|
BIOPSY PUNCH 4MM
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2400200
|
|
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 5MM
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2400161
|
|
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 5MM
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2400161
|
|
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 6MM
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2400022
|
|
Hospital Revenue Code
|
272
|
| 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 6MM
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2400022
|
|
Hospital Revenue Code
|
272
|
| 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 DISP. 2MM
|
Facility
|
IP
|
$4.84
|
|
| Hospital Charge Code |
2400019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.74
|
| Rate for Payer: Aetna of WY Medicare |
$3.10
|
| Rate for Payer: Altius Commercial |
$4.65
|
| Rate for Payer: Beech Street Commercial |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.69
|
| Rate for Payer: Cigna of WY Commercial |
$4.74
|
| Rate for Payer: Entrust Commercial |
$4.60
|
| Rate for Payer: First Choice Health Commercial |
$4.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.95
|
| Rate for Payer: HealthUtah PPO |
$4.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.69
|
| Rate for Payer: Multiplan Medicare/VA |
$2.80
|
| Rate for Payer: One Health Plan of WY PPO |
$4.74
|
| Rate for Payer: PacificSource Commercial |
$4.36
|
| Rate for Payer: PHCS PPO |
$4.74
|
| Rate for Payer: Three Rivers PPO |
$3.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.95
|
| Rate for Payer: United Healthcare Commercial |
$4.62
|
| Rate for Payer: United Healthcare Medicare |
$2.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4.60
|
| Rate for Payer: Wise Provider Network Commercial |
$4.60
|
|
|
BIOPSY PUNCH DISP. 2MM
|
Facility
|
OP
|
$4.84
|
|
| Hospital Charge Code |
2400019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.74
|
| Rate for Payer: Aetna of WY Medicare |
$3.19
|
| Rate for Payer: Altius Commercial |
$4.65
|
| Rate for Payer: Beech Street Commercial |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.69
|
| Rate for Payer: Cigna of WY Commercial |
$4.74
|
| Rate for Payer: Entrust Commercial |
$4.60
|
| Rate for Payer: First Choice Health Commercial |
$4.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.69
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.74
|
| Rate for Payer: PacificSource Commercial |
$4.36
|
| Rate for Payer: PHCS PPO |
$4.74
|
| Rate for Payer: Three Rivers PPO |
$3.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.62
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.74
|
| Rate for Payer: Wise Provider Network Commercial |
$4.60
|
|
|
BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
HCPCS 25066
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,546.44
|
| Rate for Payer: Aetna of WY Medicare |
$362.35
|
| Rate for Payer: Beech Street Commercial |
$1,499.10
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,530.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,546.44
|
| Rate for Payer: First Choice Health Commercial |
$1,420.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,499.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$362.35
|
| Rate for Payer: HealthUtah PPO |
$1,578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,530.66
|
| Rate for Payer: Multiplan Medicare/VA |
$308.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,546.44
|
| Rate for Payer: PacificSource Commercial |
$1,420.20
|
| Rate for Payer: PHCS PPO |
$1,499.10
|
| Rate for Payer: Three Rivers PPO |
$1,183.50
|
| Rate for Payer: TriWest Veterans Administration |
$362.35
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,341.30
|
|
|
BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 27040
|
| Min. Negotiated Rate |
$163.38 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,564.66
|
| Rate for Payer: Aetna of WY Medicare |
$192.21
|
| Rate for Payer: Beech Street Commercial |
$2,486.15
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,538.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,564.66
|
| Rate for Payer: First Choice Health Commercial |
$2,355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,486.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.21
|
| Rate for Payer: HealthUtah PPO |
$2,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,538.49
|
| Rate for Payer: Multiplan Medicare/VA |
$163.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,564.66
|
| Rate for Payer: PacificSource Commercial |
$2,355.30
|
| Rate for Payer: PHCS PPO |
$2,486.15
|
| Rate for Payer: Three Rivers PPO |
$1,962.75
|
| Rate for Payer: TriWest Veterans Administration |
$192.21
|
| Rate for Payer: United Healthcare Commercial |
$2,486.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.45
|
|
|
BIOPSY SOFT TISSUE SHOULDER DEEP
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 23066
|
| Min. Negotiated Rate |
$307.34 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,549.38
|
| Rate for Payer: Aetna of WY Medicare |
$361.58
|
| Rate for Payer: Beech Street Commercial |
$1,501.95
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,533.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,549.38
|
| Rate for Payer: First Choice Health Commercial |
$1,422.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.58
|
| Rate for Payer: HealthUtah PPO |
$1,581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,533.57
|
| Rate for Payer: Multiplan Medicare/VA |
$307.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,549.38
|
| Rate for Payer: PacificSource Commercial |
$1,422.90
|
| Rate for Payer: PHCS PPO |
$1,501.95
|
| Rate for Payer: Three Rivers PPO |
$1,185.75
|
| Rate for Payer: TriWest Veterans Administration |
$361.58
|
| Rate for Payer: United Healthcare Commercial |
$1,501.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,343.85
|
|
|
BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 23065
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$701.68
|
| Rate for Payer: Aetna of WY Medicare |
$155.16
|
| Rate for Payer: Beech Street Commercial |
$680.20
|
| Rate for Payer: Cash Price |
$501.20
|
| Rate for Payer: Cash Price |
$501.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$694.52
|
| Rate for Payer: Cigna of WY Commercial |
$701.68
|
| Rate for Payer: First Choice Health Commercial |
$644.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$680.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.16
|
| Rate for Payer: HealthUtah PPO |
$716.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$694.52
|
| Rate for Payer: Multiplan Medicare/VA |
$131.89
|
| Rate for Payer: One Health Plan of WY PPO |
$701.68
|
| Rate for Payer: PacificSource Commercial |
$644.40
|
| Rate for Payer: PHCS PPO |
$680.20
|
| Rate for Payer: Three Rivers PPO |
$537.00
|
| Rate for Payer: TriWest Veterans Administration |
$155.16
|
| Rate for Payer: United Healthcare Commercial |
$680.20
|
| Rate for Payer: WINHealth Partners Commercial |
$608.60
|
|
|
BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP
|
Professional
|
Both
|
$2,249.00
|
|
|
Service Code
|
HCPCS 27324
|
| Min. Negotiated Rate |
$340.88 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,204.02
|
| Rate for Payer: Aetna of WY Medicare |
$401.03
|
| Rate for Payer: Beech Street Commercial |
$2,136.55
|
| Rate for Payer: Cash Price |
$1,574.30
|
| Rate for Payer: Cash Price |
$1,574.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,181.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,204.02
|
| Rate for Payer: First Choice Health Commercial |
$2,024.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,136.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.03
|
| Rate for Payer: HealthUtah PPO |
$2,249.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,181.53
|
| Rate for Payer: Multiplan Medicare/VA |
$340.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,204.02
|
| Rate for Payer: PacificSource Commercial |
$2,024.10
|
| Rate for Payer: PHCS PPO |
$2,136.55
|
| Rate for Payer: Three Rivers PPO |
$1,686.75
|
| Rate for Payer: TriWest Veterans Administration |
$401.03
|
| Rate for Payer: United Healthcare Commercial |
$2,136.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,911.65
|
|
|
BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 41100
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,081.92
|
| Rate for Payer: Aetna of WY Medicare |
$104.47
|
| Rate for Payer: Beech Street Commercial |
$1,048.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,070.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,081.92
|
| Rate for Payer: First Choice Health Commercial |
$993.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,048.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.47
|
| Rate for Payer: HealthUtah PPO |
$1,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Medicare/VA |
$88.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,081.92
|
| Rate for Payer: PacificSource Commercial |
$993.60
|
| Rate for Payer: PHCS PPO |
$1,048.80
|
| Rate for Payer: Three Rivers PPO |
$828.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.47
|
| Rate for Payer: United Healthcare Commercial |
$1,048.80
|
| Rate for Payer: WINHealth Partners Commercial |
$938.40
|
|
|
BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 41105
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$467.46
|
| Rate for Payer: Aetna of WY Medicare |
$107.41
|
| Rate for Payer: Beech Street Commercial |
$453.15
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$462.69
|
| Rate for Payer: Cigna of WY Commercial |
$467.46
|
| Rate for Payer: First Choice Health Commercial |
$429.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$453.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.41
|
| Rate for Payer: HealthUtah PPO |
$477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$462.69
|
| Rate for Payer: Multiplan Medicare/VA |
$91.30
|
| Rate for Payer: One Health Plan of WY PPO |
$467.46
|
| Rate for Payer: PacificSource Commercial |
$429.30
|
| Rate for Payer: PHCS PPO |
$453.15
|
| Rate for Payer: Three Rivers PPO |
$357.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.41
|
| Rate for Payer: United Healthcare Commercial |
$453.15
|
| Rate for Payer: WINHealth Partners Commercial |
$405.45
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$2,395.00
|
|
|
Service Code
|
HCPCS 57105
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$2,395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,347.10
|
| Rate for Payer: Aetna of WY Medicare |
$143.23
|
| Rate for Payer: Beech Street Commercial |
$2,275.25
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,323.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,347.10
|
| Rate for Payer: First Choice Health Commercial |
$2,155.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,275.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.23
|
| Rate for Payer: HealthUtah PPO |
$2,395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,323.15
|
| Rate for Payer: Multiplan Medicare/VA |
$121.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,347.10
|
| Rate for Payer: PacificSource Commercial |
$2,155.50
|
| Rate for Payer: PHCS PPO |
$2,275.25
|
| Rate for Payer: Three Rivers PPO |
$1,796.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.23
|
| Rate for Payer: United Healthcare Commercial |
$2,275.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,035.75
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$1,382.00
|
|
|
Service Code
|
HCPCS 57100
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$1,382.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,354.36
|
| Rate for Payer: Aetna of WY Medicare |
$62.47
|
| Rate for Payer: Beech Street Commercial |
$1,312.90
|
| Rate for Payer: Cash Price |
$967.40
|
| Rate for Payer: Cash Price |
$967.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,340.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,354.36
|
| Rate for Payer: First Choice Health Commercial |
$1,243.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,312.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.47
|
| Rate for Payer: HealthUtah PPO |
$1,382.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,340.54
|
| Rate for Payer: Multiplan Medicare/VA |
$53.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,354.36
|
| Rate for Payer: PacificSource Commercial |
$1,243.80
|
| Rate for Payer: PHCS PPO |
$1,312.90
|
| Rate for Payer: Three Rivers PPO |
$1,036.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.47
|
| Rate for Payer: United Healthcare Commercial |
$1,312.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,174.70
|
|
|
BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 40808
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$86.97
|
| Rate for Payer: Beech Street Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.97
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$73.92
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$361.00
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$86.97
|
| Rate for Payer: United Healthcare Commercial |
$361.00
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
|
|
BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$595.84
|
| Rate for Payer: Aetna of WY Medicare |
$56.42
|
| Rate for Payer: Beech Street Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$589.76
|
| Rate for Payer: Cigna of WY Commercial |
$595.84
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$577.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.42
|
| Rate for Payer: HealthUtah PPO |
$608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$589.76
|
| Rate for Payer: Multiplan Medicare/VA |
$47.96
|
| Rate for Payer: One Health Plan of WY PPO |
$595.84
|
| Rate for Payer: PacificSource Commercial |
$547.20
|
| Rate for Payer: PHCS PPO |
$577.60
|
| Rate for Payer: Three Rivers PPO |
$456.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.42
|
| Rate for Payer: United Healthcare Commercial |
$577.60
|
| Rate for Payer: WINHealth Partners Commercial |
$516.80
|
|
|
BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.64
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$254.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$259.96
|
| Rate for Payer: Cigna of WY Commercial |
$262.64
|
| Rate for Payer: First Choice Health Commercial |
$241.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$268.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$259.96
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$262.64
|
| Rate for Payer: PacificSource Commercial |
$241.20
|
| Rate for Payer: PHCS PPO |
$254.60
|
| Rate for Payer: Three Rivers PPO |
$201.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: WINHealth Partners Commercial |
$227.80
|
|
|
BIOSURGE BONE GRAFT KIT
|
Facility
|
IP
|
$6,125.00
|
|
| Hospital Charge Code |
3004387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.44 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,002.50
|
| Rate for Payer: Aetna of WY Medicare |
$3,920.00
|
| Rate for Payer: Altius Commercial |
$5,880.00
|
| Rate for Payer: Beech Street Commercial |
$6,002.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,941.25
|
| Rate for Payer: Cash Price |
$4,287.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,941.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,002.50
|
| Rate for Payer: Entrust Commercial |
$5,818.75
|
| Rate for Payer: First Choice Health Commercial |
$5,818.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,818.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,736.25
|
| Rate for Payer: HealthUtah PPO |
$6,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,941.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,549.44
|
| Rate for Payer: One Health Plan of WY PPO |
$6,002.50
|
| Rate for Payer: PacificSource Commercial |
$5,512.50
|
| Rate for Payer: PHCS PPO |
$6,002.50
|
| Rate for Payer: Three Rivers PPO |
$4,593.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,736.25
|
| Rate for Payer: United Healthcare Commercial |
$5,849.38
|
| Rate for Payer: United Healthcare Medicare |
$3,736.25
|
| Rate for Payer: WINHealth Partners Commercial |
$5,818.75
|
| Rate for Payer: Wise Provider Network Commercial |
$5,818.75
|
|
|
BIOSURGE BONE GRAFT KIT
|
Facility
|
OP
|
$6,125.00
|
|
| Hospital Charge Code |
3004387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,316.69 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,002.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,042.50
|
| Rate for Payer: Altius Commercial |
$5,880.00
|
| Rate for Payer: Beech Street Commercial |
$6,002.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,941.25
|
| Rate for Payer: Cash Price |
$4,287.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,941.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,002.50
|
| Rate for Payer: Entrust Commercial |
$5,818.75
|
| Rate for Payer: First Choice Health Commercial |
$5,818.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,818.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,491.25
|
| Rate for Payer: HealthUtah PPO |
$6,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,941.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,316.69
|
| Rate for Payer: One Health Plan of WY PPO |
$6,002.50
|
| Rate for Payer: PacificSource Commercial |
$5,512.50
|
| Rate for Payer: PHCS PPO |
$6,002.50
|
| Rate for Payer: Three Rivers PPO |
$4,593.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,491.25
|
| Rate for Payer: United Healthcare Commercial |
$5,849.38
|
| Rate for Payer: United Healthcare Medicare |
$3,491.25
|
| Rate for Payer: WINHealth Partners Commercial |
$6,002.50
|
| Rate for Payer: Wise Provider Network Commercial |
$5,818.75
|
|
|
BIOTENODESIS DISP KT AR-1676DS
|
Facility
|
OP
|
$797.16
|
|
| Hospital Charge Code |
2650502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.66 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$526.13
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$773.25
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.38
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$431.66
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$454.38
|
| Rate for Payer: United Healthcare Commercial |
$761.29
|
| Rate for Payer: United Healthcare Medicare |
$454.38
|
| Rate for Payer: WINHealth Partners Commercial |
$781.22
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
BIOTENODESIS DISP KT AR-1676DS
|
Facility
|
IP
|
$797.16
|
|
| Hospital Charge Code |
2650502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.95 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$510.18
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$773.25
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.27
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$461.95
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$486.27
|
| Rate for Payer: United Healthcare Commercial |
$761.29
|
| Rate for Payer: United Healthcare Medicare |
$486.27
|
| Rate for Payer: WINHealth Partners Commercial |
$757.30
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
BIOTIN 5,000 MCG DISINTEGRATING TABLET [147504]
|
Facility
|
OP
|
$15.35
|
|
|
Service Code
|
NDC 4009310118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.04
|
| Rate for Payer: Aetna of WY Medicare |
$10.13
|
| Rate for Payer: Altius Commercial |
$14.74
|
| Rate for Payer: Beech Street Commercial |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.89
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$15.04
|
| Rate for Payer: Entrust Commercial |
$14.58
|
| Rate for Payer: First Choice Health Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.75
|
| Rate for Payer: HealthUtah PPO |
$15.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.89
|
| Rate for Payer: Multiplan Medicare/VA |
$8.31
|
| Rate for Payer: One Health Plan of WY PPO |
$15.04
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.04
|
| Rate for Payer: Three Rivers PPO |
$11.51
|
| Rate for Payer: TriWest Veterans Administration |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Medicare |
$8.75
|
| Rate for Payer: WINHealth Partners Commercial |
$15.04
|
| Rate for Payer: Wise Provider Network Commercial |
$14.58
|
|
|
BIOTIN 5,000 MCG DISINTEGRATING TABLET [147504]
|
Facility
|
IP
|
$15.35
|
|
|
Service Code
|
NDC 4009310118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.04
|
| Rate for Payer: Aetna of WY Medicare |
$9.82
|
| Rate for Payer: Altius Commercial |
$14.74
|
| Rate for Payer: Beech Street Commercial |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.89
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$15.04
|
| Rate for Payer: Entrust Commercial |
$14.58
|
| Rate for Payer: First Choice Health Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.36
|
| Rate for Payer: HealthUtah PPO |
$15.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.89
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.04
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.04
|
| Rate for Payer: Three Rivers PPO |
$11.51
|
| Rate for Payer: TriWest Veterans Administration |
$9.36
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Medicare |
$9.36
|
| Rate for Payer: WINHealth Partners Commercial |
$14.58
|
| Rate for Payer: Wise Provider Network Commercial |
$14.58
|
|
