|
HC PRO ILEOSCOPY THRU STOMA,BIOPSY - ENTEROSCOPY
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
9834438201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,543.50
|
| Rate for Payer: Aetna of WY Medicare |
$70.76
|
| Rate for Payer: Beech Street Commercial |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,527.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,543.50
|
| Rate for Payer: First Choice Health Commercial |
$1,417.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$1,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,527.75
|
| Rate for Payer: Multiplan Medicare/VA |
$60.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,543.50
|
| Rate for Payer: PacificSource Commercial |
$1,417.50
|
| Rate for Payer: PHCS PPO |
$1,496.25
|
| Rate for Payer: Three Rivers PPO |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$1,370.25
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,338.75
|
|
|
HC PRO ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD - ENTEROSCOPY
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 44380
|
| Hospital Charge Code |
9834438001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.79 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,196.18
|
| Rate for Payer: Aetna of WY Medicare |
$55.05
|
| Rate for Payer: Beech Street Commercial |
$2,128.95
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,173.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,196.18
|
| Rate for Payer: First Choice Health Commercial |
$2,016.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.05
|
| Rate for Payer: HealthUtah PPO |
$2,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,173.77
|
| Rate for Payer: Multiplan Medicare/VA |
$46.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,196.18
|
| Rate for Payer: PacificSource Commercial |
$2,016.90
|
| Rate for Payer: PHCS PPO |
$2,128.95
|
| Rate for Payer: Three Rivers PPO |
$1,680.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.05
|
| Rate for Payer: United Healthcare Commercial |
$1,949.67
|
| Rate for Payer: United Healthcare Medicare |
$55.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,904.85
|
|
|
HC PRO ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 44310
|
| Hospital Charge Code |
9754431001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$837.91 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$985.78
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$985.78
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$837.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$985.78
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$985.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
HC PRO IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT CLOSURE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 49568
|
| Hospital Charge Code |
9834956801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,356.32
|
| Rate for Payer: Beech Street Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,342.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,356.32
|
| Rate for Payer: First Choice Health Commercial |
$1,245.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,314.80
|
| Rate for Payer: HealthUtah PPO |
$1,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,342.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,356.32
|
| Rate for Payer: PacificSource Commercial |
$1,245.60
|
| Rate for Payer: PHCS PPO |
$1,314.80
|
| Rate for Payer: Three Rivers PPO |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$1,204.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.40
|
|
|
HC PRO IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 69714
|
| Hospital Charge Code |
9756971401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.35 |
| Max. Negotiated Rate |
$1,465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,435.70
|
| Rate for Payer: Aetna of WY Medicare |
$480.41
|
| Rate for Payer: Beech Street Commercial |
$1,391.75
|
| Rate for Payer: Cash Price |
$1,025.50
|
| Rate for Payer: Cash Price |
$1,025.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,421.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,435.70
|
| Rate for Payer: First Choice Health Commercial |
$1,318.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,391.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$480.41
|
| Rate for Payer: HealthUtah PPO |
$1,465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,421.05
|
| Rate for Payer: Multiplan Medicare/VA |
$408.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,435.70
|
| Rate for Payer: PacificSource Commercial |
$1,318.50
|
| Rate for Payer: PHCS PPO |
$1,391.75
|
| Rate for Payer: Three Rivers PPO |
$1,098.75
|
| Rate for Payer: TriWest Veterans Administration |
$480.41
|
| Rate for Payer: United Healthcare Commercial |
$1,274.55
|
| Rate for Payer: United Healthcare Medicare |
$480.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,245.25
|
|
|
HC PRO INCISE THROMBOSED HEMORRHOID EXT
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
9834608301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$550.76
|
| Rate for Payer: Aetna of WY Medicare |
$106.73
|
| Rate for Payer: Aetna of WY Medicare |
$106.73
|
| Rate for Payer: Beech Street Commercial |
$533.90
|
| Rate for Payer: Beech Street Commercial |
$523.45
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: Cash Price |
$385.70
|
| Rate for Payer: Cash Price |
$385.70
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$545.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$534.47
|
| Rate for Payer: Cigna of WY Commercial |
$539.98
|
| Rate for Payer: Cigna of WY Commercial |
$550.76
|
| Rate for Payer: First Choice Health Commercial |
$505.80
|
| Rate for Payer: First Choice Health Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$523.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$533.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.73
|
| Rate for Payer: HealthUtah PPO |
$551.00
|
| Rate for Payer: HealthUtah PPO |
$562.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$545.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$534.47
|
| Rate for Payer: Multiplan Medicare/VA |
$90.72
|
| Rate for Payer: Multiplan Medicare/VA |
$90.72
|
| Rate for Payer: One Health Plan of WY PPO |
$550.76
|
| Rate for Payer: One Health Plan of WY PPO |
$539.98
|
| Rate for Payer: PacificSource Commercial |
$495.90
|
| Rate for Payer: PacificSource Commercial |
$505.80
|
| Rate for Payer: PHCS PPO |
$523.45
|
| Rate for Payer: PHCS PPO |
$533.90
|
| Rate for Payer: Three Rivers PPO |
$413.25
|
| Rate for Payer: Three Rivers PPO |
$421.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.73
|
| Rate for Payer: TriWest Veterans Administration |
$106.73
|
| Rate for Payer: United Healthcare Commercial |
$488.94
|
| Rate for Payer: United Healthcare Commercial |
$479.37
|
| Rate for Payer: United Healthcare Medicare |
$106.73
|
| Rate for Payer: United Healthcare Medicare |
$106.73
|
| Rate for Payer: WINHealth Partners Commercial |
$468.35
|
| Rate for Payer: WINHealth Partners Commercial |
$477.70
|
|
|
HC PRO INCISIONAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
9831110601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$233.24
|
| Rate for Payer: Aetna of WY Medicare |
$53.90
|
| Rate for Payer: Beech Street Commercial |
$226.10
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.86
|
| Rate for Payer: Cigna of WY Commercial |
$233.24
|
| Rate for Payer: First Choice Health Commercial |
$214.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.90
|
| Rate for Payer: HealthUtah PPO |
$238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.86
|
| Rate for Payer: Multiplan Medicare/VA |
$45.82
|
| Rate for Payer: One Health Plan of WY PPO |
$233.24
|
| Rate for Payer: PacificSource Commercial |
$214.20
|
| Rate for Payer: PHCS PPO |
$226.10
|
| Rate for Payer: Three Rivers PPO |
$178.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$207.06
|
| Rate for Payer: United Healthcare Medicare |
$53.90
|
| Rate for Payer: WINHealth Partners Commercial |
$202.30
|
|
|
HC PRO INCISIONAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 11106 NONPBBPAYER
|
| Hospital Charge Code |
9831110601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.06
|
| Rate for Payer: Aetna of WY Medicare |
$53.90
|
| Rate for Payer: Beech Street Commercial |
$282.15
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.09
|
| Rate for Payer: Cigna of WY Commercial |
$291.06
|
| Rate for Payer: First Choice Health Commercial |
$267.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.90
|
| Rate for Payer: HealthUtah PPO |
$297.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.09
|
| Rate for Payer: Multiplan Medicare/VA |
$45.82
|
| Rate for Payer: One Health Plan of WY PPO |
$291.06
|
| Rate for Payer: PacificSource Commercial |
$267.30
|
| Rate for Payer: PHCS PPO |
$282.15
|
| Rate for Payer: Three Rivers PPO |
$222.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$258.39
|
| Rate for Payer: United Healthcare Medicare |
$53.90
|
| Rate for Payer: WINHealth Partners Commercial |
$252.45
|
|
|
HC PRO INCISION DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$892.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
9831014001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$874.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.10
|
| Rate for Payer: Aetna of WY Medicare |
$115.10
|
| Rate for Payer: Beech Street Commercial |
$451.25
|
| Rate for Payer: Beech Street Commercial |
$847.40
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$865.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Cigna of WY Commercial |
$874.16
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$802.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$847.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.10
|
| Rate for Payer: HealthUtah PPO |
$892.00
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$865.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$97.84
|
| Rate for Payer: Multiplan Medicare/VA |
$97.84
|
| Rate for Payer: One Health Plan of WY PPO |
$874.16
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PacificSource Commercial |
$802.80
|
| Rate for Payer: PHCS PPO |
$847.40
|
| Rate for Payer: PHCS PPO |
$451.25
|
| Rate for Payer: Three Rivers PPO |
$669.00
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.10
|
| Rate for Payer: TriWest Veterans Administration |
$115.10
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Commercial |
$776.04
|
| Rate for Payer: United Healthcare Medicare |
$115.10
|
| Rate for Payer: United Healthcare Medicare |
$115.10
|
| Rate for Payer: WINHealth Partners Commercial |
$758.20
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
|
|
HC PRO INCISION DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 10140 NONPBBPAYER
|
| Hospital Charge Code |
9831014001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$582.12
|
| Rate for Payer: Aetna of WY Medicare |
$115.10
|
| Rate for Payer: Beech Street Commercial |
$564.30
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$576.18
|
| Rate for Payer: Cigna of WY Commercial |
$582.12
|
| Rate for Payer: First Choice Health Commercial |
$534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.10
|
| Rate for Payer: HealthUtah PPO |
$594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$576.18
|
| Rate for Payer: Multiplan Medicare/VA |
$97.84
|
| Rate for Payer: One Health Plan of WY PPO |
$582.12
|
| Rate for Payer: PacificSource Commercial |
$534.60
|
| Rate for Payer: PHCS PPO |
$564.30
|
| Rate for Payer: Three Rivers PPO |
$445.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.10
|
| Rate for Payer: United Healthcare Commercial |
$516.78
|
| Rate for Payer: United Healthcare Medicare |
$115.10
|
| Rate for Payer: WINHealth Partners Commercial |
$504.90
|
|
|
HC PRO INCISION DRAIN PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
9831008001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$102.42
|
| Rate for Payer: Beech Street Commercial |
$489.25
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: First Choice Health Commercial |
$463.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.42
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$87.06
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$489.25
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.42
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$102.42
|
| Rate for Payer: WINHealth Partners Commercial |
$437.75
|
|
|
HC PRO INCISION DRAIN SKIN ABSCESS COMPLEX
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
9831006101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Aetna of WY Medicare |
$179.32
|
| Rate for Payer: Beech Street Commercial |
$862.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: First Choice Health Commercial |
$817.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.32
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$152.42
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$862.60
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.32
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$179.32
|
| Rate for Payer: WINHealth Partners Commercial |
$771.80
|
|
|
HC PRO INCISION DRAIN SKIN ABSCESS SIMPLE
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
9831006001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.68 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$636.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Aetna of WY Medicare |
$104.33
|
| Rate for Payer: Aetna of WY Medicare |
$104.33
|
| Rate for Payer: Beech Street Commercial |
$476.90
|
| Rate for Payer: Beech Street Commercial |
$616.55
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$629.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: Cigna of WY Commercial |
$636.02
|
| Rate for Payer: First Choice Health Commercial |
$451.80
|
| Rate for Payer: First Choice Health Commercial |
$584.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$616.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.33
|
| Rate for Payer: HealthUtah PPO |
$649.00
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$629.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$88.68
|
| Rate for Payer: Multiplan Medicare/VA |
$88.68
|
| Rate for Payer: One Health Plan of WY PPO |
$636.02
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PacificSource Commercial |
$584.10
|
| Rate for Payer: PHCS PPO |
$616.55
|
| Rate for Payer: PHCS PPO |
$476.90
|
| Rate for Payer: Three Rivers PPO |
$486.75
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.33
|
| Rate for Payer: TriWest Veterans Administration |
$104.33
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Commercial |
$564.63
|
| Rate for Payer: United Healthcare Medicare |
$104.33
|
| Rate for Payer: United Healthcare Medicare |
$104.33
|
| Rate for Payer: WINHealth Partners Commercial |
$551.65
|
| Rate for Payer: WINHealth Partners Commercial |
$426.70
|
|
|
HC PRO INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$2,455.00
|
|
|
Service Code
|
HCPCS 25000 50
|
| Hospital Charge Code |
9832500001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$2,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,405.90
|
| Rate for Payer: Aetna of WY Medicare |
$343.90
|
| Rate for Payer: Beech Street Commercial |
$2,332.25
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,381.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,405.90
|
| Rate for Payer: First Choice Health Commercial |
$2,209.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,332.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.90
|
| Rate for Payer: HealthUtah PPO |
$2,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,381.35
|
| Rate for Payer: Multiplan Medicare/VA |
$292.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,405.90
|
| Rate for Payer: PacificSource Commercial |
$2,209.50
|
| Rate for Payer: PHCS PPO |
$2,332.25
|
| Rate for Payer: Three Rivers PPO |
$1,841.25
|
| Rate for Payer: TriWest Veterans Administration |
$343.90
|
| Rate for Payer: United Healthcare Commercial |
$2,135.85
|
| Rate for Payer: United Healthcare Medicare |
$343.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,086.75
|
|
|
HC PRO INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
9832500001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$1,227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,202.46
|
| Rate for Payer: Aetna of WY Medicare |
$343.90
|
| Rate for Payer: Beech Street Commercial |
$1,165.65
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,190.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,202.46
|
| Rate for Payer: First Choice Health Commercial |
$1,104.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,165.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.90
|
| Rate for Payer: HealthUtah PPO |
$1,227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,190.19
|
| Rate for Payer: Multiplan Medicare/VA |
$292.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,202.46
|
| Rate for Payer: PacificSource Commercial |
$1,104.30
|
| Rate for Payer: PHCS PPO |
$1,165.65
|
| Rate for Payer: Three Rivers PPO |
$920.25
|
| Rate for Payer: TriWest Veterans Administration |
$343.90
|
| Rate for Payer: United Healthcare Commercial |
$1,067.49
|
| Rate for Payer: United Healthcare Medicare |
$343.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,042.95
|
|
|
HC PRO INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 40806 NONPBBPAYER
|
| Hospital Charge Code |
9834080601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Beech Street Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: First Choice Health Commercial |
$140.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$148.20
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: WINHealth Partners Commercial |
$132.60
|
|
|
HC PRO INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
9834080601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Beech Street Commercial |
$118.75
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: First Choice Health Commercial |
$112.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$118.75
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: WINHealth Partners Commercial |
$106.25
|
|
|
HC PRO INCISION OF TONGUE FOLD
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
9834101001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.88
|
| Rate for Payer: Aetna of WY Medicare |
$107.67
|
| Rate for Payer: Beech Street Commercial |
$575.70
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.82
|
| Rate for Payer: Cigna of WY Commercial |
$593.88
|
| Rate for Payer: First Choice Health Commercial |
$545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.67
|
| Rate for Payer: HealthUtah PPO |
$606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.82
|
| Rate for Payer: Multiplan Medicare/VA |
$91.52
|
| Rate for Payer: One Health Plan of WY PPO |
$593.88
|
| Rate for Payer: PacificSource Commercial |
$545.40
|
| Rate for Payer: PHCS PPO |
$575.70
|
| Rate for Payer: Three Rivers PPO |
$454.50
|
| Rate for Payer: TriWest Veterans Administration |
$107.67
|
| Rate for Payer: United Healthcare Commercial |
$527.22
|
| Rate for Payer: United Healthcare Medicare |
$107.67
|
| Rate for Payer: WINHealth Partners Commercial |
$515.10
|
|
|
HC PRO INCISION OF TONGUE FOLD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41010 NONPBBPAYER
|
| Hospital Charge Code |
9834101001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$757.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$741.86
|
| Rate for Payer: Aetna of WY Medicare |
$107.67
|
| Rate for Payer: Beech Street Commercial |
$719.15
|
| Rate for Payer: Cash Price |
$529.90
|
| Rate for Payer: Cash Price |
$529.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$734.29
|
| Rate for Payer: Cigna of WY Commercial |
$741.86
|
| Rate for Payer: First Choice Health Commercial |
$681.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$719.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.67
|
| Rate for Payer: HealthUtah PPO |
$757.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$734.29
|
| Rate for Payer: Multiplan Medicare/VA |
$91.52
|
| Rate for Payer: One Health Plan of WY PPO |
$741.86
|
| Rate for Payer: PacificSource Commercial |
$681.30
|
| Rate for Payer: PHCS PPO |
$719.15
|
| Rate for Payer: Three Rivers PPO |
$567.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.67
|
| Rate for Payer: United Healthcare Commercial |
$658.59
|
| Rate for Payer: United Healthcare Medicare |
$107.67
|
| Rate for Payer: WINHealth Partners Commercial |
$643.45
|
|
|
HC PRO INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 59855
|
| Hospital Charge Code |
9755985501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.21 |
| Max. Negotiated Rate |
$1,239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,214.22
|
| Rate for Payer: Aetna of WY Medicare |
$406.13
|
| Rate for Payer: Beech Street Commercial |
$1,177.05
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,201.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,214.22
|
| Rate for Payer: First Choice Health Commercial |
$1,115.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,177.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.13
|
| Rate for Payer: HealthUtah PPO |
$1,239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,201.83
|
| Rate for Payer: Multiplan Medicare/VA |
$345.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,214.22
|
| Rate for Payer: PacificSource Commercial |
$1,115.10
|
| Rate for Payer: PHCS PPO |
$1,177.05
|
| Rate for Payer: Three Rivers PPO |
$929.25
|
| Rate for Payer: TriWest Veterans Administration |
$406.13
|
| Rate for Payer: United Healthcare Commercial |
$1,077.93
|
| Rate for Payer: United Healthcare Medicare |
$406.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,053.15
|
|
|
HC PRO INIT HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
9839946001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$88.94
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.94
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$75.60
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$88.94
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
|
|
HC PRO INITIAL HOSPITAL CARE 50 MINUTES
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
9839922201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$405.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$405.72
|
| Rate for Payer: Aetna of WY Medicare |
$125.08
|
| Rate for Payer: Beech Street Commercial |
$393.30
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$401.58
|
| Rate for Payer: Cigna of WY Commercial |
$405.72
|
| Rate for Payer: First Choice Health Commercial |
$372.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.08
|
| Rate for Payer: HealthUtah PPO |
$137.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$401.58
|
| Rate for Payer: Multiplan Medicare/VA |
$106.32
|
| Rate for Payer: One Health Plan of WY PPO |
$405.72
|
| Rate for Payer: PacificSource Commercial |
$372.60
|
| Rate for Payer: PHCS PPO |
$393.30
|
| Rate for Payer: Three Rivers PPO |
$310.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$360.18
|
| Rate for Payer: United Healthcare Medicare |
$125.08
|
| Rate for Payer: WINHealth Partners Commercial |
$393.30
|
|
|
HC PRO INITIAL HOSPITAL CARE 50 MINUTES
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
9839922202
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$405.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$405.72
|
| Rate for Payer: Aetna of WY Medicare |
$125.08
|
| Rate for Payer: Beech Street Commercial |
$393.30
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$401.58
|
| Rate for Payer: Cigna of WY Commercial |
$405.72
|
| Rate for Payer: First Choice Health Commercial |
$372.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.08
|
| Rate for Payer: HealthUtah PPO |
$137.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$401.58
|
| Rate for Payer: Multiplan Medicare/VA |
$106.32
|
| Rate for Payer: One Health Plan of WY PPO |
$405.72
|
| Rate for Payer: PacificSource Commercial |
$372.60
|
| Rate for Payer: PHCS PPO |
$393.30
|
| Rate for Payer: Three Rivers PPO |
$310.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$360.18
|
| Rate for Payer: United Healthcare Medicare |
$125.08
|
| Rate for Payer: WINHealth Partners Commercial |
$393.30
|
|
|
HC PRO INITIAL HOSPITAL CARE 70 MINUTES
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
9839922302
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$500.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$500.78
|
| Rate for Payer: Aetna of WY Medicare |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$485.45
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$495.67
|
| Rate for Payer: Cigna of WY Commercial |
$500.78
|
| Rate for Payer: First Choice Health Commercial |
$459.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$485.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.08
|
| Rate for Payer: HealthUtah PPO |
$191.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$495.67
|
| Rate for Payer: Multiplan Medicare/VA |
$141.17
|
| Rate for Payer: One Health Plan of WY PPO |
$500.78
|
| Rate for Payer: PacificSource Commercial |
$459.90
|
| Rate for Payer: PHCS PPO |
$485.45
|
| Rate for Payer: Three Rivers PPO |
$383.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.08
|
| Rate for Payer: United Healthcare Commercial |
$444.57
|
| Rate for Payer: United Healthcare Medicare |
$166.08
|
| Rate for Payer: WINHealth Partners Commercial |
$485.45
|
|
|
HC PRO INITIAL HOSPITAL CARE 70 MINUTES
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
9839922301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$500.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$500.78
|
| Rate for Payer: Aetna of WY Medicare |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$485.45
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$495.67
|
| Rate for Payer: Cigna of WY Commercial |
$500.78
|
| Rate for Payer: First Choice Health Commercial |
$459.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$485.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.08
|
| Rate for Payer: HealthUtah PPO |
$191.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$495.67
|
| Rate for Payer: Multiplan Medicare/VA |
$141.17
|
| Rate for Payer: One Health Plan of WY PPO |
$500.78
|
| Rate for Payer: PacificSource Commercial |
$459.90
|
| Rate for Payer: PHCS PPO |
$485.45
|
| Rate for Payer: Three Rivers PPO |
$383.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.08
|
| Rate for Payer: United Healthcare Commercial |
$444.57
|
| Rate for Payer: United Healthcare Medicare |
$166.08
|
| Rate for Payer: WINHealth Partners Commercial |
$485.45
|
|
