|
HC PRO SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB
|
Professional
|
Both
|
$3,024.00
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
9832981901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$486.18 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,963.52
|
| Rate for Payer: Aetna of WY Medicare |
$571.98
|
| Rate for Payer: Beech Street Commercial |
$2,872.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,933.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,963.52
|
| Rate for Payer: First Choice Health Commercial |
$2,721.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$571.98
|
| Rate for Payer: HealthUtah PPO |
$3,024.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,933.28
|
| Rate for Payer: Multiplan Medicare/VA |
$486.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,963.52
|
| Rate for Payer: PacificSource Commercial |
$2,721.60
|
| Rate for Payer: PHCS PPO |
$2,872.80
|
| Rate for Payer: Three Rivers PPO |
$2,268.00
|
| Rate for Payer: TriWest Veterans Administration |
$571.98
|
| Rate for Payer: United Healthcare Commercial |
$2,630.88
|
| Rate for Payer: United Healthcare Medicare |
$571.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,570.40
|
|
|
HC PRO SURG IMPLNT NEUROELECT,EPIDURAL
|
Professional
|
Both
|
$4,261.00
|
|
|
Service Code
|
HCPCS 63655
|
| Hospital Charge Code |
9836365501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$684.76 |
| Max. Negotiated Rate |
$4,261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,175.78
|
| Rate for Payer: Aetna of WY Medicare |
$805.60
|
| Rate for Payer: Beech Street Commercial |
$4,047.95
|
| Rate for Payer: Cash Price |
$2,982.70
|
| Rate for Payer: Cash Price |
$2,982.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,133.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,175.78
|
| Rate for Payer: First Choice Health Commercial |
$3,834.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,047.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$805.60
|
| Rate for Payer: HealthUtah PPO |
$4,261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,133.17
|
| Rate for Payer: Multiplan Medicare/VA |
$684.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,175.78
|
| Rate for Payer: PacificSource Commercial |
$3,834.90
|
| Rate for Payer: PHCS PPO |
$4,047.95
|
| Rate for Payer: Three Rivers PPO |
$3,195.75
|
| Rate for Payer: TriWest Veterans Administration |
$805.60
|
| Rate for Payer: United Healthcare Commercial |
$3,707.07
|
| Rate for Payer: United Healthcare Medicare |
$805.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,621.85
|
|
|
HC PRO SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
9834460401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$847.05 |
| Max. Negotiated Rate |
$3,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,484.88
|
| Rate for Payer: Aetna of WY Medicare |
$996.53
|
| Rate for Payer: Beech Street Commercial |
$3,378.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,449.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,484.88
|
| Rate for Payer: First Choice Health Commercial |
$3,200.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,378.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$996.53
|
| Rate for Payer: HealthUtah PPO |
$3,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,449.32
|
| Rate for Payer: Multiplan Medicare/VA |
$847.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,484.88
|
| Rate for Payer: PacificSource Commercial |
$3,200.40
|
| Rate for Payer: PHCS PPO |
$3,378.20
|
| Rate for Payer: Three Rivers PPO |
$2,667.00
|
| Rate for Payer: TriWest Veterans Administration |
$996.53
|
| Rate for Payer: United Healthcare Commercial |
$3,093.72
|
| Rate for Payer: United Healthcare Medicare |
$996.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,022.60
|
|
|
HC PRO SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
9822738601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$707.45 |
| Max. Negotiated Rate |
$2,972.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,912.56
|
| Rate for Payer: Aetna of WY Medicare |
$832.29
|
| Rate for Payer: Beech Street Commercial |
$2,823.40
|
| Rate for Payer: Cash Price |
$2,080.40
|
| Rate for Payer: Cash Price |
$2,080.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,882.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,912.56
|
| Rate for Payer: First Choice Health Commercial |
$2,674.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,823.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$832.29
|
| Rate for Payer: HealthUtah PPO |
$2,972.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,882.84
|
| Rate for Payer: Multiplan Medicare/VA |
$707.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2,912.56
|
| Rate for Payer: PacificSource Commercial |
$2,674.80
|
| Rate for Payer: PHCS PPO |
$2,823.40
|
| Rate for Payer: Three Rivers PPO |
$2,229.00
|
| Rate for Payer: TriWest Veterans Administration |
$832.29
|
| Rate for Payer: United Healthcare Commercial |
$2,585.64
|
| Rate for Payer: United Healthcare Medicare |
$832.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,526.20
|
|
|
HC PRO SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
9836483101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$573.45 |
| Max. Negotiated Rate |
$3,558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,486.84
|
| Rate for Payer: Aetna of WY Medicare |
$674.65
|
| Rate for Payer: Beech Street Commercial |
$3,380.10
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,451.26
|
| Rate for Payer: Cigna of WY Commercial |
$3,486.84
|
| Rate for Payer: First Choice Health Commercial |
$3,202.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,380.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$674.65
|
| Rate for Payer: HealthUtah PPO |
$3,558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,451.26
|
| Rate for Payer: Multiplan Medicare/VA |
$573.45
|
| Rate for Payer: One Health Plan of WY PPO |
$3,486.84
|
| Rate for Payer: PacificSource Commercial |
$3,202.20
|
| Rate for Payer: PHCS PPO |
$3,380.10
|
| Rate for Payer: Three Rivers PPO |
$2,668.50
|
| Rate for Payer: TriWest Veterans Administration |
$674.65
|
| Rate for Payer: United Healthcare Commercial |
$3,095.46
|
| Rate for Payer: United Healthcare Medicare |
$674.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3,024.30
|
|
|
HC PRO SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$3,139.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
9832738001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$517.57 |
| Max. Negotiated Rate |
$3,139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,076.22
|
| Rate for Payer: Aetna of WY Medicare |
$608.91
|
| Rate for Payer: Beech Street Commercial |
$2,982.05
|
| Rate for Payer: Cash Price |
$2,197.30
|
| Rate for Payer: Cash Price |
$2,197.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,044.83
|
| Rate for Payer: Cigna of WY Commercial |
$3,076.22
|
| Rate for Payer: First Choice Health Commercial |
$2,825.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,982.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$608.91
|
| Rate for Payer: HealthUtah PPO |
$3,139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,044.83
|
| Rate for Payer: Multiplan Medicare/VA |
$517.57
|
| Rate for Payer: One Health Plan of WY PPO |
$3,076.22
|
| Rate for Payer: PacificSource Commercial |
$2,825.10
|
| Rate for Payer: PHCS PPO |
$2,982.05
|
| Rate for Payer: Three Rivers PPO |
$2,354.25
|
| Rate for Payer: TriWest Veterans Administration |
$608.91
|
| Rate for Payer: United Healthcare Commercial |
$2,730.93
|
| Rate for Payer: United Healthcare Medicare |
$608.91
|
| Rate for Payer: WINHealth Partners Commercial |
$2,668.15
|
|
|
HC PRO SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
9832738501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$505.72 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,081.52
|
| Rate for Payer: Aetna of WY Medicare |
$594.96
|
| Rate for Payer: Beech Street Commercial |
$2,017.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,060.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,081.52
|
| Rate for Payer: First Choice Health Commercial |
$1,911.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.96
|
| Rate for Payer: HealthUtah PPO |
$2,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,060.28
|
| Rate for Payer: Multiplan Medicare/VA |
$505.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,081.52
|
| Rate for Payer: PacificSource Commercial |
$1,911.60
|
| Rate for Payer: PHCS PPO |
$2,017.80
|
| Rate for Payer: Three Rivers PPO |
$1,593.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.96
|
| Rate for Payer: United Healthcare Commercial |
$1,847.88
|
| Rate for Payer: United Healthcare Medicare |
$594.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.40
|
|
|
HC PRO SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$4,247.00
|
|
|
Service Code
|
HCPCS 27385 50
|
| Hospital Charge Code |
9832738501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$505.72 |
| Max. Negotiated Rate |
$4,247.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,162.06
|
| Rate for Payer: Aetna of WY Medicare |
$594.96
|
| Rate for Payer: Beech Street Commercial |
$4,034.65
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,119.59
|
| Rate for Payer: Cigna of WY Commercial |
$4,162.06
|
| Rate for Payer: First Choice Health Commercial |
$3,822.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,034.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.96
|
| Rate for Payer: HealthUtah PPO |
$4,247.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,119.59
|
| Rate for Payer: Multiplan Medicare/VA |
$505.72
|
| Rate for Payer: One Health Plan of WY PPO |
$4,162.06
|
| Rate for Payer: PacificSource Commercial |
$3,822.30
|
| Rate for Payer: PHCS PPO |
$4,034.65
|
| Rate for Payer: Three Rivers PPO |
$3,185.25
|
| Rate for Payer: TriWest Veterans Administration |
$594.96
|
| Rate for Payer: United Healthcare Commercial |
$3,694.89
|
| Rate for Payer: United Healthcare Medicare |
$594.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,609.95
|
|
|
HC PRO SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
9249511501
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Beech Street Commercial |
$52.25
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: First Choice Health Commercial |
$49.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$8.56
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$52.25
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
|
|
HC PRO SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$3,287.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
9832511801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,221.26
|
| Rate for Payer: Aetna of WY Medicare |
$379.12
|
| Rate for Payer: Beech Street Commercial |
$3,122.65
|
| Rate for Payer: Cash Price |
$2,300.90
|
| Rate for Payer: Cash Price |
$2,300.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,188.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,221.26
|
| Rate for Payer: First Choice Health Commercial |
$2,958.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,122.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.12
|
| Rate for Payer: HealthUtah PPO |
$3,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,188.39
|
| Rate for Payer: Multiplan Medicare/VA |
$322.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,221.26
|
| Rate for Payer: PacificSource Commercial |
$2,958.30
|
| Rate for Payer: PHCS PPO |
$3,122.65
|
| Rate for Payer: Three Rivers PPO |
$2,465.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.12
|
| Rate for Payer: United Healthcare Commercial |
$2,859.69
|
| Rate for Payer: United Healthcare Medicare |
$379.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,793.95
|
|
|
HC PRO SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$3,785.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
9832614501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$431.38 |
| Max. Negotiated Rate |
$3,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,709.30
|
| Rate for Payer: Aetna of WY Medicare |
$507.50
|
| Rate for Payer: Beech Street Commercial |
$3,595.75
|
| Rate for Payer: Cash Price |
$2,649.50
|
| Rate for Payer: Cash Price |
$2,649.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,671.45
|
| Rate for Payer: Cigna of WY Commercial |
$3,709.30
|
| Rate for Payer: First Choice Health Commercial |
$3,406.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,595.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$3,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,671.45
|
| Rate for Payer: Multiplan Medicare/VA |
$431.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,709.30
|
| Rate for Payer: PacificSource Commercial |
$3,406.50
|
| Rate for Payer: PHCS PPO |
$3,595.75
|
| Rate for Payer: Three Rivers PPO |
$2,838.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$3,292.95
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,217.25
|
|
|
HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
9831110301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$20.94
|
| Rate for Payer: Beech Street Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: First Choice Health Commercial |
$81.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.94
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$17.80
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$85.50
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.94
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$20.94
|
| Rate for Payer: WINHealth Partners Commercial |
$76.50
|
|
|
HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 11103 NONPBBPAYER
|
| Hospital Charge Code |
9831110301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Aetna of WY Medicare |
$20.94
|
| Rate for Payer: Beech Street Commercial |
$107.35
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: First Choice Health Commercial |
$101.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.94
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$17.80
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$107.35
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.94
|
| Rate for Payer: United Healthcare Commercial |
$98.31
|
| Rate for Payer: United Healthcare Medicare |
$20.94
|
| Rate for Payer: WINHealth Partners Commercial |
$96.05
|
|
|
HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
9831110201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: First Choice Health Commercial |
$140.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.08
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$30.67
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$148.20
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$36.08
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$36.08
|
| Rate for Payer: WINHealth Partners Commercial |
$132.60
|
|
|
HC PRO TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 11102 NONPBBPAYER
|
| Hospital Charge Code |
9831110201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$185.25
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: First Choice Health Commercial |
$175.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.08
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$30.67
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$185.25
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.08
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$36.08
|
| Rate for Payer: WINHealth Partners Commercial |
$165.75
|
|
|
HC PRO TAP BLOCK BILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
9836448801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$55.56 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$65.36
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: First Choice Health Commercial |
$441.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.36
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$55.56
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$65.36
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$65.36
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
|
|
HC PRO TAP BLOCK BILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 64488 50
|
| Hospital Charge Code |
9836448801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$55.56 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$65.36
|
| Rate for Payer: Beech Street Commercial |
$931.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: First Choice Health Commercial |
$882.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.36
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$55.56
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$931.00
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$65.36
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$65.36
|
| Rate for Payer: WINHealth Partners Commercial |
$833.00
|
|
|
HC PRO TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 64486 50
|
| Hospital Charge Code |
9826448601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$52.43
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.43
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$44.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.43
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$52.43
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
HC PRO TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
9826448601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$562.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$550.76
|
| Rate for Payer: Aetna of WY Medicare |
$52.43
|
| Rate for Payer: Beech Street Commercial |
$533.90
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$545.14
|
| Rate for Payer: Cigna of WY Commercial |
$550.76
|
| Rate for Payer: First Choice Health Commercial |
$505.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$533.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.43
|
| Rate for Payer: HealthUtah PPO |
$562.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$545.14
|
| Rate for Payer: Multiplan Medicare/VA |
$44.57
|
| Rate for Payer: One Health Plan of WY PPO |
$550.76
|
| Rate for Payer: PacificSource Commercial |
$505.80
|
| Rate for Payer: PHCS PPO |
$533.90
|
| Rate for Payer: Three Rivers PPO |
$421.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.43
|
| Rate for Payer: United Healthcare Commercial |
$488.94
|
| Rate for Payer: United Healthcare Medicare |
$52.43
|
| Rate for Payer: WINHealth Partners Commercial |
$477.70
|
|
|
HC PRO TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,173.00
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
9832531001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$517.50 |
| Max. Negotiated Rate |
$2,173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,129.54
|
| Rate for Payer: Aetna of WY Medicare |
$608.82
|
| Rate for Payer: Beech Street Commercial |
$2,064.35
|
| Rate for Payer: Cash Price |
$1,521.10
|
| Rate for Payer: Cash Price |
$1,521.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,107.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,129.54
|
| Rate for Payer: First Choice Health Commercial |
$1,955.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,064.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$608.82
|
| Rate for Payer: HealthUtah PPO |
$2,173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,107.81
|
| Rate for Payer: Multiplan Medicare/VA |
$517.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,129.54
|
| Rate for Payer: PacificSource Commercial |
$1,955.70
|
| Rate for Payer: PHCS PPO |
$2,064.35
|
| Rate for Payer: Three Rivers PPO |
$1,629.75
|
| Rate for Payer: TriWest Veterans Administration |
$608.82
|
| Rate for Payer: United Healthcare Commercial |
$1,890.51
|
| Rate for Payer: United Healthcare Medicare |
$608.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,847.05
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$10.74
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.74
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.13
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$10.74
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3018416601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$17.83
|
| Rate for Payer: Beech Street Commercial |
$209.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: First Choice Health Commercial |
$198.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.83
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$15.16
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$209.00
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$17.83
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN BODY FLUID
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$4.00
|
| Rate for Payer: Beech Street Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: First Choice Health Commercial |
$180.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$190.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$4.00
|
| Rate for Payer: Beech Street Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: First Choice Health Commercial |
$180.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$190.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - ADDITIONAL CHARGE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3018415502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$3.67
|
| Rate for Payer: Beech Street Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.67
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.12
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$47.50
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$3.67
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
|
