|
HC PRO FREEING BOWEL ADHESION,ENTEROLYSIS
|
Professional
|
Both
|
$5,662.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
9834400501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,548.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,032.78
|
| Rate for Payer: Beech Street Commercial |
$5,378.90
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,492.14
|
| Rate for Payer: Cigna of WY Commercial |
$5,548.76
|
| Rate for Payer: First Choice Health Commercial |
$5,095.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,378.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,032.78
|
| Rate for Payer: HealthUtah PPO |
$5,662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,492.14
|
| Rate for Payer: Multiplan Medicare/VA |
$877.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,548.76
|
| Rate for Payer: PacificSource Commercial |
$5,095.80
|
| Rate for Payer: PHCS PPO |
$5,378.90
|
| Rate for Payer: Three Rivers PPO |
$4,246.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,032.78
|
| Rate for Payer: United Healthcare Commercial |
$4,925.94
|
| Rate for Payer: United Healthcare Medicare |
$1,032.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,812.70
|
|
|
HC PRO FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<
|
Professional
|
Both
|
$3,971.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
9831524001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$655.29 |
| Max. Negotiated Rate |
$3,971.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,891.58
|
| Rate for Payer: Aetna of WY Medicare |
$770.93
|
| Rate for Payer: Beech Street Commercial |
$3,772.45
|
| Rate for Payer: Cash Price |
$2,779.70
|
| Rate for Payer: Cash Price |
$2,779.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,851.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,891.58
|
| Rate for Payer: First Choice Health Commercial |
$3,573.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,772.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.93
|
| Rate for Payer: HealthUtah PPO |
$3,971.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,851.87
|
| Rate for Payer: Multiplan Medicare/VA |
$655.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3,891.58
|
| Rate for Payer: PacificSource Commercial |
$3,573.90
|
| Rate for Payer: PHCS PPO |
$3,772.45
|
| Rate for Payer: Three Rivers PPO |
$2,978.25
|
| Rate for Payer: TriWest Veterans Administration |
$770.93
|
| Rate for Payer: United Healthcare Commercial |
$3,454.77
|
| Rate for Payer: United Healthcare Medicare |
$770.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3,375.35
|
|
|
HC PRO FULL GFT S/A/L;20 SQ CM OR <
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 15220
|
| Hospital Charge Code |
9831522001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$501.81 |
| Max. Negotiated Rate |
$3,050.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,989.00
|
| Rate for Payer: Aetna of WY Medicare |
$590.36
|
| Rate for Payer: Beech Street Commercial |
$2,897.50
|
| Rate for Payer: Cash Price |
$2,135.00
|
| Rate for Payer: Cash Price |
$2,135.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,958.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,989.00
|
| Rate for Payer: First Choice Health Commercial |
$2,745.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,897.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$590.36
|
| Rate for Payer: HealthUtah PPO |
$3,050.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,958.50
|
| Rate for Payer: Multiplan Medicare/VA |
$501.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,989.00
|
| Rate for Payer: PacificSource Commercial |
$2,745.00
|
| Rate for Payer: PHCS PPO |
$2,897.50
|
| Rate for Payer: Three Rivers PPO |
$2,287.50
|
| Rate for Payer: TriWest Veterans Administration |
$590.36
|
| Rate for Payer: United Healthcare Commercial |
$2,653.50
|
| Rate for Payer: United Healthcare Medicare |
$590.36
|
| Rate for Payer: WINHealth Partners Commercial |
$2,592.50
|
|
|
HC PRO GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
9834375301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$20.27
|
| Rate for Payer: Beech Street Commercial |
$109.25
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: First Choice Health Commercial |
$103.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.27
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$17.23
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$109.25
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.27
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$20.27
|
| Rate for Payer: WINHealth Partners Commercial |
$97.75
|
|
|
HC PRO GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$6,372.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
9754384001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,094.38 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,244.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,287.51
|
| Rate for Payer: Beech Street Commercial |
$6,053.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,180.84
|
| Rate for Payer: Cigna of WY Commercial |
$6,244.56
|
| Rate for Payer: First Choice Health Commercial |
$5,734.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,053.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,287.51
|
| Rate for Payer: HealthUtah PPO |
$6,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,180.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1,094.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,244.56
|
| Rate for Payer: PacificSource Commercial |
$5,734.80
|
| Rate for Payer: PHCS PPO |
$6,053.40
|
| Rate for Payer: Three Rivers PPO |
$4,779.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,287.51
|
| Rate for Payer: United Healthcare Commercial |
$5,543.64
|
| Rate for Payer: United Healthcare Medicare |
$1,287.51
|
| Rate for Payer: WINHealth Partners Commercial |
$5,416.20
|
|
|
HC PRO HALLUX RID CORR W/CHEILECTOM
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
9832828901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,327.50
|
| Rate for Payer: Aetna of WY Medicare |
$450.93
|
| Rate for Payer: Beech Street Commercial |
$2,256.25
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,303.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,327.50
|
| Rate for Payer: First Choice Health Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,256.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.93
|
| Rate for Payer: HealthUtah PPO |
$2,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,303.75
|
| Rate for Payer: Multiplan Medicare/VA |
$383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,327.50
|
| Rate for Payer: PacificSource Commercial |
$2,137.50
|
| Rate for Payer: PHCS PPO |
$2,256.25
|
| Rate for Payer: Three Rivers PPO |
$1,781.25
|
| Rate for Payer: TriWest Veterans Administration |
$450.93
|
| Rate for Payer: United Healthcare Commercial |
$2,066.25
|
| Rate for Payer: United Healthcare Medicare |
$450.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,018.75
|
|
|
HC PRO HANGE OF GASTROS-MY TUBE
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
9834376001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$304.78
|
| Rate for Payer: Beech Street Commercial |
$295.45
|
| Rate for Payer: Beech Street Commercial |
$541.50
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$301.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$304.78
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: First Choice Health Commercial |
$279.90
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$295.45
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: HealthUtah PPO |
$311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$301.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: One Health Plan of WY PPO |
$304.78
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$279.90
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$541.50
|
| Rate for Payer: PHCS PPO |
$295.45
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: Three Rivers PPO |
$233.25
|
| Rate for Payer: United Healthcare Commercial |
$270.57
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: WINHealth Partners Commercial |
$264.35
|
|
|
HC PRO HEART/LUNG RESUSCITATION (CPR)
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
9819295001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.67 |
| Max. Negotiated Rate |
$1,103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,080.94
|
| Rate for Payer: Aetna of WY Medicare |
$173.73
|
| Rate for Payer: Beech Street Commercial |
$1,047.85
|
| Rate for Payer: Cash Price |
$772.10
|
| Rate for Payer: Cash Price |
$772.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,069.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,080.94
|
| Rate for Payer: First Choice Health Commercial |
$992.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,047.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$173.73
|
| Rate for Payer: HealthUtah PPO |
$1,103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,069.91
|
| Rate for Payer: Multiplan Medicare/VA |
$147.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,080.94
|
| Rate for Payer: PacificSource Commercial |
$992.70
|
| Rate for Payer: PHCS PPO |
$1,047.85
|
| Rate for Payer: Three Rivers PPO |
$827.25
|
| Rate for Payer: TriWest Veterans Administration |
$173.73
|
| Rate for Payer: United Healthcare Commercial |
$959.61
|
| Rate for Payer: United Healthcare Medicare |
$173.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,047.85
|
|
|
HC PRO HEMIOARTHROPLASTY HIP PARTIAL
|
Professional
|
Both
|
$5,845.00
|
|
|
Service Code
|
HCPCS 27125
|
| Hospital Charge Code |
9832712501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$925.16 |
| Max. Negotiated Rate |
$5,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,728.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,088.42
|
| Rate for Payer: Beech Street Commercial |
$5,552.75
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: Cash Price |
$4,091.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,669.65
|
| Rate for Payer: Cigna of WY Commercial |
$5,728.10
|
| Rate for Payer: First Choice Health Commercial |
$5,260.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,552.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,088.42
|
| Rate for Payer: HealthUtah PPO |
$5,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,669.65
|
| Rate for Payer: Multiplan Medicare/VA |
$925.16
|
| Rate for Payer: One Health Plan of WY PPO |
$5,728.10
|
| Rate for Payer: PacificSource Commercial |
$5,260.50
|
| Rate for Payer: PHCS PPO |
$5,552.75
|
| Rate for Payer: Three Rivers PPO |
$4,383.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,088.42
|
| Rate for Payer: United Healthcare Commercial |
$5,085.15
|
| Rate for Payer: United Healthcare Medicare |
$1,088.42
|
| Rate for Payer: WINHealth Partners Commercial |
$4,968.25
|
|
|
HC PRO HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
9834622101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,278.50
|
| Rate for Payer: Aetna of WY Medicare |
$186.93
|
| Rate for Payer: Beech Street Commercial |
$2,208.75
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,255.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,278.50
|
| Rate for Payer: First Choice Health Commercial |
$2,092.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,208.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.93
|
| Rate for Payer: HealthUtah PPO |
$2,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,255.25
|
| Rate for Payer: Multiplan Medicare/VA |
$158.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,278.50
|
| Rate for Payer: PacificSource Commercial |
$2,092.50
|
| Rate for Payer: PHCS PPO |
$2,208.75
|
| Rate for Payer: Three Rivers PPO |
$1,743.75
|
| Rate for Payer: TriWest Veterans Administration |
$186.93
|
| Rate for Payer: United Healthcare Commercial |
$2,022.75
|
| Rate for Payer: United Healthcare Medicare |
$186.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,976.25
|
|
|
HC PRO HEMORRHOIDECTOMY INT & XTRNL 1 COLUMN/GROUP
|
Professional
|
Both
|
$4,397.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
9834625501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$291.61 |
| Max. Negotiated Rate |
$4,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,309.06
|
| Rate for Payer: Aetna of WY Medicare |
$343.07
|
| Rate for Payer: Beech Street Commercial |
$4,177.15
|
| Rate for Payer: Cash Price |
$3,077.90
|
| Rate for Payer: Cash Price |
$3,077.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,265.09
|
| Rate for Payer: Cigna of WY Commercial |
$4,309.06
|
| Rate for Payer: First Choice Health Commercial |
$3,957.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,177.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.07
|
| Rate for Payer: HealthUtah PPO |
$4,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,265.09
|
| Rate for Payer: Multiplan Medicare/VA |
$291.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4,309.06
|
| Rate for Payer: PacificSource Commercial |
$3,957.30
|
| Rate for Payer: PHCS PPO |
$4,177.15
|
| Rate for Payer: Three Rivers PPO |
$3,297.75
|
| Rate for Payer: TriWest Veterans Administration |
$343.07
|
| Rate for Payer: United Healthcare Commercial |
$3,825.39
|
| Rate for Payer: United Healthcare Medicare |
$343.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,737.45
|
|
|
HC PRO HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GROUP
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
9834626001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$395.58 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,698.52
|
| Rate for Payer: Aetna of WY Medicare |
$465.39
|
| Rate for Payer: Beech Street Commercial |
$3,585.30
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,660.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,698.52
|
| Rate for Payer: First Choice Health Commercial |
$3,396.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,585.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.39
|
| Rate for Payer: HealthUtah PPO |
$3,774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,660.78
|
| Rate for Payer: Multiplan Medicare/VA |
$395.58
|
| Rate for Payer: One Health Plan of WY PPO |
$3,698.52
|
| Rate for Payer: PacificSource Commercial |
$3,396.60
|
| Rate for Payer: PHCS PPO |
$3,585.30
|
| Rate for Payer: Three Rivers PPO |
$2,830.50
|
| Rate for Payer: TriWest Veterans Administration |
$465.39
|
| Rate for Payer: United Healthcare Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Medicare |
$465.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,207.90
|
|
|
HC PRO HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Professional
|
Both
|
$3,847.00
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
9834625001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,770.06
|
| Rate for Payer: Aetna of WY Medicare |
$308.32
|
| Rate for Payer: Beech Street Commercial |
$3,654.65
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,731.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,770.06
|
| Rate for Payer: First Choice Health Commercial |
$3,462.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,654.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.32
|
| Rate for Payer: HealthUtah PPO |
$3,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,731.59
|
| Rate for Payer: Multiplan Medicare/VA |
$262.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,770.06
|
| Rate for Payer: PacificSource Commercial |
$3,462.30
|
| Rate for Payer: PHCS PPO |
$3,654.65
|
| Rate for Payer: Three Rivers PPO |
$2,885.25
|
| Rate for Payer: TriWest Veterans Administration |
$308.32
|
| Rate for Payer: United Healthcare Commercial |
$3,346.89
|
| Rate for Payer: United Healthcare Medicare |
$308.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,269.95
|
|
|
HC PRO HIP ARTHO W/LABRAL REPAIR
|
Professional
|
Both
|
$3,487.00
|
|
|
Service Code
|
HCPCS 29916
|
| Hospital Charge Code |
9832991601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$830.61 |
| Max. Negotiated Rate |
$3,487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.26
|
| Rate for Payer: Aetna of WY Medicare |
$977.19
|
| Rate for Payer: Beech Street Commercial |
$3,312.65
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.26
|
| Rate for Payer: First Choice Health Commercial |
$3,138.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.19
|
| Rate for Payer: HealthUtah PPO |
$3,487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.39
|
| Rate for Payer: Multiplan Medicare/VA |
$830.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.26
|
| Rate for Payer: PacificSource Commercial |
$3,138.30
|
| Rate for Payer: PHCS PPO |
$3,312.65
|
| Rate for Payer: Three Rivers PPO |
$2,615.25
|
| Rate for Payer: TriWest Veterans Administration |
$977.19
|
| Rate for Payer: United Healthcare Commercial |
$3,033.69
|
| Rate for Payer: United Healthcare Medicare |
$977.19
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.95
|
|
|
HC PRO HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
9839934901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$122.73
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.73
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$104.32
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.73
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$122.73
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
|
|
HC PRO HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
9839934801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.87 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$73.97
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.97
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$62.87
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$73.97
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$73.97
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
|
HC PRO HOSPITAL DISCHARGE DAY,<30 MIN
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
9839923801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Aetna of WY Medicare |
$77.97
|
| Rate for Payer: Aetna of WY Medicare |
$77.97
|
| Rate for Payer: Beech Street Commercial |
$180.50
|
| Rate for Payer: Beech Street Commercial |
$377.15
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$357.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.97
|
| Rate for Payer: HealthUtah PPO |
$84.24
|
| Rate for Payer: HealthUtah PPO |
$84.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$66.27
|
| Rate for Payer: Multiplan Medicare/VA |
$66.27
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$180.50
|
| Rate for Payer: PHCS PPO |
$377.15
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$77.97
|
| Rate for Payer: TriWest Veterans Administration |
$77.97
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: United Healthcare Medicare |
$77.97
|
| Rate for Payer: United Healthcare Medicare |
$77.97
|
| Rate for Payer: WINHealth Partners Commercial |
$377.15
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
|
|
HC PRO HOSPITAL DISCHARGE DAY,<30 MIN
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
9839923802
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$77.97
|
| Rate for Payer: Beech Street Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.97
|
| Rate for Payer: HealthUtah PPO |
$84.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$66.27
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$180.50
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$77.97
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$77.97
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
|
|
HC PRO HOSPITAL DISCHARGE DAY,>30 MIN
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
9839923902
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$110.05
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.05
|
| Rate for Payer: HealthUtah PPO |
$115.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$93.54
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$110.05
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$110.05
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
HC PRO HOSPITAL DISCHARGE DAY,>30 MIN
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
9839923901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$110.05
|
| Rate for Payer: Aetna of WY Medicare |
$110.05
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Beech Street Commercial |
$555.75
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: First Choice Health Commercial |
$526.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.05
|
| Rate for Payer: HealthUtah PPO |
$115.60
|
| Rate for Payer: HealthUtah PPO |
$115.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$93.54
|
| Rate for Payer: Multiplan Medicare/VA |
$93.54
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: PHCS PPO |
$555.75
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$110.05
|
| Rate for Payer: TriWest Veterans Administration |
$110.05
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$110.05
|
| Rate for Payer: United Healthcare Medicare |
$110.05
|
| Rate for Payer: WINHealth Partners Commercial |
$555.75
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
HC PRO HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
9825855501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$2,821.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,764.58
|
| Rate for Payer: Aetna of WY Medicare |
$144.57
|
| Rate for Payer: Beech Street Commercial |
$2,679.95
|
| Rate for Payer: Cash Price |
$1,974.70
|
| Rate for Payer: Cash Price |
$1,974.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,736.37
|
| Rate for Payer: Cigna of WY Commercial |
$2,764.58
|
| Rate for Payer: First Choice Health Commercial |
$2,538.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,679.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.57
|
| Rate for Payer: HealthUtah PPO |
$2,821.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,736.37
|
| Rate for Payer: Multiplan Medicare/VA |
$122.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,764.58
|
| Rate for Payer: PacificSource Commercial |
$2,538.90
|
| Rate for Payer: PHCS PPO |
$2,679.95
|
| Rate for Payer: Three Rivers PPO |
$2,115.75
|
| Rate for Payer: TriWest Veterans Administration |
$144.57
|
| Rate for Payer: United Healthcare Commercial |
$2,454.27
|
| Rate for Payer: United Healthcare Medicare |
$144.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,397.85
|
|
|
HC PRO HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 58560
|
| Hospital Charge Code |
9825856001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$253.11 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,289.68
|
| Rate for Payer: Aetna of WY Medicare |
$297.78
|
| Rate for Payer: Beech Street Commercial |
$1,250.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,276.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,289.68
|
| Rate for Payer: First Choice Health Commercial |
$1,184.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.78
|
| Rate for Payer: HealthUtah PPO |
$1,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,276.52
|
| Rate for Payer: Multiplan Medicare/VA |
$253.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,289.68
|
| Rate for Payer: PacificSource Commercial |
$1,184.40
|
| Rate for Payer: PHCS PPO |
$1,250.20
|
| Rate for Payer: Three Rivers PPO |
$987.00
|
| Rate for Payer: TriWest Veterans Administration |
$297.78
|
| Rate for Payer: United Healthcare Commercial |
$1,144.92
|
| Rate for Payer: United Healthcare Medicare |
$297.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,118.60
|
|
|
HC PRO HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$4,255.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
9835856301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$199.12 |
| Max. Negotiated Rate |
$4,255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,169.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.26
|
| Rate for Payer: Beech Street Commercial |
$4,042.25
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,127.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,169.90
|
| Rate for Payer: First Choice Health Commercial |
$3,829.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,042.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.26
|
| Rate for Payer: HealthUtah PPO |
$4,255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,127.35
|
| Rate for Payer: Multiplan Medicare/VA |
$199.12
|
| Rate for Payer: One Health Plan of WY PPO |
$4,169.90
|
| Rate for Payer: PacificSource Commercial |
$3,829.50
|
| Rate for Payer: PHCS PPO |
$4,042.25
|
| Rate for Payer: Three Rivers PPO |
$3,191.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.26
|
| Rate for Payer: United Healthcare Commercial |
$3,701.85
|
| Rate for Payer: United Healthcare Medicare |
$234.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3,616.75
|
|
|
HC PRO HYSTEROSCOPY REMOVAL FB
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
9835856201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$179.59 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,132.88
|
| Rate for Payer: Aetna of WY Medicare |
$211.28
|
| Rate for Payer: Beech Street Commercial |
$1,098.20
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,121.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,132.88
|
| Rate for Payer: First Choice Health Commercial |
$1,040.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,098.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.28
|
| Rate for Payer: HealthUtah PPO |
$1,156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,121.32
|
| Rate for Payer: Multiplan Medicare/VA |
$179.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,132.88
|
| Rate for Payer: PacificSource Commercial |
$1,040.40
|
| Rate for Payer: PHCS PPO |
$1,098.20
|
| Rate for Payer: Three Rivers PPO |
$867.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.28
|
| Rate for Payer: United Healthcare Commercial |
$1,005.72
|
| Rate for Payer: United Healthcare Medicare |
$211.28
|
| Rate for Payer: WINHealth Partners Commercial |
$982.60
|
|
|
HC PRO HYSTEROSCOPY,W/ENDO BX
|
Professional
|
Both
|
$4,324.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
9835855801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$4,324.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,237.52
|
| Rate for Payer: Aetna of WY Medicare |
$220.52
|
| Rate for Payer: Beech Street Commercial |
$4,107.80
|
| Rate for Payer: Cash Price |
$3,026.80
|
| Rate for Payer: Cash Price |
$3,026.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,194.28
|
| Rate for Payer: Cigna of WY Commercial |
$4,237.52
|
| Rate for Payer: First Choice Health Commercial |
$3,891.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,107.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.52
|
| Rate for Payer: HealthUtah PPO |
$4,324.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,194.28
|
| Rate for Payer: Multiplan Medicare/VA |
$187.44
|
| Rate for Payer: One Health Plan of WY PPO |
$4,237.52
|
| Rate for Payer: PacificSource Commercial |
$3,891.60
|
| Rate for Payer: PHCS PPO |
$4,107.80
|
| Rate for Payer: Three Rivers PPO |
$3,243.00
|
| Rate for Payer: TriWest Veterans Administration |
$220.52
|
| Rate for Payer: United Healthcare Commercial |
$3,761.88
|
| Rate for Payer: United Healthcare Medicare |
$220.52
|
| Rate for Payer: WINHealth Partners Commercial |
$3,675.40
|
|
