|
HC PRO TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
9832845501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$193.57 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,042.72
|
| Rate for Payer: Aetna of WY Medicare |
$227.73
|
| Rate for Payer: Beech Street Commercial |
$1,010.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,032.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,042.72
|
| Rate for Payer: First Choice Health Commercial |
$957.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,010.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.73
|
| Rate for Payer: HealthUtah PPO |
$1,064.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,032.08
|
| Rate for Payer: Multiplan Medicare/VA |
$193.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,042.72
|
| Rate for Payer: PacificSource Commercial |
$957.60
|
| Rate for Payer: PHCS PPO |
$1,010.80
|
| Rate for Payer: Three Rivers PPO |
$798.00
|
| Rate for Payer: TriWest Veterans Administration |
$227.73
|
| Rate for Payer: United Healthcare Commercial |
$925.68
|
| Rate for Payer: United Healthcare Medicare |
$227.73
|
| Rate for Payer: WINHealth Partners Commercial |
$904.40
|
|
|
HC PRO TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 28455 NONPBBPAYER
|
| Hospital Charge Code |
9832845501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$193.57 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
| Rate for Payer: Aetna of WY Medicare |
$227.73
|
| Rate for Payer: Beech Street Commercial |
$1,263.50
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.73
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$193.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
| Rate for Payer: PacificSource Commercial |
$1,197.00
|
| Rate for Payer: PHCS PPO |
$1,263.50
|
| Rate for Payer: Three Rivers PPO |
$997.50
|
| Rate for Payer: TriWest Veterans Administration |
$227.73
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$227.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
|
|
HC PRO TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$5,155.00
|
|
|
Service Code
|
HCPCS 27759
|
| Hospital Charge Code |
9832775901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$817.24 |
| Max. Negotiated Rate |
$5,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,051.90
|
| Rate for Payer: Aetna of WY Medicare |
$961.46
|
| Rate for Payer: Beech Street Commercial |
$4,897.25
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,000.35
|
| Rate for Payer: Cigna of WY Commercial |
$5,051.90
|
| Rate for Payer: First Choice Health Commercial |
$4,639.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,897.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$961.46
|
| Rate for Payer: HealthUtah PPO |
$5,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,000.35
|
| Rate for Payer: Multiplan Medicare/VA |
$817.24
|
| Rate for Payer: One Health Plan of WY PPO |
$5,051.90
|
| Rate for Payer: PacificSource Commercial |
$4,639.50
|
| Rate for Payer: PHCS PPO |
$4,897.25
|
| Rate for Payer: Three Rivers PPO |
$3,866.25
|
| Rate for Payer: TriWest Veterans Administration |
$961.46
|
| Rate for Payer: United Healthcare Commercial |
$4,484.85
|
| Rate for Payer: United Healthcare Medicare |
$961.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4,381.75
|
|
|
HC PRO TYMPANIC MEMBRANE REPAIR BILATERAL
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
9836961001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$236.51 |
| Max. Negotiated Rate |
$1,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,448.44
|
| Rate for Payer: Aetna of WY Medicare |
$278.25
|
| Rate for Payer: Beech Street Commercial |
$1,404.10
|
| Rate for Payer: Cash Price |
$1,034.60
|
| Rate for Payer: Cash Price |
$1,034.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,433.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,448.44
|
| Rate for Payer: First Choice Health Commercial |
$1,330.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,404.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.25
|
| Rate for Payer: HealthUtah PPO |
$1,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,433.66
|
| Rate for Payer: Multiplan Medicare/VA |
$236.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,448.44
|
| Rate for Payer: PacificSource Commercial |
$1,330.20
|
| Rate for Payer: PHCS PPO |
$1,404.10
|
| Rate for Payer: Three Rivers PPO |
$1,108.50
|
| Rate for Payer: TriWest Veterans Administration |
$278.25
|
| Rate for Payer: United Healthcare Commercial |
$1,285.86
|
| Rate for Payer: United Healthcare Medicare |
$278.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,256.30
|
|
|
HC PRO TYMPANOSTOMY UNILATERAL
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 69436
|
| Hospital Charge Code |
9836943601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$156.00
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.00
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$132.60
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$156.00
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
HC PRO TYMPANOSTOMY UNILATERAL
|
Professional
|
Both
|
$1,610.00
|
|
|
Service Code
|
HCPCS 69436 50
|
| Hospital Charge Code |
9836943601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,577.80
|
| Rate for Payer: Aetna of WY Medicare |
$156.00
|
| Rate for Payer: Beech Street Commercial |
$1,529.50
|
| Rate for Payer: Cash Price |
$1,127.00
|
| Rate for Payer: Cash Price |
$1,127.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,561.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,577.80
|
| Rate for Payer: First Choice Health Commercial |
$1,449.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,529.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.00
|
| Rate for Payer: HealthUtah PPO |
$1,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,561.70
|
| Rate for Payer: Multiplan Medicare/VA |
$132.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,577.80
|
| Rate for Payer: PacificSource Commercial |
$1,449.00
|
| Rate for Payer: PHCS PPO |
$1,529.50
|
| Rate for Payer: Three Rivers PPO |
$1,207.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$1,400.70
|
| Rate for Payer: United Healthcare Medicare |
$156.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,368.50
|
|
|
HC PRO UNLISTED ANESTHESIA PROCEDURE
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01999
|
| Hospital Charge Code |
9640199901
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO UNLISTED CASTING/STRAPPING
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
9832979901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Beech Street Commercial |
$451.25
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$451.25
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
|
|
HC PRO UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
9825555901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,179.00 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.56
|
| Rate for Payer: Beech Street Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.56
|
| Rate for Payer: First Choice Health Commercial |
$1,414.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,493.40
|
| Rate for Payer: HealthUtah PPO |
$1,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.56
|
| Rate for Payer: PacificSource Commercial |
$1,414.80
|
| Rate for Payer: PHCS PPO |
$1,493.40
|
| Rate for Payer: Three Rivers PPO |
$1,179.00
|
| Rate for Payer: United Healthcare Commercial |
$1,367.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,336.20
|
|
|
HC PRO UNLISTED PROC DENTOALVEOLAR STRUCTURES
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
9834189901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,879.50 |
| Max. Negotiated Rate |
$2,506.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,455.88
|
| Rate for Payer: Beech Street Commercial |
$2,380.70
|
| Rate for Payer: Cash Price |
$1,754.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,430.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,455.88
|
| Rate for Payer: First Choice Health Commercial |
$2,255.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,380.70
|
| Rate for Payer: HealthUtah PPO |
$2,506.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,430.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,455.88
|
| Rate for Payer: PacificSource Commercial |
$2,255.40
|
| Rate for Payer: PHCS PPO |
$2,380.70
|
| Rate for Payer: Three Rivers PPO |
$1,879.50
|
| Rate for Payer: United Healthcare Commercial |
$2,180.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,130.10
|
|
|
HC PRO UNLISTED PROCEDURE ARTHROSCOPY
|
Professional
|
Both
|
$3,487.00
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
9832999901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,615.25 |
| Max. Negotiated Rate |
$3,487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.26
|
| Rate for Payer: Beech Street Commercial |
$3,312.65
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.26
|
| Rate for Payer: First Choice Health Commercial |
$3,138.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.65
|
| Rate for Payer: HealthUtah PPO |
$3,487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.26
|
| Rate for Payer: PacificSource Commercial |
$3,138.30
|
| Rate for Payer: PHCS PPO |
$3,312.65
|
| Rate for Payer: Three Rivers PPO |
$2,615.25
|
| Rate for Payer: United Healthcare Commercial |
$3,033.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.95
|
|
|
HC PRO UNLISTED PROCEDURE HANDS/FINGERS
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
9832698901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,842.75 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,407.86
|
| Rate for Payer: Beech Street Commercial |
$2,334.15
|
| Rate for Payer: Cash Price |
$1,719.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,383.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,407.86
|
| Rate for Payer: First Choice Health Commercial |
$2,211.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,334.15
|
| Rate for Payer: HealthUtah PPO |
$2,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,407.86
|
| Rate for Payer: PacificSource Commercial |
$2,211.30
|
| Rate for Payer: PHCS PPO |
$2,334.15
|
| Rate for Payer: Three Rivers PPO |
$1,842.75
|
| Rate for Payer: United Healthcare Commercial |
$2,137.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2,088.45
|
|
|
HC PRO UNLISTED PROCEDURE NOSE
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 30999
|
| Hospital Charge Code |
9833099901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,160.75 |
| Max. Negotiated Rate |
$2,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,823.38
|
| Rate for Payer: Beech Street Commercial |
$2,736.95
|
| Rate for Payer: Cash Price |
$2,016.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,794.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,823.38
|
| Rate for Payer: First Choice Health Commercial |
$2,592.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,736.95
|
| Rate for Payer: HealthUtah PPO |
$2,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,794.57
|
| Rate for Payer: One Health Plan of WY PPO |
$2,823.38
|
| Rate for Payer: PacificSource Commercial |
$2,592.90
|
| Rate for Payer: PHCS PPO |
$2,736.95
|
| Rate for Payer: Three Rivers PPO |
$2,160.75
|
| Rate for Payer: United Healthcare Commercial |
$2,506.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,448.85
|
|
|
HC PRO US GUIDED VASCULAR ACCESS
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
9647693701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$141.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.31
|
| Rate for Payer: Beech Street Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.68
|
| Rate for Payer: Cigna of WY Commercial |
$141.12
|
| Rate for Payer: First Choice Health Commercial |
$129.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.31
|
| Rate for Payer: HealthUtah PPO |
$144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.68
|
| Rate for Payer: Multiplan Medicare/VA |
$31.71
|
| Rate for Payer: One Health Plan of WY PPO |
$141.12
|
| Rate for Payer: PacificSource Commercial |
$129.60
|
| Rate for Payer: PHCS PPO |
$136.80
|
| Rate for Payer: Three Rivers PPO |
$108.00
|
| Rate for Payer: TriWest Veterans Administration |
$37.31
|
| Rate for Payer: United Healthcare Commercial |
$125.28
|
| Rate for Payer: United Healthcare Medicare |
$37.31
|
| Rate for Payer: WINHealth Partners Commercial |
$136.80
|
|
|
HC PRO US GUIDE NDL PLMT IMG S&I - US GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
9637694201
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$56.63
|
| Rate for Payer: Beech Street Commercial |
$189.05
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: First Choice Health Commercial |
$179.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.63
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$48.14
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$189.05
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.63
|
| Rate for Payer: United Healthcare Commercial |
$173.13
|
| Rate for Payer: United Healthcare Medicare |
$56.63
|
| Rate for Payer: WINHealth Partners Commercial |
$189.05
|
|
|
HC PRO US GUIDE NDL PLMT IMG S&I - US GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
9737694201
|
|
Hospital Revenue Code
|
973
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$551.74
|
| Rate for Payer: Aetna of WY Medicare |
$56.63
|
| Rate for Payer: Aetna of WY Medicare |
$56.63
|
| Rate for Payer: Beech Street Commercial |
$534.85
|
| Rate for Payer: Beech Street Commercial |
$189.05
|
| Rate for Payer: Cash Price |
$394.10
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: Cash Price |
$394.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$546.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: Cigna of WY Commercial |
$551.74
|
| Rate for Payer: First Choice Health Commercial |
$506.70
|
| Rate for Payer: First Choice Health Commercial |
$179.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$534.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.63
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: HealthUtah PPO |
$563.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$546.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$48.14
|
| Rate for Payer: Multiplan Medicare/VA |
$48.14
|
| Rate for Payer: One Health Plan of WY PPO |
$551.74
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PacificSource Commercial |
$506.70
|
| Rate for Payer: PHCS PPO |
$189.05
|
| Rate for Payer: PHCS PPO |
$534.85
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: Three Rivers PPO |
$422.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.63
|
| Rate for Payer: TriWest Veterans Administration |
$56.63
|
| Rate for Payer: United Healthcare Commercial |
$489.81
|
| Rate for Payer: United Healthcare Commercial |
$173.13
|
| Rate for Payer: United Healthcare Medicare |
$56.63
|
| Rate for Payer: United Healthcare Medicare |
$56.63
|
| Rate for Payer: WINHealth Partners Commercial |
$189.05
|
| Rate for Payer: WINHealth Partners Commercial |
$534.85
|
|
|
HC PRO US GUIDE NDL PLMT IMG S&I - US GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 76942 26
|
| Hospital Charge Code |
9737694201
|
|
Hospital Revenue Code
|
973
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$577.22
|
| Rate for Payer: Aetna of WY Medicare |
$28.89
|
| Rate for Payer: Beech Street Commercial |
$559.55
|
| Rate for Payer: Cash Price |
$412.30
|
| Rate for Payer: Cash Price |
$412.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$571.33
|
| Rate for Payer: Cigna of WY Commercial |
$577.22
|
| Rate for Payer: First Choice Health Commercial |
$530.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$559.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.89
|
| Rate for Payer: HealthUtah PPO |
$589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$571.33
|
| Rate for Payer: Multiplan Medicare/VA |
$24.56
|
| Rate for Payer: One Health Plan of WY PPO |
$577.22
|
| Rate for Payer: PacificSource Commercial |
$530.10
|
| Rate for Payer: PHCS PPO |
$559.55
|
| Rate for Payer: Three Rivers PPO |
$441.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.89
|
| Rate for Payer: United Healthcare Commercial |
$512.43
|
| Rate for Payer: United Healthcare Medicare |
$28.89
|
| Rate for Payer: WINHealth Partners Commercial |
$559.55
|
|
|
HC PRO UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$1,631.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
9835840001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$382.36 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,598.38
|
| Rate for Payer: Aetna of WY Medicare |
$449.83
|
| Rate for Payer: Beech Street Commercial |
$1,549.45
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,582.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,598.38
|
| Rate for Payer: First Choice Health Commercial |
$1,467.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.83
|
| Rate for Payer: HealthUtah PPO |
$1,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,582.07
|
| Rate for Payer: Multiplan Medicare/VA |
$382.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,598.38
|
| Rate for Payer: PacificSource Commercial |
$1,467.90
|
| Rate for Payer: PHCS PPO |
$1,549.45
|
| Rate for Payer: Three Rivers PPO |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$449.83
|
| Rate for Payer: United Healthcare Commercial |
$1,418.97
|
| Rate for Payer: United Healthcare Medicare |
$449.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.35
|
|
|
HC PRO VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$4,407.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
9835826201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$758.95 |
| Max. Negotiated Rate |
$4,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,318.86
|
| Rate for Payer: Aetna of WY Medicare |
$892.88
|
| Rate for Payer: Beech Street Commercial |
$4,186.65
|
| Rate for Payer: Cash Price |
$3,084.90
|
| Rate for Payer: Cash Price |
$3,084.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,274.79
|
| Rate for Payer: Cigna of WY Commercial |
$4,318.86
|
| Rate for Payer: First Choice Health Commercial |
$3,966.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,186.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$892.88
|
| Rate for Payer: HealthUtah PPO |
$4,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,274.79
|
| Rate for Payer: Multiplan Medicare/VA |
$758.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,318.86
|
| Rate for Payer: PacificSource Commercial |
$3,966.30
|
| Rate for Payer: PHCS PPO |
$4,186.65
|
| Rate for Payer: Three Rivers PPO |
$3,305.25
|
| Rate for Payer: TriWest Veterans Administration |
$892.88
|
| Rate for Payer: United Healthcare Commercial |
$3,834.09
|
| Rate for Payer: United Healthcare Medicare |
$892.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,745.95
|
|
|
HC PRO VAGINAL DELIVERY/POSTPARTUM
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
9835941001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$867.42 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,070.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,020.50
|
| Rate for Payer: Beech Street Commercial |
$2,976.35
|
| Rate for Payer: Cash Price |
$2,193.10
|
| Rate for Payer: Cash Price |
$2,193.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,039.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,070.34
|
| Rate for Payer: First Choice Health Commercial |
$2,819.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,976.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,020.50
|
| Rate for Payer: HealthUtah PPO |
$3,133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,039.01
|
| Rate for Payer: Multiplan Medicare/VA |
$867.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,070.34
|
| Rate for Payer: PacificSource Commercial |
$2,819.70
|
| Rate for Payer: PHCS PPO |
$2,976.35
|
| Rate for Payer: Three Rivers PPO |
$2,349.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,020.50
|
| Rate for Payer: United Healthcare Commercial |
$2,725.71
|
| Rate for Payer: United Healthcare Medicare |
$1,020.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,663.05
|
|
|
HC PRO VAGINAL HYSTERECTOMY
|
Professional
|
Both
|
$4,035.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
9835826001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$687.22 |
| Max. Negotiated Rate |
$4,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,954.30
|
| Rate for Payer: Aetna of WY Medicare |
$808.50
|
| Rate for Payer: Beech Street Commercial |
$3,833.25
|
| Rate for Payer: Cash Price |
$2,824.50
|
| Rate for Payer: Cash Price |
$2,824.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,913.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,954.30
|
| Rate for Payer: First Choice Health Commercial |
$3,631.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,833.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$808.50
|
| Rate for Payer: HealthUtah PPO |
$4,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,913.95
|
| Rate for Payer: Multiplan Medicare/VA |
$687.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,954.30
|
| Rate for Payer: PacificSource Commercial |
$3,631.50
|
| Rate for Payer: PHCS PPO |
$3,833.25
|
| Rate for Payer: Three Rivers PPO |
$3,026.25
|
| Rate for Payer: TriWest Veterans Administration |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$3,510.45
|
| Rate for Payer: United Healthcare Medicare |
$808.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,429.75
|
|
|
HC PRO VASC ENDOVENOUS RF, 1ST VEIN
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
9833647501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,128.96
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$1,094.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,117.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,128.96
|
| Rate for Payer: First Choice Health Commercial |
$1,036.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,094.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$1,152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,117.44
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,128.96
|
| Rate for Payer: PacificSource Commercial |
$1,036.80
|
| Rate for Payer: PHCS PPO |
$1,094.40
|
| Rate for Payer: Three Rivers PPO |
$864.00
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$1,002.24
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$979.20
|
|
|
HC PRO VASC ENDOVENOUS RF, 1ST VEIN
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 36475 NONPBBPAYER
|
| Hospital Charge Code |
9833647501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,411.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$1,368.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,396.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,411.20
|
| Rate for Payer: First Choice Health Commercial |
$1,296.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,368.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$1,440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,396.80
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,411.20
|
| Rate for Payer: PacificSource Commercial |
$1,296.00
|
| Rate for Payer: PHCS PPO |
$1,368.00
|
| Rate for Payer: Three Rivers PPO |
$1,080.00
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,224.00
|
|
|
HC PRO VASC ENDOVENOUS RF, 1ST VEIN
|
Professional
|
Both
|
$2,880.00
|
|
|
Service Code
|
HCPCS 36475 50,NONPBBPAYER
|
| Hospital Charge Code |
9833647501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,822.40
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$2,736.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,793.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,822.40
|
| Rate for Payer: First Choice Health Commercial |
$2,592.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,736.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$2,880.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,793.60
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,822.40
|
| Rate for Payer: PacificSource Commercial |
$2,592.00
|
| Rate for Payer: PHCS PPO |
$2,736.00
|
| Rate for Payer: Three Rivers PPO |
$2,160.00
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$2,505.60
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,448.00
|
|
|
HC PRO VASC ENDOVENOUS RF, 1ST VEIN
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
HCPCS 36475 50
|
| Hospital Charge Code |
9833647501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,257.92
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$2,188.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,234.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,257.92
|
| Rate for Payer: First Choice Health Commercial |
$2,073.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,188.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$2,304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,234.88
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,257.92
|
| Rate for Payer: PacificSource Commercial |
$2,073.60
|
| Rate for Payer: PHCS PPO |
$2,188.80
|
| Rate for Payer: Three Rivers PPO |
$1,728.00
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$2,004.48
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,958.40
|
|
