|
HC PRO KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$5,583.00
|
|
|
Service Code
|
HCPCS 29881 50
|
| Hospital Charge Code |
9832988101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$5,583.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,471.34
|
| Rate for Payer: Aetna of WY Medicare |
$528.31
|
| Rate for Payer: Beech Street Commercial |
$5,303.85
|
| Rate for Payer: Cash Price |
$3,908.10
|
| Rate for Payer: Cash Price |
$3,908.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,415.51
|
| Rate for Payer: Cigna of WY Commercial |
$5,471.34
|
| Rate for Payer: First Choice Health Commercial |
$5,024.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,303.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.31
|
| Rate for Payer: HealthUtah PPO |
$5,583.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,415.51
|
| Rate for Payer: Multiplan Medicare/VA |
$449.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5,471.34
|
| Rate for Payer: PacificSource Commercial |
$5,024.70
|
| Rate for Payer: PHCS PPO |
$5,303.85
|
| Rate for Payer: Three Rivers PPO |
$4,187.25
|
| Rate for Payer: TriWest Veterans Administration |
$528.31
|
| Rate for Payer: United Healthcare Commercial |
$4,857.21
|
| Rate for Payer: United Healthcare Medicare |
$528.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4,745.55
|
|
|
HC PRO KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
9832987901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$3,414.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,345.72
|
| Rate for Payer: Aetna of WY Medicare |
$643.34
|
| Rate for Payer: Beech Street Commercial |
$3,243.30
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,311.58
|
| Rate for Payer: Cigna of WY Commercial |
$3,345.72
|
| Rate for Payer: First Choice Health Commercial |
$3,072.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,243.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.34
|
| Rate for Payer: HealthUtah PPO |
$3,414.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,311.58
|
| Rate for Payer: Multiplan Medicare/VA |
$546.84
|
| Rate for Payer: One Health Plan of WY PPO |
$3,345.72
|
| Rate for Payer: PacificSource Commercial |
$3,072.60
|
| Rate for Payer: PHCS PPO |
$3,243.30
|
| Rate for Payer: Three Rivers PPO |
$2,560.50
|
| Rate for Payer: TriWest Veterans Administration |
$643.34
|
| Rate for Payer: United Healthcare Commercial |
$2,970.18
|
| Rate for Payer: United Healthcare Medicare |
$643.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,901.90
|
|
|
HC PRO LAMINEC/FACETECT/FORAMIN,EACH ADDNL
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 63048 50
|
| Hospital Charge Code |
9836304801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$1,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,818.88
|
| Rate for Payer: Aetna of WY Medicare |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,800.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,818.88
|
| Rate for Payer: First Choice Health Commercial |
$1,670.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,763.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.80
|
| Rate for Payer: HealthUtah PPO |
$1,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,800.32
|
| Rate for Payer: Multiplan Medicare/VA |
$167.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,818.88
|
| Rate for Payer: PacificSource Commercial |
$1,670.40
|
| Rate for Payer: PHCS PPO |
$1,763.20
|
| Rate for Payer: Three Rivers PPO |
$1,392.00
|
| Rate for Payer: TriWest Veterans Administration |
$196.80
|
| Rate for Payer: United Healthcare Commercial |
$1,614.72
|
| Rate for Payer: United Healthcare Medicare |
$196.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,577.60
|
|
|
HC PRO LAMINEC/FACETECT/FORAMIN,EACH ADDNL
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
HCPCS 63048
|
| Hospital Charge Code |
9836304801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$1,086.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,064.28
|
| Rate for Payer: Aetna of WY Medicare |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$1,031.70
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,053.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,064.28
|
| Rate for Payer: First Choice Health Commercial |
$977.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.80
|
| Rate for Payer: HealthUtah PPO |
$1,086.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,053.42
|
| Rate for Payer: Multiplan Medicare/VA |
$167.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,064.28
|
| Rate for Payer: PacificSource Commercial |
$977.40
|
| Rate for Payer: PHCS PPO |
$1,031.70
|
| Rate for Payer: Three Rivers PPO |
$814.50
|
| Rate for Payer: TriWest Veterans Administration |
$196.80
|
| Rate for Payer: United Healthcare Commercial |
$944.82
|
| Rate for Payer: United Healthcare Medicare |
$196.80
|
| Rate for Payer: WINHealth Partners Commercial |
$923.10
|
|
|
HC PRO LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG
|
Professional
|
Both
|
$9,680.00
|
|
|
Service Code
|
HCPCS 63047 50
|
| Hospital Charge Code |
9836304701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$899.72 |
| Max. Negotiated Rate |
$9,680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,486.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,058.49
|
| Rate for Payer: Beech Street Commercial |
$9,196.00
|
| Rate for Payer: Cash Price |
$6,776.00
|
| Rate for Payer: Cash Price |
$6,776.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,389.60
|
| Rate for Payer: Cigna of WY Commercial |
$9,486.40
|
| Rate for Payer: First Choice Health Commercial |
$8,712.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,196.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,058.49
|
| Rate for Payer: HealthUtah PPO |
$9,680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,389.60
|
| Rate for Payer: Multiplan Medicare/VA |
$899.72
|
| Rate for Payer: One Health Plan of WY PPO |
$9,486.40
|
| Rate for Payer: PacificSource Commercial |
$8,712.00
|
| Rate for Payer: PHCS PPO |
$9,196.00
|
| Rate for Payer: Three Rivers PPO |
$7,260.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,058.49
|
| Rate for Payer: United Healthcare Commercial |
$8,421.60
|
| Rate for Payer: United Healthcare Medicare |
$1,058.49
|
| Rate for Payer: WINHealth Partners Commercial |
$8,228.00
|
|
|
HC PRO LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG
|
Professional
|
Both
|
$5,663.00
|
|
|
Service Code
|
HCPCS 63047
|
| Hospital Charge Code |
9836304701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$899.72 |
| Max. Negotiated Rate |
$5,663.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,549.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,058.49
|
| Rate for Payer: Beech Street Commercial |
$5,379.85
|
| Rate for Payer: Cash Price |
$3,964.10
|
| Rate for Payer: Cash Price |
$3,964.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,493.11
|
| Rate for Payer: Cigna of WY Commercial |
$5,549.74
|
| Rate for Payer: First Choice Health Commercial |
$5,096.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,379.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,058.49
|
| Rate for Payer: HealthUtah PPO |
$5,663.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,493.11
|
| Rate for Payer: Multiplan Medicare/VA |
$899.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,549.74
|
| Rate for Payer: PacificSource Commercial |
$5,096.70
|
| Rate for Payer: PHCS PPO |
$5,379.85
|
| Rate for Payer: Three Rivers PPO |
$4,247.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,058.49
|
| Rate for Payer: United Healthcare Commercial |
$4,926.81
|
| Rate for Payer: United Healthcare Medicare |
$1,058.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4,813.55
|
|
|
HC PRO LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR
|
Professional
|
Both
|
$4,556.00
|
|
|
Service Code
|
HCPCS 63030
|
| Hospital Charge Code |
9836303001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$746.81 |
| Max. Negotiated Rate |
$4,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,464.88
|
| Rate for Payer: Aetna of WY Medicare |
$878.60
|
| Rate for Payer: Beech Street Commercial |
$4,328.20
|
| Rate for Payer: Cash Price |
$3,189.20
|
| Rate for Payer: Cash Price |
$3,189.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,419.32
|
| Rate for Payer: Cigna of WY Commercial |
$4,464.88
|
| Rate for Payer: First Choice Health Commercial |
$4,100.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,328.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.60
|
| Rate for Payer: HealthUtah PPO |
$4,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,419.32
|
| Rate for Payer: Multiplan Medicare/VA |
$746.81
|
| Rate for Payer: One Health Plan of WY PPO |
$4,464.88
|
| Rate for Payer: PacificSource Commercial |
$4,100.40
|
| Rate for Payer: PHCS PPO |
$4,328.20
|
| Rate for Payer: Three Rivers PPO |
$3,417.00
|
| Rate for Payer: TriWest Veterans Administration |
$878.60
|
| Rate for Payer: United Healthcare Commercial |
$3,963.72
|
| Rate for Payer: United Healthcare Medicare |
$878.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,872.60
|
|
|
HC PRO LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR
|
Professional
|
Both
|
$9,112.00
|
|
|
Service Code
|
HCPCS 63030 50
|
| Hospital Charge Code |
9836303001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$746.81 |
| Max. Negotiated Rate |
$9,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,929.76
|
| Rate for Payer: Aetna of WY Medicare |
$878.60
|
| Rate for Payer: Beech Street Commercial |
$8,656.40
|
| Rate for Payer: Cash Price |
$6,378.40
|
| Rate for Payer: Cash Price |
$6,378.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,838.64
|
| Rate for Payer: Cigna of WY Commercial |
$8,929.76
|
| Rate for Payer: First Choice Health Commercial |
$8,200.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,656.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.60
|
| Rate for Payer: HealthUtah PPO |
$9,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,838.64
|
| Rate for Payer: Multiplan Medicare/VA |
$746.81
|
| Rate for Payer: One Health Plan of WY PPO |
$8,929.76
|
| Rate for Payer: PacificSource Commercial |
$8,200.80
|
| Rate for Payer: PHCS PPO |
$8,656.40
|
| Rate for Payer: Three Rivers PPO |
$6,834.00
|
| Rate for Payer: TriWest Veterans Administration |
$878.60
|
| Rate for Payer: United Healthcare Commercial |
$7,927.44
|
| Rate for Payer: United Healthcare Medicare |
$878.60
|
| Rate for Payer: WINHealth Partners Commercial |
$7,745.20
|
|
|
HC PRO LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 63035
|
| Hospital Charge Code |
9836303501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.48 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$963.34
|
| Rate for Payer: Aetna of WY Medicare |
$218.21
|
| Rate for Payer: Beech Street Commercial |
$933.85
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: Cash Price |
$688.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$953.51
|
| Rate for Payer: Cigna of WY Commercial |
$963.34
|
| Rate for Payer: First Choice Health Commercial |
$884.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$933.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.21
|
| Rate for Payer: HealthUtah PPO |
$983.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$953.51
|
| Rate for Payer: Multiplan Medicare/VA |
$185.48
|
| Rate for Payer: One Health Plan of WY PPO |
$963.34
|
| Rate for Payer: PacificSource Commercial |
$884.70
|
| Rate for Payer: PHCS PPO |
$933.85
|
| Rate for Payer: Three Rivers PPO |
$737.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.21
|
| Rate for Payer: United Healthcare Commercial |
$855.21
|
| Rate for Payer: United Healthcare Medicare |
$218.21
|
| Rate for Payer: WINHealth Partners Commercial |
$835.55
|
|
|
HC PRO LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR
|
Professional
|
Both
|
$1,966.00
|
|
|
Service Code
|
HCPCS 63035 50
|
| Hospital Charge Code |
9836303501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.48 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,926.68
|
| Rate for Payer: Aetna of WY Medicare |
$218.21
|
| Rate for Payer: Beech Street Commercial |
$1,867.70
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,907.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,926.68
|
| Rate for Payer: First Choice Health Commercial |
$1,769.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,867.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.21
|
| Rate for Payer: HealthUtah PPO |
$1,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,907.02
|
| Rate for Payer: Multiplan Medicare/VA |
$185.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,926.68
|
| Rate for Payer: PacificSource Commercial |
$1,769.40
|
| Rate for Payer: PHCS PPO |
$1,867.70
|
| Rate for Payer: Three Rivers PPO |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration |
$218.21
|
| Rate for Payer: United Healthcare Commercial |
$1,710.42
|
| Rate for Payer: United Healthcare Medicare |
$218.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,671.10
|
|
|
HC PRO LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,667.00
|
|
|
Service Code
|
HCPCS 63042
|
| Hospital Charge Code |
9836304201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,052.64 |
| Max. Negotiated Rate |
$6,667.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,533.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,238.40
|
| Rate for Payer: Beech Street Commercial |
$6,333.65
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,466.99
|
| Rate for Payer: Cigna of WY Commercial |
$6,533.66
|
| Rate for Payer: First Choice Health Commercial |
$6,000.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,333.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,238.40
|
| Rate for Payer: HealthUtah PPO |
$6,667.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,466.99
|
| Rate for Payer: Multiplan Medicare/VA |
$1,052.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,533.66
|
| Rate for Payer: PacificSource Commercial |
$6,000.30
|
| Rate for Payer: PHCS PPO |
$6,333.65
|
| Rate for Payer: Three Rivers PPO |
$5,000.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,238.40
|
| Rate for Payer: United Healthcare Commercial |
$5,800.29
|
| Rate for Payer: United Healthcare Medicare |
$1,238.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,666.95
|
|
|
HC PRO LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$3,112.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
9834497001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.76
|
| Rate for Payer: Aetna of WY Medicare |
$575.29
|
| Rate for Payer: Beech Street Commercial |
$2,956.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.76
|
| Rate for Payer: First Choice Health Commercial |
$2,800.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,956.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$575.29
|
| Rate for Payer: HealthUtah PPO |
$3,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.64
|
| Rate for Payer: Multiplan Medicare/VA |
$489.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.76
|
| Rate for Payer: PacificSource Commercial |
$2,800.80
|
| Rate for Payer: PHCS PPO |
$2,956.40
|
| Rate for Payer: Three Rivers PPO |
$2,334.00
|
| Rate for Payer: TriWest Veterans Administration |
$575.29
|
| Rate for Payer: United Healthcare Commercial |
$2,707.44
|
| Rate for Payer: United Healthcare Medicare |
$575.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,645.20
|
|
|
HC PRO LAPAROSCOPIC CHOLECYSTECTOMY
|
Professional
|
Both
|
$5,451.00
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
9834756201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$535.24 |
| Max. Negotiated Rate |
$5,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,341.98
|
| Rate for Payer: Aetna of WY Medicare |
$629.70
|
| Rate for Payer: Beech Street Commercial |
$5,178.45
|
| Rate for Payer: Cash Price |
$3,815.70
|
| Rate for Payer: Cash Price |
$3,815.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,287.47
|
| Rate for Payer: Cigna of WY Commercial |
$5,341.98
|
| Rate for Payer: First Choice Health Commercial |
$4,905.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,178.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.70
|
| Rate for Payer: HealthUtah PPO |
$5,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,287.47
|
| Rate for Payer: Multiplan Medicare/VA |
$535.24
|
| Rate for Payer: One Health Plan of WY PPO |
$5,341.98
|
| Rate for Payer: PacificSource Commercial |
$4,905.90
|
| Rate for Payer: PHCS PPO |
$5,178.45
|
| Rate for Payer: Three Rivers PPO |
$4,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$629.70
|
| Rate for Payer: United Healthcare Commercial |
$4,742.37
|
| Rate for Payer: United Healthcare Medicare |
$629.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,633.35
|
|
|
HC PRO LAPAROSCOPIC INGUINAL HERNIA REPAIR,INITIAL
|
Professional
|
Both
|
$4,451.00
|
|
|
Service Code
|
HCPCS 49650 50
|
| Hospital Charge Code |
9834965001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$4,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,361.98
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$4,228.45
|
| Rate for Payer: Cash Price |
$3,115.70
|
| Rate for Payer: Cash Price |
$3,115.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,317.47
|
| Rate for Payer: Cigna of WY Commercial |
$4,361.98
|
| Rate for Payer: First Choice Health Commercial |
$4,005.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,228.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$4,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,317.47
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,361.98
|
| Rate for Payer: PacificSource Commercial |
$4,005.90
|
| Rate for Payer: PHCS PPO |
$4,228.45
|
| Rate for Payer: Three Rivers PPO |
$3,338.25
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$3,872.37
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$3,783.35
|
|
|
HC PRO LAPAROSCOPIC INGUINAL HERNIA REPAIR,INITIAL
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
9834965001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,180.50
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,158.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,180.50
|
| Rate for Payer: First Choice Health Commercial |
$2,002.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,113.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$2,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,158.25
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,180.50
|
| Rate for Payer: PacificSource Commercial |
$2,002.50
|
| Rate for Payer: PHCS PPO |
$2,113.75
|
| Rate for Payer: Three Rivers PPO |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$1,935.75
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,891.25
|
|
|
HC PRO LAPAROSCOPIC INGUINAL HERNIA REPAIR,RECUR
|
Professional
|
Both
|
$2,899.00
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
9834965101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$461.02 |
| Max. Negotiated Rate |
$2,899.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,841.02
|
| Rate for Payer: Aetna of WY Medicare |
$542.38
|
| Rate for Payer: Beech Street Commercial |
$2,754.05
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,812.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,841.02
|
| Rate for Payer: First Choice Health Commercial |
$2,609.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,754.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$542.38
|
| Rate for Payer: HealthUtah PPO |
$2,899.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,812.03
|
| Rate for Payer: Multiplan Medicare/VA |
$461.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,841.02
|
| Rate for Payer: PacificSource Commercial |
$2,609.10
|
| Rate for Payer: PHCS PPO |
$2,754.05
|
| Rate for Payer: Three Rivers PPO |
$2,174.25
|
| Rate for Payer: TriWest Veterans Administration |
$542.38
|
| Rate for Payer: United Healthcare Commercial |
$2,522.13
|
| Rate for Payer: United Healthcare Medicare |
$542.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,464.15
|
|
|
HC PRO LAPAROSCOPY ABDOMEN PERITONEUM DIAGNOSTIC
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
9834932001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$267.79 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$315.05
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.05
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$267.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$315.05
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$315.05
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
HC PRO LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$7,956.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
9754420401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,233.10 |
| Max. Negotiated Rate |
$7,956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,796.88
|
| Rate for Payer: Aetna of WY Medicare |
$1,450.71
|
| Rate for Payer: Beech Street Commercial |
$7,558.20
|
| Rate for Payer: Cash Price |
$5,569.20
|
| Rate for Payer: Cash Price |
$5,569.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,717.32
|
| Rate for Payer: Cigna of WY Commercial |
$7,796.88
|
| Rate for Payer: First Choice Health Commercial |
$7,160.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,558.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.71
|
| Rate for Payer: HealthUtah PPO |
$7,956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,717.32
|
| Rate for Payer: Multiplan Medicare/VA |
$1,233.10
|
| Rate for Payer: One Health Plan of WY PPO |
$7,796.88
|
| Rate for Payer: PacificSource Commercial |
$7,160.40
|
| Rate for Payer: PHCS PPO |
$7,558.20
|
| Rate for Payer: Three Rivers PPO |
$5,967.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.71
|
| Rate for Payer: United Healthcare Commercial |
$6,921.72
|
| Rate for Payer: United Healthcare Medicare |
$1,450.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6,762.60
|
|
|
HC PRO LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 57425
|
| Hospital Charge Code |
9825742501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$794.99 |
| Max. Negotiated Rate |
$3,905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,826.90
|
| Rate for Payer: Aetna of WY Medicare |
$935.28
|
| Rate for Payer: Beech Street Commercial |
$3,709.75
|
| Rate for Payer: Cash Price |
$2,733.50
|
| Rate for Payer: Cash Price |
$2,733.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,787.85
|
| Rate for Payer: Cigna of WY Commercial |
$3,826.90
|
| Rate for Payer: First Choice Health Commercial |
$3,514.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,709.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$935.28
|
| Rate for Payer: HealthUtah PPO |
$3,905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,787.85
|
| Rate for Payer: Multiplan Medicare/VA |
$794.99
|
| Rate for Payer: One Health Plan of WY PPO |
$3,826.90
|
| Rate for Payer: PacificSource Commercial |
$3,514.50
|
| Rate for Payer: PHCS PPO |
$3,709.75
|
| Rate for Payer: Three Rivers PPO |
$2,928.75
|
| Rate for Payer: TriWest Veterans Administration |
$935.28
|
| Rate for Payer: United Healthcare Commercial |
$3,397.35
|
| Rate for Payer: United Healthcare Medicare |
$935.28
|
| Rate for Payer: WINHealth Partners Commercial |
$3,319.25
|
|
|
HC PRO LAPAROSCOPY RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$6,222.00
|
|
|
Service Code
|
HCPCS 50545
|
| Hospital Charge Code |
9835054501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,079.86 |
| Max. Negotiated Rate |
$6,222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,097.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,270.42
|
| Rate for Payer: Beech Street Commercial |
$5,910.90
|
| Rate for Payer: Cash Price |
$4,355.40
|
| Rate for Payer: Cash Price |
$4,355.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,035.34
|
| Rate for Payer: Cigna of WY Commercial |
$6,097.56
|
| Rate for Payer: First Choice Health Commercial |
$5,599.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,910.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,270.42
|
| Rate for Payer: HealthUtah PPO |
$6,222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,035.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.86
|
| Rate for Payer: One Health Plan of WY PPO |
$6,097.56
|
| Rate for Payer: PacificSource Commercial |
$5,599.80
|
| Rate for Payer: PHCS PPO |
$5,910.90
|
| Rate for Payer: Three Rivers PPO |
$4,666.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,270.42
|
| Rate for Payer: United Healthcare Commercial |
$5,413.14
|
| Rate for Payer: United Healthcare Medicare |
$1,270.42
|
| Rate for Payer: WINHealth Partners Commercial |
$5,288.70
|
|
|
HC PRO LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE
|
Professional
|
Both
|
$4,377.00
|
|
|
Service Code
|
HCPCS 49654
|
| Hospital Charge Code |
9834965401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3,282.75 |
| Max. Negotiated Rate |
$4,377.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,289.46
|
| Rate for Payer: Beech Street Commercial |
$4,158.15
|
| Rate for Payer: Cash Price |
$3,063.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,245.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,289.46
|
| Rate for Payer: First Choice Health Commercial |
$3,939.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,158.15
|
| Rate for Payer: HealthUtah PPO |
$4,377.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,245.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,289.46
|
| Rate for Payer: PacificSource Commercial |
$3,939.30
|
| Rate for Payer: PHCS PPO |
$4,158.15
|
| Rate for Payer: Three Rivers PPO |
$3,282.75
|
| Rate for Payer: United Healthcare Commercial |
$3,807.99
|
| Rate for Payer: WINHealth Partners Commercial |
$3,720.45
|
|
|
HC PRO LAPAROSCOPY SLING OPERATION STRESS INCONT
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 51992
|
| Hospital Charge Code |
9825199201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$680.48 |
| Max. Negotiated Rate |
$2,442.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,393.16
|
| Rate for Payer: Aetna of WY Medicare |
$800.57
|
| Rate for Payer: Beech Street Commercial |
$2,319.90
|
| Rate for Payer: Cash Price |
$1,709.40
|
| Rate for Payer: Cash Price |
$1,709.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,368.74
|
| Rate for Payer: Cigna of WY Commercial |
$2,393.16
|
| Rate for Payer: First Choice Health Commercial |
$2,197.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,319.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$800.57
|
| Rate for Payer: HealthUtah PPO |
$2,442.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,368.74
|
| Rate for Payer: Multiplan Medicare/VA |
$680.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,393.16
|
| Rate for Payer: PacificSource Commercial |
$2,197.80
|
| Rate for Payer: PHCS PPO |
$2,319.90
|
| Rate for Payer: Three Rivers PPO |
$1,831.50
|
| Rate for Payer: TriWest Veterans Administration |
$800.57
|
| Rate for Payer: United Healthcare Commercial |
$2,124.54
|
| Rate for Payer: United Healthcare Medicare |
$800.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,075.70
|
|
|
HC PRO LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$4,246.00
|
|
|
Service Code
|
HCPCS 58573
|
| Hospital Charge Code |
9825857301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$996.37 |
| Max. Negotiated Rate |
$4,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,161.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,172.20
|
| Rate for Payer: Beech Street Commercial |
$4,033.70
|
| Rate for Payer: Cash Price |
$2,972.20
|
| Rate for Payer: Cash Price |
$2,972.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,118.62
|
| Rate for Payer: Cigna of WY Commercial |
$4,161.08
|
| Rate for Payer: First Choice Health Commercial |
$3,821.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,033.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,172.20
|
| Rate for Payer: HealthUtah PPO |
$4,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,118.62
|
| Rate for Payer: Multiplan Medicare/VA |
$996.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4,161.08
|
| Rate for Payer: PacificSource Commercial |
$3,821.40
|
| Rate for Payer: PHCS PPO |
$4,033.70
|
| Rate for Payer: Three Rivers PPO |
$3,184.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,172.20
|
| Rate for Payer: United Healthcare Commercial |
$3,694.02
|
| Rate for Payer: United Healthcare Medicare |
$1,172.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,609.10
|
|
|
HC PRO LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 51990
|
| Hospital Charge Code |
9825199001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$606.24 |
| Max. Negotiated Rate |
$2,959.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,899.82
|
| Rate for Payer: Aetna of WY Medicare |
$713.22
|
| Rate for Payer: Beech Street Commercial |
$2,811.05
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,870.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,899.82
|
| Rate for Payer: First Choice Health Commercial |
$2,663.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,811.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$713.22
|
| Rate for Payer: HealthUtah PPO |
$2,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,870.23
|
| Rate for Payer: Multiplan Medicare/VA |
$606.24
|
| Rate for Payer: One Health Plan of WY PPO |
$2,899.82
|
| Rate for Payer: PacificSource Commercial |
$2,663.10
|
| Rate for Payer: PHCS PPO |
$2,811.05
|
| Rate for Payer: Three Rivers PPO |
$2,219.25
|
| Rate for Payer: TriWest Veterans Administration |
$713.22
|
| Rate for Payer: United Healthcare Commercial |
$2,574.33
|
| Rate for Payer: United Healthcare Medicare |
$713.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,515.15
|
|
|
HC PRO LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
9835866001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Aetna of WY Medicare |
$656.94
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.94
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: Multiplan Medicare/VA |
$558.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: TriWest Veterans Administration |
$656.94
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: United Healthcare Medicare |
$656.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3,821.60
|
|
