|
HC PRO DRAIN FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 26010 NONPBBPAYER
|
| Hospital Charge Code |
9832601001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,178.94
|
| Rate for Payer: Aetna of WY Medicare |
$138.49
|
| Rate for Payer: Beech Street Commercial |
$1,142.85
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,166.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,178.94
|
| Rate for Payer: First Choice Health Commercial |
$1,082.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,142.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.49
|
| Rate for Payer: HealthUtah PPO |
$1,203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,166.91
|
| Rate for Payer: Multiplan Medicare/VA |
$117.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,178.94
|
| Rate for Payer: PacificSource Commercial |
$1,082.70
|
| Rate for Payer: PHCS PPO |
$1,142.85
|
| Rate for Payer: Three Rivers PPO |
$902.25
|
| Rate for Payer: TriWest Veterans Administration |
$138.49
|
| Rate for Payer: United Healthcare Commercial |
$1,046.61
|
| Rate for Payer: United Healthcare Medicare |
$138.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,022.55
|
|
|
HC PRO DRAIN FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
9832601001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,057.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$942.76
|
| Rate for Payer: Aetna of WY Medicare |
$138.49
|
| Rate for Payer: Aetna of WY Medicare |
$138.49
|
| Rate for Payer: Beech Street Commercial |
$913.90
|
| Rate for Payer: Beech Street Commercial |
$1,025.05
|
| Rate for Payer: Cash Price |
$673.40
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$673.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$933.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,046.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,057.42
|
| Rate for Payer: Cigna of WY Commercial |
$942.76
|
| Rate for Payer: First Choice Health Commercial |
$865.80
|
| Rate for Payer: First Choice Health Commercial |
$971.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,025.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$913.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.49
|
| Rate for Payer: HealthUtah PPO |
$1,079.00
|
| Rate for Payer: HealthUtah PPO |
$962.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$933.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,046.63
|
| Rate for Payer: Multiplan Medicare/VA |
$117.72
|
| Rate for Payer: Multiplan Medicare/VA |
$117.72
|
| Rate for Payer: One Health Plan of WY PPO |
$942.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,057.42
|
| Rate for Payer: PacificSource Commercial |
$971.10
|
| Rate for Payer: PacificSource Commercial |
$865.80
|
| Rate for Payer: PHCS PPO |
$1,025.05
|
| Rate for Payer: PHCS PPO |
$913.90
|
| Rate for Payer: Three Rivers PPO |
$809.25
|
| Rate for Payer: Three Rivers PPO |
$721.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.49
|
| Rate for Payer: TriWest Veterans Administration |
$138.49
|
| Rate for Payer: United Healthcare Commercial |
$836.94
|
| Rate for Payer: United Healthcare Commercial |
$938.73
|
| Rate for Payer: United Healthcare Medicare |
$138.49
|
| Rate for Payer: United Healthcare Medicare |
$138.49
|
| Rate for Payer: WINHealth Partners Commercial |
$917.15
|
| Rate for Payer: WINHealth Partners Commercial |
$817.70
|
|
|
HC PRO DRESS/DEBRID LARGE BURN NO ANES
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
HCPCS 16030 NONPBBPAYER
|
| Hospital Charge Code |
9831603001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.89 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$653.66
|
| Rate for Payer: Aetna of WY Medicare |
$125.75
|
| Rate for Payer: Beech Street Commercial |
$633.65
|
| Rate for Payer: Cash Price |
$466.90
|
| Rate for Payer: Cash Price |
$466.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$646.99
|
| Rate for Payer: Cigna of WY Commercial |
$653.66
|
| Rate for Payer: First Choice Health Commercial |
$600.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$633.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.75
|
| Rate for Payer: HealthUtah PPO |
$667.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$646.99
|
| Rate for Payer: Multiplan Medicare/VA |
$106.89
|
| Rate for Payer: One Health Plan of WY PPO |
$653.66
|
| Rate for Payer: PacificSource Commercial |
$600.30
|
| Rate for Payer: PHCS PPO |
$633.65
|
| Rate for Payer: Three Rivers PPO |
$500.25
|
| Rate for Payer: TriWest Veterans Administration |
$125.75
|
| Rate for Payer: United Healthcare Commercial |
$580.29
|
| Rate for Payer: United Healthcare Medicare |
$125.75
|
| Rate for Payer: WINHealth Partners Commercial |
$566.95
|
|
|
HC PRO DRESS/DEBRID LARGE BURN NO ANES
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
9831603001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.89 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$125.75
|
| Rate for Payer: Beech Street Commercial |
$507.30
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: First Choice Health Commercial |
$480.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.75
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$106.89
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$507.30
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.75
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$125.75
|
| Rate for Payer: WINHealth Partners Commercial |
$453.90
|
|
|
HC PRO DRESS/DEBRID MED BURN NO ANES
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
9831602501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.16
|
| Rate for Payer: Aetna of WY Medicare |
$106.89
|
| Rate for Payer: Aetna of WY Medicare |
$106.89
|
| Rate for Payer: Beech Street Commercial |
$419.90
|
| Rate for Payer: Beech Street Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.74
|
| Rate for Payer: Cigna of WY Commercial |
$433.16
|
| Rate for Payer: Cigna of WY Commercial |
$901.60
|
| Rate for Payer: First Choice Health Commercial |
$397.80
|
| Rate for Payer: First Choice Health Commercial |
$828.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$419.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.89
|
| Rate for Payer: HealthUtah PPO |
$920.00
|
| Rate for Payer: HealthUtah PPO |
$442.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.74
|
| Rate for Payer: Multiplan Medicare/VA |
$90.86
|
| Rate for Payer: Multiplan Medicare/VA |
$90.86
|
| Rate for Payer: One Health Plan of WY PPO |
$901.60
|
| Rate for Payer: One Health Plan of WY PPO |
$433.16
|
| Rate for Payer: PacificSource Commercial |
$397.80
|
| Rate for Payer: PacificSource Commercial |
$828.00
|
| Rate for Payer: PHCS PPO |
$874.00
|
| Rate for Payer: PHCS PPO |
$419.90
|
| Rate for Payer: Three Rivers PPO |
$690.00
|
| Rate for Payer: Three Rivers PPO |
$331.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.89
|
| Rate for Payer: TriWest Veterans Administration |
$106.89
|
| Rate for Payer: United Healthcare Commercial |
$384.54
|
| Rate for Payer: United Healthcare Commercial |
$800.40
|
| Rate for Payer: United Healthcare Medicare |
$106.89
|
| Rate for Payer: United Healthcare Medicare |
$106.89
|
| Rate for Payer: WINHealth Partners Commercial |
$782.00
|
| Rate for Payer: WINHealth Partners Commercial |
$375.70
|
|
|
HC PRO DRESS/DEBRID MED BURN NO ANES
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 16025 NONPBBPAYER
|
| Hospital Charge Code |
9831602501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$541.94
|
| Rate for Payer: Aetna of WY Medicare |
$106.89
|
| Rate for Payer: Beech Street Commercial |
$525.35
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$536.41
|
| Rate for Payer: Cigna of WY Commercial |
$541.94
|
| Rate for Payer: First Choice Health Commercial |
$497.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.89
|
| Rate for Payer: HealthUtah PPO |
$553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$536.41
|
| Rate for Payer: Multiplan Medicare/VA |
$90.86
|
| Rate for Payer: One Health Plan of WY PPO |
$541.94
|
| Rate for Payer: PacificSource Commercial |
$497.70
|
| Rate for Payer: PHCS PPO |
$525.35
|
| Rate for Payer: Three Rivers PPO |
$414.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.89
|
| Rate for Payer: United Healthcare Commercial |
$481.11
|
| Rate for Payer: United Healthcare Medicare |
$106.89
|
| Rate for Payer: WINHealth Partners Commercial |
$470.05
|
|
|
HC PRO DRESS/DEBRID SMALL BURN NO ANES
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 16020 NONPBBPAYER
|
| Hospital Charge Code |
9831602001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$53.98
|
| Rate for Payer: Beech Street Commercial |
$256.50
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: First Choice Health Commercial |
$243.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.98
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$45.88
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$256.50
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.98
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$53.98
|
| Rate for Payer: WINHealth Partners Commercial |
$229.50
|
|
|
HC PRO DRESS/DEBRID SMALL BURN NO ANES
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
9831602001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$53.98
|
| Rate for Payer: Aetna of WY Medicare |
$53.98
|
| Rate for Payer: Beech Street Commercial |
$205.20
|
| Rate for Payer: Beech Street Commercial |
$394.25
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: First Choice Health Commercial |
$194.40
|
| Rate for Payer: First Choice Health Commercial |
$373.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.98
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$45.88
|
| Rate for Payer: Multiplan Medicare/VA |
$45.88
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$394.25
|
| Rate for Payer: PHCS PPO |
$205.20
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.98
|
| Rate for Payer: TriWest Veterans Administration |
$53.98
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$53.98
|
| Rate for Payer: United Healthcare Medicare |
$53.98
|
| Rate for Payer: WINHealth Partners Commercial |
$352.75
|
| Rate for Payer: WINHealth Partners Commercial |
$183.60
|
|
|
HC PRO DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
9834690001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$687.96
|
| Rate for Payer: Aetna of WY Medicare |
$133.67
|
| Rate for Payer: Beech Street Commercial |
$666.90
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$680.94
|
| Rate for Payer: Cigna of WY Commercial |
$687.96
|
| Rate for Payer: First Choice Health Commercial |
$631.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.67
|
| Rate for Payer: HealthUtah PPO |
$702.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$680.94
|
| Rate for Payer: Multiplan Medicare/VA |
$113.62
|
| Rate for Payer: One Health Plan of WY PPO |
$687.96
|
| Rate for Payer: PacificSource Commercial |
$631.80
|
| Rate for Payer: PHCS PPO |
$666.90
|
| Rate for Payer: Three Rivers PPO |
$526.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.67
|
| Rate for Payer: United Healthcare Commercial |
$610.74
|
| Rate for Payer: United Healthcare Medicare |
$133.67
|
| Rate for Payer: WINHealth Partners Commercial |
$596.70
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
9836463401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$875.14
|
| Rate for Payer: Aetna of WY Medicare |
$64.05
|
| Rate for Payer: Beech Street Commercial |
$848.35
|
| Rate for Payer: Cash Price |
$625.10
|
| Rate for Payer: Cash Price |
$625.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$866.21
|
| Rate for Payer: Cigna of WY Commercial |
$875.14
|
| Rate for Payer: First Choice Health Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$848.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$893.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$866.21
|
| Rate for Payer: Multiplan Medicare/VA |
$54.44
|
| Rate for Payer: One Health Plan of WY PPO |
$875.14
|
| Rate for Payer: PacificSource Commercial |
$803.70
|
| Rate for Payer: PHCS PPO |
$848.35
|
| Rate for Payer: Three Rivers PPO |
$669.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$776.91
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| Rate for Payer: WINHealth Partners Commercial |
$759.05
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 64634 50
|
| Hospital Charge Code |
9836463401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,786.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,750.28
|
| Rate for Payer: Aetna of WY Medicare |
$64.05
|
| Rate for Payer: Beech Street Commercial |
$1,696.70
|
| Rate for Payer: Cash Price |
$1,250.20
|
| Rate for Payer: Cash Price |
$1,250.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,732.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,750.28
|
| Rate for Payer: First Choice Health Commercial |
$1,607.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,696.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$1,786.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,732.42
|
| Rate for Payer: Multiplan Medicare/VA |
$54.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,750.28
|
| Rate for Payer: PacificSource Commercial |
$1,607.40
|
| Rate for Payer: PHCS PPO |
$1,696.70
|
| Rate for Payer: Three Rivers PPO |
$1,339.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$1,553.82
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,518.10
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$1,676.00
|
|
|
Service Code
|
HCPCS 64636 50
|
| Hospital Charge Code |
9836463601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$1,676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,642.48
|
| Rate for Payer: Aetna of WY Medicare |
$56.03
|
| Rate for Payer: Beech Street Commercial |
$1,592.20
|
| Rate for Payer: Cash Price |
$1,173.20
|
| Rate for Payer: Cash Price |
$1,173.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,625.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,642.48
|
| Rate for Payer: First Choice Health Commercial |
$1,508.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,592.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.03
|
| Rate for Payer: HealthUtah PPO |
$1,676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,625.72
|
| Rate for Payer: Multiplan Medicare/VA |
$47.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,642.48
|
| Rate for Payer: PacificSource Commercial |
$1,508.40
|
| Rate for Payer: PHCS PPO |
$1,592.20
|
| Rate for Payer: Three Rivers PPO |
$1,257.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.03
|
| Rate for Payer: United Healthcare Commercial |
$1,458.12
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,424.60
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
9836463601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.24
|
| Rate for Payer: Aetna of WY Medicare |
$56.03
|
| 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 |
$56.03
|
| Rate for Payer: HealthUtah PPO |
$838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.86
|
| Rate for Payer: Multiplan Medicare/VA |
$47.63
|
| 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 |
$56.03
|
| Rate for Payer: United Healthcare Commercial |
$729.06
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WINHealth Partners Commercial |
$712.30
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
9836463301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$1,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,496.46
|
| Rate for Payer: Aetna of WY Medicare |
$185.22
|
| Rate for Payer: Beech Street Commercial |
$1,450.65
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,481.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,496.46
|
| Rate for Payer: First Choice Health Commercial |
$1,374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,450.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.22
|
| Rate for Payer: HealthUtah PPO |
$1,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,481.19
|
| Rate for Payer: Multiplan Medicare/VA |
$157.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,496.46
|
| Rate for Payer: PacificSource Commercial |
$1,374.30
|
| Rate for Payer: PHCS PPO |
$1,450.65
|
| Rate for Payer: Three Rivers PPO |
$1,145.25
|
| Rate for Payer: TriWest Veterans Administration |
$185.22
|
| Rate for Payer: United Healthcare Commercial |
$1,328.49
|
| Rate for Payer: United Healthcare Medicare |
$185.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,297.95
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
HCPCS 64633 50
|
| Hospital Charge Code |
9836463301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,992.92
|
| Rate for Payer: Aetna of WY Medicare |
$185.22
|
| Rate for Payer: Beech Street Commercial |
$2,901.30
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,962.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,992.92
|
| Rate for Payer: First Choice Health Commercial |
$2,748.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,901.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.22
|
| Rate for Payer: HealthUtah PPO |
$3,054.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,962.38
|
| Rate for Payer: Multiplan Medicare/VA |
$157.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,992.92
|
| Rate for Payer: PacificSource Commercial |
$2,748.60
|
| Rate for Payer: PHCS PPO |
$2,901.30
|
| Rate for Payer: Three Rivers PPO |
$2,290.50
|
| Rate for Payer: TriWest Veterans Administration |
$185.22
|
| Rate for Payer: United Healthcare Commercial |
$2,656.98
|
| Rate for Payer: United Healthcare Medicare |
$185.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.90
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$3,080.00
|
|
|
Service Code
|
HCPCS 64635 50
|
| Hospital Charge Code |
9836463501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$157.71 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,018.40
|
| Rate for Payer: Aetna of WY Medicare |
$185.54
|
| Rate for Payer: Beech Street Commercial |
$2,926.00
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: Cash Price |
$2,156.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,987.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,018.40
|
| Rate for Payer: First Choice Health Commercial |
$2,772.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.54
|
| Rate for Payer: HealthUtah PPO |
$3,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,987.60
|
| Rate for Payer: Multiplan Medicare/VA |
$157.71
|
| Rate for Payer: One Health Plan of WY PPO |
$3,018.40
|
| Rate for Payer: PacificSource Commercial |
$2,772.00
|
| Rate for Payer: PHCS PPO |
$2,926.00
|
| Rate for Payer: Three Rivers PPO |
$2,310.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.54
|
| Rate for Payer: United Healthcare Commercial |
$2,679.60
|
| Rate for Payer: United Healthcare Medicare |
$185.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2,618.00
|
|
|
HC PRO DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
9836463501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$157.71 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,509.20
|
| Rate for Payer: Aetna of WY Medicare |
$185.54
|
| Rate for Payer: Beech Street Commercial |
$1,463.00
|
| Rate for Payer: Cash Price |
$1,078.00
|
| Rate for Payer: Cash Price |
$1,078.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,493.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,509.20
|
| Rate for Payer: First Choice Health Commercial |
$1,386.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,463.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.54
|
| Rate for Payer: HealthUtah PPO |
$1,540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,493.80
|
| Rate for Payer: Multiplan Medicare/VA |
$157.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,509.20
|
| Rate for Payer: PacificSource Commercial |
$1,386.00
|
| Rate for Payer: PHCS PPO |
$1,463.00
|
| Rate for Payer: Three Rivers PPO |
$1,155.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.54
|
| Rate for Payer: United Healthcare Commercial |
$1,339.80
|
| Rate for Payer: United Healthcare Medicare |
$185.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,309.00
|
|
|
HC PRO EAR AND THROAT EXAMINATION
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
9839250201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.02
|
| Rate for Payer: Aetna of WY Medicare |
$92.47
|
| Rate for Payer: Beech Street Commercial |
$236.55
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.53
|
| Rate for Payer: Cigna of WY Commercial |
$244.02
|
| Rate for Payer: First Choice Health Commercial |
$224.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.47
|
| Rate for Payer: HealthUtah PPO |
$249.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.53
|
| Rate for Payer: Multiplan Medicare/VA |
$78.60
|
| Rate for Payer: One Health Plan of WY PPO |
$244.02
|
| Rate for Payer: PacificSource Commercial |
$224.10
|
| Rate for Payer: PHCS PPO |
$236.55
|
| Rate for Payer: Three Rivers PPO |
$186.75
|
| Rate for Payer: TriWest Veterans Administration |
$92.47
|
| Rate for Payer: United Healthcare Commercial |
$216.63
|
| Rate for Payer: United Healthcare Medicare |
$92.47
|
| Rate for Payer: WINHealth Partners Commercial |
$236.55
|
|
|
HC PRO EAR/COMPLEX DRAIN EXT
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
9836900501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$633.08
|
| Rate for Payer: Aetna of WY Medicare |
$157.30
|
| Rate for Payer: Beech Street Commercial |
$613.70
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$626.62
|
| Rate for Payer: Cigna of WY Commercial |
$633.08
|
| Rate for Payer: First Choice Health Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.30
|
| Rate for Payer: HealthUtah PPO |
$646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$626.62
|
| Rate for Payer: Multiplan Medicare/VA |
$133.70
|
| Rate for Payer: One Health Plan of WY PPO |
$633.08
|
| Rate for Payer: PacificSource Commercial |
$581.40
|
| Rate for Payer: PHCS PPO |
$613.70
|
| Rate for Payer: Three Rivers PPO |
$484.50
|
| Rate for Payer: TriWest Veterans Administration |
$157.30
|
| Rate for Payer: United Healthcare Commercial |
$562.02
|
| Rate for Payer: United Healthcare Medicare |
$157.30
|
| Rate for Payer: WINHealth Partners Commercial |
$549.10
|
|
|
HC PRO EAR/COMPLEX DRAIN EXT
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 69005 NONPBBPAYER
|
| Hospital Charge Code |
9836900501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Aetna of WY Medicare |
$157.30
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.30
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: Multiplan Medicare/VA |
$133.70
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: TriWest Veterans Administration |
$157.30
|
| Rate for Payer: United Healthcare Commercial |
$702.96
|
| Rate for Payer: United Healthcare Medicare |
$157.30
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
|
HC PRO ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
9859301001
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$43.70
|
| Rate for Payer: Beech Street Commercial |
$52.25
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: First Choice Health Commercial |
$41.40
|
| Rate for Payer: First Choice Health Commercial |
$49.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$52.25
|
| Rate for Payer: PHCS PPO |
$43.70
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$40.02
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
|
|
HC PRO ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
9839301001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$60.80
|
| Rate for Payer: Beech Street Commercial |
$43.70
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: First Choice Health Commercial |
$57.60
|
| Rate for Payer: First Choice Health Commercial |
$41.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$43.70
|
| Rate for Payer: PHCS PPO |
$60.80
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$40.02
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: WINHealth Partners Commercial |
$60.80
|
|
|
HC PRO EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM - EGD
|
Professional
|
Both
|
$3,733.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
9834324901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$3,733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,658.34
|
| Rate for Payer: Aetna of WY Medicare |
$145.75
|
| Rate for Payer: Beech Street Commercial |
$3,546.35
|
| Rate for Payer: Cash Price |
$2,613.10
|
| Rate for Payer: Cash Price |
$2,613.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,621.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,658.34
|
| Rate for Payer: First Choice Health Commercial |
$3,359.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,546.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.75
|
| Rate for Payer: HealthUtah PPO |
$3,733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,621.01
|
| Rate for Payer: Multiplan Medicare/VA |
$123.89
|
| Rate for Payer: One Health Plan of WY PPO |
$3,658.34
|
| Rate for Payer: PacificSource Commercial |
$3,359.70
|
| Rate for Payer: PHCS PPO |
$3,546.35
|
| Rate for Payer: Three Rivers PPO |
$2,799.75
|
| Rate for Payer: TriWest Veterans Administration |
$145.75
|
| Rate for Payer: United Healthcare Commercial |
$3,247.71
|
| Rate for Payer: United Healthcare Medicare |
$145.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,173.05
|
|
|
HC PRO EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
9834324501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$141.25 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,015.86
|
| Rate for Payer: Aetna of WY Medicare |
$166.18
|
| Rate for Payer: Beech Street Commercial |
$1,954.15
|
| Rate for Payer: Cash Price |
$1,439.90
|
| Rate for Payer: Cash Price |
$1,439.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,995.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,015.86
|
| Rate for Payer: First Choice Health Commercial |
$1,851.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,954.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.18
|
| Rate for Payer: HealthUtah PPO |
$2,057.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,995.29
|
| Rate for Payer: Multiplan Medicare/VA |
$141.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,015.86
|
| Rate for Payer: PacificSource Commercial |
$1,851.30
|
| Rate for Payer: PHCS PPO |
$1,954.15
|
| Rate for Payer: Three Rivers PPO |
$1,542.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.18
|
| Rate for Payer: United Healthcare Commercial |
$1,789.59
|
| Rate for Payer: United Healthcare Medicare |
$166.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,748.45
|
|
|
HC PRO EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER - EGD
|
Professional
|
Both
|
$4,272.00
|
|
|
Service Code
|
HCPCS 43233
|
| Hospital Charge Code |
9754323301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$4,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,186.56
|
| Rate for Payer: Aetna of WY Medicare |
$216.29
|
| Rate for Payer: Beech Street Commercial |
$4,058.40
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,143.84
|
| Rate for Payer: Cigna of WY Commercial |
$4,186.56
|
| Rate for Payer: First Choice Health Commercial |
$3,844.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,058.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.29
|
| Rate for Payer: HealthUtah PPO |
$4,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,143.84
|
| Rate for Payer: Multiplan Medicare/VA |
$183.85
|
| Rate for Payer: One Health Plan of WY PPO |
$4,186.56
|
| Rate for Payer: PacificSource Commercial |
$3,844.80
|
| Rate for Payer: PHCS PPO |
$4,058.40
|
| Rate for Payer: Three Rivers PPO |
$3,204.00
|
| Rate for Payer: TriWest Veterans Administration |
$216.29
|
| Rate for Payer: United Healthcare Commercial |
$3,716.64
|
| Rate for Payer: United Healthcare Medicare |
$216.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,631.20
|
|
