for Payer: Three Rivers PPO |
$1,532.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.70
|
| Rate for Payer: United Healthcare Commercial |
$1,777.41
|
| Rate for Payer: United Healthcare Medicare |
$143.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,736.55
|
|
|
HC PRO DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01996
|
| Hospital Charge Code |
9640199601
|
|
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
|
|
