|
BIOPATCH CHG 1" DISK 4150
|
Facility
|
OP
|
$20.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.12
|
| Rate for Payer: Aetna of WY Medicare |
$13.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.71
|
| Rate for Payer: Altius Commercial |
$19.71
|
| Rate for Payer: Beech Street Commercial |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.86
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.91
|
| Rate for Payer: Cigna of WY Commercial |
$20.12
|
| Rate for Payer: Entrust Commercial |
$19.50
|
| Rate for Payer: First Choice Health Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.91
|
| Rate for Payer: HealthUtah PPO |
$20.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.91
|
| Rate for Payer: Multiplan Medicare/VA |
$11.31
|
| Rate for Payer: One Health Plan of WY PPO |
$20.12
|
| Rate for Payer: PacificSource Commercial |
$18.48
|
| Rate for Payer: PHCS PPO |
$20.12
|
| Rate for Payer: Three Rivers PPO |
$15.40
|
| Rate for Payer: TriWest Veterans Administration |
$11.91
|
| Rate for Payer: United Healthcare Commercial |
$17.86
|
| Rate for Payer: United Healthcare Medicare |
$11.91
|
| Rate for Payer: WINHealth Partners Commercial |
$20.12
|
| Rate for Payer: Wise Provider Network Commercial |
$19.50
|
|
|
BIOPATCH CHG 1" DISK 4150
|
Facility
|
IP
|
$20.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.71
|
| Rate for Payer: Altius Commercial |
$19.71
|
| Rate for Payer: Beech Street Commercial |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.86
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.91
|
| Rate for Payer: Cigna of WY Commercial |
$20.12
|
| Rate for Payer: Entrust Commercial |
$19.50
|
| Rate for Payer: First Choice Health Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.55
|
| Rate for Payer: HealthUtah PPO |
$20.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.91
|
| Rate for Payer: Multiplan Medicare/VA |
$12.87
|
| Rate for Payer: One Health Plan of WY PPO |
$20.12
|
| Rate for Payer: PacificSource Commercial |
$18.48
|
| Rate for Payer: PHCS PPO |
$20.12
|
| Rate for Payer: Three Rivers PPO |
$15.40
|
| Rate for Payer: TriWest Veterans Administration |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$17.86
|
| Rate for Payer: United Healthcare Medicare |
$13.55
|
| Rate for Payer: WINHealth Partners Commercial |
$19.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.50
|
|
|
BIOPSY BONE OPEN SUPERFICIAL
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
20240
|
| Min. Negotiated Rate |
$114.16 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$693.84
|
| Rate for Payer: Aetna of WY Medicare |
$134.31
|
| 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 |
$134.31
|
| Rate for Payer: HealthUtah PPO |
$708.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$686.76
|
| Rate for Payer: Multiplan Medicare/VA |
$114.16
|
| 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 |
$134.31
|
| Rate for Payer: United Healthcare Commercial |
$615.96
|
| Rate for Payer: United Healthcare Medicare |
$134.31
|
| Rate for Payer: WINHealth Partners Commercial |
$601.80
|
|
|
BIOPSY BONE TROCAR/NEEDLE DEEP
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 20225 80
|
| Hospital Charge Code |
20225
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$122.62
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.62
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$104.23
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$122.62
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$122.62
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
BIOPSY BONE TROCAR/NEEDLE DEEP
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
20225
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$122.62
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.62
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$104.23
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$122.62
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$122.62
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
BIOPSY BREAST OPEN INCISIONAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
19101
|
| Min. Negotiated Rate |
$181.85 |
| Max. Negotiated Rate |
$1,142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,119.16
|
| Rate for Payer: Aetna of WY Medicare |
$213.94
|
| Rate for Payer: Beech Street Commercial |
$1,084.90
|
| Rate for Payer: Cash Price |
$799.40
|
| Rate for Payer: Cash Price |
$799.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,107.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,119.16
|
| Rate for Payer: First Choice Health Commercial |
$1,027.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,084.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.94
|
| Rate for Payer: HealthUtah PPO |
$1,142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,107.74
|
| Rate for Payer: Multiplan Medicare/VA |
$181.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,119.16
|
| Rate for Payer: PacificSource Commercial |
$1,027.80
|
| Rate for Payer: PHCS PPO |
$1,084.90
|
| Rate for Payer: Three Rivers PPO |
$856.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.94
|
| Rate for Payer: United Healthcare Commercial |
$993.54
|
| Rate for Payer: United Healthcare Medicare |
$213.94
|
| Rate for Payer: WINHealth Partners Commercial |
$970.70
|
|
|
BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
57500
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$72.29
|
| Rate for Payer: Beech Street Commercial |
$359.10
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: First Choice Health Commercial |
$340.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.29
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$359.10
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.29
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$72.29
|
| Rate for Payer: WINHealth Partners Commercial |
$321.30
|
|
|
BIOPSY, EACH ADDED LESION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 11101
|
| Hospital Charge Code |
11101
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Beech Street Commercial |
$130.15
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: First Choice Health Commercial |
$123.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$130.15
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: WINHealth Partners Commercial |
$116.45
|
|
|
BIOPSY EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
69105
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$314.58
|
| Rate for Payer: Aetna of WY Medicare |
$61.84
|
| Rate for Payer: Beech Street Commercial |
$304.95
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$311.37
|
| Rate for Payer: Cigna of WY Commercial |
$314.58
|
| Rate for Payer: First Choice Health Commercial |
$288.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.84
|
| Rate for Payer: HealthUtah PPO |
$321.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$311.37
|
| Rate for Payer: Multiplan Medicare/VA |
$52.56
|
| Rate for Payer: One Health Plan of WY PPO |
$314.58
|
| Rate for Payer: PacificSource Commercial |
$288.90
|
| Rate for Payer: PHCS PPO |
$304.95
|
| Rate for Payer: Three Rivers PPO |
$240.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.84
|
| Rate for Payer: United Healthcare Commercial |
$279.27
|
| Rate for Payer: United Healthcare Medicare |
$61.84
|
| Rate for Payer: WINHealth Partners Commercial |
$272.85
|
|
|
BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
69100
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$44.42
|
| Rate for Payer: Beech Street Commercial |
$233.70
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: First Choice Health Commercial |
$221.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.42
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$37.76
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$233.70
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.42
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$44.42
|
| Rate for Payer: WINHealth Partners Commercial |
$209.10
|
|
|
BIOPSY GUIDE TRANSPERINEAL TP PIVOT PRO
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
BIOPSY GUIDE TRANSPERINEAL TP PIVOT PRO
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
BIOPSY INTRANASAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
30100
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Beech Street Commercial |
$466.45
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: First Choice Health Commercial |
$441.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$466.45
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: WINHealth Partners Commercial |
$417.35
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$4,385.00
|
|
|
Service Code
|
HCPCS 47100
|
| Hospital Charge Code |
47100
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$4,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,297.30
|
| Rate for Payer: Aetna of WY Medicare |
$810.58
|
| Rate for Payer: Beech Street Commercial |
$4,165.75
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,253.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,297.30
|
| Rate for Payer: First Choice Health Commercial |
$3,946.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.58
|
| Rate for Payer: HealthUtah PPO |
$4,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,253.45
|
| Rate for Payer: Multiplan Medicare/VA |
$688.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,297.30
|
| Rate for Payer: PacificSource Commercial |
$3,946.50
|
| Rate for Payer: PHCS PPO |
$4,165.75
|
| Rate for Payer: Three Rivers PPO |
$3,288.75
|
| Rate for Payer: TriWest Veterans Administration |
$810.58
|
| Rate for Payer: United Healthcare Commercial |
$3,814.95
|
| Rate for Payer: United Healthcare Medicare |
$810.58
|
| Rate for Payer: WINHealth Partners Commercial |
$3,727.25
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$4,385.00
|
|
|
Service Code
|
HCPCS 47100 80
|
| Hospital Charge Code |
47100
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$4,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,297.30
|
| Rate for Payer: Aetna of WY Medicare |
$810.58
|
| Rate for Payer: Beech Street Commercial |
$4,165.75
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,253.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,297.30
|
| Rate for Payer: First Choice Health Commercial |
$3,946.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.58
|
| Rate for Payer: HealthUtah PPO |
$4,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,253.45
|
| Rate for Payer: Multiplan Medicare/VA |
$688.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,297.30
|
| Rate for Payer: PacificSource Commercial |
$3,946.50
|
| Rate for Payer: PHCS PPO |
$4,165.75
|
| Rate for Payer: Three Rivers PPO |
$3,288.75
|
| Rate for Payer: TriWest Veterans Administration |
$810.58
|
| Rate for Payer: United Healthcare Commercial |
$3,814.95
|
| Rate for Payer: United Healthcare Medicare |
$810.58
|
| Rate for Payer: WINHealth Partners Commercial |
$3,727.25
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$4,385.00
|
|
|
Service Code
|
HCPCS 47100 AS
|
| Hospital Charge Code |
47100
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$4,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,297.30
|
| Rate for Payer: Aetna of WY Medicare |
$810.58
|
| Rate for Payer: Beech Street Commercial |
$4,165.75
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: Cash Price |
$3,069.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,253.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,297.30
|
| Rate for Payer: First Choice Health Commercial |
$3,946.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.58
|
| Rate for Payer: HealthUtah PPO |
$4,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,253.45
|
| Rate for Payer: Multiplan Medicare/VA |
$688.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,297.30
|
| Rate for Payer: PacificSource Commercial |
$3,946.50
|
| Rate for Payer: PHCS PPO |
$4,165.75
|
| Rate for Payer: Three Rivers PPO |
$3,288.75
|
| Rate for Payer: TriWest Veterans Administration |
$810.58
|
| Rate for Payer: United Healthcare Commercial |
$3,814.95
|
| Rate for Payer: United Healthcare Medicare |
$810.58
|
| Rate for Payer: WINHealth Partners Commercial |
$3,727.25
|
|
|
BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$7,926.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
20205
|
| Min. Negotiated Rate |
$124.91 |
| Max. Negotiated Rate |
$7,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,767.48
|
| Rate for Payer: Aetna of WY Medicare |
$146.95
|
| Rate for Payer: Beech Street Commercial |
$7,529.70
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,688.22
|
| Rate for Payer: Cigna of WY Commercial |
$7,767.48
|
| Rate for Payer: First Choice Health Commercial |
$7,133.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,529.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.95
|
| Rate for Payer: HealthUtah PPO |
$7,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,688.22
|
| Rate for Payer: Multiplan Medicare/VA |
$124.91
|
| Rate for Payer: One Health Plan of WY PPO |
$7,767.48
|
| Rate for Payer: PacificSource Commercial |
$7,133.40
|
| Rate for Payer: PHCS PPO |
$7,529.70
|
| Rate for Payer: Three Rivers PPO |
$5,944.50
|
| Rate for Payer: TriWest Veterans Administration |
$146.95
|
| Rate for Payer: United Healthcare Commercial |
$6,895.62
|
| Rate for Payer: United Healthcare Medicare |
$146.95
|
| Rate for Payer: WINHealth Partners Commercial |
$6,737.10
|
|
|
BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 20200
|
| Hospital Charge Code |
20200
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,053.50
|
| Rate for Payer: Aetna of WY Medicare |
$90.49
|
| Rate for Payer: Beech Street Commercial |
$1,021.25
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,042.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,053.50
|
| Rate for Payer: First Choice Health Commercial |
$967.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,021.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.49
|
| Rate for Payer: HealthUtah PPO |
$1,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,042.75
|
| Rate for Payer: Multiplan Medicare/VA |
$76.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,053.50
|
| Rate for Payer: PacificSource Commercial |
$967.50
|
| Rate for Payer: PHCS PPO |
$1,021.25
|
| Rate for Payer: Three Rivers PPO |
$806.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.49
|
| Rate for Payer: United Healthcare Commercial |
$935.25
|
| Rate for Payer: United Healthcare Medicare |
$90.49
|
| Rate for Payer: WINHealth Partners Commercial |
$913.75
|
|
|
BIOPSY OF SKIN LESION
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
11100
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Beech Street Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: First Choice Health Commercial |
$131.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$138.70
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$124.10
|
|
|
BIOPSY OVARY UNI/BI SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 58900
|
| Hospital Charge Code |
58900
|
| Min. Negotiated Rate |
$360.57 |
| Max. Negotiated Rate |
$1,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,747.34
|
| Rate for Payer: Aetna of WY Medicare |
$424.20
|
| Rate for Payer: Beech Street Commercial |
$1,693.85
|
| Rate for Payer: Cash Price |
$1,248.10
|
| Rate for Payer: Cash Price |
$1,248.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,729.51
|
| Rate for Payer: Cigna of WY Commercial |
$1,747.34
|
| Rate for Payer: First Choice Health Commercial |
$1,604.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,693.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.20
|
| Rate for Payer: HealthUtah PPO |
$1,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,729.51
|
| Rate for Payer: Multiplan Medicare/VA |
$360.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,747.34
|
| Rate for Payer: PacificSource Commercial |
$1,604.70
|
| Rate for Payer: PHCS PPO |
$1,693.85
|
| Rate for Payer: Three Rivers PPO |
$1,337.25
|
| Rate for Payer: TriWest Veterans Administration |
$424.20
|
| Rate for Payer: United Healthcare Commercial |
$1,551.21
|
| Rate for Payer: United Healthcare Medicare |
$424.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,515.55
|
|
|
BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
HCPCS 25066
|
| Hospital Charge Code |
25066
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,809.08
|
| Rate for Payer: Aetna of WY Medicare |
$362.35
|
| Rate for Payer: Beech Street Commercial |
$1,753.70
|
| Rate for Payer: Cash Price |
$1,292.20
|
| Rate for Payer: Cash Price |
$1,292.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,790.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,809.08
|
| Rate for Payer: First Choice Health Commercial |
$1,661.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,753.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$362.35
|
| Rate for Payer: HealthUtah PPO |
$1,846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,790.62
|
| Rate for Payer: Multiplan Medicare/VA |
$308.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,809.08
|
| Rate for Payer: PacificSource Commercial |
$1,661.40
|
| Rate for Payer: PHCS PPO |
$1,753.70
|
| Rate for Payer: Three Rivers PPO |
$1,384.50
|
| Rate for Payer: TriWest Veterans Administration |
$362.35
|
| Rate for Payer: United Healthcare Commercial |
$1,606.02
|
| Rate for Payer: United Healthcare Medicare |
$362.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,569.10
|
|
|
BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL
|
Professional
|
Both
|
$3,062.00
|
|
|
Service Code
|
HCPCS 27040
|
| Hospital Charge Code |
27040
|
| Min. Negotiated Rate |
$163.38 |
| Max. Negotiated Rate |
$3,062.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,000.76
|
| Rate for Payer: Aetna of WY Medicare |
$192.21
|
| Rate for Payer: Beech Street Commercial |
$2,908.90
|
| Rate for Payer: Cash Price |
$2,143.40
|
| Rate for Payer: Cash Price |
$2,143.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,970.14
|
| Rate for Payer: Cigna of WY Commercial |
$3,000.76
|
| Rate for Payer: First Choice Health Commercial |
$2,755.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,908.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.21
|
| Rate for Payer: HealthUtah PPO |
$3,062.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,970.14
|
| Rate for Payer: Multiplan Medicare/VA |
$163.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,000.76
|
| Rate for Payer: PacificSource Commercial |
$2,755.80
|
| Rate for Payer: PHCS PPO |
$2,908.90
|
| Rate for Payer: Three Rivers PPO |
$2,296.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.21
|
| Rate for Payer: United Healthcare Commercial |
$2,663.94
|
| Rate for Payer: United Healthcare Medicare |
$192.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2,602.70
|
|
|
BIOPSY SOFT TISSUE SHOULDER DEEP
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 23066
|
| Hospital Charge Code |
23066
|
| Min. Negotiated Rate |
$307.34 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,813.00
|
| Rate for Payer: Aetna of WY Medicare |
$361.58
|
| Rate for Payer: Beech Street Commercial |
$1,757.50
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,794.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,813.00
|
| Rate for Payer: First Choice Health Commercial |
$1,665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,757.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.58
|
| Rate for Payer: HealthUtah PPO |
$1,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,794.50
|
| Rate for Payer: Multiplan Medicare/VA |
$307.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,813.00
|
| Rate for Payer: PacificSource Commercial |
$1,665.00
|
| Rate for Payer: PHCS PPO |
$1,757.50
|
| Rate for Payer: Three Rivers PPO |
$1,387.50
|
| Rate for Payer: TriWest Veterans Administration |
$361.58
|
| Rate for Payer: United Healthcare Commercial |
$1,609.50
|
| Rate for Payer: United Healthcare Medicare |
$361.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,572.50
|
|
|
BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
23065
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.24
|
| Rate for Payer: Aetna of WY Medicare |
$155.16
|
| Rate for Payer: Beech Street Commercial |
$796.10
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.86
|
| Rate for Payer: Cigna of WY Commercial |
$821.24
|
| Rate for Payer: First Choice Health Commercial |
$754.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.16
|
| Rate for Payer: HealthUtah PPO |
$838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.86
|
| Rate for Payer: Multiplan Medicare/VA |
$131.89
|
| Rate for Payer: One Health Plan of WY PPO |
$821.24
|
| Rate for Payer: PacificSource Commercial |
$754.20
|
| Rate for Payer: PHCS PPO |
$796.10
|
| Rate for Payer: Three Rivers PPO |
$628.50
|
| Rate for Payer: TriWest Veterans Administration |
$155.16
|
| Rate for Payer: United Healthcare Commercial |
$729.06
|
| Rate for Payer: United Healthcare Medicare |
$155.16
|
| Rate for Payer: WINHealth Partners Commercial |
$712.30
|
|
|
BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 27324
|
| Hospital Charge Code |
27324
|
| Min. Negotiated Rate |
$340.88 |
| Max. Negotiated Rate |
$2,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,578.38
|
| Rate for Payer: Aetna of WY Medicare |
$401.03
|
| Rate for Payer: Beech Street Commercial |
$2,499.45
|
| Rate for Payer: Cash Price |
$1,841.70
|
| Rate for Payer: Cash Price |
$1,841.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,552.07
|
| Rate for Payer: Cigna of WY Commercial |
$2,578.38
|
| Rate for Payer: First Choice Health Commercial |
$2,367.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,499.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.03
|
| Rate for Payer: HealthUtah PPO |
$2,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,552.07
|
| Rate for Payer: Multiplan Medicare/VA |
$340.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,578.38
|
| Rate for Payer: PacificSource Commercial |
$2,367.90
|
| Rate for Payer: PHCS PPO |
$2,499.45
|
| Rate for Payer: Three Rivers PPO |
$1,973.25
|
| Rate for Payer: TriWest Veterans Administration |
$401.03
|
| Rate for Payer: United Healthcare Commercial |
$2,288.97
|
| Rate for Payer: United Healthcare Medicare |
$401.03
|
| Rate for Payer: WINHealth Partners Commercial |
$2,236.35
|
|
