|
HC PRO REMOVAL SUPERFICIAL IMPLANT
|
Professional
|
Both
|
$597.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
9832067001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$585.06
|
| Rate for Payer: Aetna of WY Medicare |
$141.11
|
| Rate for Payer: Beech Street Commercial |
$567.15
|
| Rate for Payer: Cash Price |
$417.90
|
| Rate for Payer: Cash Price |
$417.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$579.09
|
| Rate for Payer: Cigna of WY Commercial |
$585.06
|
| Rate for Payer: First Choice Health Commercial |
$537.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$567.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.11
|
| Rate for Payer: HealthUtah PPO |
$597.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$579.09
|
| Rate for Payer: Multiplan Medicare/VA |
$119.94
|
| Rate for Payer: One Health Plan of WY PPO |
$585.06
|
| Rate for Payer: PacificSource Commercial |
$537.30
|
| Rate for Payer: PHCS PPO |
$567.15
|
| Rate for Payer: Three Rivers PPO |
$447.75
|
| Rate for Payer: TriWest Veterans Administration |
$141.11
|
| Rate for Payer: United Healthcare Commercial |
$519.39
|
| Rate for Payer: United Healthcare Medicare |
$141.11
|
| Rate for Payer: WINHealth Partners Commercial |
$507.45
|
|
|
HC PRO REMOVAL SUPERFICIAL IMPLANT
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 20670 NONPBBPAYER
|
| Hospital Charge Code |
9832067001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$731.08
|
| Rate for Payer: Aetna of WY Medicare |
$141.11
|
| Rate for Payer: Beech Street Commercial |
$708.70
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$723.62
|
| Rate for Payer: Cigna of WY Commercial |
$731.08
|
| Rate for Payer: First Choice Health Commercial |
$671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$708.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.11
|
| Rate for Payer: HealthUtah PPO |
$746.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$723.62
|
| Rate for Payer: Multiplan Medicare/VA |
$119.94
|
| Rate for Payer: One Health Plan of WY PPO |
$731.08
|
| Rate for Payer: PacificSource Commercial |
$671.40
|
| Rate for Payer: PHCS PPO |
$708.70
|
| Rate for Payer: Three Rivers PPO |
$559.50
|
| Rate for Payer: TriWest Veterans Administration |
$141.11
|
| Rate for Payer: United Healthcare Commercial |
$649.02
|
| Rate for Payer: United Healthcare Medicare |
$141.11
|
| Rate for Payer: WINHealth Partners Commercial |
$634.10
|
|
|
HC PRO REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 15853 NONPBBPAYER
|
| Hospital Charge Code |
9831585301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: First Choice Health Commercial |
$36.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$38.00
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$34.00
|
|
|
HC PRO REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
9831585301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: First Choice Health Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$30.40
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$27.20
|
|
|
HC PRO REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 15850
|
| Hospital Charge Code |
9831585001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.38
|
| Rate for Payer: Beech Street Commercial |
$124.45
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.07
|
| Rate for Payer: Cigna of WY Commercial |
$128.38
|
| Rate for Payer: First Choice Health Commercial |
$117.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.45
|
| Rate for Payer: HealthUtah PPO |
$131.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.07
|
| Rate for Payer: One Health Plan of WY PPO |
$128.38
|
| Rate for Payer: PacificSource Commercial |
$117.90
|
| Rate for Payer: PHCS PPO |
$124.45
|
| Rate for Payer: Three Rivers PPO |
$98.25
|
| Rate for Payer: United Healthcare Commercial |
$113.97
|
| Rate for Payer: WINHealth Partners Commercial |
$111.35
|
|
|
HC PRO REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 36590 NONPBBPAYER
|
| Hospital Charge Code |
9833659001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$179.41
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: First Choice Health Commercial |
$885.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.41
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$152.50
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.41
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$179.41
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
HC PRO REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
9833659001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$787.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$771.26
|
| Rate for Payer: Aetna of WY Medicare |
$179.41
|
| Rate for Payer: Beech Street Commercial |
$747.65
|
| Rate for Payer: Cash Price |
$550.90
|
| Rate for Payer: Cash Price |
$550.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$763.39
|
| Rate for Payer: Cigna of WY Commercial |
$771.26
|
| Rate for Payer: First Choice Health Commercial |
$708.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$747.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.41
|
| Rate for Payer: HealthUtah PPO |
$787.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$763.39
|
| Rate for Payer: Multiplan Medicare/VA |
$152.50
|
| Rate for Payer: One Health Plan of WY PPO |
$771.26
|
| Rate for Payer: PacificSource Commercial |
$708.30
|
| Rate for Payer: PHCS PPO |
$747.65
|
| Rate for Payer: Three Rivers PPO |
$590.25
|
| Rate for Payer: TriWest Veterans Administration |
$179.41
|
| Rate for Payer: United Healthcare Commercial |
$684.69
|
| Rate for Payer: United Healthcare Medicare |
$179.41
|
| Rate for Payer: WINHealth Partners Commercial |
$668.95
|
|
|
HC PRO REMOVE FB EYE CORNEA W SLIT LAMP
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
9836522201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.88
|
| Rate for Payer: Aetna of WY Medicare |
$48.36
|
| Rate for Payer: Beech Street Commercial |
$575.70
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.82
|
| Rate for Payer: Cigna of WY Commercial |
$593.88
|
| Rate for Payer: First Choice Health Commercial |
$545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.36
|
| Rate for Payer: HealthUtah PPO |
$606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.82
|
| Rate for Payer: Multiplan Medicare/VA |
$41.11
|
| Rate for Payer: One Health Plan of WY PPO |
$593.88
|
| Rate for Payer: PacificSource Commercial |
$545.40
|
| Rate for Payer: PHCS PPO |
$575.70
|
| Rate for Payer: Three Rivers PPO |
$454.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.36
|
| Rate for Payer: United Healthcare Commercial |
$527.22
|
| Rate for Payer: United Healthcare Medicare |
$48.36
|
| Rate for Payer: WINHealth Partners Commercial |
$515.10
|
|
|
HC PRO REMOVE FB INTRAOCULAR
|
Professional
|
Both
|
$5,541.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
9836523501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$5,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,430.18
|
| Rate for Payer: Aetna of WY Medicare |
$708.00
|
| Rate for Payer: Beech Street Commercial |
$5,263.95
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,374.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,430.18
|
| Rate for Payer: First Choice Health Commercial |
$4,986.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$708.00
|
| Rate for Payer: HealthUtah PPO |
$5,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,374.77
|
| Rate for Payer: Multiplan Medicare/VA |
$601.80
|
| Rate for Payer: One Health Plan of WY PPO |
$5,430.18
|
| Rate for Payer: PacificSource Commercial |
$4,986.90
|
| Rate for Payer: PHCS PPO |
$5,263.95
|
| Rate for Payer: Three Rivers PPO |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$708.00
|
| Rate for Payer: United Healthcare Commercial |
$4,820.67
|
| Rate for Payer: United Healthcare Medicare |
$708.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.85
|
|
|
HC PRO REMOVE FOREARM/WRIST FOREIGN BODY
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
9832524801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,407.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,774.38
|
| Rate for Payer: Aetna of WY Medicare |
$416.59
|
| Rate for Payer: Aetna of WY Medicare |
$416.59
|
| Rate for Payer: Beech Street Commercial |
$2,689.45
|
| Rate for Payer: Beech Street Commercial |
$1,364.20
|
| Rate for Payer: Cash Price |
$1,981.70
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: Cash Price |
$1,981.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,746.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,392.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,407.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,774.38
|
| Rate for Payer: First Choice Health Commercial |
$2,547.90
|
| Rate for Payer: First Choice Health Commercial |
$1,292.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,364.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,689.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.59
|
| Rate for Payer: HealthUtah PPO |
$1,436.00
|
| Rate for Payer: HealthUtah PPO |
$2,831.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,746.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,392.92
|
| Rate for Payer: Multiplan Medicare/VA |
$354.10
|
| Rate for Payer: Multiplan Medicare/VA |
$354.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,774.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,407.28
|
| Rate for Payer: PacificSource Commercial |
$1,292.40
|
| Rate for Payer: PacificSource Commercial |
$2,547.90
|
| Rate for Payer: PHCS PPO |
$1,364.20
|
| Rate for Payer: PHCS PPO |
$2,689.45
|
| Rate for Payer: Three Rivers PPO |
$1,077.00
|
| Rate for Payer: Three Rivers PPO |
$2,123.25
|
| Rate for Payer: TriWest Veterans Administration |
$416.59
|
| Rate for Payer: TriWest Veterans Administration |
$416.59
|
| Rate for Payer: United Healthcare Commercial |
$2,462.97
|
| Rate for Payer: United Healthcare Commercial |
$1,249.32
|
| Rate for Payer: United Healthcare Medicare |
$416.59
|
| Rate for Payer: United Healthcare Medicare |
$416.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,220.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,406.35
|
|
|
HC PRO REMOVE FOREIGN BODY COMPLEX
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 10121 NONPBBPAYER
|
| Hospital Charge Code |
9831012101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$150.73 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$908.46
|
| Rate for Payer: Aetna of WY Medicare |
$177.33
|
| Rate for Payer: Beech Street Commercial |
$880.65
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$899.19
|
| Rate for Payer: Cigna of WY Commercial |
$908.46
|
| Rate for Payer: First Choice Health Commercial |
$834.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$880.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.33
|
| Rate for Payer: HealthUtah PPO |
$927.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$899.19
|
| Rate for Payer: Multiplan Medicare/VA |
$150.73
|
| Rate for Payer: One Health Plan of WY PPO |
$908.46
|
| Rate for Payer: PacificSource Commercial |
$834.30
|
| Rate for Payer: PHCS PPO |
$880.65
|
| Rate for Payer: Three Rivers PPO |
$695.25
|
| Rate for Payer: TriWest Veterans Administration |
$177.33
|
| Rate for Payer: United Healthcare Commercial |
$806.49
|
| Rate for Payer: United Healthcare Medicare |
$177.33
|
| Rate for Payer: WINHealth Partners Commercial |
$787.95
|
|
|
HC PRO REMOVE FOREIGN BODY COMPLEX
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
9831012101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$150.73 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$727.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,513.12
|
| Rate for Payer: Aetna of WY Medicare |
$177.33
|
| Rate for Payer: Aetna of WY Medicare |
$177.33
|
| Rate for Payer: Beech Street Commercial |
$1,466.80
|
| Rate for Payer: Beech Street Commercial |
$704.90
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: Cash Price |
$1,080.80
|
| Rate for Payer: Cash Price |
$519.40
|
| Rate for Payer: Cash Price |
$519.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$719.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,497.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,513.12
|
| Rate for Payer: Cigna of WY Commercial |
$727.16
|
| Rate for Payer: First Choice Health Commercial |
$1,389.60
|
| Rate for Payer: First Choice Health Commercial |
$667.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$704.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,466.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.33
|
| Rate for Payer: HealthUtah PPO |
$742.00
|
| Rate for Payer: HealthUtah PPO |
$1,544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$719.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,497.68
|
| Rate for Payer: Multiplan Medicare/VA |
$150.73
|
| Rate for Payer: Multiplan Medicare/VA |
$150.73
|
| Rate for Payer: One Health Plan of WY PPO |
$727.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,513.12
|
| Rate for Payer: PacificSource Commercial |
$1,389.60
|
| Rate for Payer: PacificSource Commercial |
$667.80
|
| Rate for Payer: PHCS PPO |
$704.90
|
| Rate for Payer: PHCS PPO |
$1,466.80
|
| Rate for Payer: Three Rivers PPO |
$556.50
|
| Rate for Payer: Three Rivers PPO |
$1,158.00
|
| Rate for Payer: TriWest Veterans Administration |
$177.33
|
| Rate for Payer: TriWest Veterans Administration |
$177.33
|
| Rate for Payer: United Healthcare Commercial |
$1,343.28
|
| Rate for Payer: United Healthcare Commercial |
$645.54
|
| Rate for Payer: United Healthcare Medicare |
$177.33
|
| Rate for Payer: United Healthcare Medicare |
$177.33
|
| Rate for Payer: WINHealth Partners Commercial |
$630.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,312.40
|
|
|
HC PRO REMOVE FOREIGN BODY SIMPLE
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
9831012001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Aetna of WY Medicare |
$103.17
|
| Rate for Payer: Beech Street Commercial |
$390.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: First Choice Health Commercial |
$369.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.17
|
| Rate for Payer: HealthUtah PPO |
$411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: Multiplan Medicare/VA |
$87.69
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$390.45
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.17
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: United Healthcare Medicare |
$103.17
|
| Rate for Payer: WINHealth Partners Commercial |
$349.35
|
|
|
HC PRO REMOVE FOREIGN BODY SIMPLE
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 10120 NONPBBPAYER
|
| Hospital Charge Code |
9831012001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$103.17
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.17
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$87.69
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.17
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$103.17
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
HC PRO REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
9835830101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$63.04
|
| Rate for Payer: Aetna of WY Medicare |
$63.04
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Beech Street Commercial |
$389.50
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: First Choice Health Commercial |
$369.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.04
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$53.58
|
| Rate for Payer: Multiplan Medicare/VA |
$53.58
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$389.50
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.04
|
| Rate for Payer: TriWest Veterans Administration |
$63.04
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$63.04
|
| Rate for Payer: United Healthcare Medicare |
$63.04
|
| Rate for Payer: WINHealth Partners Commercial |
$198.05
|
| Rate for Payer: WINHealth Partners Commercial |
$348.50
|
|
|
HC PRO REMOVE LOWER LEG BONE LESION
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
9832763501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$479.82 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,974.70
|
| Rate for Payer: Aetna of WY Medicare |
$564.49
|
| Rate for Payer: Beech Street Commercial |
$1,914.25
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,954.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,974.70
|
| Rate for Payer: First Choice Health Commercial |
$1,813.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,914.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.49
|
| Rate for Payer: HealthUtah PPO |
$2,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,954.55
|
| Rate for Payer: Multiplan Medicare/VA |
$479.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,974.70
|
| Rate for Payer: PacificSource Commercial |
$1,813.50
|
| Rate for Payer: PHCS PPO |
$1,914.25
|
| Rate for Payer: Three Rivers PPO |
$1,511.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.49
|
| Rate for Payer: United Healthcare Commercial |
$1,753.05
|
| Rate for Payer: United Healthcare Medicare |
$564.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.75
|
|
|
HC PRO REMOVE NASAL BREATHING PASSAGES
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 31240 50
|
| Hospital Charge Code |
9833124001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$152.61
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.61
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$129.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.61
|
| Rate for Payer: United Healthcare Commercial |
$946.56
|
| Rate for Payer: United Healthcare Medicare |
$152.61
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
HC PRO REMOVE NASAL BREATHING PASSAGES
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
9833124001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$533.12
|
| Rate for Payer: Aetna of WY Medicare |
$152.61
|
| Rate for Payer: Beech Street Commercial |
$516.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$527.68
|
| Rate for Payer: Cigna of WY Commercial |
$533.12
|
| Rate for Payer: First Choice Health Commercial |
$489.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$516.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.61
|
| Rate for Payer: HealthUtah PPO |
$544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$527.68
|
| Rate for Payer: Multiplan Medicare/VA |
$129.72
|
| Rate for Payer: One Health Plan of WY PPO |
$533.12
|
| Rate for Payer: PacificSource Commercial |
$489.60
|
| Rate for Payer: PHCS PPO |
$516.80
|
| Rate for Payer: Three Rivers PPO |
$408.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.61
|
| Rate for Payer: United Healthcare Commercial |
$473.28
|
| Rate for Payer: United Healthcare Medicare |
$152.61
|
| Rate for Payer: WINHealth Partners Commercial |
$462.40
|
|
|
HC PRO REMOVE NASAL FOREIGN BODY
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 30300 NONPBBPAYER
|
| Hospital Charge Code |
9833030001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$722.26
|
| Rate for Payer: Aetna of WY Medicare |
$120.44
|
| Rate for Payer: Beech Street Commercial |
$700.15
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$714.89
|
| Rate for Payer: Cigna of WY Commercial |
$722.26
|
| Rate for Payer: First Choice Health Commercial |
$663.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$700.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.44
|
| Rate for Payer: HealthUtah PPO |
$737.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$714.89
|
| Rate for Payer: Multiplan Medicare/VA |
$102.37
|
| Rate for Payer: One Health Plan of WY PPO |
$722.26
|
| Rate for Payer: PacificSource Commercial |
$663.30
|
| Rate for Payer: PHCS PPO |
$700.15
|
| Rate for Payer: Three Rivers PPO |
$552.75
|
| Rate for Payer: TriWest Veterans Administration |
$120.44
|
| Rate for Payer: United Healthcare Commercial |
$641.19
|
| Rate for Payer: United Healthcare Medicare |
$120.44
|
| Rate for Payer: WINHealth Partners Commercial |
$626.45
|
|
|
HC PRO REMOVE NASAL FOREIGN BODY
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
9833030001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,002.54
|
| Rate for Payer: Aetna of WY Medicare |
$120.44
|
| Rate for Payer: Aetna of WY Medicare |
$120.44
|
| Rate for Payer: Beech Street Commercial |
$971.85
|
| Rate for Payer: Beech Street Commercial |
$560.50
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$992.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,002.54
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: First Choice Health Commercial |
$920.70
|
| Rate for Payer: First Choice Health Commercial |
$531.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$971.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.44
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: HealthUtah PPO |
$1,023.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$992.31
|
| Rate for Payer: Multiplan Medicare/VA |
$102.37
|
| Rate for Payer: Multiplan Medicare/VA |
$102.37
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,002.54
|
| Rate for Payer: PacificSource Commercial |
$920.70
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PHCS PPO |
$560.50
|
| Rate for Payer: PHCS PPO |
$971.85
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: Three Rivers PPO |
$767.25
|
| Rate for Payer: TriWest Veterans Administration |
$120.44
|
| Rate for Payer: TriWest Veterans Administration |
$120.44
|
| Rate for Payer: United Healthcare Commercial |
$890.01
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$120.44
|
| Rate for Payer: United Healthcare Medicare |
$120.44
|
| Rate for Payer: WINHealth Partners Commercial |
$501.50
|
| Rate for Payer: WINHealth Partners Commercial |
$869.55
|
|
|
HC PRO REMOVE PHARYNX FOREIGN BODY
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
9834280901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$937.86
|
| Rate for Payer: Aetna of WY Medicare |
$123.17
|
| Rate for Payer: Beech Street Commercial |
$909.15
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$928.29
|
| Rate for Payer: Cigna of WY Commercial |
$937.86
|
| Rate for Payer: First Choice Health Commercial |
$861.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$909.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.17
|
| Rate for Payer: HealthUtah PPO |
$957.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$928.29
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$937.86
|
| Rate for Payer: PacificSource Commercial |
$861.30
|
| Rate for Payer: PHCS PPO |
$909.15
|
| Rate for Payer: Three Rivers PPO |
$717.75
|
| Rate for Payer: TriWest Veterans Administration |
$123.17
|
| Rate for Payer: United Healthcare Commercial |
$832.59
|
| Rate for Payer: United Healthcare Medicare |
$123.17
|
| Rate for Payer: WINHealth Partners Commercial |
$813.45
|
|
|
HC PRO REMV EMBEDDED FB EYELID
|
Professional
|
Both
|
$779.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
9836793801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$763.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$464.52
|
| Rate for Payer: Aetna of WY Medicare |
$114.16
|
| Rate for Payer: Aetna of WY Medicare |
$114.16
|
| Rate for Payer: Beech Street Commercial |
$450.30
|
| Rate for Payer: Beech Street Commercial |
$740.05
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$545.30
|
| Rate for Payer: Cash Price |
$545.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$755.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$459.78
|
| Rate for Payer: Cigna of WY Commercial |
$464.52
|
| Rate for Payer: Cigna of WY Commercial |
$763.42
|
| Rate for Payer: First Choice Health Commercial |
$426.60
|
| Rate for Payer: First Choice Health Commercial |
$701.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$740.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$450.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.16
|
| Rate for Payer: HealthUtah PPO |
$779.00
|
| Rate for Payer: HealthUtah PPO |
$474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$755.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$459.78
|
| Rate for Payer: Multiplan Medicare/VA |
$97.04
|
| Rate for Payer: Multiplan Medicare/VA |
$97.04
|
| Rate for Payer: One Health Plan of WY PPO |
$763.42
|
| Rate for Payer: One Health Plan of WY PPO |
$464.52
|
| Rate for Payer: PacificSource Commercial |
$426.60
|
| Rate for Payer: PacificSource Commercial |
$701.10
|
| Rate for Payer: PHCS PPO |
$740.05
|
| Rate for Payer: PHCS PPO |
$450.30
|
| Rate for Payer: Three Rivers PPO |
$584.25
|
| Rate for Payer: Three Rivers PPO |
$355.50
|
| Rate for Payer: TriWest Veterans Administration |
$114.16
|
| Rate for Payer: TriWest Veterans Administration |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$412.38
|
| Rate for Payer: United Healthcare Commercial |
$677.73
|
| Rate for Payer: United Healthcare Medicare |
$114.16
|
| Rate for Payer: United Healthcare Medicare |
$114.16
|
| Rate for Payer: WINHealth Partners Commercial |
$662.15
|
| Rate for Payer: WINHealth Partners Commercial |
$402.90
|
|
|
HC PRO REMV EMBEDDED FB EYELID
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 67938 NONPBBPAYER
|
| Hospital Charge Code |
9836793801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$580.16
|
| Rate for Payer: Aetna of WY Medicare |
$114.16
|
| Rate for Payer: Beech Street Commercial |
$562.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$574.24
|
| Rate for Payer: Cigna of WY Commercial |
$580.16
|
| Rate for Payer: First Choice Health Commercial |
$532.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.16
|
| Rate for Payer: HealthUtah PPO |
$592.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$574.24
|
| Rate for Payer: Multiplan Medicare/VA |
$97.04
|
| Rate for Payer: One Health Plan of WY PPO |
$580.16
|
| Rate for Payer: PacificSource Commercial |
$532.80
|
| Rate for Payer: PHCS PPO |
$562.40
|
| Rate for Payer: Three Rivers PPO |
$444.00
|
| Rate for Payer: TriWest Veterans Administration |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$515.04
|
| Rate for Payer: United Healthcare Medicare |
$114.16
|
| Rate for Payer: WINHealth Partners Commercial |
$503.20
|
|
|
HC PRO REMV FB EXT AUDITORY CANAL W ANESTH
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
9836920501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$731.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$716.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$473.34
|
| Rate for Payer: Aetna of WY Medicare |
$92.85
|
| Rate for Payer: Aetna of WY Medicare |
$92.85
|
| Rate for Payer: Beech Street Commercial |
$458.85
|
| Rate for Payer: Beech Street Commercial |
$694.45
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cash Price |
$511.70
|
| Rate for Payer: Cash Price |
$511.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$709.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$468.51
|
| Rate for Payer: Cigna of WY Commercial |
$473.34
|
| Rate for Payer: Cigna of WY Commercial |
$716.38
|
| Rate for Payer: First Choice Health Commercial |
$434.70
|
| Rate for Payer: First Choice Health Commercial |
$657.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$694.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$458.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.85
|
| Rate for Payer: HealthUtah PPO |
$731.00
|
| Rate for Payer: HealthUtah PPO |
$483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$709.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$468.51
|
| Rate for Payer: Multiplan Medicare/VA |
$78.92
|
| Rate for Payer: Multiplan Medicare/VA |
$78.92
|
| Rate for Payer: One Health Plan of WY PPO |
$716.38
|
| Rate for Payer: One Health Plan of WY PPO |
$473.34
|
| Rate for Payer: PacificSource Commercial |
$434.70
|
| Rate for Payer: PacificSource Commercial |
$657.90
|
| Rate for Payer: PHCS PPO |
$694.45
|
| Rate for Payer: PHCS PPO |
$458.85
|
| Rate for Payer: Three Rivers PPO |
$548.25
|
| Rate for Payer: Three Rivers PPO |
$362.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.85
|
| Rate for Payer: TriWest Veterans Administration |
$92.85
|
| Rate for Payer: United Healthcare Commercial |
$420.21
|
| Rate for Payer: United Healthcare Commercial |
$635.97
|
| Rate for Payer: United Healthcare Medicare |
$92.85
|
| Rate for Payer: United Healthcare Medicare |
$92.85
|
| Rate for Payer: WINHealth Partners Commercial |
$621.35
|
| Rate for Payer: WINHealth Partners Commercial |
$410.55
|
|
|
HC PRO REMV FB EXT AUDITORY CANAL W ANESTH
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 69205 50
|
| Hospital Charge Code |
9836920501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Medicare |
$92.85
|
| 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 |
$92.85
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Multiplan Medicare/VA |
$78.92
|
| 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 |
$92.85
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$92.85
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
|
