|
I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON
|
Professional
|
Both
|
$4,486.00
|
|
|
Service Code
|
HCPCS 46060
|
| Hospital Charge Code |
46060
|
| Min. Negotiated Rate |
$401.05 |
| Max. Negotiated Rate |
$4,486.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,396.28
|
| Rate for Payer: Aetna of WY Medicare |
$471.82
|
| Rate for Payer: Beech Street Commercial |
$4,261.70
|
| Rate for Payer: Cash Price |
$3,140.20
|
| Rate for Payer: Cash Price |
$3,140.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,351.42
|
| Rate for Payer: Cigna of WY Commercial |
$4,396.28
|
| Rate for Payer: First Choice Health Commercial |
$4,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.82
|
| Rate for Payer: HealthUtah PPO |
$4,486.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,351.42
|
| Rate for Payer: Multiplan Medicare/VA |
$401.05
|
| Rate for Payer: One Health Plan of WY PPO |
$4,396.28
|
| Rate for Payer: PacificSource Commercial |
$4,037.40
|
| Rate for Payer: PHCS PPO |
$4,261.70
|
| Rate for Payer: Three Rivers PPO |
$3,364.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.82
|
| Rate for Payer: United Healthcare Commercial |
$3,902.82
|
| Rate for Payer: United Healthcare Medicare |
$471.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,813.10
|
|
|
I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
46040
|
| Min. Negotiated Rate |
$350.54 |
| Max. Negotiated Rate |
$2,174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,130.52
|
| Rate for Payer: Aetna of WY Medicare |
$412.40
|
| Rate for Payer: Beech Street Commercial |
$2,065.30
|
| Rate for Payer: Cash Price |
$1,521.80
|
| Rate for Payer: Cash Price |
$1,521.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,108.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,130.52
|
| Rate for Payer: First Choice Health Commercial |
$1,956.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,065.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.40
|
| Rate for Payer: HealthUtah PPO |
$2,174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,108.78
|
| Rate for Payer: Multiplan Medicare/VA |
$350.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,130.52
|
| Rate for Payer: PacificSource Commercial |
$1,956.60
|
| Rate for Payer: PHCS PPO |
$2,065.30
|
| Rate for Payer: Three Rivers PPO |
$1,630.50
|
| Rate for Payer: TriWest Veterans Administration |
$412.40
|
| Rate for Payer: United Healthcare Commercial |
$1,891.38
|
| Rate for Payer: United Healthcare Medicare |
$412.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,847.90
|
|
|
I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
56420
|
| Min. Negotiated Rate |
$91.49 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$649.74
|
| Rate for Payer: Aetna of WY Medicare |
$107.64
|
| Rate for Payer: Beech Street Commercial |
$629.85
|
| Rate for Payer: Cash Price |
$464.10
|
| Rate for Payer: Cash Price |
$464.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$643.11
|
| Rate for Payer: Cigna of WY Commercial |
$649.74
|
| Rate for Payer: First Choice Health Commercial |
$596.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$629.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.64
|
| Rate for Payer: HealthUtah PPO |
$663.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$643.11
|
| Rate for Payer: Multiplan Medicare/VA |
$91.49
|
| Rate for Payer: One Health Plan of WY PPO |
$649.74
|
| Rate for Payer: PacificSource Commercial |
$596.70
|
| Rate for Payer: PHCS PPO |
$629.85
|
| Rate for Payer: Three Rivers PPO |
$497.25
|
| Rate for Payer: TriWest Veterans Administration |
$107.64
|
| Rate for Payer: United Healthcare Commercial |
$576.81
|
| Rate for Payer: United Healthcare Medicare |
$107.64
|
| Rate for Payer: WINHealth Partners Commercial |
$563.55
|
|
|
I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
46050
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$500.78
|
| Rate for Payer: Aetna of WY Medicare |
$98.47
|
| Rate for Payer: Beech Street Commercial |
$485.45
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$495.67
|
| Rate for Payer: Cigna of WY Commercial |
$500.78
|
| Rate for Payer: First Choice Health Commercial |
$459.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$485.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.47
|
| Rate for Payer: HealthUtah PPO |
$511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$495.67
|
| Rate for Payer: Multiplan Medicare/VA |
$83.70
|
| Rate for Payer: One Health Plan of WY PPO |
$500.78
|
| Rate for Payer: PacificSource Commercial |
$459.90
|
| Rate for Payer: PHCS PPO |
$485.45
|
| Rate for Payer: Three Rivers PPO |
$383.25
|
| Rate for Payer: TriWest Veterans Administration |
$98.47
|
| Rate for Payer: United Healthcare Commercial |
$444.57
|
| Rate for Payer: United Healthcare Medicare |
$98.47
|
| Rate for Payer: WINHealth Partners Commercial |
$434.35
|
|
|
I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$2,237.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
23030
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$2,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,192.26
|
| Rate for Payer: Aetna of WY Medicare |
$247.13
|
| Rate for Payer: Beech Street Commercial |
$2,125.15
|
| Rate for Payer: Cash Price |
$1,565.90
|
| Rate for Payer: Cash Price |
$1,565.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,169.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,192.26
|
| Rate for Payer: First Choice Health Commercial |
$2,013.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,125.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.13
|
| Rate for Payer: HealthUtah PPO |
$2,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,169.89
|
| Rate for Payer: Multiplan Medicare/VA |
$210.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,192.26
|
| Rate for Payer: PacificSource Commercial |
$2,013.30
|
| Rate for Payer: PHCS PPO |
$2,125.15
|
| Rate for Payer: Three Rivers PPO |
$1,677.75
|
| Rate for Payer: TriWest Veterans Administration |
$247.13
|
| Rate for Payer: United Healthcare Commercial |
$1,946.19
|
| Rate for Payer: United Healthcare Medicare |
$247.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,901.45
|
|
|
I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$3,613.00
|
|
|
Service Code
|
HCPCS 20005
|
| Hospital Charge Code |
20005
|
| Min. Negotiated Rate |
$2,709.75 |
| Max. Negotiated Rate |
$3,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,540.74
|
| Rate for Payer: Beech Street Commercial |
$3,432.35
|
| Rate for Payer: Cash Price |
$2,529.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,504.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,540.74
|
| Rate for Payer: First Choice Health Commercial |
$3,251.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,432.35
|
| Rate for Payer: HealthUtah PPO |
$3,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,504.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,540.74
|
| Rate for Payer: PacificSource Commercial |
$3,251.70
|
| Rate for Payer: PHCS PPO |
$3,432.35
|
| Rate for Payer: Three Rivers PPO |
$2,709.75
|
| Rate for Payer: United Healthcare Commercial |
$3,143.31
|
| Rate for Payer: WINHealth Partners Commercial |
$3,071.05
|
|
|
I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$3,613.00
|
|
|
Service Code
|
HCPCS 20005 80
|
| Hospital Charge Code |
20005
|
| Min. Negotiated Rate |
$2,709.75 |
| Max. Negotiated Rate |
$3,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,540.74
|
| Rate for Payer: Beech Street Commercial |
$3,432.35
|
| Rate for Payer: Cash Price |
$2,529.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,504.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,540.74
|
| Rate for Payer: First Choice Health Commercial |
$3,251.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,432.35
|
| Rate for Payer: HealthUtah PPO |
$3,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,504.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,540.74
|
| Rate for Payer: PacificSource Commercial |
$3,251.70
|
| Rate for Payer: PHCS PPO |
$3,432.35
|
| Rate for Payer: Three Rivers PPO |
$2,709.75
|
| Rate for Payer: United Healthcare Commercial |
$3,143.31
|
| Rate for Payer: WINHealth Partners Commercial |
$3,071.05
|
|
|
I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$5,267.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
45005
|
| Min. Negotiated Rate |
$135.46 |
| Max. Negotiated Rate |
$5,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,161.66
|
| Rate for Payer: Aetna of WY Medicare |
$159.36
|
| Rate for Payer: Beech Street Commercial |
$5,003.65
|
| Rate for Payer: Cash Price |
$3,686.90
|
| Rate for Payer: Cash Price |
$3,686.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,108.99
|
| Rate for Payer: Cigna of WY Commercial |
$5,161.66
|
| Rate for Payer: First Choice Health Commercial |
$4,740.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,003.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.36
|
| Rate for Payer: HealthUtah PPO |
$5,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,108.99
|
| Rate for Payer: Multiplan Medicare/VA |
$135.46
|
| Rate for Payer: One Health Plan of WY PPO |
$5,161.66
|
| Rate for Payer: PacificSource Commercial |
$4,740.30
|
| Rate for Payer: PHCS PPO |
$5,003.65
|
| Rate for Payer: Three Rivers PPO |
$3,950.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.36
|
| Rate for Payer: United Healthcare Commercial |
$4,582.29
|
| Rate for Payer: United Healthcare Medicare |
$159.36
|
| Rate for Payer: WINHealth Partners Commercial |
$4,476.95
|
|
|
I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,094.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
23930
|
| Min. Negotiated Rate |
$177.17 |
| Max. Negotiated Rate |
$1,094.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,072.12
|
| Rate for Payer: Aetna of WY Medicare |
$208.44
|
| Rate for Payer: Beech Street Commercial |
$1,039.30
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,061.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,072.12
|
| Rate for Payer: First Choice Health Commercial |
$984.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,039.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.44
|
| Rate for Payer: HealthUtah PPO |
$1,094.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,061.18
|
| Rate for Payer: Multiplan Medicare/VA |
$177.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,072.12
|
| Rate for Payer: PacificSource Commercial |
$984.60
|
| Rate for Payer: PHCS PPO |
$1,039.30
|
| Rate for Payer: Three Rivers PPO |
$820.50
|
| Rate for Payer: TriWest Veterans Administration |
$208.44
|
| Rate for Payer: United Healthcare Commercial |
$951.78
|
| Rate for Payer: United Healthcare Medicare |
$208.44
|
| Rate for Payer: WINHealth Partners Commercial |
$929.90
|
|
|
I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
HCPCS 57023
|
| Hospital Charge Code |
57023
|
| Min. Negotiated Rate |
$262.75 |
| Max. Negotiated Rate |
$4,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,484.48
|
| Rate for Payer: Aetna of WY Medicare |
$309.12
|
| Rate for Payer: Beech Street Commercial |
$4,347.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,438.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,484.48
|
| Rate for Payer: First Choice Health Commercial |
$4,118.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.12
|
| Rate for Payer: HealthUtah PPO |
$4,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,438.72
|
| Rate for Payer: Multiplan Medicare/VA |
$262.75
|
| Rate for Payer: One Health Plan of WY PPO |
$4,484.48
|
| Rate for Payer: PacificSource Commercial |
$4,118.40
|
| Rate for Payer: PHCS PPO |
$4,347.20
|
| Rate for Payer: Three Rivers PPO |
$3,432.00
|
| Rate for Payer: TriWest Veterans Administration |
$309.12
|
| Rate for Payer: United Healthcare Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare Medicare |
$309.12
|
| Rate for Payer: WINHealth Partners Commercial |
$3,889.60
|
|
|
I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 57022
|
| Hospital Charge Code |
57022
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$287.14
|
| Rate for Payer: Aetna of WY Medicare |
$175.59
|
| Rate for Payer: Beech Street Commercial |
$278.35
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$284.21
|
| Rate for Payer: Cigna of WY Commercial |
$287.14
|
| Rate for Payer: First Choice Health Commercial |
$263.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.59
|
| Rate for Payer: HealthUtah PPO |
$293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$284.21
|
| Rate for Payer: Multiplan Medicare/VA |
$149.25
|
| Rate for Payer: One Health Plan of WY PPO |
$287.14
|
| Rate for Payer: PacificSource Commercial |
$263.70
|
| Rate for Payer: PHCS PPO |
$278.35
|
| Rate for Payer: Three Rivers PPO |
$219.75
|
| Rate for Payer: TriWest Veterans Administration |
$175.59
|
| Rate for Payer: United Healthcare Commercial |
$254.91
|
| Rate for Payer: United Healthcare Medicare |
$175.59
|
| Rate for Payer: WINHealth Partners Commercial |
$249.05
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
56405
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$584.08
|
| Rate for Payer: Aetna of WY Medicare |
$123.93
|
| Rate for Payer: Beech Street Commercial |
$566.20
|
| Rate for Payer: Cash Price |
$417.20
|
| Rate for Payer: Cash Price |
$417.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$578.12
|
| Rate for Payer: Cigna of WY Commercial |
$584.08
|
| Rate for Payer: First Choice Health Commercial |
$536.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$566.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.93
|
| Rate for Payer: HealthUtah PPO |
$596.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$578.12
|
| Rate for Payer: Multiplan Medicare/VA |
$105.34
|
| Rate for Payer: One Health Plan of WY PPO |
$584.08
|
| Rate for Payer: PacificSource Commercial |
$536.40
|
| Rate for Payer: PHCS PPO |
$566.20
|
| Rate for Payer: Three Rivers PPO |
$447.00
|
| Rate for Payer: TriWest Veterans Administration |
$123.93
|
| Rate for Payer: United Healthcare Commercial |
$518.52
|
| Rate for Payer: United Healthcare Medicare |
$123.93
|
| Rate for Payer: WINHealth Partners Commercial |
$506.60
|
|
|
IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
90657
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
|
|
IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
90658
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
|
|
IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
90656
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: WINHealth Partners Commercial |
$30.00
|
|
|
IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
90686
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$22.35
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.35
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$19.00
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$22.35
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
|
|
IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90685
|
| Hospital Charge Code |
90685
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
|
|
IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
90653
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Beech Street Commercial |
$71.25
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: First Choice Health Commercial |
$67.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$71.25
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: WINHealth Partners Commercial |
$75.00
|
|
|
IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
90662
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$73.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$73.40
|
| Rate for Payer: Beech Street Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: First Choice Health Commercial |
$58.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.40
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$62.39
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$61.75
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
| Rate for Payer: WINHealth Partners Commercial |
$65.00
|
|
|
ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 44382
|
| Hospital Charge Code |
44382
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,543.50
|
| Rate for Payer: Aetna of WY Medicare |
$70.76
|
| Rate for Payer: Beech Street Commercial |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,527.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,543.50
|
| Rate for Payer: First Choice Health Commercial |
$1,417.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$1,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,527.75
|
| Rate for Payer: Multiplan Medicare/VA |
$60.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,543.50
|
| Rate for Payer: PacificSource Commercial |
$1,417.50
|
| Rate for Payer: PHCS PPO |
$1,496.25
|
| Rate for Payer: Three Rivers PPO |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$1,370.25
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,338.75
|
|
|
ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 44380
|
| Hospital Charge Code |
44380
|
| Min. Negotiated Rate |
$46.79 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,196.18
|
| Rate for Payer: Aetna of WY Medicare |
$55.05
|
| Rate for Payer: Beech Street Commercial |
$2,128.95
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,173.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,196.18
|
| Rate for Payer: First Choice Health Commercial |
$2,016.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.05
|
| Rate for Payer: HealthUtah PPO |
$2,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,173.77
|
| Rate for Payer: Multiplan Medicare/VA |
$46.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,196.18
|
| Rate for Payer: PacificSource Commercial |
$2,016.90
|
| Rate for Payer: PHCS PPO |
$2,128.95
|
| Rate for Payer: Three Rivers PPO |
$1,680.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.05
|
| Rate for Payer: United Healthcare Commercial |
$1,949.67
|
| Rate for Payer: United Healthcare Medicare |
$55.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,904.85
|
|
|
ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 44310
|
| Hospital Charge Code |
44310
|
| Min. Negotiated Rate |
$837.91 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$985.78
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$985.78
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$837.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$985.78
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$985.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 44310 AS
|
| Hospital Charge Code |
44310
|
| Min. Negotiated Rate |
$837.91 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$985.78
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$985.78
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$837.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$985.78
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$985.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 44310 80
|
| Hospital Charge Code |
44310
|
| Min. Negotiated Rate |
$837.91 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$985.78
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$985.78
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$837.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$985.78
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$985.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
90473
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Aetna of WY Medicare |
$16.29
|
| Rate for Payer: Beech Street Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: First Choice Health Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.29
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$13.85
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.10
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$16.29
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$16.29
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
|
