|
HC PRO VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
9835525001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$686.25 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$896.70
|
| Rate for Payer: Beech Street Commercial |
$869.25
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$887.55
|
| Rate for Payer: Cigna of WY Commercial |
$896.70
|
| Rate for Payer: First Choice Health Commercial |
$823.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$869.25
|
| Rate for Payer: HealthUtah PPO |
$915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$887.55
|
| Rate for Payer: One Health Plan of WY PPO |
$896.70
|
| Rate for Payer: PacificSource Commercial |
$823.50
|
| Rate for Payer: PHCS PPO |
$869.25
|
| Rate for Payer: Three Rivers PPO |
$686.25
|
| Rate for Payer: United Healthcare Commercial |
$796.05
|
| Rate for Payer: WINHealth Partners Commercial |
$777.75
|
|
|
HC PRO VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 55250 NONPBBPAYER
|
| Hospital Charge Code |
9835525001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,121.12
|
| Rate for Payer: Beech Street Commercial |
$1,086.80
|
| Rate for Payer: Cash Price |
$800.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,109.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,121.12
|
| Rate for Payer: First Choice Health Commercial |
$1,029.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,086.80
|
| Rate for Payer: HealthUtah PPO |
$1,144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,109.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,121.12
|
| Rate for Payer: PacificSource Commercial |
$1,029.60
|
| Rate for Payer: PHCS PPO |
$1,086.80
|
| Rate for Payer: Three Rivers PPO |
$858.00
|
| Rate for Payer: United Healthcare Commercial |
$995.28
|
| Rate for Payer: WINHealth Partners Commercial |
$972.40
|
|
|
HC PRO VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 36425
|
| Hospital Charge Code |
9833642501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$162.68
|
| Rate for Payer: Aetna of WY Medicare |
$37.37
|
| Rate for Payer: Beech Street Commercial |
$157.70
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: Cash Price |
$116.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.02
|
| Rate for Payer: Cigna of WY Commercial |
$162.68
|
| Rate for Payer: First Choice Health Commercial |
$149.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$157.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.37
|
| Rate for Payer: HealthUtah PPO |
$166.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.02
|
| Rate for Payer: Multiplan Medicare/VA |
$31.76
|
| Rate for Payer: One Health Plan of WY PPO |
$162.68
|
| Rate for Payer: PacificSource Commercial |
$149.40
|
| Rate for Payer: PHCS PPO |
$157.70
|
| Rate for Payer: Three Rivers PPO |
$124.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.37
|
| Rate for Payer: United Healthcare Commercial |
$144.42
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
| Rate for Payer: WINHealth Partners Commercial |
$141.10
|
|
|
HC PRO VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 36425 NONPBBPAYER
|
| Hospital Charge Code |
9833642501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$37.37
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.37
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$31.76
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$37.37
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
| Rate for Payer: WINHealth Partners Commercial |
$175.95
|
|
|
HC PRO VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
9836942401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.08
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Beech Street Commercial |
$423.70
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$432.62
|
| Rate for Payer: Cigna of WY Commercial |
$437.08
|
| Rate for Payer: First Choice Health Commercial |
$401.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$423.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$446.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$432.62
|
| Rate for Payer: Multiplan Medicare/VA |
$49.93
|
| Rate for Payer: One Health Plan of WY PPO |
$437.08
|
| Rate for Payer: PacificSource Commercial |
$401.40
|
| Rate for Payer: PHCS PPO |
$423.70
|
| Rate for Payer: Three Rivers PPO |
$334.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$388.02
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$379.10
|
|
|
HC PRO VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$892.00
|
|
|
Service Code
|
HCPCS 69424 50
|
| Hospital Charge Code |
9836942401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$874.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Beech Street Commercial |
$847.40
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$865.24
|
| Rate for Payer: Cigna of WY Commercial |
$874.16
|
| Rate for Payer: First Choice Health Commercial |
$802.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$847.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$892.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$865.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.93
|
| Rate for Payer: One Health Plan of WY PPO |
$874.16
|
| Rate for Payer: PacificSource Commercial |
$802.80
|
| Rate for Payer: PHCS PPO |
$847.40
|
| Rate for Payer: Three Rivers PPO |
$669.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$776.04
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$758.20
|
|
|
HC PROVEXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 21014
|
| Hospital Charge Code |
9822101401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$429.39 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$505.17
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$505.17
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$429.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$505.17
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$505.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
HC PRO VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 94150 50,NONPBBPAYER
|
| Hospital Charge Code |
9769415001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Beech Street Commercial |
$172.90
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: First Choice Health Commercial |
$163.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PHCS PPO |
$172.90
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: WINHealth Partners Commercial |
$172.90
|
|
|
HC PRO VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
9769415001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: WINHealth Partners Commercial |
$69.35
|
|
|
HC PRO VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 94150 NONPBBPAYER
|
| Hospital Charge Code |
9769415001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Beech Street Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: First Choice Health Commercial |
$81.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$86.45
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
|
|
HC PRO VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 94150 26
|
| Hospital Charge Code |
9769415001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
|
|
HC PRO VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
9833641001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$8.67
|
| Rate for Payer: Aetna of WY Medicare |
$8.67
|
| Rate for Payer: Beech Street Commercial |
$55.10
|
| Rate for Payer: Beech Street Commercial |
$62.70
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: First Choice Health Commercial |
$52.20
|
| Rate for Payer: First Choice Health Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.67
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$7.37
|
| Rate for Payer: Multiplan Medicare/VA |
$7.37
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$62.70
|
| Rate for Payer: PHCS PPO |
$55.10
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.67
|
| Rate for Payer: TriWest Veterans Administration |
$8.67
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WINHealth Partners Commercial |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$49.30
|
|
|
HC PRO VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 36410 NONPBBPAYER
|
| Hospital Charge Code |
9833641001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Aetna of WY Medicare |
$8.67
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.67
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: Multiplan Medicare/VA |
$7.37
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.67
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
|
|
HC PRO VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
9835179701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$773.22
|
| Rate for Payer: Aetna of WY Medicare |
$184.98
|
| Rate for Payer: Beech Street Commercial |
$749.55
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$765.33
|
| Rate for Payer: Cigna of WY Commercial |
$773.22
|
| Rate for Payer: First Choice Health Commercial |
$710.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$749.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.98
|
| Rate for Payer: HealthUtah PPO |
$789.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$765.33
|
| Rate for Payer: Multiplan Medicare/VA |
$157.23
|
| Rate for Payer: One Health Plan of WY PPO |
$773.22
|
| Rate for Payer: PacificSource Commercial |
$710.10
|
| Rate for Payer: PHCS PPO |
$749.55
|
| Rate for Payer: Three Rivers PPO |
$591.75
|
| Rate for Payer: TriWest Veterans Administration |
$184.98
|
| Rate for Payer: United Healthcare Commercial |
$686.43
|
| Rate for Payer: United Healthcare Medicare |
$184.98
|
| Rate for Payer: WINHealth Partners Commercial |
$670.65
|
|
|
HC PRO WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
9831176501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$693.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$90.83
|
| Rate for Payer: Aetna of WY Medicare |
$90.83
|
| Rate for Payer: Beech Street Commercial |
$351.50
|
| Rate for Payer: Beech Street Commercial |
$672.60
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$686.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Cigna of WY Commercial |
$693.84
|
| Rate for Payer: First Choice Health Commercial |
$333.00
|
| Rate for Payer: First Choice Health Commercial |
$637.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$672.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.83
|
| Rate for Payer: HealthUtah PPO |
$708.00
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$686.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$77.21
|
| Rate for Payer: Multiplan Medicare/VA |
$77.21
|
| Rate for Payer: One Health Plan of WY PPO |
$693.84
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PacificSource Commercial |
$637.20
|
| Rate for Payer: PHCS PPO |
$672.60
|
| Rate for Payer: PHCS PPO |
$351.50
|
| Rate for Payer: Three Rivers PPO |
$531.00
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$90.83
|
| Rate for Payer: TriWest Veterans Administration |
$90.83
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Commercial |
$615.96
|
| Rate for Payer: United Healthcare Medicare |
$90.83
|
| Rate for Payer: United Healthcare Medicare |
$90.83
|
| Rate for Payer: WINHealth Partners Commercial |
$601.80
|
| Rate for Payer: WINHealth Partners Commercial |
$314.50
|
|
|
HC PRO WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 11765 NONPBBPAYER
|
| Hospital Charge Code |
9831176501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$453.74
|
| Rate for Payer: Aetna of WY Medicare |
$90.83
|
| Rate for Payer: Beech Street Commercial |
$439.85
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$449.11
|
| Rate for Payer: Cigna of WY Commercial |
$453.74
|
| Rate for Payer: First Choice Health Commercial |
$416.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$439.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.83
|
| Rate for Payer: HealthUtah PPO |
$463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$449.11
|
| Rate for Payer: Multiplan Medicare/VA |
$77.21
|
| Rate for Payer: One Health Plan of WY PPO |
$453.74
|
| Rate for Payer: PacificSource Commercial |
$416.70
|
| Rate for Payer: PHCS PPO |
$439.85
|
| Rate for Payer: Three Rivers PPO |
$347.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.83
|
| Rate for Payer: United Healthcare Commercial |
$402.81
|
| Rate for Payer: United Healthcare Medicare |
$90.83
|
| Rate for Payer: WINHealth Partners Commercial |
$393.55
|
|
|
HC PRO WND PREP PED FACE/NCK/HND/FT/GEN 1ST 100 CM
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 15004
|
| Hospital Charge Code |
9831500401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$210.09 |
| 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 |
$247.16
|
| 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 |
$247.16
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$210.09
|
| 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 |
$247.16
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$247.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
|
|
HC PRO WOUND CLOSURE ADHESIVE
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
983G016801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$13.89
|
| Rate for Payer: Beech Street Commercial |
$345.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: First Choice Health Commercial |
$327.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.89
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$11.81
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$345.80
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.89
|
| Rate for Payer: United Healthcare Commercial |
$316.68
|
| Rate for Payer: United Healthcare Medicare |
$13.89
|
| Rate for Payer: WINHealth Partners Commercial |
$345.80
|
|
|
HC PRO WRIST ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
9832984601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$434.21 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,099.16
|
| Rate for Payer: Aetna of WY Medicare |
$510.83
|
| Rate for Payer: Beech Street Commercial |
$2,034.90
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,077.74
|
| Rate for Payer: Cigna of WY Commercial |
$2,099.16
|
| Rate for Payer: First Choice Health Commercial |
$1,927.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,034.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$510.83
|
| Rate for Payer: HealthUtah PPO |
$2,142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,077.74
|
| Rate for Payer: Multiplan Medicare/VA |
$434.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,099.16
|
| Rate for Payer: PacificSource Commercial |
$1,927.80
|
| Rate for Payer: PHCS PPO |
$2,034.90
|
| Rate for Payer: Three Rivers PPO |
$1,606.50
|
| Rate for Payer: TriWest Veterans Administration |
$510.83
|
| Rate for Payer: United Healthcare Commercial |
$1,863.54
|
| Rate for Payer: United Healthcare Medicare |
$510.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,820.70
|
|
|
HC PRO XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 93272 26
|
| Hospital Charge Code |
9859327201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$23.08
|
| 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 |
$23.08
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$19.62
|
| 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 |
$23.08
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$23.08
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HC PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
5102863601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$197.76
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.13
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.96
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$129.16
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.96
|
| Rate for Payer: United Healthcare Commercial |
$179.22
|
| Rate for Payer: United Healthcare Medicare |
$135.96
|
| Rate for Payer: WINHealth Partners Commercial |
$195.70
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
|
HC PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
5102863601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$135.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$197.76
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.13
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.48
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$113.51
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.48
|
| Rate for Payer: United Healthcare Commercial |
$179.22
|
| Rate for Payer: United Healthcare Medicare |
$119.48
|
| Rate for Payer: WINHealth Partners Commercial |
$201.88
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
3018415401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| 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: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.10
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$107.44
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$113.10
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
3018415401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| 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: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.70
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$128.70
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC PSA SCREENING
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
301G010301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
