|
ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$2,889.00
|
|
|
Service Code
|
HCPCS 23107
|
| Min. Negotiated Rate |
$551.09 |
| Max. Negotiated Rate |
$2,889.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,831.22
|
| Rate for Payer: Aetna of WY Medicare |
$648.34
|
| Rate for Payer: Beech Street Commercial |
$2,744.55
|
| Rate for Payer: Cash Price |
$2,022.30
|
| Rate for Payer: Cash Price |
$2,022.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,802.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,831.22
|
| Rate for Payer: First Choice Health Commercial |
$2,600.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,744.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$648.34
|
| Rate for Payer: HealthUtah PPO |
$2,889.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,802.33
|
| Rate for Payer: Multiplan Medicare/VA |
$551.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,831.22
|
| Rate for Payer: PacificSource Commercial |
$2,600.10
|
| Rate for Payer: PHCS PPO |
$2,744.55
|
| Rate for Payer: Three Rivers PPO |
$2,166.75
|
| Rate for Payer: TriWest Veterans Administration |
$648.34
|
| Rate for Payer: United Healthcare Commercial |
$2,744.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,455.65
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$5,398.00
|
|
|
Service Code
|
HCPCS 27310 AS
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,290.04
|
| Rate for Payer: Beech Street Commercial |
$5,128.10
|
| Rate for Payer: Cash Price |
$3,778.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,236.06
|
| Rate for Payer: Cigna of WY Commercial |
$5,290.04
|
| Rate for Payer: First Choice Health Commercial |
$4,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,128.10
|
| Rate for Payer: HealthUtah PPO |
$5,398.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,236.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5,290.04
|
| Rate for Payer: PacificSource Commercial |
$4,858.20
|
| Rate for Payer: PHCS PPO |
$5,128.10
|
| Rate for Payer: Three Rivers PPO |
$4,048.50
|
| Rate for Payer: United Healthcare Commercial |
$5,128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,588.30
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$5,398.00
|
|
|
Service Code
|
HCPCS 27310 80
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,290.04
|
| Rate for Payer: Beech Street Commercial |
$5,128.10
|
| Rate for Payer: Cash Price |
$3,778.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,236.06
|
| Rate for Payer: Cigna of WY Commercial |
$5,290.04
|
| Rate for Payer: First Choice Health Commercial |
$4,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,128.10
|
| Rate for Payer: HealthUtah PPO |
$5,398.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,236.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5,290.04
|
| Rate for Payer: PacificSource Commercial |
$4,858.20
|
| Rate for Payer: PHCS PPO |
$5,128.10
|
| Rate for Payer: Three Rivers PPO |
$4,048.50
|
| Rate for Payer: United Healthcare Commercial |
$5,128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,588.30
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$5,398.00
|
|
|
Service Code
|
HCPCS 27310
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,290.04
|
| Rate for Payer: Aetna of WY Medicare |
$712.43
|
| Rate for Payer: Beech Street Commercial |
$5,128.10
|
| Rate for Payer: Cash Price |
$3,778.60
|
| Rate for Payer: Cash Price |
$3,778.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,236.06
|
| Rate for Payer: Cigna of WY Commercial |
$5,290.04
|
| Rate for Payer: First Choice Health Commercial |
$4,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,128.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.43
|
| Rate for Payer: HealthUtah PPO |
$5,398.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,236.06
|
| Rate for Payer: Multiplan Medicare/VA |
$605.57
|
| Rate for Payer: One Health Plan of WY PPO |
$5,290.04
|
| Rate for Payer: PacificSource Commercial |
$4,858.20
|
| Rate for Payer: PHCS PPO |
$5,128.10
|
| Rate for Payer: Three Rivers PPO |
$4,048.50
|
| Rate for Payer: TriWest Veterans Administration |
$712.43
|
| Rate for Payer: United Healthcare Commercial |
$5,128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,588.30
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$5,668.00
|
|
|
Service Code
|
HCPCS 27331 AS
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$5,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,554.64
|
| Rate for Payer: Beech Street Commercial |
$5,384.60
|
| Rate for Payer: Cash Price |
$3,967.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,497.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,554.64
|
| Rate for Payer: First Choice Health Commercial |
$5,101.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,384.60
|
| Rate for Payer: HealthUtah PPO |
$5,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,497.96
|
| Rate for Payer: One Health Plan of WY PPO |
$5,554.64
|
| Rate for Payer: PacificSource Commercial |
$5,101.20
|
| Rate for Payer: PHCS PPO |
$5,384.60
|
| Rate for Payer: Three Rivers PPO |
$4,251.00
|
| Rate for Payer: United Healthcare Commercial |
$5,384.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,817.80
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$5,668.00
|
|
|
Service Code
|
HCPCS 27331
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$5,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,554.64
|
| Rate for Payer: Aetna of WY Medicare |
$467.88
|
| Rate for Payer: Beech Street Commercial |
$5,384.60
|
| Rate for Payer: Cash Price |
$3,967.60
|
| Rate for Payer: Cash Price |
$3,967.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,497.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,554.64
|
| Rate for Payer: First Choice Health Commercial |
$5,101.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,384.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.88
|
| Rate for Payer: HealthUtah PPO |
$5,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,497.96
|
| Rate for Payer: Multiplan Medicare/VA |
$397.70
|
| Rate for Payer: One Health Plan of WY PPO |
$5,554.64
|
| Rate for Payer: PacificSource Commercial |
$5,101.20
|
| Rate for Payer: PHCS PPO |
$5,384.60
|
| Rate for Payer: Three Rivers PPO |
$4,251.00
|
| Rate for Payer: TriWest Veterans Administration |
$467.88
|
| Rate for Payer: United Healthcare Commercial |
$5,384.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,817.80
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$5,668.00
|
|
|
Service Code
|
HCPCS 27331 80
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$5,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,554.64
|
| Rate for Payer: Beech Street Commercial |
$5,384.60
|
| Rate for Payer: Cash Price |
$3,967.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,497.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,554.64
|
| Rate for Payer: First Choice Health Commercial |
$5,101.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,384.60
|
| Rate for Payer: HealthUtah PPO |
$5,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,497.96
|
| Rate for Payer: One Health Plan of WY PPO |
$5,554.64
|
| Rate for Payer: PacificSource Commercial |
$5,101.20
|
| Rate for Payer: PHCS PPO |
$5,384.60
|
| Rate for Payer: Three Rivers PPO |
$4,251.00
|
| Rate for Payer: United Healthcare Commercial |
$5,384.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,817.80
|
|
|
ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$4,480.00
|
|
|
Service Code
|
HCPCS 28052
|
| Min. Negotiated Rate |
$213.38 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,390.40
|
| Rate for Payer: Aetna of WY Medicare |
$251.03
|
| Rate for Payer: Beech Street Commercial |
$4,256.00
|
| Rate for Payer: Cash Price |
$3,136.00
|
| Rate for Payer: Cash Price |
$3,136.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,345.60
|
| Rate for Payer: Cigna of WY Commercial |
$4,390.40
|
| Rate for Payer: First Choice Health Commercial |
$4,032.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,256.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$251.03
|
| Rate for Payer: HealthUtah PPO |
$4,480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,345.60
|
| Rate for Payer: Multiplan Medicare/VA |
$213.38
|
| Rate for Payer: One Health Plan of WY PPO |
$4,390.40
|
| Rate for Payer: PacificSource Commercial |
$4,032.00
|
| Rate for Payer: PHCS PPO |
$4,256.00
|
| Rate for Payer: Three Rivers PPO |
$3,360.00
|
| Rate for Payer: TriWest Veterans Administration |
$251.03
|
| Rate for Payer: United Healthcare Commercial |
$4,256.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,808.00
|
|
|
ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 28052 80
|
| Min. Negotiated Rate |
$453.00 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$591.92
|
| Rate for Payer: Beech Street Commercial |
$573.80
|
| Rate for Payer: Cash Price |
$422.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$585.88
|
| Rate for Payer: Cigna of WY Commercial |
$591.92
|
| Rate for Payer: First Choice Health Commercial |
$543.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$573.80
|
| Rate for Payer: HealthUtah PPO |
$604.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$585.88
|
| Rate for Payer: One Health Plan of WY PPO |
$591.92
|
| Rate for Payer: PacificSource Commercial |
$543.60
|
| Rate for Payer: PHCS PPO |
$573.80
|
| Rate for Payer: Three Rivers PPO |
$453.00
|
| Rate for Payer: United Healthcare Commercial |
$573.80
|
| Rate for Payer: WINHealth Partners Commercial |
$513.40
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,476.00
|
|
|
Service Code
|
HCPCS 25040
|
| Min. Negotiated Rate |
$464.22 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,426.48
|
| Rate for Payer: Aetna of WY Medicare |
$546.14
|
| Rate for Payer: Beech Street Commercial |
$2,352.20
|
| Rate for Payer: Cash Price |
$1,733.20
|
| Rate for Payer: Cash Price |
$1,733.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,401.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,426.48
|
| Rate for Payer: First Choice Health Commercial |
$2,228.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,352.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$546.14
|
| Rate for Payer: HealthUtah PPO |
$2,476.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,401.72
|
| Rate for Payer: Multiplan Medicare/VA |
$464.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,426.48
|
| Rate for Payer: PacificSource Commercial |
$2,228.40
|
| Rate for Payer: PHCS PPO |
$2,352.20
|
| Rate for Payer: Three Rivers PPO |
$1,857.00
|
| Rate for Payer: TriWest Veterans Administration |
$546.14
|
| Rate for Payer: United Healthcare Commercial |
$2,352.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,104.60
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
HCPCS 28022
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$1,439.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,410.22
|
| Rate for Payer: Aetna of WY Medicare |
$320.53
|
| Rate for Payer: Beech Street Commercial |
$1,367.05
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,395.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,410.22
|
| Rate for Payer: First Choice Health Commercial |
$1,295.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,367.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.53
|
| Rate for Payer: HealthUtah PPO |
$1,439.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,395.83
|
| Rate for Payer: Multiplan Medicare/VA |
$272.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,410.22
|
| Rate for Payer: PacificSource Commercial |
$1,295.10
|
| Rate for Payer: PHCS PPO |
$1,367.05
|
| Rate for Payer: Three Rivers PPO |
$1,079.25
|
| Rate for Payer: TriWest Veterans Administration |
$320.53
|
| Rate for Payer: United Healthcare Commercial |
$1,367.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,223.15
|
|
|
ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,744.40
|
| Rate for Payer: Aetna of WY Medicare |
$401.18
|
| Rate for Payer: Beech Street Commercial |
$1,691.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,726.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,744.40
|
| Rate for Payer: First Choice Health Commercial |
$1,602.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,691.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.18
|
| Rate for Payer: HealthUtah PPO |
$1,780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,726.60
|
| Rate for Payer: Multiplan Medicare/VA |
$341.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,744.40
|
| Rate for Payer: PacificSource Commercial |
$1,602.00
|
| Rate for Payer: PHCS PPO |
$1,691.00
|
| Rate for Payer: Three Rivers PPO |
$1,335.00
|
| Rate for Payer: TriWest Veterans Administration |
$401.18
|
| Rate for Payer: United Healthcare Commercial |
$1,691.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,513.00
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$8,216.00
|
|
|
Service Code
|
HCPCS 27335 AS
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$8,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,051.68
|
| Rate for Payer: Beech Street Commercial |
$7,805.20
|
| Rate for Payer: Cash Price |
$5,751.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,969.52
|
| Rate for Payer: Cigna of WY Commercial |
$8,051.68
|
| Rate for Payer: First Choice Health Commercial |
$7,394.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,805.20
|
| Rate for Payer: HealthUtah PPO |
$8,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,969.52
|
| Rate for Payer: One Health Plan of WY PPO |
$8,051.68
|
| Rate for Payer: PacificSource Commercial |
$7,394.40
|
| Rate for Payer: PHCS PPO |
$7,805.20
|
| Rate for Payer: Three Rivers PPO |
$6,162.00
|
| Rate for Payer: United Healthcare Commercial |
$7,805.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,983.60
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$8,216.00
|
|
|
Service Code
|
HCPCS 27335 80
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$8,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,051.68
|
| Rate for Payer: Beech Street Commercial |
$7,805.20
|
| Rate for Payer: Cash Price |
$5,751.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,969.52
|
| Rate for Payer: Cigna of WY Commercial |
$8,051.68
|
| Rate for Payer: First Choice Health Commercial |
$7,394.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,805.20
|
| Rate for Payer: HealthUtah PPO |
$8,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,969.52
|
| Rate for Payer: One Health Plan of WY PPO |
$8,051.68
|
| Rate for Payer: PacificSource Commercial |
$7,394.40
|
| Rate for Payer: PHCS PPO |
$7,805.20
|
| Rate for Payer: Three Rivers PPO |
$6,162.00
|
| Rate for Payer: United Healthcare Commercial |
$7,805.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,983.60
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$8,216.00
|
|
|
Service Code
|
HCPCS 27335
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$8,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,051.68
|
| Rate for Payer: Aetna of WY Medicare |
$744.39
|
| Rate for Payer: Beech Street Commercial |
$7,805.20
|
| Rate for Payer: Cash Price |
$5,751.20
|
| Rate for Payer: Cash Price |
$5,751.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,969.52
|
| Rate for Payer: Cigna of WY Commercial |
$8,051.68
|
| Rate for Payer: First Choice Health Commercial |
$7,394.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,805.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$744.39
|
| Rate for Payer: HealthUtah PPO |
$8,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,969.52
|
| Rate for Payer: Multiplan Medicare/VA |
$632.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8,051.68
|
| Rate for Payer: PacificSource Commercial |
$7,394.40
|
| Rate for Payer: PHCS PPO |
$7,805.20
|
| Rate for Payer: Three Rivers PPO |
$6,162.00
|
| Rate for Payer: TriWest Veterans Administration |
$744.39
|
| Rate for Payer: United Healthcare Commercial |
$7,805.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,983.60
|
|
|
ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$45.78
|
| Rate for Payer: Beech Street Commercial |
$270.75
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.78
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$38.91
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$270.75
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$45.78
|
| Rate for Payer: United Healthcare Commercial |
$270.75
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
|
|
ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$403.76
|
| Rate for Payer: Aetna of WY Medicare |
$54.70
|
| Rate for Payer: Beech Street Commercial |
$391.40
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$399.64
|
| Rate for Payer: Cigna of WY Commercial |
$403.76
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.70
|
| Rate for Payer: HealthUtah PPO |
$412.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$399.64
|
| Rate for Payer: Multiplan Medicare/VA |
$46.50
|
| Rate for Payer: One Health Plan of WY PPO |
$403.76
|
| Rate for Payer: PacificSource Commercial |
$370.80
|
| Rate for Payer: PHCS PPO |
$391.40
|
| Rate for Payer: Three Rivers PPO |
$309.00
|
| Rate for Payer: TriWest Veterans Administration |
$54.70
|
| Rate for Payer: United Healthcare Commercial |
$391.40
|
| Rate for Payer: WINHealth Partners Commercial |
$350.20
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$192.08
|
| Rate for Payer: Aetna of WY Medicare |
$41.80
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Cash Price |
$137.20
|
| Rate for Payer: Cash Price |
$137.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$190.12
|
| Rate for Payer: Cigna of WY Commercial |
$192.08
|
| Rate for Payer: First Choice Health Commercial |
$176.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$186.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.80
|
| Rate for Payer: HealthUtah PPO |
$196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$190.12
|
| Rate for Payer: Multiplan Medicare/VA |
$35.53
|
| Rate for Payer: One Health Plan of WY PPO |
$192.08
|
| Rate for Payer: PacificSource Commercial |
$176.40
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$147.00
|
| Rate for Payer: TriWest Veterans Administration |
$41.80
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
|
|
ARTLINE PRESSURE TUBING TRANSDUCER
|
Facility
|
OP
|
$35.94
|
|
| Hospital Charge Code |
2500059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.22
|
| Rate for Payer: Aetna of WY Medicare |
$23.72
|
| Rate for Payer: Altius Commercial |
$34.50
|
| Rate for Payer: Beech Street Commercial |
$35.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.86
|
| Rate for Payer: Cigna of WY Commercial |
$35.22
|
| Rate for Payer: Entrust Commercial |
$34.14
|
| Rate for Payer: First Choice Health Commercial |
$34.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.49
|
| Rate for Payer: HealthUtah PPO |
$35.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.86
|
| Rate for Payer: Multiplan Medicare/VA |
$19.46
|
| Rate for Payer: One Health Plan of WY PPO |
$35.22
|
| Rate for Payer: PacificSource Commercial |
$32.35
|
| Rate for Payer: PHCS PPO |
$35.22
|
| Rate for Payer: Three Rivers PPO |
$26.96
|
| Rate for Payer: TriWest Veterans Administration |
$20.49
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare |
$20.49
|
| Rate for Payer: WINHealth Partners Commercial |
$35.22
|
| Rate for Payer: Wise Provider Network Commercial |
$34.14
|
|
|
ARTLINE PRESSURE TUBING TRANSDUCER
|
Facility
|
IP
|
$35.94
|
|
| Hospital Charge Code |
2500059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.22
|
| Rate for Payer: Aetna of WY Medicare |
$23.00
|
| Rate for Payer: Altius Commercial |
$34.50
|
| Rate for Payer: Beech Street Commercial |
$35.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$25.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.86
|
| Rate for Payer: Cigna of WY Commercial |
$35.22
|
| Rate for Payer: Entrust Commercial |
$34.14
|
| Rate for Payer: First Choice Health Commercial |
$34.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.92
|
| Rate for Payer: HealthUtah PPO |
$35.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.83
|
| Rate for Payer: One Health Plan of WY PPO |
$35.22
|
| Rate for Payer: PacificSource Commercial |
$32.35
|
| Rate for Payer: PHCS PPO |
$35.22
|
| Rate for Payer: Three Rivers PPO |
$26.96
|
| Rate for Payer: TriWest Veterans Administration |
$21.92
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare |
$21.92
|
| Rate for Payer: WINHealth Partners Commercial |
$34.14
|
| Rate for Payer: Wise Provider Network Commercial |
$34.14
|
|
|
ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Medicare |
$135.53
|
| Rate for Payer: Beech Street Commercial |
$611.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: First Choice Health Commercial |
$579.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.53
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$115.20
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$611.80
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$135.53
|
| Rate for Payer: United Healthcare Commercial |
$611.80
|
| Rate for Payer: WINHealth Partners Commercial |
$547.40
|
|
|
ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Beech Street Commercial |
$209.95
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: First Choice Health Commercial |
$198.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$209.95
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
| Rate for Payer: WINHealth Partners Commercial |
$187.85
|
|
|
ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$39.42
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.42
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$33.51
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.42
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: WINHealth Partners Commercial |
$149.60
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY [857]
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 0574703412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$19.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.28
|
| Rate for Payer: Aetna of WY Medicare |
$12.98
|
| Rate for Payer: Altius Commercial |
$18.88
|
| Rate for Payer: Beech Street Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.08
|
| Rate for Payer: Cigna of WY Commercial |
$19.28
|
| Rate for Payer: Entrust Commercial |
$18.69
|
| Rate for Payer: First Choice Health Commercial |
$18.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.21
|
| Rate for Payer: HealthUtah PPO |
$19.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.08
|
| Rate for Payer: Multiplan Medicare/VA |
$10.65
|
| Rate for Payer: One Health Plan of WY PPO |
$19.28
|
| Rate for Payer: PacificSource Commercial |
$17.70
|
| Rate for Payer: PHCS PPO |
$19.28
|
| Rate for Payer: Three Rivers PPO |
$14.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.21
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
| Rate for Payer: United Healthcare Medicare |
$11.21
|
| Rate for Payer: WINHealth Partners Commercial |
$19.28
|
| Rate for Payer: Wise Provider Network Commercial |
$18.69
|
|
|
ASPIRIN 300 MG RECTAL SUPPOSITORY [857]
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
NDC 0574703412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$19.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.28
|
| Rate for Payer: Aetna of WY Medicare |
$12.59
|
| Rate for Payer: Altius Commercial |
$18.88
|
| Rate for Payer: Beech Street Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.08
|
| Rate for Payer: Cigna of WY Commercial |
$19.28
|
| Rate for Payer: Entrust Commercial |
$18.69
|
| Rate for Payer: First Choice Health Commercial |
$18.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.00
|
| Rate for Payer: HealthUtah PPO |
$19.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.08
|
| Rate for Payer: Multiplan Medicare/VA |
$11.40
|
| Rate for Payer: One Health Plan of WY PPO |
$19.28
|
| Rate for Payer: PacificSource Commercial |
$17.70
|
| Rate for Payer: PHCS PPO |
$19.28
|
| Rate for Payer: Three Rivers PPO |
$14.75
|
| Rate for Payer: TriWest Veterans Administration |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: WINHealth Partners Commercial |
$18.69
|
| Rate for Payer: Wise Provider Network Commercial |
$18.69
|
|
