|
HC PRO LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
9835866101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
HC PRO LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$6,742.00
|
|
|
Service Code
|
HCPCS 58661 50
|
| Hospital Charge Code |
9835866101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$6,742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,607.16
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$6,404.90
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,539.74
|
| Rate for Payer: Cigna of WY Commercial |
$6,607.16
|
| Rate for Payer: First Choice Health Commercial |
$6,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$6,742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,539.74
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$6,607.16
|
| Rate for Payer: PacificSource Commercial |
$6,067.80
|
| Rate for Payer: PHCS PPO |
$6,404.90
|
| Rate for Payer: Three Rivers PPO |
$5,056.50
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$5,865.54
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5,730.70
|
|
|
HC PRO LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,308.00
|
|
|
Service Code
|
HCPCS 58570
|
| Hospital Charge Code |
9825857001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$661.73 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,241.84
|
| Rate for Payer: Aetna of WY Medicare |
$778.51
|
| Rate for Payer: Beech Street Commercial |
$3,142.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,208.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,241.84
|
| Rate for Payer: First Choice Health Commercial |
$2,977.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,142.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.51
|
| Rate for Payer: HealthUtah PPO |
$3,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,208.76
|
| Rate for Payer: Multiplan Medicare/VA |
$661.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,241.84
|
| Rate for Payer: PacificSource Commercial |
$2,977.20
|
| Rate for Payer: PHCS PPO |
$3,142.60
|
| Rate for Payer: Three Rivers PPO |
$2,481.00
|
| Rate for Payer: TriWest Veterans Administration |
$778.51
|
| Rate for Payer: United Healthcare Commercial |
$2,877.96
|
| Rate for Payer: United Healthcare Medicare |
$778.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,811.80
|
|
|
HC PRO LAPARO VAGINAL HYSTER W UTERUS >250
|
Professional
|
Both
|
$4,468.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
9835855401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,064.45 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,378.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,252.29
|
| Rate for Payer: Beech Street Commercial |
$4,244.60
|
| Rate for Payer: Cash Price |
$3,127.60
|
| Rate for Payer: Cash Price |
$3,127.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,333.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,378.64
|
| Rate for Payer: First Choice Health Commercial |
$4,021.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,244.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,252.29
|
| Rate for Payer: HealthUtah PPO |
$4,468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,333.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1,064.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4,378.64
|
| Rate for Payer: PacificSource Commercial |
$4,021.20
|
| Rate for Payer: PHCS PPO |
$4,244.60
|
| Rate for Payer: Three Rivers PPO |
$3,351.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,252.29
|
| Rate for Payer: United Healthcare Commercial |
$3,887.16
|
| Rate for Payer: United Healthcare Medicare |
$1,252.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,797.80
|
|
|
HC PRO LAP,DX SURGICAL ABD W/BIOPSY
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
9834932101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.79
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.79
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$280.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$329.79
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$329.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
HC PRO LAP ENTEROLYSIS
|
Professional
|
Both
|
$4,763.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
9834418001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$741.57 |
| Max. Negotiated Rate |
$4,763.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,667.74
|
| Rate for Payer: Aetna of WY Medicare |
$872.43
|
| Rate for Payer: Beech Street Commercial |
$4,524.85
|
| Rate for Payer: Cash Price |
$3,334.10
|
| Rate for Payer: Cash Price |
$3,334.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,620.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,667.74
|
| Rate for Payer: First Choice Health Commercial |
$4,286.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,524.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$872.43
|
| Rate for Payer: HealthUtah PPO |
$4,763.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,620.11
|
| Rate for Payer: Multiplan Medicare/VA |
$741.57
|
| Rate for Payer: One Health Plan of WY PPO |
$4,667.74
|
| Rate for Payer: PacificSource Commercial |
$4,286.70
|
| Rate for Payer: PHCS PPO |
$4,524.85
|
| Rate for Payer: Three Rivers PPO |
$3,572.25
|
| Rate for Payer: TriWest Veterans Administration |
$872.43
|
| Rate for Payer: United Healthcare Commercial |
$4,143.81
|
| Rate for Payer: United Healthcare Medicare |
$872.43
|
| Rate for Payer: WINHealth Partners Commercial |
$4,048.55
|
|
|
HC PRO LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,816.00
|
|
|
Service Code
|
HCPCS 49653
|
| Hospital Charge Code |
9834965301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3,612.00 |
| Max. Negotiated Rate |
$4,816.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,719.68
|
| Rate for Payer: Beech Street Commercial |
$4,575.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,671.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,719.68
|
| Rate for Payer: First Choice Health Commercial |
$4,334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,575.20
|
| Rate for Payer: HealthUtah PPO |
$4,816.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,671.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,719.68
|
| Rate for Payer: PacificSource Commercial |
$4,334.40
|
| Rate for Payer: PHCS PPO |
$4,575.20
|
| Rate for Payer: Three Rivers PPO |
$3,612.00
|
| Rate for Payer: United Healthcare Commercial |
$4,189.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,093.60
|
|
|
HC PRO LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,749.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
9754422701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$7,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,594.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,563.17
|
| Rate for Payer: Beech Street Commercial |
$7,361.55
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,516.53
|
| Rate for Payer: Cigna of WY Commercial |
$7,594.02
|
| Rate for Payer: First Choice Health Commercial |
$6,974.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,361.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,563.17
|
| Rate for Payer: HealthUtah PPO |
$7,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,516.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,328.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,594.02
|
| Rate for Payer: PacificSource Commercial |
$6,974.10
|
| Rate for Payer: PHCS PPO |
$7,361.55
|
| Rate for Payer: Three Rivers PPO |
$5,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,563.17
|
| Rate for Payer: United Healthcare Commercial |
$6,741.63
|
| Rate for Payer: United Healthcare Medicare |
$1,563.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6,586.65
|
|
|
HC PRO LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$10,229.00
|
|
|
Service Code
|
HCPCS 44208
|
| Hospital Charge Code |
9834420801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,582.22 |
| Max. Negotiated Rate |
$10,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,024.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,861.44
|
| Rate for Payer: Beech Street Commercial |
$9,717.55
|
| Rate for Payer: Cash Price |
$7,160.30
|
| Rate for Payer: Cash Price |
$7,160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,922.13
|
| Rate for Payer: Cigna of WY Commercial |
$10,024.42
|
| Rate for Payer: First Choice Health Commercial |
$9,206.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,717.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,861.44
|
| Rate for Payer: HealthUtah PPO |
$10,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,922.13
|
| Rate for Payer: Multiplan Medicare/VA |
$1,582.22
|
| Rate for Payer: One Health Plan of WY PPO |
$10,024.42
|
| Rate for Payer: PacificSource Commercial |
$9,206.10
|
| Rate for Payer: PHCS PPO |
$9,717.55
|
| Rate for Payer: Three Rivers PPO |
$7,671.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,861.44
|
| Rate for Payer: United Healthcare Commercial |
$8,899.23
|
| Rate for Payer: United Healthcare Medicare |
$1,861.44
|
| Rate for Payer: WINHealth Partners Commercial |
$8,694.65
|
|
|
HC PRO LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
9835866201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$583.50 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,613.26
|
| Rate for Payer: Aetna of WY Medicare |
$686.47
|
| Rate for Payer: Beech Street Commercial |
$3,502.65
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,576.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,613.26
|
| Rate for Payer: First Choice Health Commercial |
$3,318.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,502.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.47
|
| Rate for Payer: HealthUtah PPO |
$3,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,576.39
|
| Rate for Payer: Multiplan Medicare/VA |
$583.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,613.26
|
| Rate for Payer: PacificSource Commercial |
$3,318.30
|
| Rate for Payer: PHCS PPO |
$3,502.65
|
| Rate for Payer: Three Rivers PPO |
$2,765.25
|
| Rate for Payer: TriWest Veterans Administration |
$686.47
|
| Rate for Payer: United Healthcare Commercial |
$3,207.69
|
| Rate for Payer: United Healthcare Medicare |
$686.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,133.95
|
|
|
HC PRO LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 43772
|
| Hospital Charge Code |
9754377201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$766.05 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$901.23
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.23
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$766.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$901.23
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$901.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
HC PRO LAP SLEEVE GASTRECTOMY
|
Professional
|
Both
|
$3,701.00
|
|
|
Service Code
|
HCPCS 43775
|
| Hospital Charge Code |
9834377501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$881.54 |
| Max. Negotiated Rate |
$3,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,626.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,037.10
|
| Rate for Payer: Beech Street Commercial |
$3,515.95
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,589.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,626.98
|
| Rate for Payer: First Choice Health Commercial |
$3,330.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,515.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,037.10
|
| Rate for Payer: HealthUtah PPO |
$3,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,589.97
|
| Rate for Payer: Multiplan Medicare/VA |
$881.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,626.98
|
| Rate for Payer: PacificSource Commercial |
$3,330.90
|
| Rate for Payer: PHCS PPO |
$3,515.95
|
| Rate for Payer: Three Rivers PPO |
$2,775.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,037.10
|
| Rate for Payer: United Healthcare Commercial |
$3,219.87
|
| Rate for Payer: United Healthcare Medicare |
$1,037.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,145.85
|
|
|
HC PRO LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
9834421301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Medicare |
$174.35
|
| Rate for Payer: Beech Street Commercial |
$917.70
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.02
|
| Rate for Payer: Cigna of WY Commercial |
$946.68
|
| Rate for Payer: First Choice Health Commercial |
$869.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.35
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Multiplan Medicare/VA |
$148.20
|
| Rate for Payer: One Health Plan of WY PPO |
$946.68
|
| Rate for Payer: PacificSource Commercial |
$869.40
|
| Rate for Payer: PHCS PPO |
$917.70
|
| Rate for Payer: Three Rivers PPO |
$724.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.35
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$174.35
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
|
|
HC PRO LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$4,139.00
|
|
|
Service Code
|
HCPCS 58545
|
| Hospital Charge Code |
9825854501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$737.15 |
| Max. Negotiated Rate |
$4,139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,056.22
|
| Rate for Payer: Aetna of WY Medicare |
$867.24
|
| Rate for Payer: Beech Street Commercial |
$3,932.05
|
| Rate for Payer: Cash Price |
$2,897.30
|
| Rate for Payer: Cash Price |
$2,897.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,014.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,056.22
|
| Rate for Payer: First Choice Health Commercial |
$3,725.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,932.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.24
|
| Rate for Payer: HealthUtah PPO |
$4,139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,014.83
|
| Rate for Payer: Multiplan Medicare/VA |
$737.15
|
| Rate for Payer: One Health Plan of WY PPO |
$4,056.22
|
| Rate for Payer: PacificSource Commercial |
$3,725.10
|
| Rate for Payer: PHCS PPO |
$3,932.05
|
| Rate for Payer: Three Rivers PPO |
$3,104.25
|
| Rate for Payer: TriWest Veterans Administration |
$867.24
|
| Rate for Payer: United Healthcare Commercial |
$3,600.93
|
| Rate for Payer: United Healthcare Medicare |
$867.24
|
| Rate for Payer: WINHealth Partners Commercial |
$3,518.15
|
|
|
HC PRO LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$3,856.00
|
|
|
Service Code
|
HCPCS 49652
|
| Hospital Charge Code |
9834965201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,892.00 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,778.88
|
| Rate for Payer: Beech Street Commercial |
$3,663.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,740.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,778.88
|
| Rate for Payer: First Choice Health Commercial |
$3,470.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,663.20
|
| Rate for Payer: HealthUtah PPO |
$3,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,740.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,778.88
|
| Rate for Payer: PacificSource Commercial |
$3,470.40
|
| Rate for Payer: PHCS PPO |
$3,663.20
|
| Rate for Payer: Three Rivers PPO |
$2,892.00
|
| Rate for Payer: United Healthcare Commercial |
$3,354.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.60
|
|
|
HC PRO LAPS RPARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$7,993.00
|
|
|
Service Code
|
HCPCS 43281
|
| Hospital Charge Code |
9834328101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,229.81 |
| Max. Negotiated Rate |
$7,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,833.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,446.84
|
| Rate for Payer: Beech Street Commercial |
$7,593.35
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,753.21
|
| Rate for Payer: Cigna of WY Commercial |
$7,833.14
|
| Rate for Payer: First Choice Health Commercial |
$7,193.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,593.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,446.84
|
| Rate for Payer: HealthUtah PPO |
$7,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,753.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,229.81
|
| Rate for Payer: One Health Plan of WY PPO |
$7,833.14
|
| Rate for Payer: PacificSource Commercial |
$7,193.70
|
| Rate for Payer: PHCS PPO |
$7,593.35
|
| Rate for Payer: Three Rivers PPO |
$5,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,446.84
|
| Rate for Payer: United Healthcare Commercial |
$6,953.91
|
| Rate for Payer: United Healthcare Medicare |
$1,446.84
|
| Rate for Payer: WINHealth Partners Commercial |
$6,794.05
|
|
|
HC PRO LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$5,540.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
9825854301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$689.57 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,429.20
|
| Rate for Payer: Aetna of WY Medicare |
$811.26
|
| Rate for Payer: Beech Street Commercial |
$5,263.00
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,373.80
|
| Rate for Payer: Cigna of WY Commercial |
$5,429.20
|
| Rate for Payer: First Choice Health Commercial |
$4,986.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.26
|
| Rate for Payer: HealthUtah PPO |
$5,540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,373.80
|
| Rate for Payer: Multiplan Medicare/VA |
$689.57
|
| Rate for Payer: One Health Plan of WY PPO |
$5,429.20
|
| Rate for Payer: PacificSource Commercial |
$4,986.00
|
| Rate for Payer: PHCS PPO |
$5,263.00
|
| Rate for Payer: Three Rivers PPO |
$4,155.00
|
| Rate for Payer: TriWest Veterans Administration |
$811.26
|
| Rate for Payer: United Healthcare Commercial |
$4,819.80
|
| Rate for Payer: United Healthcare Medicare |
$811.26
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.00
|
|
|
HC PRO LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$6,423.00
|
|
|
Service Code
|
HCPCS 58544
|
| Hospital Charge Code |
9825854401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$740.65 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,294.54
|
| Rate for Payer: Aetna of WY Medicare |
$871.35
|
| Rate for Payer: Beech Street Commercial |
$6,101.85
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,230.31
|
| Rate for Payer: Cigna of WY Commercial |
$6,294.54
|
| Rate for Payer: First Choice Health Commercial |
$5,780.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,101.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$871.35
|
| Rate for Payer: HealthUtah PPO |
$6,423.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,230.31
|
| Rate for Payer: Multiplan Medicare/VA |
$740.65
|
| Rate for Payer: One Health Plan of WY PPO |
$6,294.54
|
| Rate for Payer: PacificSource Commercial |
$5,780.70
|
| Rate for Payer: PHCS PPO |
$6,101.85
|
| Rate for Payer: Three Rivers PPO |
$4,817.25
|
| Rate for Payer: TriWest Veterans Administration |
$871.35
|
| Rate for Payer: United Healthcare Commercial |
$5,588.01
|
| Rate for Payer: United Healthcare Medicare |
$871.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,459.55
|
|
|
HC PRO LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 58542
|
| Hospital Charge Code |
9835854201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$679.59 |
| Max. Negotiated Rate |
$2,852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,794.96
|
| Rate for Payer: Aetna of WY Medicare |
$799.52
|
| Rate for Payer: Beech Street Commercial |
$2,709.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,766.44
|
| Rate for Payer: Cigna of WY Commercial |
$2,794.96
|
| Rate for Payer: First Choice Health Commercial |
$2,566.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,709.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$799.52
|
| Rate for Payer: HealthUtah PPO |
$2,852.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,766.44
|
| Rate for Payer: Multiplan Medicare/VA |
$679.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,794.96
|
| Rate for Payer: PacificSource Commercial |
$2,566.80
|
| Rate for Payer: PHCS PPO |
$2,709.40
|
| Rate for Payer: Three Rivers PPO |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration |
$799.52
|
| Rate for Payer: United Healthcare Commercial |
$2,481.24
|
| Rate for Payer: United Healthcare Medicare |
$799.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,424.20
|
|
|
HC PRO LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$6,187.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
9834756301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$581.58 |
| Max. Negotiated Rate |
$6,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,063.26
|
| Rate for Payer: Aetna of WY Medicare |
$684.21
|
| Rate for Payer: Beech Street Commercial |
$5,877.65
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,001.39
|
| Rate for Payer: Cigna of WY Commercial |
$6,063.26
|
| Rate for Payer: First Choice Health Commercial |
$5,568.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,877.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.21
|
| Rate for Payer: HealthUtah PPO |
$6,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,001.39
|
| Rate for Payer: Multiplan Medicare/VA |
$581.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,063.26
|
| Rate for Payer: PacificSource Commercial |
$5,568.30
|
| Rate for Payer: PHCS PPO |
$5,877.65
|
| Rate for Payer: Three Rivers PPO |
$4,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$684.21
|
| Rate for Payer: United Healthcare Commercial |
$5,382.69
|
| Rate for Payer: United Healthcare Medicare |
$684.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5,258.95
|
|
|
HC PRO LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$5,594.00
|
|
|
Service Code
|
HCPCS 43280
|
| Hospital Charge Code |
9834328001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$866.50 |
| Max. Negotiated Rate |
$5,594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,482.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,019.41
|
| Rate for Payer: Beech Street Commercial |
$5,314.30
|
| Rate for Payer: Cash Price |
$3,915.80
|
| Rate for Payer: Cash Price |
$3,915.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,426.18
|
| Rate for Payer: Cigna of WY Commercial |
$5,482.12
|
| Rate for Payer: First Choice Health Commercial |
$5,034.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,314.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,019.41
|
| Rate for Payer: HealthUtah PPO |
$5,594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,426.18
|
| Rate for Payer: Multiplan Medicare/VA |
$866.50
|
| Rate for Payer: One Health Plan of WY PPO |
$5,482.12
|
| Rate for Payer: PacificSource Commercial |
$5,034.60
|
| Rate for Payer: PHCS PPO |
$5,314.30
|
| Rate for Payer: Three Rivers PPO |
$4,195.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,019.41
|
| Rate for Payer: United Healthcare Commercial |
$4,866.78
|
| Rate for Payer: United Healthcare Medicare |
$1,019.41
|
| Rate for Payer: WINHealth Partners Commercial |
$4,754.90
|
|
|
HC PRO LAPS SURG RETROPERITONEAL LYMP
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
9833857001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$421.41 |
| Max. Negotiated Rate |
$2,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,503.90
|
| Rate for Payer: Aetna of WY Medicare |
$495.78
|
| Rate for Payer: Beech Street Commercial |
$2,427.25
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,478.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,503.90
|
| Rate for Payer: First Choice Health Commercial |
$2,299.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,427.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.78
|
| Rate for Payer: HealthUtah PPO |
$2,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,478.35
|
| Rate for Payer: Multiplan Medicare/VA |
$421.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,503.90
|
| Rate for Payer: PacificSource Commercial |
$2,299.50
|
| Rate for Payer: PHCS PPO |
$2,427.25
|
| Rate for Payer: Three Rivers PPO |
$1,916.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.78
|
| Rate for Payer: United Healthcare Commercial |
$2,222.85
|
| Rate for Payer: United Healthcare Medicare |
$495.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2,171.75
|
|
|
HC PRO LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
9834932201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$304.41 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$358.13
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.13
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$304.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$358.13
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$358.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
HC PRO LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
9825915001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$641.22 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,308.88
|
| Rate for Payer: Aetna of WY Medicare |
$754.38
|
| Rate for Payer: Beech Street Commercial |
$2,238.20
|
| Rate for Payer: Cash Price |
$1,649.20
|
| Rate for Payer: Cash Price |
$1,649.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,285.32
|
| Rate for Payer: Cigna of WY Commercial |
$2,308.88
|
| Rate for Payer: First Choice Health Commercial |
$2,120.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,238.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$754.38
|
| Rate for Payer: HealthUtah PPO |
$2,356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,285.32
|
| Rate for Payer: Multiplan Medicare/VA |
$641.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,308.88
|
| Rate for Payer: PacificSource Commercial |
$2,120.40
|
| Rate for Payer: PHCS PPO |
$2,238.20
|
| Rate for Payer: Three Rivers PPO |
$1,767.00
|
| Rate for Payer: TriWest Veterans Administration |
$754.38
|
| Rate for Payer: United Healthcare Commercial |
$2,049.72
|
| Rate for Payer: United Healthcare Medicare |
$754.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,002.60
|
|
|
HC PRO LAP SUPRACERV HYSTERECTOMY
|
Professional
|
Both
|
$5,139.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
9835854101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$5,139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,036.22
|
| Rate for Payer: Aetna of WY Medicare |
$704.93
|
| Rate for Payer: Beech Street Commercial |
$4,882.05
|
| Rate for Payer: Cash Price |
$3,597.30
|
| Rate for Payer: Cash Price |
$3,597.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,984.83
|
| Rate for Payer: Cigna of WY Commercial |
$5,036.22
|
| Rate for Payer: First Choice Health Commercial |
$4,625.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,882.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.93
|
| Rate for Payer: HealthUtah PPO |
$5,139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,984.83
|
| Rate for Payer: Multiplan Medicare/VA |
$599.19
|
| Rate for Payer: One Health Plan of WY PPO |
$5,036.22
|
| Rate for Payer: PacificSource Commercial |
$4,625.10
|
| Rate for Payer: PHCS PPO |
$4,882.05
|
| Rate for Payer: Three Rivers PPO |
$3,854.25
|
| Rate for Payer: TriWest Veterans Administration |
$704.93
|
| Rate for Payer: United Healthcare Commercial |
$4,470.93
|
| Rate for Payer: United Healthcare Medicare |
$704.93
|
| Rate for Payer: WINHealth Partners Commercial |
$4,368.15
|
|
