|
HC PRO REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
9832052001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.31 |
| Max. Negotiated Rate |
$607.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$594.86
|
| Rate for Payer: Aetna of WY Medicare |
$143.89
|
| Rate for Payer: Beech Street Commercial |
$576.65
|
| Rate for Payer: Cash Price |
$424.90
|
| Rate for Payer: Cash Price |
$424.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$588.79
|
| Rate for Payer: Cigna of WY Commercial |
$594.86
|
| Rate for Payer: First Choice Health Commercial |
$546.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$576.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.89
|
| Rate for Payer: HealthUtah PPO |
$607.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$588.79
|
| Rate for Payer: Multiplan Medicare/VA |
$122.31
|
| Rate for Payer: One Health Plan of WY PPO |
$594.86
|
| Rate for Payer: PacificSource Commercial |
$546.30
|
| Rate for Payer: PHCS PPO |
$576.65
|
| Rate for Payer: Three Rivers PPO |
$455.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.89
|
| Rate for Payer: United Healthcare Commercial |
$528.09
|
| Rate for Payer: United Healthcare Medicare |
$143.89
|
| Rate for Payer: WINHealth Partners Commercial |
$515.95
|
|
|
HC PRO REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 20520 NONPBBPAYER
|
| Hospital Charge Code |
9832052001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.31 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$143.89
|
| Rate for Payer: Beech Street Commercial |
$721.05
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: First Choice Health Commercial |
$683.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.89
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$122.31
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$721.05
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.89
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$143.89
|
| Rate for Payer: WINHealth Partners Commercial |
$645.15
|
|
|
HC PRO REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
9832819201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$257.80 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,587.60
|
| Rate for Payer: Aetna of WY Medicare |
$303.29
|
| Rate for Payer: Beech Street Commercial |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,571.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,587.60
|
| Rate for Payer: First Choice Health Commercial |
$1,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,539.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.29
|
| Rate for Payer: HealthUtah PPO |
$1,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,571.40
|
| Rate for Payer: Multiplan Medicare/VA |
$257.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,587.60
|
| Rate for Payer: PacificSource Commercial |
$1,458.00
|
| Rate for Payer: PHCS PPO |
$1,539.00
|
| Rate for Payer: Three Rivers PPO |
$1,215.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.29
|
| Rate for Payer: United Healthcare Commercial |
$1,409.40
|
| Rate for Payer: United Healthcare Medicare |
$303.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,377.00
|
|
|
HC PRO REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
9833031001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$173.24 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$570.36
|
| Rate for Payer: Aetna of WY Medicare |
$203.81
|
| Rate for Payer: Beech Street Commercial |
$552.90
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$564.54
|
| Rate for Payer: Cigna of WY Commercial |
$570.36
|
| Rate for Payer: First Choice Health Commercial |
$523.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$552.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.81
|
| Rate for Payer: HealthUtah PPO |
$582.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$564.54
|
| Rate for Payer: Multiplan Medicare/VA |
$173.24
|
| Rate for Payer: One Health Plan of WY PPO |
$570.36
|
| Rate for Payer: PacificSource Commercial |
$523.80
|
| Rate for Payer: PHCS PPO |
$552.90
|
| Rate for Payer: Three Rivers PPO |
$436.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.81
|
| Rate for Payer: United Healthcare Commercial |
$506.34
|
| Rate for Payer: United Healthcare Medicare |
$203.81
|
| Rate for Payer: WINHealth Partners Commercial |
$494.70
|
|
|
HC PRO REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 30310 NONPBBPAYER
|
| Hospital Charge Code |
9833031001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$173.24 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$712.46
|
| Rate for Payer: Aetna of WY Medicare |
$203.81
|
| Rate for Payer: Beech Street Commercial |
$690.65
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$705.19
|
| Rate for Payer: Cigna of WY Commercial |
$712.46
|
| Rate for Payer: First Choice Health Commercial |
$654.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$690.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.81
|
| Rate for Payer: HealthUtah PPO |
$727.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$705.19
|
| Rate for Payer: Multiplan Medicare/VA |
$173.24
|
| Rate for Payer: One Health Plan of WY PPO |
$712.46
|
| Rate for Payer: PacificSource Commercial |
$654.30
|
| Rate for Payer: PHCS PPO |
$690.65
|
| Rate for Payer: Three Rivers PPO |
$545.25
|
| Rate for Payer: TriWest Veterans Administration |
$203.81
|
| Rate for Payer: United Healthcare Commercial |
$632.49
|
| Rate for Payer: United Healthcare Medicare |
$203.81
|
| Rate for Payer: WINHealth Partners Commercial |
$617.95
|
|
|
HC PRO REMOVAL FULL ARM/LEG AST
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 29705
|
| Hospital Charge Code |
9832970501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$42.52
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.52
|
| Rate for Payer: HealthUtah PPO |
$546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Multiplan Medicare/VA |
$36.14
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.52
|
| Rate for Payer: United Healthcare Commercial |
$475.02
|
| Rate for Payer: United Healthcare Medicare |
$42.52
|
| Rate for Payer: WINHealth Partners Commercial |
$464.10
|
|
|
HC PRO REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$5,900.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
9832632001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$5,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,782.00
|
| Rate for Payer: Aetna of WY Medicare |
$345.18
|
| Rate for Payer: Beech Street Commercial |
$5,605.00
|
| Rate for Payer: Cash Price |
$4,130.00
|
| Rate for Payer: Cash Price |
$4,130.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,723.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,782.00
|
| Rate for Payer: First Choice Health Commercial |
$5,310.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,605.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$345.18
|
| Rate for Payer: HealthUtah PPO |
$5,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,723.00
|
| Rate for Payer: Multiplan Medicare/VA |
$293.40
|
| Rate for Payer: One Health Plan of WY PPO |
$5,782.00
|
| Rate for Payer: PacificSource Commercial |
$5,310.00
|
| Rate for Payer: PHCS PPO |
$5,605.00
|
| Rate for Payer: Three Rivers PPO |
$4,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$345.18
|
| Rate for Payer: United Healthcare Commercial |
$5,133.00
|
| Rate for Payer: United Healthcare Medicare |
$345.18
|
| Rate for Payer: WINHealth Partners Commercial |
$5,015.00
|
|
|
HC PRO REMOVAL KNEE CYST
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
9832734701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$2,162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,118.76
|
| Rate for Payer: Aetna of WY Medicare |
$517.04
|
| Rate for Payer: Beech Street Commercial |
$2,053.90
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,097.14
|
| Rate for Payer: Cigna of WY Commercial |
$2,118.76
|
| Rate for Payer: First Choice Health Commercial |
$1,945.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,053.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.04
|
| Rate for Payer: HealthUtah PPO |
$2,162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,097.14
|
| Rate for Payer: Multiplan Medicare/VA |
$439.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,118.76
|
| Rate for Payer: PacificSource Commercial |
$1,945.80
|
| Rate for Payer: PHCS PPO |
$2,053.90
|
| Rate for Payer: Three Rivers PPO |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration |
$517.04
|
| Rate for Payer: United Healthcare Commercial |
$1,880.94
|
| Rate for Payer: United Healthcare Medicare |
$517.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,837.70
|
|
|
HC PRO REMOVAL OF ADENOIDS
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 42835
|
| Hospital Charge Code |
9834283501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$166.12 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$970.20
|
| Rate for Payer: Aetna of WY Medicare |
$195.44
|
| Rate for Payer: Beech Street Commercial |
$940.50
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$960.30
|
| Rate for Payer: Cigna of WY Commercial |
$970.20
|
| Rate for Payer: First Choice Health Commercial |
$891.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.44
|
| Rate for Payer: HealthUtah PPO |
$990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$960.30
|
| Rate for Payer: Multiplan Medicare/VA |
$166.12
|
| Rate for Payer: One Health Plan of WY PPO |
$970.20
|
| Rate for Payer: PacificSource Commercial |
$891.00
|
| Rate for Payer: PHCS PPO |
$940.50
|
| Rate for Payer: Three Rivers PPO |
$742.50
|
| Rate for Payer: TriWest Veterans Administration |
$195.44
|
| Rate for Payer: United Healthcare Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare |
$195.44
|
| Rate for Payer: WINHealth Partners Commercial |
$841.50
|
|
|
HC PRO REMOVAL OF ADENOIDS <12
|
Professional
|
Both
|
$1,068.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
9834283001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,046.64
|
| Rate for Payer: Aetna of WY Medicare |
$209.18
|
| Rate for Payer: Beech Street Commercial |
$1,014.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,035.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,046.64
|
| Rate for Payer: First Choice Health Commercial |
$961.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,014.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.18
|
| Rate for Payer: HealthUtah PPO |
$1,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,035.96
|
| Rate for Payer: Multiplan Medicare/VA |
$177.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,046.64
|
| Rate for Payer: PacificSource Commercial |
$961.20
|
| Rate for Payer: PHCS PPO |
$1,014.60
|
| Rate for Payer: Three Rivers PPO |
$801.00
|
| Rate for Payer: TriWest Veterans Administration |
$209.18
|
| Rate for Payer: United Healthcare Commercial |
$929.16
|
| Rate for Payer: United Healthcare Medicare |
$209.18
|
| Rate for Payer: WINHealth Partners Commercial |
$907.80
|
|
|
HC PRO REMOVAL OF ANKLE IMPLANT
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
9832765901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$392.42 |
| Max. Negotiated Rate |
$2,149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,106.02
|
| Rate for Payer: Aetna of WY Medicare |
$461.67
|
| Rate for Payer: Beech Street Commercial |
$2,041.55
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,084.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,106.02
|
| Rate for Payer: First Choice Health Commercial |
$1,934.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,041.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.67
|
| Rate for Payer: HealthUtah PPO |
$2,149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,084.53
|
| Rate for Payer: Multiplan Medicare/VA |
$392.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,106.02
|
| Rate for Payer: PacificSource Commercial |
$1,934.10
|
| Rate for Payer: PHCS PPO |
$2,041.55
|
| Rate for Payer: Three Rivers PPO |
$1,611.75
|
| Rate for Payer: TriWest Veterans Administration |
$461.67
|
| Rate for Payer: United Healthcare Commercial |
$1,869.63
|
| Rate for Payer: United Healthcare Medicare |
$461.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,826.65
|
|
|
HC PRO REMOVAL OF HUMERUS LESION W/ ALLOGRAFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
9832315601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$661.82
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.82
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$562.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$661.82
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$661.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
HC PRO REMOVAL OF KNEECAP
|
Professional
|
Both
|
$7,052.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
9832735001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$542.90 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,910.96
|
| Rate for Payer: Aetna of WY Medicare |
$638.70
|
| Rate for Payer: Beech Street Commercial |
$6,699.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,840.44
|
| Rate for Payer: Cigna of WY Commercial |
$6,910.96
|
| Rate for Payer: First Choice Health Commercial |
$6,346.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,699.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.70
|
| Rate for Payer: HealthUtah PPO |
$7,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,840.44
|
| Rate for Payer: Multiplan Medicare/VA |
$542.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,910.96
|
| Rate for Payer: PacificSource Commercial |
$6,346.80
|
| Rate for Payer: PHCS PPO |
$6,699.40
|
| Rate for Payer: Three Rivers PPO |
$5,289.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.70
|
| Rate for Payer: United Healthcare Commercial |
$6,135.24
|
| Rate for Payer: United Healthcare Medicare |
$638.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,994.20
|
|
|
HC PRO REMOVAL OF KNEECAP BURSA
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 27340
|
| Hospital Charge Code |
9832734001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,296.54
|
| Rate for Payer: Aetna of WY Medicare |
$370.67
|
| Rate for Payer: Beech Street Commercial |
$1,256.85
|
| Rate for Payer: Cash Price |
$926.10
|
| Rate for Payer: Cash Price |
$926.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,283.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,296.54
|
| Rate for Payer: First Choice Health Commercial |
$1,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,256.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$370.67
|
| Rate for Payer: HealthUtah PPO |
$1,323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,283.31
|
| Rate for Payer: Multiplan Medicare/VA |
$315.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,296.54
|
| Rate for Payer: PacificSource Commercial |
$1,190.70
|
| Rate for Payer: PHCS PPO |
$1,256.85
|
| Rate for Payer: Three Rivers PPO |
$992.25
|
| Rate for Payer: TriWest Veterans Administration |
$370.67
|
| Rate for Payer: United Healthcare Commercial |
$1,151.01
|
| Rate for Payer: United Healthcare Medicare |
$370.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,124.55
|
|
|
HC PRO REMOVAL OF KNEE CYST
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
9832734501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Aetna of WY Medicare |
$477.46
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.46
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: Multiplan Medicare/VA |
$405.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: TriWest Veterans Administration |
$477.46
|
| Rate for Payer: United Healthcare Commercial |
$4,120.32
|
| Rate for Payer: United Healthcare Medicare |
$477.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
|
HC PRO REMOVAL OF NASAL SINUS TISSUE
|
Professional
|
Both
|
$1,594.00
|
|
|
Service Code
|
HCPCS 31288 50
|
| Hospital Charge Code |
9833128801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$1,594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,562.12
|
| Rate for Payer: Aetna of WY Medicare |
$223.43
|
| Rate for Payer: Beech Street Commercial |
$1,514.30
|
| Rate for Payer: Cash Price |
$1,115.80
|
| Rate for Payer: Cash Price |
$1,115.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,546.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,562.12
|
| Rate for Payer: First Choice Health Commercial |
$1,434.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,514.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.43
|
| Rate for Payer: HealthUtah PPO |
$1,594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,546.18
|
| Rate for Payer: Multiplan Medicare/VA |
$189.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,562.12
|
| Rate for Payer: PacificSource Commercial |
$1,434.60
|
| Rate for Payer: PHCS PPO |
$1,514.30
|
| Rate for Payer: Three Rivers PPO |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration |
$223.43
|
| Rate for Payer: United Healthcare Commercial |
$1,386.78
|
| Rate for Payer: United Healthcare Medicare |
$223.43
|
| Rate for Payer: WINHealth Partners Commercial |
$1,354.90
|
|
|
HC PRO REMOVAL OF NASAL SINUS TISSUE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 31288
|
| Hospital Charge Code |
9833128801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$797.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.06
|
| Rate for Payer: Aetna of WY Medicare |
$223.43
|
| Rate for Payer: Beech Street Commercial |
$757.15
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.09
|
| Rate for Payer: Cigna of WY Commercial |
$781.06
|
| Rate for Payer: First Choice Health Commercial |
$717.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.43
|
| Rate for Payer: HealthUtah PPO |
$797.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.09
|
| Rate for Payer: Multiplan Medicare/VA |
$189.92
|
| Rate for Payer: One Health Plan of WY PPO |
$781.06
|
| Rate for Payer: PacificSource Commercial |
$717.30
|
| Rate for Payer: PHCS PPO |
$757.15
|
| Rate for Payer: Three Rivers PPO |
$597.75
|
| Rate for Payer: TriWest Veterans Administration |
$223.43
|
| Rate for Payer: United Healthcare Commercial |
$693.39
|
| Rate for Payer: United Healthcare Medicare |
$223.43
|
| Rate for Payer: WINHealth Partners Commercial |
$677.45
|
|
|
HC PRO REMOVAL OF OVARY (S)
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
9835894001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$456.25 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,205.00
|
| Rate for Payer: Aetna of WY Medicare |
$536.77
|
| Rate for Payer: Beech Street Commercial |
$2,137.50
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,182.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,205.00
|
| Rate for Payer: First Choice Health Commercial |
$2,025.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$536.77
|
| Rate for Payer: HealthUtah PPO |
$2,250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,182.50
|
| Rate for Payer: Multiplan Medicare/VA |
$456.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,205.00
|
| Rate for Payer: PacificSource Commercial |
$2,025.00
|
| Rate for Payer: PHCS PPO |
$2,137.50
|
| Rate for Payer: Three Rivers PPO |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration |
$536.77
|
| Rate for Payer: United Healthcare Commercial |
$1,957.50
|
| Rate for Payer: United Healthcare Medicare |
$536.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1,912.50
|
|
|
HC PRO REMOVAL OF SKIN TAGS, UP TO 15
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
9831120001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$74.87
|
| Rate for Payer: Beech Street Commercial |
$280.25
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: First Choice Health Commercial |
$265.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.87
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$63.64
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$280.25
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$74.87
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$74.87
|
| Rate for Payer: WINHealth Partners Commercial |
$250.75
|
|
|
HC PRO REMOVAL OF SKIN TAGS, UP TO 15
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 11200 NONPBBPAYER
|
| Hospital Charge Code |
9831120001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$361.62
|
| Rate for Payer: Aetna of WY Medicare |
$74.87
|
| Rate for Payer: Beech Street Commercial |
$350.55
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$357.93
|
| Rate for Payer: Cigna of WY Commercial |
$361.62
|
| Rate for Payer: First Choice Health Commercial |
$332.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$350.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.87
|
| Rate for Payer: HealthUtah PPO |
$369.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$357.93
|
| Rate for Payer: Multiplan Medicare/VA |
$63.64
|
| Rate for Payer: One Health Plan of WY PPO |
$361.62
|
| Rate for Payer: PacificSource Commercial |
$332.10
|
| Rate for Payer: PHCS PPO |
$350.55
|
| Rate for Payer: Three Rivers PPO |
$276.75
|
| Rate for Payer: TriWest Veterans Administration |
$74.87
|
| Rate for Payer: United Healthcare Commercial |
$321.03
|
| Rate for Payer: United Healthcare Medicare |
$74.87
|
| Rate for Payer: WINHealth Partners Commercial |
$313.65
|
|
|
HC PRO REMOVAL OVARY/TUBES
|
Professional
|
Both
|
$3,856.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
9835872001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$623.42 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,778.88
|
| Rate for Payer: Aetna of WY Medicare |
$733.43
|
| Rate for Payer: Beech Street Commercial |
$3,663.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| 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: Government Employees Health Association (GEHA) Medicare |
$733.43
|
| Rate for Payer: HealthUtah PPO |
$3,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,740.32
|
| Rate for Payer: Multiplan Medicare/VA |
$623.42
|
| 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: TriWest Veterans Administration |
$733.43
|
| Rate for Payer: United Healthcare Commercial |
$3,354.72
|
| Rate for Payer: United Healthcare Medicare |
$733.43
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.60
|
|
|
HC PRO REMOVAL OVARY/TUBES
|
Professional
|
Both
|
$3,102.00
|
|
|
Service Code
|
HCPCS 58720 AS
|
| Hospital Charge Code |
9835872001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$623.42 |
| Max. Negotiated Rate |
$3,102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,039.96
|
| Rate for Payer: Aetna of WY Medicare |
$733.43
|
| Rate for Payer: Beech Street Commercial |
$2,946.90
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,008.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,039.96
|
| Rate for Payer: First Choice Health Commercial |
$2,791.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,946.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.43
|
| Rate for Payer: HealthUtah PPO |
$3,102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,008.94
|
| Rate for Payer: Multiplan Medicare/VA |
$623.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,039.96
|
| Rate for Payer: PacificSource Commercial |
$2,791.80
|
| Rate for Payer: PHCS PPO |
$2,946.90
|
| Rate for Payer: Three Rivers PPO |
$2,326.50
|
| Rate for Payer: TriWest Veterans Administration |
$733.43
|
| Rate for Payer: United Healthcare Commercial |
$2,698.74
|
| Rate for Payer: United Healthcare Medicare |
$733.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,636.70
|
|
|
HC PRO REMOVAL OVARY/TUBES
|
Professional
|
Both
|
$3,102.00
|
|
|
Service Code
|
HCPCS 58720 80
|
| Hospital Charge Code |
9835872001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$623.42 |
| Max. Negotiated Rate |
$3,102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,039.96
|
| Rate for Payer: Aetna of WY Medicare |
$733.43
|
| Rate for Payer: Beech Street Commercial |
$2,946.90
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,008.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,039.96
|
| Rate for Payer: First Choice Health Commercial |
$2,791.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,946.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.43
|
| Rate for Payer: HealthUtah PPO |
$3,102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,008.94
|
| Rate for Payer: Multiplan Medicare/VA |
$623.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,039.96
|
| Rate for Payer: PacificSource Commercial |
$2,791.80
|
| Rate for Payer: PHCS PPO |
$2,946.90
|
| Rate for Payer: Three Rivers PPO |
$2,326.50
|
| Rate for Payer: TriWest Veterans Administration |
$733.43
|
| Rate for Payer: United Healthcare Commercial |
$2,698.74
|
| Rate for Payer: United Healthcare Medicare |
$733.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,636.70
|
|
|
HC PRO REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11201 NONPBBPAYER
|
| Hospital Charge Code |
9831120101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$15.46
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.46
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$13.14
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$15.46
|
| Rate for Payer: WINHealth Partners Commercial |
$69.70
|
|
|
HC PRO REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
9831120101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Medicare |
$15.46
|
| Rate for Payer: Beech Street Commercial |
$62.70
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: First Choice Health Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.46
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$13.14
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$62.70
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$15.46
|
| Rate for Payer: WINHealth Partners Commercial |
$56.10
|
|
