|
IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 86294
|
| Hospital Charge Code |
86294
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$25.57
|
| 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 |
$25.57
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$21.73
|
| 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 |
$25.57
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$25.57
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
IMP 12" MORPHBOARD PEG 105-12P
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.16
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.86
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$13.17
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.86
|
| Rate for Payer: United Healthcare Commercial |
$18.27
|
| Rate for Payer: United Healthcare Medicare |
$13.86
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
IMP 12" MORPHBOARD PEG 105-12P
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Aetna of WY Medicare |
$13.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.16
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.18
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.57
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$12.18
|
| Rate for Payer: United Healthcare Commercial |
$18.27
|
| Rate for Payer: United Healthcare Medicare |
$12.18
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
IMPLANTATION NERVE END BONE/MUSCLE
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 64787
|
| Hospital Charge Code |
64787
|
| Min. Negotiated Rate |
$187.78 |
| Max. Negotiated Rate |
$1,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,216.18
|
| Rate for Payer: Aetna of WY Medicare |
$220.92
|
| Rate for Payer: Beech Street Commercial |
$1,178.95
|
| Rate for Payer: Cash Price |
$868.70
|
| Rate for Payer: Cash Price |
$868.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,203.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,216.18
|
| Rate for Payer: First Choice Health Commercial |
$1,116.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,178.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.92
|
| Rate for Payer: HealthUtah PPO |
$1,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,203.77
|
| Rate for Payer: Multiplan Medicare/VA |
$187.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,216.18
|
| Rate for Payer: PacificSource Commercial |
$1,116.90
|
| Rate for Payer: PHCS PPO |
$1,178.95
|
| Rate for Payer: Three Rivers PPO |
$930.75
|
| Rate for Payer: TriWest Veterans Administration |
$220.92
|
| Rate for Payer: United Healthcare Commercial |
$1,079.67
|
| Rate for Payer: United Healthcare Medicare |
$220.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.85
|
|
|
IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 49568
|
| Hospital Charge Code |
49568
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,356.32
|
| Rate for Payer: Beech Street Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,342.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,356.32
|
| Rate for Payer: First Choice Health Commercial |
$1,245.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,314.80
|
| Rate for Payer: HealthUtah PPO |
$1,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,342.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,356.32
|
| Rate for Payer: PacificSource Commercial |
$1,245.60
|
| Rate for Payer: PHCS PPO |
$1,314.80
|
| Rate for Payer: Three Rivers PPO |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$1,204.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.40
|
|
|
IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 49568 AS
|
| Hospital Charge Code |
49568
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,356.32
|
| Rate for Payer: Beech Street Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,342.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,356.32
|
| Rate for Payer: First Choice Health Commercial |
$1,245.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,314.80
|
| Rate for Payer: HealthUtah PPO |
$1,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,342.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,356.32
|
| Rate for Payer: PacificSource Commercial |
$1,245.60
|
| Rate for Payer: PHCS PPO |
$1,314.80
|
| Rate for Payer: Three Rivers PPO |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$1,204.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.40
|
|
|
IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 49568 80
|
| Hospital Charge Code |
49568
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,356.32
|
| Rate for Payer: Beech Street Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,342.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,356.32
|
| Rate for Payer: First Choice Health Commercial |
$1,245.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,314.80
|
| Rate for Payer: HealthUtah PPO |
$1,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,342.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,356.32
|
| Rate for Payer: PacificSource Commercial |
$1,245.60
|
| Rate for Payer: PHCS PPO |
$1,314.80
|
| Rate for Payer: Three Rivers PPO |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$1,204.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.40
|
|
|
IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 15777
|
| Hospital Charge Code |
15777
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,083.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,061.34
|
| Rate for Payer: Aetna of WY Medicare |
$202.51
|
| Rate for Payer: Beech Street Commercial |
$1,028.85
|
| Rate for Payer: Cash Price |
$758.10
|
| Rate for Payer: Cash Price |
$758.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,050.51
|
| Rate for Payer: Cigna of WY Commercial |
$1,061.34
|
| Rate for Payer: First Choice Health Commercial |
$974.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,028.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.51
|
| Rate for Payer: HealthUtah PPO |
$1,083.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,050.51
|
| Rate for Payer: Multiplan Medicare/VA |
$172.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,061.34
|
| Rate for Payer: PacificSource Commercial |
$974.70
|
| Rate for Payer: PHCS PPO |
$1,028.85
|
| Rate for Payer: Three Rivers PPO |
$812.25
|
| Rate for Payer: TriWest Veterans Administration |
$202.51
|
| Rate for Payer: United Healthcare Commercial |
$942.21
|
| Rate for Payer: United Healthcare Medicare |
$202.51
|
| Rate for Payer: WINHealth Partners Commercial |
$920.55
|
|
|
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP
|
Professional
|
Both
|
$3,598.00
|
|
|
Service Code
|
HCPCS 62362 50
|
| Hospital Charge Code |
62362
|
| Min. Negotiated Rate |
$315.49 |
| Max. Negotiated Rate |
$3,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,526.04
|
| Rate for Payer: Aetna of WY Medicare |
$371.17
|
| Rate for Payer: Beech Street Commercial |
$3,418.10
|
| Rate for Payer: Cash Price |
$2,518.60
|
| Rate for Payer: Cash Price |
$2,518.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,490.06
|
| Rate for Payer: Cigna of WY Commercial |
$3,526.04
|
| Rate for Payer: First Choice Health Commercial |
$3,238.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,418.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.17
|
| Rate for Payer: HealthUtah PPO |
$3,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,490.06
|
| Rate for Payer: Multiplan Medicare/VA |
$315.49
|
| Rate for Payer: One Health Plan of WY PPO |
$3,526.04
|
| Rate for Payer: PacificSource Commercial |
$3,238.20
|
| Rate for Payer: PHCS PPO |
$3,418.10
|
| Rate for Payer: Three Rivers PPO |
$2,698.50
|
| Rate for Payer: TriWest Veterans Administration |
$371.17
|
| Rate for Payer: United Healthcare Commercial |
$3,130.26
|
| Rate for Payer: United Healthcare Medicare |
$371.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3,058.30
|
|
|
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP
|
Professional
|
Both
|
$1,797.00
|
|
|
Service Code
|
HCPCS 62362
|
| Hospital Charge Code |
62362
|
| Min. Negotiated Rate |
$315.49 |
| Max. Negotiated Rate |
$1,797.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,761.06
|
| Rate for Payer: Aetna of WY Medicare |
$371.17
|
| Rate for Payer: Beech Street Commercial |
$1,707.15
|
| Rate for Payer: Cash Price |
$1,257.90
|
| Rate for Payer: Cash Price |
$1,257.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,743.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,761.06
|
| Rate for Payer: First Choice Health Commercial |
$1,617.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,707.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.17
|
| Rate for Payer: HealthUtah PPO |
$1,797.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,743.09
|
| Rate for Payer: Multiplan Medicare/VA |
$315.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,761.06
|
| Rate for Payer: PacificSource Commercial |
$1,617.30
|
| Rate for Payer: PHCS PPO |
$1,707.15
|
| Rate for Payer: Three Rivers PPO |
$1,347.75
|
| Rate for Payer: TriWest Veterans Administration |
$371.17
|
| Rate for Payer: United Healthcare Commercial |
$1,563.39
|
| Rate for Payer: United Healthcare Medicare |
$371.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,527.45
|
|
|
IMPULSE AR MOD 5F
|
Facility
|
IP
|
$28.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.83
|
| Rate for Payer: Altius Commercial |
$27.83
|
| Rate for Payer: Beech Street Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.12
|
| Rate for Payer: Cigna of WY Commercial |
$28.41
|
| Rate for Payer: Entrust Commercial |
$27.54
|
| Rate for Payer: First Choice Health Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.13
|
| Rate for Payer: HealthUtah PPO |
$28.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.12
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$28.41
|
| Rate for Payer: PacificSource Commercial |
$26.09
|
| Rate for Payer: PHCS PPO |
$28.41
|
| Rate for Payer: Three Rivers PPO |
$21.74
|
| Rate for Payer: TriWest Veterans Administration |
$19.13
|
| Rate for Payer: United Healthcare Commercial |
$25.22
|
| Rate for Payer: United Healthcare Medicare |
$19.13
|
| Rate for Payer: WINHealth Partners Commercial |
$27.54
|
| Rate for Payer: Wise Provider Network Commercial |
$27.54
|
|
|
IMPULSE AR MOD 5F
|
Facility
|
OP
|
$28.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.41
|
| Rate for Payer: Aetna of WY Medicare |
$19.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.83
|
| Rate for Payer: Altius Commercial |
$27.83
|
| Rate for Payer: Beech Street Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.12
|
| Rate for Payer: Cigna of WY Commercial |
$28.41
|
| Rate for Payer: Entrust Commercial |
$27.54
|
| Rate for Payer: First Choice Health Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.81
|
| Rate for Payer: HealthUtah PPO |
$28.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.12
|
| Rate for Payer: Multiplan Medicare/VA |
$15.97
|
| Rate for Payer: One Health Plan of WY PPO |
$28.41
|
| Rate for Payer: PacificSource Commercial |
$26.09
|
| Rate for Payer: PHCS PPO |
$28.41
|
| Rate for Payer: Three Rivers PPO |
$21.74
|
| Rate for Payer: TriWest Veterans Administration |
$16.81
|
| Rate for Payer: United Healthcare Commercial |
$25.22
|
| Rate for Payer: United Healthcare Medicare |
$16.81
|
| Rate for Payer: WINHealth Partners Commercial |
$28.41
|
| Rate for Payer: Wise Provider Network Commercial |
$27.54
|
|
|
INCISIONAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
11106
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.06
|
| Rate for Payer: Aetna of WY Medicare |
$53.90
|
| Rate for Payer: Beech Street Commercial |
$282.15
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.09
|
| Rate for Payer: Cigna of WY Commercial |
$291.06
|
| Rate for Payer: First Choice Health Commercial |
$267.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.90
|
| Rate for Payer: HealthUtah PPO |
$297.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.09
|
| Rate for Payer: Multiplan Medicare/VA |
$45.82
|
| Rate for Payer: One Health Plan of WY PPO |
$291.06
|
| Rate for Payer: PacificSource Commercial |
$267.30
|
| Rate for Payer: PHCS PPO |
$282.15
|
| Rate for Payer: Three Rivers PPO |
$222.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$258.39
|
| Rate for Payer: United Healthcare Medicare |
$53.90
|
| Rate for Payer: WINHealth Partners Commercial |
$252.45
|
|
|
INCISION BONE CORTEX HAND/FINGER
|
Professional
|
Both
|
$2,759.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
26034
|
| Min. Negotiated Rate |
$460.66 |
| Max. Negotiated Rate |
$2,759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,703.82
|
| Rate for Payer: Aetna of WY Medicare |
$541.95
|
| Rate for Payer: Beech Street Commercial |
$2,621.05
|
| Rate for Payer: Cash Price |
$1,931.30
|
| Rate for Payer: Cash Price |
$1,931.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,676.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,703.82
|
| Rate for Payer: First Choice Health Commercial |
$2,483.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,621.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.95
|
| Rate for Payer: HealthUtah PPO |
$2,759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,676.23
|
| Rate for Payer: Multiplan Medicare/VA |
$460.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,703.82
|
| Rate for Payer: PacificSource Commercial |
$2,483.10
|
| Rate for Payer: PHCS PPO |
$2,621.05
|
| Rate for Payer: Three Rivers PPO |
$2,069.25
|
| Rate for Payer: TriWest Veterans Administration |
$541.95
|
| Rate for Payer: United Healthcare Commercial |
$2,400.33
|
| Rate for Payer: United Healthcare Medicare |
$541.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,345.15
|
|
|
INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
10061
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Aetna of WY Medicare |
$179.32
|
| Rate for Payer: Beech Street Commercial |
$862.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: First Choice Health Commercial |
$817.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.32
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$152.42
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$862.60
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.32
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$179.32
|
| Rate for Payer: WINHealth Partners Commercial |
$771.80
|
|
|
INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 10061 80
|
| Hospital Charge Code |
10061
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Aetna of WY Medicare |
$179.32
|
| Rate for Payer: Beech Street Commercial |
$862.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: First Choice Health Commercial |
$817.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.32
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$152.42
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$862.60
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.32
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$179.32
|
| Rate for Payer: WINHealth Partners Commercial |
$771.80
|
|
|
INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
10060
|
| Min. Negotiated Rate |
$88.68 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Aetna of WY Medicare |
$104.33
|
| Rate for Payer: Beech Street Commercial |
$476.90
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: First Choice Health Commercial |
$451.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.33
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$88.68
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PHCS PPO |
$476.90
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.33
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Medicare |
$104.33
|
| Rate for Payer: WINHealth Partners Commercial |
$426.70
|
|
|
INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$146.31 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$870.24
|
| Rate for Payer: Aetna of WY Medicare |
$172.13
|
| Rate for Payer: Beech Street Commercial |
$843.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$861.36
|
| Rate for Payer: Cigna of WY Commercial |
$870.24
|
| Rate for Payer: First Choice Health Commercial |
$799.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$843.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.13
|
| Rate for Payer: HealthUtah PPO |
$888.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$861.36
|
| Rate for Payer: Multiplan Medicare/VA |
$146.31
|
| Rate for Payer: One Health Plan of WY PPO |
$870.24
|
| Rate for Payer: PacificSource Commercial |
$799.20
|
| Rate for Payer: PHCS PPO |
$843.60
|
| Rate for Payer: Three Rivers PPO |
$666.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.13
|
| Rate for Payer: United Healthcare Commercial |
$772.56
|
| Rate for Payer: United Healthcare Medicare |
$172.13
|
| Rate for Payer: WINHealth Partners Commercial |
$754.80
|
|
|
INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 10180 AS
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$146.31 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$172.13
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.13
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$146.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.13
|
| Rate for Payer: United Healthcare Commercial |
$946.56
|
| Rate for Payer: United Healthcare Medicare |
$172.13
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
27603
|
| Min. Negotiated Rate |
$322.08 |
| Max. Negotiated Rate |
$2,010.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,969.80
|
| Rate for Payer: Aetna of WY Medicare |
$378.92
|
| Rate for Payer: Beech Street Commercial |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,949.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,969.80
|
| Rate for Payer: First Choice Health Commercial |
$1,809.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,909.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.92
|
| Rate for Payer: HealthUtah PPO |
$2,010.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,949.70
|
| Rate for Payer: Multiplan Medicare/VA |
$322.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,969.80
|
| Rate for Payer: PacificSource Commercial |
$1,809.00
|
| Rate for Payer: PHCS PPO |
$1,909.50
|
| Rate for Payer: Three Rivers PPO |
$1,507.50
|
| Rate for Payer: TriWest Veterans Administration |
$378.92
|
| Rate for Payer: United Healthcare Commercial |
$1,748.70
|
| Rate for Payer: United Healthcare Medicare |
$378.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,708.50
|
|
|
INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
10081
|
| Min. Negotiated Rate |
$139.93 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$164.62
|
| Rate for Payer: Beech Street Commercial |
$816.05
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$833.23
|
| Rate for Payer: Cigna of WY Commercial |
$841.82
|
| Rate for Payer: First Choice Health Commercial |
$773.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$816.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.62
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$139.93
|
| Rate for Payer: One Health Plan of WY PPO |
$841.82
|
| Rate for Payer: PacificSource Commercial |
$773.10
|
| Rate for Payer: PHCS PPO |
$816.05
|
| Rate for Payer: Three Rivers PPO |
$644.25
|
| Rate for Payer: TriWest Veterans Administration |
$164.62
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$164.62
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
10080
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$102.42
|
| Rate for Payer: Beech Street Commercial |
$489.25
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: First Choice Health Commercial |
$463.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.42
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$87.06
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$489.25
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.42
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$102.42
|
| Rate for Payer: WINHealth Partners Commercial |
$437.75
|
|
|
INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$801.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
23931
|
| Min. Negotiated Rate |
$134.39 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.98
|
| Rate for Payer: Aetna of WY Medicare |
$158.11
|
| Rate for Payer: Beech Street Commercial |
$760.95
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.97
|
| Rate for Payer: Cigna of WY Commercial |
$784.98
|
| Rate for Payer: First Choice Health Commercial |
$720.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.11
|
| Rate for Payer: HealthUtah PPO |
$801.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.97
|
| Rate for Payer: Multiplan Medicare/VA |
$134.39
|
| Rate for Payer: One Health Plan of WY PPO |
$784.98
|
| Rate for Payer: PacificSource Commercial |
$720.90
|
| Rate for Payer: PHCS PPO |
$760.95
|
| Rate for Payer: Three Rivers PPO |
$600.75
|
| Rate for Payer: TriWest Veterans Administration |
$158.11
|
| Rate for Payer: United Healthcare Commercial |
$696.87
|
| Rate for Payer: United Healthcare Medicare |
$158.11
|
| Rate for Payer: WINHealth Partners Commercial |
$680.85
|
|
|
INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
25000
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$1,227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,202.46
|
| Rate for Payer: Aetna of WY Medicare |
$343.90
|
| Rate for Payer: Beech Street Commercial |
$1,165.65
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,190.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,202.46
|
| Rate for Payer: First Choice Health Commercial |
$1,104.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,165.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.90
|
| Rate for Payer: HealthUtah PPO |
$1,227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,190.19
|
| Rate for Payer: Multiplan Medicare/VA |
$292.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,202.46
|
| Rate for Payer: PacificSource Commercial |
$1,104.30
|
| Rate for Payer: PHCS PPO |
$1,165.65
|
| Rate for Payer: Three Rivers PPO |
$920.25
|
| Rate for Payer: TriWest Veterans Administration |
$343.90
|
| Rate for Payer: United Healthcare Commercial |
$1,067.49
|
| Rate for Payer: United Healthcare Medicare |
$343.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,042.95
|
|
|
INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 25000 AS
|
| Hospital Charge Code |
25000
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$1,227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,202.46
|
| Rate for Payer: Aetna of WY Medicare |
$343.90
|
| Rate for Payer: Beech Street Commercial |
$1,165.65
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: Cash Price |
$858.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,190.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,202.46
|
| Rate for Payer: First Choice Health Commercial |
$1,104.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,165.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.90
|
| Rate for Payer: HealthUtah PPO |
$1,227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,190.19
|
| Rate for Payer: Multiplan Medicare/VA |
$292.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,202.46
|
| Rate for Payer: PacificSource Commercial |
$1,104.30
|
| Rate for Payer: PHCS PPO |
$1,165.65
|
| Rate for Payer: Three Rivers PPO |
$920.25
|
| Rate for Payer: TriWest Veterans Administration |
$343.90
|
| Rate for Payer: United Healthcare Commercial |
$1,067.49
|
| Rate for Payer: United Healthcare Medicare |
$343.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,042.95
|
|
