|
BIOPSY BREAST OPEN INCISIONAL
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 19101
|
| Min. Negotiated Rate |
$181.85 |
| Max. Negotiated Rate |
$976.00 |
| Rate for Payer: United Healthcare Commercial |
$927.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$956.48
|
| Rate for Payer: Aetna of WY Medicare |
$213.94
|
| Rate for Payer: Beech Street Commercial |
$927.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$946.72
|
| Rate for Payer: Cigna of WY Commercial |
$956.48
|
| Rate for Payer: First Choice Health Commercial |
$878.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$927.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.94
|
| Rate for Payer: HealthUtah PPO |
$976.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$946.72
|
| Rate for Payer: Multiplan Medicare/VA |
$181.85
|
| Rate for Payer: One Health Plan of WY PPO |
$956.48
|
| Rate for Payer: PacificSource Commercial |
$878.40
|
| Rate for Payer: PHCS PPO |
$927.20
|
| Rate for Payer: Three Rivers PPO |
$732.00
|
| Rate for Payer: TriWest Veterans Administration |
$213.94
|
| Rate for Payer: WINHealth Partners Commercial |
$829.60
|
|
|
BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 57500
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$72.29
|
| Rate for Payer: Beech Street Commercial |
$306.85
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: First Choice Health Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.29
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$306.85
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$72.29
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
| Rate for Payer: WINHealth Partners Commercial |
$274.55
|
|
|
BIOPSY, EACH ADDED LESION
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 11101
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Beech Street Commercial |
$111.15
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: First Choice Health Commercial |
$105.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$111.15
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$111.15
|
| Rate for Payer: WINHealth Partners Commercial |
$99.45
|
|
|
BIOPSY EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 69105
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.52
|
| Rate for Payer: Aetna of WY Medicare |
$61.84
|
| Rate for Payer: Beech Street Commercial |
$260.30
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.78
|
| Rate for Payer: Cigna of WY Commercial |
$268.52
|
| Rate for Payer: First Choice Health Commercial |
$246.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.84
|
| Rate for Payer: HealthUtah PPO |
$274.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.78
|
| Rate for Payer: Multiplan Medicare/VA |
$52.56
|
| Rate for Payer: One Health Plan of WY PPO |
$268.52
|
| Rate for Payer: PacificSource Commercial |
$246.60
|
| Rate for Payer: PHCS PPO |
$260.30
|
| Rate for Payer: Three Rivers PPO |
$205.50
|
| Rate for Payer: TriWest Veterans Administration |
$61.84
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: WINHealth Partners Commercial |
$232.90
|
|
|
BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 69100
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$44.42
|
| Rate for Payer: Beech Street Commercial |
$199.50
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: First Choice Health Commercial |
$189.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.42
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$37.76
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$199.50
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.42
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$178.50
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$3,748.00
|
|
|
Service Code
|
HCPCS 47100 80
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$3,748.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,673.04
|
| Rate for Payer: Beech Street Commercial |
$3,560.60
|
| Rate for Payer: Cash Price |
$2,623.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.56
|
| Rate for Payer: Cigna of WY Commercial |
$3,673.04
|
| Rate for Payer: First Choice Health Commercial |
$3,373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.60
|
| Rate for Payer: HealthUtah PPO |
$3,748.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.56
|
| Rate for Payer: One Health Plan of WY PPO |
$3,673.04
|
| Rate for Payer: PacificSource Commercial |
$3,373.20
|
| Rate for Payer: PHCS PPO |
$3,560.60
|
| Rate for Payer: Three Rivers PPO |
$2,811.00
|
| Rate for Payer: United Healthcare Commercial |
$3,560.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,185.80
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$3,748.00
|
|
|
Service Code
|
HCPCS 47100
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$3,748.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,673.04
|
| Rate for Payer: Aetna of WY Medicare |
$810.58
|
| Rate for Payer: Beech Street Commercial |
$3,560.60
|
| Rate for Payer: Cash Price |
$2,623.60
|
| Rate for Payer: Cash Price |
$2,623.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.56
|
| Rate for Payer: Cigna of WY Commercial |
$3,673.04
|
| Rate for Payer: First Choice Health Commercial |
$3,373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.58
|
| Rate for Payer: HealthUtah PPO |
$3,748.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.56
|
| Rate for Payer: Multiplan Medicare/VA |
$688.99
|
| Rate for Payer: One Health Plan of WY PPO |
$3,673.04
|
| Rate for Payer: PacificSource Commercial |
$3,373.20
|
| Rate for Payer: PHCS PPO |
$3,560.60
|
| Rate for Payer: Three Rivers PPO |
$2,811.00
|
| Rate for Payer: TriWest Veterans Administration |
$810.58
|
| Rate for Payer: United Healthcare Commercial |
$3,560.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,185.80
|
|
|
BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$3,748.00
|
|
|
Service Code
|
HCPCS 47100 AS
|
| Min. Negotiated Rate |
$688.99 |
| Max. Negotiated Rate |
$3,748.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,673.04
|
| Rate for Payer: Beech Street Commercial |
$3,560.60
|
| Rate for Payer: Cash Price |
$2,623.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.56
|
| Rate for Payer: Cigna of WY Commercial |
$3,673.04
|
| Rate for Payer: First Choice Health Commercial |
$3,373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.60
|
| Rate for Payer: HealthUtah PPO |
$3,748.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.56
|
| Rate for Payer: One Health Plan of WY PPO |
$3,673.04
|
| Rate for Payer: PacificSource Commercial |
$3,373.20
|
| Rate for Payer: PHCS PPO |
$3,560.60
|
| Rate for Payer: Three Rivers PPO |
$2,811.00
|
| Rate for Payer: United Healthcare Commercial |
$3,560.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,185.80
|
|
|
BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$6,774.00
|
|
|
Service Code
|
HCPCS 20205
|
| Min. Negotiated Rate |
$124.91 |
| Max. Negotiated Rate |
$6,774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,638.52
|
| Rate for Payer: Aetna of WY Medicare |
$146.95
|
| Rate for Payer: Beech Street Commercial |
$6,435.30
|
| Rate for Payer: Cash Price |
$4,741.80
|
| Rate for Payer: Cash Price |
$4,741.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,570.78
|
| Rate for Payer: Cigna of WY Commercial |
$6,638.52
|
| Rate for Payer: First Choice Health Commercial |
$6,096.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,435.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.95
|
| Rate for Payer: HealthUtah PPO |
$6,774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,570.78
|
| Rate for Payer: Multiplan Medicare/VA |
$124.91
|
| Rate for Payer: One Health Plan of WY PPO |
$6,638.52
|
| Rate for Payer: PacificSource Commercial |
$6,096.60
|
| Rate for Payer: PHCS PPO |
$6,435.30
|
| Rate for Payer: Three Rivers PPO |
$5,080.50
|
| Rate for Payer: TriWest Veterans Administration |
$146.95
|
| Rate for Payer: United Healthcare Commercial |
$6,435.30
|
| Rate for Payer: WINHealth Partners Commercial |
$5,757.90
|
|
|
BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20200
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$900.62
|
| Rate for Payer: Aetna of WY Medicare |
$90.49
|
| Rate for Payer: Beech Street Commercial |
$873.05
|
| Rate for Payer: Cash Price |
$643.30
|
| Rate for Payer: Cash Price |
$643.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$891.43
|
| Rate for Payer: Cigna of WY Commercial |
$900.62
|
| Rate for Payer: First Choice Health Commercial |
$827.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.49
|
| Rate for Payer: HealthUtah PPO |
$919.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$891.43
|
| Rate for Payer: Multiplan Medicare/VA |
$76.92
|
| Rate for Payer: One Health Plan of WY PPO |
$900.62
|
| Rate for Payer: PacificSource Commercial |
$827.10
|
| Rate for Payer: PHCS PPO |
$873.05
|
| Rate for Payer: Three Rivers PPO |
$689.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.49
|
| Rate for Payer: United Healthcare Commercial |
$873.05
|
| Rate for Payer: WINHealth Partners Commercial |
$781.15
|
|
|
BIOPSY NEEDLE 13GX7.8 C1410A
|
Facility
|
OP
|
$274.44
|
|
| Hospital Charge Code |
6550175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.61 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.95
|
| Rate for Payer: Aetna of WY Medicare |
$181.13
|
| Rate for Payer: Altius Commercial |
$263.46
|
| Rate for Payer: Beech Street Commercial |
$268.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.21
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.21
|
| Rate for Payer: Cigna of WY Commercial |
$268.95
|
| Rate for Payer: Entrust Commercial |
$260.72
|
| Rate for Payer: First Choice Health Commercial |
$260.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.43
|
| Rate for Payer: HealthUtah PPO |
$274.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.21
|
| Rate for Payer: Multiplan Medicare/VA |
$148.61
|
| Rate for Payer: One Health Plan of WY PPO |
$268.95
|
| Rate for Payer: PacificSource Commercial |
$247.00
|
| Rate for Payer: PHCS PPO |
$268.95
|
| Rate for Payer: Three Rivers PPO |
$205.83
|
| Rate for Payer: TriWest Veterans Administration |
$156.43
|
| Rate for Payer: United Healthcare Commercial |
$262.09
|
| Rate for Payer: United Healthcare Medicare |
$156.43
|
| Rate for Payer: WINHealth Partners Commercial |
$268.95
|
| Rate for Payer: Wise Provider Network Commercial |
$260.72
|
|
|
BIOPSY NEEDLE 13GX7.8 C1410A
|
Facility
|
IP
|
$274.44
|
|
| Hospital Charge Code |
6550175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.95
|
| Rate for Payer: Aetna of WY Medicare |
$175.64
|
| Rate for Payer: Altius Commercial |
$263.46
|
| Rate for Payer: Beech Street Commercial |
$268.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.21
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.21
|
| Rate for Payer: Cigna of WY Commercial |
$268.95
|
| Rate for Payer: Entrust Commercial |
$260.72
|
| Rate for Payer: First Choice Health Commercial |
$260.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.41
|
| Rate for Payer: HealthUtah PPO |
$274.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.21
|
| Rate for Payer: Multiplan Medicare/VA |
$159.04
|
| Rate for Payer: One Health Plan of WY PPO |
$268.95
|
| Rate for Payer: PacificSource Commercial |
$247.00
|
| Rate for Payer: PHCS PPO |
$268.95
|
| Rate for Payer: Three Rivers PPO |
$205.83
|
| Rate for Payer: TriWest Veterans Administration |
$167.41
|
| Rate for Payer: United Healthcare Commercial |
$262.09
|
| Rate for Payer: United Healthcare Medicare |
$167.41
|
| Rate for Payer: WINHealth Partners Commercial |
$260.72
|
| Rate for Payer: Wise Provider Network Commercial |
$260.72
|
|
|
BIOPSY NEEDLE 14GAX10CM MQ1410
|
Facility
|
OP
|
$848.93
|
|
| Hospital Charge Code |
6550202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.70 |
| Max. Negotiated Rate |
$848.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$831.95
|
| Rate for Payer: Aetna of WY Medicare |
$560.29
|
| Rate for Payer: Altius Commercial |
$814.97
|
| Rate for Payer: Beech Street Commercial |
$831.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$823.46
|
| Rate for Payer: Cash Price |
$594.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$823.46
|
| Rate for Payer: Cigna of WY Commercial |
$831.95
|
| Rate for Payer: Entrust Commercial |
$806.48
|
| Rate for Payer: First Choice Health Commercial |
$806.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$806.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.89
|
| Rate for Payer: HealthUtah PPO |
$848.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$823.46
|
| Rate for Payer: Multiplan Medicare/VA |
$459.70
|
| Rate for Payer: One Health Plan of WY PPO |
$831.95
|
| Rate for Payer: PacificSource Commercial |
$764.04
|
| Rate for Payer: PHCS PPO |
$831.95
|
| Rate for Payer: Three Rivers PPO |
$636.70
|
| Rate for Payer: TriWest Veterans Administration |
$483.89
|
| Rate for Payer: United Healthcare Commercial |
$810.73
|
| Rate for Payer: United Healthcare Medicare |
$483.89
|
| Rate for Payer: WINHealth Partners Commercial |
$831.95
|
| Rate for Payer: Wise Provider Network Commercial |
$806.48
|
|
|
BIOPSY NEEDLE 14GAX10CM MQ1410
|
Facility
|
IP
|
$848.93
|
|
| Hospital Charge Code |
6550202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.95 |
| Max. Negotiated Rate |
$848.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$831.95
|
| Rate for Payer: Aetna of WY Medicare |
$543.32
|
| Rate for Payer: Altius Commercial |
$814.97
|
| Rate for Payer: Beech Street Commercial |
$831.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$823.46
|
| Rate for Payer: Cash Price |
$594.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$823.46
|
| Rate for Payer: Cigna of WY Commercial |
$831.95
|
| Rate for Payer: Entrust Commercial |
$806.48
|
| Rate for Payer: First Choice Health Commercial |
$806.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$806.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.85
|
| Rate for Payer: HealthUtah PPO |
$848.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$823.46
|
| Rate for Payer: Multiplan Medicare/VA |
$491.95
|
| Rate for Payer: One Health Plan of WY PPO |
$831.95
|
| Rate for Payer: PacificSource Commercial |
$764.04
|
| Rate for Payer: PHCS PPO |
$831.95
|
| Rate for Payer: Three Rivers PPO |
$636.70
|
| Rate for Payer: TriWest Veterans Administration |
$517.85
|
| Rate for Payer: United Healthcare Commercial |
$810.73
|
| Rate for Payer: United Healthcare Medicare |
$517.85
|
| Rate for Payer: WINHealth Partners Commercial |
$806.48
|
| Rate for Payer: Wise Provider Network Commercial |
$806.48
|
|
|
BIOPSY NEEDLE 14GAX10CM MQ1410
|
Facility
|
IP
|
$169.79
|
|
| Hospital Charge Code |
6550202A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.39 |
| Max. Negotiated Rate |
$169.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.39
|
| Rate for Payer: Aetna of WY Medicare |
$108.67
|
| Rate for Payer: Altius Commercial |
$163.00
|
| Rate for Payer: Beech Street Commercial |
$166.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.70
|
| Rate for Payer: Cash Price |
$118.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.70
|
| Rate for Payer: Cigna of WY Commercial |
$166.39
|
| Rate for Payer: Entrust Commercial |
$161.30
|
| Rate for Payer: First Choice Health Commercial |
$161.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.57
|
| Rate for Payer: HealthUtah PPO |
$169.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.70
|
| Rate for Payer: Multiplan Medicare/VA |
$98.39
|
| Rate for Payer: One Health Plan of WY PPO |
$166.39
|
| Rate for Payer: PacificSource Commercial |
$152.81
|
| Rate for Payer: PHCS PPO |
$166.39
|
| Rate for Payer: Three Rivers PPO |
$127.34
|
| Rate for Payer: TriWest Veterans Administration |
$103.57
|
| Rate for Payer: United Healthcare Commercial |
$162.15
|
| Rate for Payer: United Healthcare Medicare |
$103.57
|
| Rate for Payer: WINHealth Partners Commercial |
$161.30
|
| Rate for Payer: Wise Provider Network Commercial |
$161.30
|
|
|
BIOPSY NEEDLE 14GAX10CM MQ1410
|
Facility
|
OP
|
$169.79
|
|
| Hospital Charge Code |
6550202A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$169.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.39
|
| Rate for Payer: Aetna of WY Medicare |
$112.06
|
| Rate for Payer: Altius Commercial |
$163.00
|
| Rate for Payer: Beech Street Commercial |
$166.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.70
|
| Rate for Payer: Cash Price |
$118.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.70
|
| Rate for Payer: Cigna of WY Commercial |
$166.39
|
| Rate for Payer: Entrust Commercial |
$161.30
|
| Rate for Payer: First Choice Health Commercial |
$161.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.78
|
| Rate for Payer: HealthUtah PPO |
$169.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.70
|
| Rate for Payer: Multiplan Medicare/VA |
$91.94
|
| Rate for Payer: One Health Plan of WY PPO |
$166.39
|
| Rate for Payer: PacificSource Commercial |
$152.81
|
| Rate for Payer: PHCS PPO |
$166.39
|
| Rate for Payer: Three Rivers PPO |
$127.34
|
| Rate for Payer: TriWest Veterans Administration |
$96.78
|
| Rate for Payer: United Healthcare Commercial |
$162.15
|
| Rate for Payer: United Healthcare Medicare |
$96.78
|
| Rate for Payer: WINHealth Partners Commercial |
$166.39
|
| Rate for Payer: Wise Provider Network Commercial |
$161.30
|
|
|
BIOPSY OF SKIN LESION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 11100
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Beech Street Commercial |
$118.75
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: First Choice Health Commercial |
$112.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$118.75
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
| Rate for Payer: WINHealth Partners Commercial |
$106.25
|
|
|
BIOPSY OVARY UNI/BI SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 58900
|
| Min. Negotiated Rate |
$360.57 |
| Max. Negotiated Rate |
$1,524.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,493.52
|
| Rate for Payer: Aetna of WY Medicare |
$424.20
|
| Rate for Payer: Beech Street Commercial |
$1,447.80
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,478.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,493.52
|
| Rate for Payer: First Choice Health Commercial |
$1,371.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,447.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.20
|
| Rate for Payer: HealthUtah PPO |
$1,524.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,478.28
|
| Rate for Payer: Multiplan Medicare/VA |
$360.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,493.52
|
| Rate for Payer: PacificSource Commercial |
$1,371.60
|
| Rate for Payer: PHCS PPO |
$1,447.80
|
| Rate for Payer: Three Rivers PPO |
$1,143.00
|
| Rate for Payer: TriWest Veterans Administration |
$424.20
|
| Rate for Payer: United Healthcare Commercial |
$1,447.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,295.40
|
|
|
BIOPSY PUNCH 2.5MM
|
Facility
|
IP
|
$4.36
|
|
| Hospital Charge Code |
2400207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.27
|
| Rate for Payer: Aetna of WY Medicare |
$2.79
|
| Rate for Payer: Altius Commercial |
$4.19
|
| Rate for Payer: Beech Street Commercial |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.23
|
| Rate for Payer: Cigna of WY Commercial |
$4.27
|
| Rate for Payer: Entrust Commercial |
$4.14
|
| Rate for Payer: First Choice Health Commercial |
$4.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.66
|
| Rate for Payer: HealthUtah PPO |
$4.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.23
|
| Rate for Payer: Multiplan Medicare/VA |
$2.53
|
| Rate for Payer: One Health Plan of WY PPO |
$4.27
|
| Rate for Payer: PacificSource Commercial |
$3.92
|
| Rate for Payer: PHCS PPO |
$4.27
|
| Rate for Payer: Three Rivers PPO |
$3.27
|
| Rate for Payer: TriWest Veterans Administration |
$2.66
|
| Rate for Payer: United Healthcare Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare |
$2.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4.14
|
| Rate for Payer: Wise Provider Network Commercial |
$4.14
|
|
|
BIOPSY PUNCH 2.5MM
|
Facility
|
OP
|
$4.36
|
|
| Hospital Charge Code |
2400207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.27
|
| Rate for Payer: Aetna of WY Medicare |
$2.88
|
| Rate for Payer: Altius Commercial |
$4.19
|
| Rate for Payer: Beech Street Commercial |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.23
|
| Rate for Payer: Cigna of WY Commercial |
$4.27
|
| Rate for Payer: Entrust Commercial |
$4.14
|
| Rate for Payer: First Choice Health Commercial |
$4.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.49
|
| Rate for Payer: HealthUtah PPO |
$4.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.23
|
| Rate for Payer: Multiplan Medicare/VA |
$2.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4.27
|
| Rate for Payer: PacificSource Commercial |
$3.92
|
| Rate for Payer: PHCS PPO |
$4.27
|
| Rate for Payer: Three Rivers PPO |
$3.27
|
| Rate for Payer: TriWest Veterans Administration |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare |
$2.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4.27
|
| Rate for Payer: Wise Provider Network Commercial |
$4.14
|
|
|
BIOPSY PUNCH 2MM
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2400198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.42
|
| Rate for Payer: Aetna of WY Medicare |
$2.30
|
| Rate for Payer: Altius Commercial |
$3.35
|
| Rate for Payer: Beech Street Commercial |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.39
|
| Rate for Payer: Cigna of WY Commercial |
$3.42
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.99
|
| Rate for Payer: HealthUtah PPO |
$3.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.39
|
| Rate for Payer: Multiplan Medicare/VA |
$1.89
|
| Rate for Payer: One Health Plan of WY PPO |
$3.42
|
| Rate for Payer: PacificSource Commercial |
$3.14
|
| Rate for Payer: PHCS PPO |
$3.42
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$1.99
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Medicare |
$1.99
|
| Rate for Payer: WINHealth Partners Commercial |
$3.42
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BIOPSY PUNCH 2MM
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2400198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.42
|
| Rate for Payer: Aetna of WY Medicare |
$2.23
|
| Rate for Payer: Altius Commercial |
$3.35
|
| Rate for Payer: Beech Street Commercial |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.39
|
| Rate for Payer: Cigna of WY Commercial |
$3.42
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.13
|
| Rate for Payer: HealthUtah PPO |
$3.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.39
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.42
|
| Rate for Payer: PacificSource Commercial |
$3.14
|
| Rate for Payer: PHCS PPO |
$3.42
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.13
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Medicare |
$2.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3.32
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BIOPSY PUNCH 3MM
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2400199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.42
|
| Rate for Payer: Aetna of WY Medicare |
$2.23
|
| Rate for Payer: Altius Commercial |
$3.35
|
| Rate for Payer: Beech Street Commercial |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.39
|
| Rate for Payer: Cigna of WY Commercial |
$3.42
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.13
|
| Rate for Payer: HealthUtah PPO |
$3.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.39
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.42
|
| Rate for Payer: PacificSource Commercial |
$3.14
|
| Rate for Payer: PHCS PPO |
$3.42
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.13
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Medicare |
$2.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3.32
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BIOPSY PUNCH 3MM
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2400199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.42
|
| Rate for Payer: Aetna of WY Medicare |
$2.30
|
| Rate for Payer: Altius Commercial |
$3.35
|
| Rate for Payer: Beech Street Commercial |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.39
|
| Rate for Payer: Cigna of WY Commercial |
$3.42
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.99
|
| Rate for Payer: HealthUtah PPO |
$3.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.39
|
| Rate for Payer: Multiplan Medicare/VA |
$1.89
|
| Rate for Payer: One Health Plan of WY PPO |
$3.42
|
| Rate for Payer: PacificSource Commercial |
$3.14
|
| Rate for Payer: PHCS PPO |
$3.42
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$1.99
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Medicare |
$1.99
|
| Rate for Payer: WINHealth Partners Commercial |
$3.42
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BIOPSY PUNCH 4MM
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2400200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.42
|
| Rate for Payer: Aetna of WY Medicare |
$2.23
|
| Rate for Payer: Altius Commercial |
$3.35
|
| Rate for Payer: Beech Street Commercial |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.39
|
| Rate for Payer: Cigna of WY Commercial |
$3.42
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.13
|
| Rate for Payer: HealthUtah PPO |
$3.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.39
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.42
|
| Rate for Payer: PacificSource Commercial |
$3.14
|
| Rate for Payer: PHCS PPO |
$3.42
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.13
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Medicare |
$2.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3.32
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
