|
INSERTION INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
58300
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.28
|
| Rate for Payer: Beech Street Commercial |
$414.20
|
| Rate for Payer: Cash Price |
$305.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$422.92
|
| Rate for Payer: Cigna of WY Commercial |
$427.28
|
| Rate for Payer: First Choice Health Commercial |
$392.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.20
|
| Rate for Payer: HealthUtah PPO |
$436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.92
|
| Rate for Payer: One Health Plan of WY PPO |
$427.28
|
| Rate for Payer: PacificSource Commercial |
$392.40
|
| Rate for Payer: PHCS PPO |
$414.20
|
| Rate for Payer: Three Rivers PPO |
$327.00
|
| Rate for Payer: United Healthcare Commercial |
$379.32
|
| Rate for Payer: WINHealth Partners Commercial |
$370.60
|
|
|
INSERTION NASAL SEPTAL PROSTHESIS BUTTON
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 30220
|
| Hospital Charge Code |
30220
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,042.72
|
| Rate for Payer: Aetna of WY Medicare |
$125.41
|
| Rate for Payer: Beech Street Commercial |
$1,010.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,032.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,042.72
|
| Rate for Payer: First Choice Health Commercial |
$957.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,010.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.41
|
| Rate for Payer: HealthUtah PPO |
$1,064.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,032.08
|
| Rate for Payer: Multiplan Medicare/VA |
$106.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,042.72
|
| Rate for Payer: PacificSource Commercial |
$957.60
|
| Rate for Payer: PHCS PPO |
$1,010.80
|
| Rate for Payer: Three Rivers PPO |
$798.00
|
| Rate for Payer: TriWest Veterans Administration |
$125.41
|
| Rate for Payer: United Healthcare Commercial |
$925.68
|
| Rate for Payer: United Healthcare Medicare |
$125.41
|
| Rate for Payer: WINHealth Partners Commercial |
$904.40
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
36569
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$88.88
|
| Rate for Payer: Beech Street Commercial |
$466.45
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: First Choice Health Commercial |
$441.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.88
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$75.55
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$466.45
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$88.88
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$88.88
|
| Rate for Payer: WINHealth Partners Commercial |
$417.35
|
|
|
INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 20650
|
| Hospital Charge Code |
20650
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Aetna of WY Medicare |
$162.52
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.52
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: Multiplan Medicare/VA |
$138.14
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.52
|
| Rate for Payer: United Healthcare Commercial |
$702.96
|
| Rate for Payer: United Healthcare Medicare |
$162.52
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
|
INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
36557
|
| Min. Negotiated Rate |
$258.11 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,611.12
|
| Rate for Payer: Aetna of WY Medicare |
$303.66
|
| Rate for Payer: Beech Street Commercial |
$1,561.80
|
| Rate for Payer: Cash Price |
$1,150.80
|
| Rate for Payer: Cash Price |
$1,150.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,594.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,611.12
|
| Rate for Payer: First Choice Health Commercial |
$1,479.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,561.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.66
|
| Rate for Payer: HealthUtah PPO |
$1,644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,594.68
|
| Rate for Payer: Multiplan Medicare/VA |
$258.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,611.12
|
| Rate for Payer: PacificSource Commercial |
$1,479.60
|
| Rate for Payer: PHCS PPO |
$1,561.80
|
| Rate for Payer: Three Rivers PPO |
$1,233.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.66
|
| Rate for Payer: United Healthcare Commercial |
$1,430.28
|
| Rate for Payer: United Healthcare Medicare |
$303.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,397.40
|
|
|
INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 22853
|
| Hospital Charge Code |
22853
|
| Min. Negotiated Rate |
$204.58 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$240.68
|
| 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 |
$240.68
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$204.58
|
| 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 |
$240.68
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$240.68
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 22853 AS
|
| Hospital Charge Code |
22853
|
| Min. Negotiated Rate |
$204.58 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$240.68
|
| 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 |
$240.68
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$204.58
|
| 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 |
$240.68
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$240.68
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 22853 80
|
| Hospital Charge Code |
22853
|
| Min. Negotiated Rate |
$204.58 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$240.68
|
| 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 |
$240.68
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$204.58
|
| 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 |
$240.68
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$240.68
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
57267
|
| Min. Negotiated Rate |
$202.18 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$710.50
|
| Rate for Payer: Aetna of WY Medicare |
$237.86
|
| Rate for Payer: Beech Street Commercial |
$688.75
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$703.25
|
| Rate for Payer: Cigna of WY Commercial |
$710.50
|
| Rate for Payer: First Choice Health Commercial |
$652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.86
|
| Rate for Payer: HealthUtah PPO |
$725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$703.25
|
| Rate for Payer: Multiplan Medicare/VA |
$202.18
|
| Rate for Payer: One Health Plan of WY PPO |
$710.50
|
| Rate for Payer: PacificSource Commercial |
$652.50
|
| Rate for Payer: PHCS PPO |
$688.75
|
| Rate for Payer: Three Rivers PPO |
$543.75
|
| Rate for Payer: TriWest Veterans Administration |
$237.86
|
| Rate for Payer: United Healthcare Commercial |
$630.75
|
| Rate for Payer: United Healthcare Medicare |
$237.86
|
| Rate for Payer: WINHealth Partners Commercial |
$616.25
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
51701
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$24.29
|
| Rate for Payer: Beech Street Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: First Choice Health Commercial |
$122.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.29
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$20.65
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$129.20
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.29
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$24.29
|
| Rate for Payer: WINHealth Partners Commercial |
$115.60
|
|
|
INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>
|
Professional
|
Both
|
$2,260.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
36556
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$79.57
|
| Rate for Payer: Beech Street Commercial |
$2,147.00
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: First Choice Health Commercial |
$2,034.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.57
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$67.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,147.00
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.57
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$79.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,921.00
|
|
|
INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$5,175.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
36571
|
| Min. Negotiated Rate |
$250.86 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,071.50
|
| Rate for Payer: Aetna of WY Medicare |
$295.13
|
| Rate for Payer: Beech Street Commercial |
$4,916.25
|
| Rate for Payer: Cash Price |
$3,622.50
|
| Rate for Payer: Cash Price |
$3,622.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,019.75
|
| Rate for Payer: Cigna of WY Commercial |
$5,071.50
|
| Rate for Payer: First Choice Health Commercial |
$4,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,916.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.13
|
| Rate for Payer: HealthUtah PPO |
$5,175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,019.75
|
| Rate for Payer: Multiplan Medicare/VA |
$250.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,071.50
|
| Rate for Payer: PacificSource Commercial |
$4,657.50
|
| Rate for Payer: PHCS PPO |
$4,916.25
|
| Rate for Payer: Three Rivers PPO |
$3,881.25
|
| Rate for Payer: TriWest Veterans Administration |
$295.13
|
| Rate for Payer: United Healthcare Commercial |
$4,502.25
|
| Rate for Payer: United Healthcare Medicare |
$295.13
|
| Rate for Payer: WINHealth Partners Commercial |
$4,398.75
|
|
|
INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
63685
|
| Min. Negotiated Rate |
$278.05 |
| Max. Negotiated Rate |
$1,853.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,815.94
|
| Rate for Payer: Aetna of WY Medicare |
$327.12
|
| Rate for Payer: Beech Street Commercial |
$1,760.35
|
| Rate for Payer: Cash Price |
$1,297.10
|
| Rate for Payer: Cash Price |
$1,297.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,797.41
|
| Rate for Payer: Cigna of WY Commercial |
$1,815.94
|
| Rate for Payer: First Choice Health Commercial |
$1,667.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,760.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.12
|
| Rate for Payer: HealthUtah PPO |
$1,853.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,797.41
|
| Rate for Payer: Multiplan Medicare/VA |
$278.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,815.94
|
| Rate for Payer: PacificSource Commercial |
$1,667.70
|
| Rate for Payer: PHCS PPO |
$1,760.35
|
| Rate for Payer: Three Rivers PPO |
$1,389.75
|
| Rate for Payer: TriWest Veterans Administration |
$327.12
|
| Rate for Payer: United Healthcare Commercial |
$1,612.11
|
| Rate for Payer: United Healthcare Medicare |
$327.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.05
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
51702
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$24.05
|
| Rate for Payer: Beech Street Commercial |
$126.35
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.05
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.44
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$126.35
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$24.05
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$24.05
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
HCPCS 36561 53
|
| Hospital Charge Code |
36561
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$1,741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,706.18
|
| Rate for Payer: Aetna of WY Medicare |
$313.02
|
| Rate for Payer: Beech Street Commercial |
$1,653.95
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,688.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,706.18
|
| Rate for Payer: First Choice Health Commercial |
$1,566.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.02
|
| Rate for Payer: HealthUtah PPO |
$1,741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,688.77
|
| Rate for Payer: Multiplan Medicare/VA |
$266.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,706.18
|
| Rate for Payer: PacificSource Commercial |
$1,566.90
|
| Rate for Payer: PHCS PPO |
$1,653.95
|
| Rate for Payer: Three Rivers PPO |
$1,305.75
|
| Rate for Payer: TriWest Veterans Administration |
$313.02
|
| Rate for Payer: United Healthcare Commercial |
$1,514.67
|
| Rate for Payer: United Healthcare Medicare |
$313.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,479.85
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
36561
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$1,741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,706.18
|
| Rate for Payer: Aetna of WY Medicare |
$313.02
|
| Rate for Payer: Beech Street Commercial |
$1,653.95
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,688.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,706.18
|
| Rate for Payer: First Choice Health Commercial |
$1,566.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.02
|
| Rate for Payer: HealthUtah PPO |
$1,741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,688.77
|
| Rate for Payer: Multiplan Medicare/VA |
$266.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,706.18
|
| Rate for Payer: PacificSource Commercial |
$1,566.90
|
| Rate for Payer: PHCS PPO |
$1,653.95
|
| Rate for Payer: Three Rivers PPO |
$1,305.75
|
| Rate for Payer: TriWest Veterans Administration |
$313.02
|
| Rate for Payer: United Healthcare Commercial |
$1,514.67
|
| Rate for Payer: United Healthcare Medicare |
$313.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,479.85
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
HCPCS 36561 AS
|
| Hospital Charge Code |
36561
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$1,741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,706.18
|
| Rate for Payer: Aetna of WY Medicare |
$313.02
|
| Rate for Payer: Beech Street Commercial |
$1,653.95
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,688.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,706.18
|
| Rate for Payer: First Choice Health Commercial |
$1,566.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.02
|
| Rate for Payer: HealthUtah PPO |
$1,741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,688.77
|
| Rate for Payer: Multiplan Medicare/VA |
$266.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,706.18
|
| Rate for Payer: PacificSource Commercial |
$1,566.90
|
| Rate for Payer: PHCS PPO |
$1,653.95
|
| Rate for Payer: Three Rivers PPO |
$1,305.75
|
| Rate for Payer: TriWest Veterans Administration |
$313.02
|
| Rate for Payer: United Healthcare Commercial |
$1,514.67
|
| Rate for Payer: United Healthcare Medicare |
$313.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,479.85
|
|
|
INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
36558
|
| Min. Negotiated Rate |
$207.71 |
| Max. Negotiated Rate |
$1,351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,323.98
|
| Rate for Payer: Aetna of WY Medicare |
$244.37
|
| Rate for Payer: Beech Street Commercial |
$1,283.45
|
| Rate for Payer: Cash Price |
$945.70
|
| Rate for Payer: Cash Price |
$945.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,310.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,323.98
|
| Rate for Payer: First Choice Health Commercial |
$1,215.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,283.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.37
|
| Rate for Payer: HealthUtah PPO |
$1,351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,310.47
|
| Rate for Payer: Multiplan Medicare/VA |
$207.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,323.98
|
| Rate for Payer: PacificSource Commercial |
$1,215.90
|
| Rate for Payer: PHCS PPO |
$1,283.45
|
| Rate for Payer: Three Rivers PPO |
$1,013.25
|
| Rate for Payer: TriWest Veterans Administration |
$244.37
|
| Rate for Payer: United Healthcare Commercial |
$1,175.37
|
| Rate for Payer: United Healthcare Medicare |
$244.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,148.35
|
|
|
INSPIRE CATHETER PASSER 38CM
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.17 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$383.04
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.58
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.34
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$250.17
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.34
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$263.34
|
| Rate for Payer: WINHealth Partners Commercial |
$379.05
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
INSPIRE CATHETER PASSER 38CM
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$263.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$383.04
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.58
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.42
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$219.85
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.42
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$231.42
|
| Rate for Payer: WINHealth Partners Commercial |
$391.02
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
INSPIRE IMPLANTABLE PULSE GENERATOR
|
Facility
|
OP
|
$63,787.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,146.91 |
| Max. Negotiated Rate |
$63,787.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62,511.75
|
| Rate for Payer: Aetna of WY Medicare |
$42,099.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61,236.00
|
| Rate for Payer: Altius Commercial |
$61,236.00
|
| Rate for Payer: Beech Street Commercial |
$62,511.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52,369.54
|
| Rate for Payer: Cash Price |
$44,651.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$61,873.88
|
| Rate for Payer: Cigna of WY Commercial |
$62,511.75
|
| Rate for Payer: Entrust Commercial |
$60,598.12
|
| Rate for Payer: First Choice Health Commercial |
$60,598.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60,598.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36,996.75
|
| Rate for Payer: HealthUtah PPO |
$63,787.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61,873.88
|
| Rate for Payer: Multiplan Medicare/VA |
$35,146.91
|
| Rate for Payer: One Health Plan of WY PPO |
$62,511.75
|
| Rate for Payer: PacificSource Commercial |
$57,408.75
|
| Rate for Payer: PHCS PPO |
$62,511.75
|
| Rate for Payer: Three Rivers PPO |
$47,840.62
|
| Rate for Payer: TriWest Veterans Administration |
$36,996.75
|
| Rate for Payer: United Healthcare Commercial |
$55,495.12
|
| Rate for Payer: United Healthcare Medicare |
$36,996.75
|
| Rate for Payer: WINHealth Partners Commercial |
$62,511.75
|
| Rate for Payer: Wise Provider Network Commercial |
$60,598.12
|
|
|
INSPIRE IMPLANTABLE PULSE GENERATOR
|
Facility
|
IP
|
$63,787.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39,994.76 |
| Max. Negotiated Rate |
$63,787.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62,511.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61,236.00
|
| Rate for Payer: Altius Commercial |
$61,236.00
|
| Rate for Payer: Beech Street Commercial |
$62,511.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52,369.54
|
| Rate for Payer: Cash Price |
$44,651.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$61,873.88
|
| Rate for Payer: Cigna of WY Commercial |
$62,511.75
|
| Rate for Payer: Entrust Commercial |
$60,598.12
|
| Rate for Payer: First Choice Health Commercial |
$60,598.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60,598.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42,099.75
|
| Rate for Payer: HealthUtah PPO |
$63,787.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61,873.88
|
| Rate for Payer: Multiplan Medicare/VA |
$39,994.76
|
| Rate for Payer: One Health Plan of WY PPO |
$62,511.75
|
| Rate for Payer: PacificSource Commercial |
$57,408.75
|
| Rate for Payer: PHCS PPO |
$62,511.75
|
| Rate for Payer: Three Rivers PPO |
$47,840.62
|
| Rate for Payer: TriWest Veterans Administration |
$42,099.75
|
| Rate for Payer: United Healthcare Commercial |
$55,495.12
|
| Rate for Payer: United Healthcare Medicare |
$42,099.75
|
| Rate for Payer: WINHealth Partners Commercial |
$60,598.12
|
| Rate for Payer: Wise Provider Network Commercial |
$60,598.12
|
|
|
INSPIRE MEDTRONIC PROBE BIPOLAR STIMULATOR
|
Facility
|
OP
|
$466.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.96 |
| Max. Negotiated Rate |
$466.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.02
|
| Rate for Payer: Aetna of WY Medicare |
$307.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$447.70
|
| Rate for Payer: Altius Commercial |
$447.70
|
| Rate for Payer: Beech Street Commercial |
$457.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$382.87
|
| Rate for Payer: Cash Price |
$326.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.36
|
| Rate for Payer: Cigna of WY Commercial |
$457.02
|
| Rate for Payer: Entrust Commercial |
$443.03
|
| Rate for Payer: First Choice Health Commercial |
$443.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.48
|
| Rate for Payer: HealthUtah PPO |
$466.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.36
|
| Rate for Payer: Multiplan Medicare/VA |
$256.96
|
| Rate for Payer: One Health Plan of WY PPO |
$457.02
|
| Rate for Payer: PacificSource Commercial |
$419.72
|
| Rate for Payer: PHCS PPO |
$457.02
|
| Rate for Payer: Three Rivers PPO |
$349.76
|
| Rate for Payer: TriWest Veterans Administration |
$270.48
|
| Rate for Payer: United Healthcare Commercial |
$405.72
|
| Rate for Payer: United Healthcare Medicare |
$270.48
|
| Rate for Payer: WINHealth Partners Commercial |
$457.02
|
| Rate for Payer: Wise Provider Network Commercial |
$443.03
|
|
|
INSPIRE MEDTRONIC PROBE BIPOLAR STIMULATOR
|
Facility
|
IP
|
$466.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$466.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$447.70
|
| Rate for Payer: Altius Commercial |
$447.70
|
| Rate for Payer: Beech Street Commercial |
$457.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$382.87
|
| Rate for Payer: Cash Price |
$326.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.36
|
| Rate for Payer: Cigna of WY Commercial |
$457.02
|
| Rate for Payer: Entrust Commercial |
$443.03
|
| Rate for Payer: First Choice Health Commercial |
$443.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.79
|
| Rate for Payer: HealthUtah PPO |
$466.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.36
|
| Rate for Payer: Multiplan Medicare/VA |
$292.40
|
| Rate for Payer: One Health Plan of WY PPO |
$457.02
|
| Rate for Payer: PacificSource Commercial |
$419.72
|
| Rate for Payer: PHCS PPO |
$457.02
|
| Rate for Payer: Three Rivers PPO |
$349.76
|
| Rate for Payer: TriWest Veterans Administration |
$307.79
|
| Rate for Payer: United Healthcare Commercial |
$405.72
|
| Rate for Payer: United Healthcare Medicare |
$307.79
|
| Rate for Payer: WINHealth Partners Commercial |
$443.03
|
| Rate for Payer: Wise Provider Network Commercial |
$443.03
|
|
|
INSPIRE RESPIRATORY SENSING LEAD
|
Facility
|
OP
|
$11,812.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,508.69 |
| Max. Negotiated Rate |
$11,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,576.25
|
| Rate for Payer: Aetna of WY Medicare |
$7,796.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,340.00
|
| Rate for Payer: Altius Commercial |
$11,340.00
|
| Rate for Payer: Beech Street Commercial |
$11,576.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,698.06
|
| Rate for Payer: Cash Price |
$8,268.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,458.12
|
| Rate for Payer: Cigna of WY Commercial |
$11,576.25
|
| Rate for Payer: Entrust Commercial |
$11,221.88
|
| Rate for Payer: First Choice Health Commercial |
$11,221.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,221.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,851.25
|
| Rate for Payer: HealthUtah PPO |
$11,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,458.12
|
| Rate for Payer: Multiplan Medicare/VA |
$6,508.69
|
| Rate for Payer: One Health Plan of WY PPO |
$11,576.25
|
| Rate for Payer: PacificSource Commercial |
$10,631.25
|
| Rate for Payer: PHCS PPO |
$11,576.25
|
| Rate for Payer: Three Rivers PPO |
$8,859.38
|
| Rate for Payer: TriWest Veterans Administration |
$6,851.25
|
| Rate for Payer: United Healthcare Commercial |
$10,276.88
|
| Rate for Payer: United Healthcare Medicare |
$6,851.25
|
| Rate for Payer: WINHealth Partners Commercial |
$11,576.25
|
| Rate for Payer: Wise Provider Network Commercial |
$11,221.88
|
|
