|
HC PRO EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
9834324701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
| Rate for Payer: Aetna of WY Medicare |
$167.51
|
| Rate for Payer: Beech Street Commercial |
$1,263.50
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.51
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$142.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
| Rate for Payer: PacificSource Commercial |
$1,197.00
|
| Rate for Payer: PHCS PPO |
$1,263.50
|
| Rate for Payer: Three Rivers PPO |
$997.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.51
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$167.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
|
|
HC PRO EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
9834324801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,407.28
|
| Rate for Payer: Aetna of WY Medicare |
$157.70
|
| Rate for Payer: Beech Street Commercial |
$1,364.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,392.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,407.28
|
| Rate for Payer: First Choice Health Commercial |
$1,292.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,364.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.70
|
| Rate for Payer: HealthUtah PPO |
$1,436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,392.92
|
| Rate for Payer: Multiplan Medicare/VA |
$134.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,407.28
|
| Rate for Payer: PacificSource Commercial |
$1,292.40
|
| Rate for Payer: PHCS PPO |
$1,364.20
|
| Rate for Payer: Three Rivers PPO |
$1,077.00
|
| Rate for Payer: TriWest Veterans Administration |
$157.70
|
| Rate for Payer: United Healthcare Commercial |
$1,249.32
|
| Rate for Payer: United Healthcare Medicare |
$157.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,220.60
|
|
|
HC PRO EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
9834324101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Aetna of WY Medicare |
$135.03
|
| Rate for Payer: Beech Street Commercial |
$698.25
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: First Choice Health Commercial |
$661.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.03
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$114.78
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$698.25
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$135.03
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$135.03
|
| Rate for Payer: WINHealth Partners Commercial |
$624.75
|
|
|
HC PRO EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
9834324601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,017.24
|
| Rate for Payer: Aetna of WY Medicare |
$189.15
|
| Rate for Payer: Beech Street Commercial |
$986.10
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,006.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,017.24
|
| Rate for Payer: First Choice Health Commercial |
$934.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$986.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.15
|
| Rate for Payer: HealthUtah PPO |
$1,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,006.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,017.24
|
| Rate for Payer: PacificSource Commercial |
$934.20
|
| Rate for Payer: PHCS PPO |
$986.10
|
| Rate for Payer: Three Rivers PPO |
$778.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.15
|
| Rate for Payer: United Healthcare Commercial |
$903.06
|
| Rate for Payer: United Healthcare Medicare |
$189.15
|
| Rate for Payer: WINHealth Partners Commercial |
$882.30
|
|
|
HC PRO EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH - EGD
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
9754325101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Aetna of WY Medicare |
$185.67
|
| Rate for Payer: Beech Street Commercial |
$1,629.25
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: First Choice Health Commercial |
$1,543.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.67
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$157.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,629.25
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$185.67
|
| Rate for Payer: United Healthcare Commercial |
$1,492.05
|
| Rate for Payer: United Healthcare Medicare |
$185.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,457.75
|
|
|
HC PRO EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
9834323901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$111.94 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,281.84
|
| Rate for Payer: Aetna of WY Medicare |
$131.69
|
| Rate for Payer: Beech Street Commercial |
$1,242.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,268.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,281.84
|
| Rate for Payer: First Choice Health Commercial |
$1,177.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,242.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.69
|
| Rate for Payer: HealthUtah PPO |
$1,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,268.76
|
| Rate for Payer: Multiplan Medicare/VA |
$111.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,281.84
|
| Rate for Payer: PacificSource Commercial |
$1,177.20
|
| Rate for Payer: PHCS PPO |
$1,242.60
|
| Rate for Payer: Three Rivers PPO |
$981.00
|
| Rate for Payer: TriWest Veterans Administration |
$131.69
|
| Rate for Payer: United Healthcare Commercial |
$1,137.96
|
| Rate for Payer: United Healthcare Medicare |
$131.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,111.80
|
|
|
HC PRO EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS G0403
|
| Hospital Charge Code |
983G040301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$13.91
|
| Rate for Payer: Beech Street Commercial |
$151.05
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: First Choice Health Commercial |
$143.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.91
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$11.82
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$151.05
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.91
|
| Rate for Payer: United Healthcare Commercial |
$138.33
|
| Rate for Payer: United Healthcare Medicare |
$13.91
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
|
|
HC PRO EKG TRACING 12 LEADS INTERP/RPT, INITIAL PREV
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS G0405
|
| Hospital Charge Code |
983G040501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Beech Street Commercial |
$60.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: First Choice Health Commercial |
$57.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$60.80
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: WINHealth Partners Commercial |
$60.80
|
|
|
HC PRO EMERGENCY ANESTHESIA
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 99140
|
| Hospital Charge Code |
9829914001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Beech Street Commercial |
$230.85
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: First Choice Health Commercial |
$218.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$230.85
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: United Healthcare Commercial |
$211.41
|
| Rate for Payer: WINHealth Partners Commercial |
$230.85
|
|
|
HC PRO EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
9819928101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$256.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Beech Street Commercial |
$248.90
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: First Choice Health Commercial |
$235.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.88
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$248.90
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$10.88
|
| Rate for Payer: WINHealth Partners Commercial |
$248.90
|
|
|
HC PRO EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
9819928201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$545.86
|
| Rate for Payer: Aetna of WY Medicare |
$39.75
|
| Rate for Payer: Beech Street Commercial |
$529.15
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$540.29
|
| Rate for Payer: Cigna of WY Commercial |
$545.86
|
| Rate for Payer: First Choice Health Commercial |
$501.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.75
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$540.29
|
| Rate for Payer: Multiplan Medicare/VA |
$33.79
|
| Rate for Payer: One Health Plan of WY PPO |
$545.86
|
| Rate for Payer: PacificSource Commercial |
$501.30
|
| Rate for Payer: PHCS PPO |
$529.15
|
| Rate for Payer: Three Rivers PPO |
$417.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.75
|
| Rate for Payer: United Healthcare Commercial |
$484.59
|
| Rate for Payer: United Healthcare Medicare |
$39.75
|
| Rate for Payer: WINHealth Partners Commercial |
$529.15
|
|
|
HC PRO EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
9819928301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$835.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.64
|
| Rate for Payer: Beech Street Commercial |
$810.35
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: First Choice Health Commercial |
$767.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.64
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$57.49
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$810.35
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$67.64
|
| Rate for Payer: WINHealth Partners Commercial |
$810.35
|
|
|
HC PRO EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
9819928401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$1,422.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,422.96
|
| Rate for Payer: Aetna of WY Medicare |
$115.07
|
| Rate for Payer: Beech Street Commercial |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,422.96
|
| Rate for Payer: First Choice Health Commercial |
$1,306.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.07
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.44
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,422.96
|
| Rate for Payer: PacificSource Commercial |
$1,306.80
|
| Rate for Payer: PHCS PPO |
$1,379.40
|
| Rate for Payer: Three Rivers PPO |
$1,089.00
|
| Rate for Payer: TriWest Veterans Administration |
$115.07
|
| Rate for Payer: United Healthcare Commercial |
$1,263.24
|
| Rate for Payer: United Healthcare Medicare |
$115.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,379.40
|
|
|
HC PRO EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
9819928501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$2,072.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,072.70
|
| Rate for Payer: Aetna of WY Medicare |
$166.68
|
| Rate for Payer: Beech Street Commercial |
$2,009.25
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,051.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,072.70
|
| Rate for Payer: First Choice Health Commercial |
$1,903.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,009.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.68
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,051.55
|
| Rate for Payer: Multiplan Medicare/VA |
$141.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,072.70
|
| Rate for Payer: PacificSource Commercial |
$1,903.50
|
| Rate for Payer: PHCS PPO |
$2,009.25
|
| Rate for Payer: Three Rivers PPO |
$1,586.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.68
|
| Rate for Payer: United Healthcare Commercial |
$1,840.05
|
| Rate for Payer: United Healthcare Medicare |
$166.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,009.25
|
|
|
HC PRO ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
9835750501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$107.00
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.00
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$90.95
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$107.00
|
| Rate for Payer: WINHealth Partners Commercial |
$343.40
|
|
|
HC PRO ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 57505 NONPBBPAYER
|
| Hospital Charge Code |
9835750501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Aetna of WY Medicare |
$107.00
|
| Rate for Payer: Beech Street Commercial |
$479.75
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: First Choice Health Commercial |
$454.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.00
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$90.95
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$479.75
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$107.00
|
| Rate for Payer: WINHealth Partners Commercial |
$429.25
|
|
|
HC PRO ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$4,891.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
9835835301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$189.64 |
| Max. Negotiated Rate |
$4,891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,793.18
|
| Rate for Payer: Aetna of WY Medicare |
$223.10
|
| Rate for Payer: Beech Street Commercial |
$4,646.45
|
| Rate for Payer: Cash Price |
$3,423.70
|
| Rate for Payer: Cash Price |
$3,423.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,744.27
|
| Rate for Payer: Cigna of WY Commercial |
$4,793.18
|
| Rate for Payer: First Choice Health Commercial |
$4,401.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,646.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.10
|
| Rate for Payer: HealthUtah PPO |
$4,891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,744.27
|
| Rate for Payer: Multiplan Medicare/VA |
$189.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4,793.18
|
| Rate for Payer: PacificSource Commercial |
$4,401.90
|
| Rate for Payer: PHCS PPO |
$4,646.45
|
| Rate for Payer: Three Rivers PPO |
$3,668.25
|
| Rate for Payer: TriWest Veterans Administration |
$223.10
|
| Rate for Payer: United Healthcare Commercial |
$4,255.17
|
| Rate for Payer: United Healthcare Medicare |
$223.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,157.35
|
|
|
HC PRO ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 58110 NONPBBPAYER
|
| Hospital Charge Code |
9835811001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$38.18
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.18
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$32.45
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$38.18
|
| Rate for Payer: WINHealth Partners Commercial |
$175.95
|
|
|
HC PRO ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 58110
|
| Hospital Charge Code |
9835811001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$162.68
|
| Rate for Payer: Aetna of WY Medicare |
$38.18
|
| Rate for Payer: Beech Street Commercial |
$157.70
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.02
|
| Rate for Payer: Cigna of WY Commercial |
$162.68
|
| Rate for Payer: First Choice Health Commercial |
$149.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$157.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.18
|
| Rate for Payer: HealthUtah PPO |
$166.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.02
|
| Rate for Payer: Multiplan Medicare/VA |
$32.45
|
| Rate for Payer: One Health Plan of WY PPO |
$162.68
|
| Rate for Payer: PacificSource Commercial |
$149.40
|
| Rate for Payer: PHCS PPO |
$157.70
|
| Rate for Payer: Three Rivers PPO |
$124.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$144.42
|
| Rate for Payer: United Healthcare Medicare |
$38.18
|
| Rate for Payer: WINHealth Partners Commercial |
$141.10
|
|
|
HC PRO ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 58100 NONPBBPAYER
|
| Hospital Charge Code |
9835810001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$60.18
|
| Rate for Payer: Beech Street Commercial |
$306.85
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: First Choice Health Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.18
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$51.15
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$306.85
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.18
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$60.18
|
| Rate for Payer: WINHealth Partners Commercial |
$274.55
|
|
|
HC PRO ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
9835810001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$252.84
|
| Rate for Payer: Aetna of WY Medicare |
$60.18
|
| Rate for Payer: Beech Street Commercial |
$245.10
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$250.26
|
| Rate for Payer: Cigna of WY Commercial |
$252.84
|
| Rate for Payer: First Choice Health Commercial |
$232.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$245.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.18
|
| Rate for Payer: HealthUtah PPO |
$258.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$250.26
|
| Rate for Payer: Multiplan Medicare/VA |
$51.15
|
| Rate for Payer: One Health Plan of WY PPO |
$252.84
|
| Rate for Payer: PacificSource Commercial |
$232.20
|
| Rate for Payer: PHCS PPO |
$245.10
|
| Rate for Payer: Three Rivers PPO |
$193.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.18
|
| Rate for Payer: United Healthcare Commercial |
$224.46
|
| Rate for Payer: United Healthcare Medicare |
$60.18
|
| Rate for Payer: WINHealth Partners Commercial |
$219.30
|
|
|
HC PRO ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
9754412101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$3,146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,083.08
|
| Rate for Payer: Aetna of WY Medicare |
$224.98
|
| Rate for Payer: Beech Street Commercial |
$2,988.70
|
| Rate for Payer: Cash Price |
$2,202.20
|
| Rate for Payer: Cash Price |
$2,202.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,051.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,083.08
|
| Rate for Payer: First Choice Health Commercial |
$2,831.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,988.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.98
|
| Rate for Payer: HealthUtah PPO |
$3,146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,051.62
|
| Rate for Payer: Multiplan Medicare/VA |
$191.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,083.08
|
| Rate for Payer: PacificSource Commercial |
$2,831.40
|
| Rate for Payer: PHCS PPO |
$2,988.70
|
| Rate for Payer: Three Rivers PPO |
$2,359.50
|
| Rate for Payer: TriWest Veterans Administration |
$224.98
|
| Rate for Payer: United Healthcare Commercial |
$2,737.02
|
| Rate for Payer: United Healthcare Medicare |
$224.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,674.10
|
|
|
HC PRO EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
9835930001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$831.04
|
| Rate for Payer: Aetna of WY Medicare |
$139.39
|
| Rate for Payer: Aetna of WY Medicare |
$139.39
|
| Rate for Payer: Beech Street Commercial |
$805.60
|
| Rate for Payer: Beech Street Commercial |
$418.00
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$822.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Cigna of WY Commercial |
$831.04
|
| Rate for Payer: First Choice Health Commercial |
$763.20
|
| Rate for Payer: First Choice Health Commercial |
$396.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$805.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.39
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: HealthUtah PPO |
$848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$822.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$118.48
|
| Rate for Payer: Multiplan Medicare/VA |
$118.48
|
| Rate for Payer: One Health Plan of WY PPO |
$831.04
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PacificSource Commercial |
$763.20
|
| Rate for Payer: PHCS PPO |
$418.00
|
| Rate for Payer: PHCS PPO |
$805.60
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: Three Rivers PPO |
$636.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.39
|
| Rate for Payer: TriWest Veterans Administration |
$139.39
|
| Rate for Payer: United Healthcare Commercial |
$737.76
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$139.39
|
| Rate for Payer: United Healthcare Medicare |
$139.39
|
| Rate for Payer: WINHealth Partners Commercial |
$374.00
|
| Rate for Payer: WINHealth Partners Commercial |
$720.80
|
|
|
HC PRO ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
9834323501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$99.14 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$980.00
|
| Rate for Payer: Aetna of WY Medicare |
$116.64
|
| Rate for Payer: Beech Street Commercial |
$950.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$970.00
|
| Rate for Payer: Cigna of WY Commercial |
$980.00
|
| Rate for Payer: First Choice Health Commercial |
$900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$950.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.64
|
| Rate for Payer: HealthUtah PPO |
$1,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$970.00
|
| Rate for Payer: Multiplan Medicare/VA |
$99.14
|
| Rate for Payer: One Health Plan of WY PPO |
$980.00
|
| Rate for Payer: PacificSource Commercial |
$900.00
|
| Rate for Payer: PHCS PPO |
$950.00
|
| Rate for Payer: Three Rivers PPO |
$750.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.64
|
| Rate for Payer: United Healthcare Commercial |
$870.00
|
| Rate for Payer: United Healthcare Medicare |
$116.64
|
| Rate for Payer: WINHealth Partners Commercial |
$850.00
|
|
|
HC PRO ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM - ESOPHAGOSCOPY
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
9834322001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$95.46 |
| Max. Negotiated Rate |
$3,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,047.80
|
| Rate for Payer: Aetna of WY Medicare |
$112.30
|
| Rate for Payer: Beech Street Commercial |
$2,954.50
|
| Rate for Payer: Cash Price |
$2,177.00
|
| Rate for Payer: Cash Price |
$2,177.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,016.70
|
| Rate for Payer: Cigna of WY Commercial |
$3,047.80
|
| Rate for Payer: First Choice Health Commercial |
$2,799.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,954.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.30
|
| Rate for Payer: HealthUtah PPO |
$3,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,016.70
|
| Rate for Payer: Multiplan Medicare/VA |
$95.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,047.80
|
| Rate for Payer: PacificSource Commercial |
$2,799.00
|
| Rate for Payer: PHCS PPO |
$2,954.50
|
| Rate for Payer: Three Rivers PPO |
$2,332.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.30
|
| Rate for Payer: United Healthcare Commercial |
$2,705.70
|
| Rate for Payer: United Healthcare Medicare |
$112.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,643.50
|
|
