|
LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,407.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$979.33 |
| Max. Negotiated Rate |
$2,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,358.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,152.15
|
| Rate for Payer: Beech Street Commercial |
$2,286.65
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,334.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,358.86
|
| Rate for Payer: First Choice Health Commercial |
$2,166.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,286.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,152.15
|
| Rate for Payer: HealthUtah PPO |
$2,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,334.79
|
| Rate for Payer: Multiplan Medicare/VA |
$979.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,358.86
|
| Rate for Payer: PacificSource Commercial |
$2,166.30
|
| Rate for Payer: PHCS PPO |
$2,286.65
|
| Rate for Payer: Three Rivers PPO |
$1,805.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,152.15
|
| Rate for Payer: United Healthcare Commercial |
$2,094.09
|
| Rate for Payer: United Healthcare Medicare |
$1,152.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,045.95
|
|
|
LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,407.00
|
|
|
Service Code
|
HCPCS 44188 80
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$979.33 |
| Max. Negotiated Rate |
$2,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,358.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,152.15
|
| Rate for Payer: Beech Street Commercial |
$2,286.65
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,334.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,358.86
|
| Rate for Payer: First Choice Health Commercial |
$2,166.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,286.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,152.15
|
| Rate for Payer: HealthUtah PPO |
$2,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,334.79
|
| Rate for Payer: Multiplan Medicare/VA |
$979.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,358.86
|
| Rate for Payer: PacificSource Commercial |
$2,166.30
|
| Rate for Payer: PHCS PPO |
$2,286.65
|
| Rate for Payer: Three Rivers PPO |
$1,805.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,152.15
|
| Rate for Payer: United Healthcare Commercial |
$2,094.09
|
| Rate for Payer: United Healthcare Medicare |
$1,152.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,045.95
|
|
|
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY
|
Professional
|
Both
|
$7,393.00
|
|
|
Service Code
|
HCPCS 44201 80
|
| Hospital Charge Code |
44201
|
| Min. Negotiated Rate |
$5,544.75 |
| Max. Negotiated Rate |
$7,393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,245.14
|
| Rate for Payer: Beech Street Commercial |
$7,023.35
|
| Rate for Payer: Cash Price |
$5,175.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,171.21
|
| Rate for Payer: Cigna of WY Commercial |
$7,245.14
|
| Rate for Payer: First Choice Health Commercial |
$6,653.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,023.35
|
| Rate for Payer: HealthUtah PPO |
$7,393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,171.21
|
| Rate for Payer: One Health Plan of WY PPO |
$7,245.14
|
| Rate for Payer: PacificSource Commercial |
$6,653.70
|
| Rate for Payer: PHCS PPO |
$7,023.35
|
| Rate for Payer: Three Rivers PPO |
$5,544.75
|
| Rate for Payer: United Healthcare Commercial |
$6,431.91
|
| Rate for Payer: WINHealth Partners Commercial |
$6,284.05
|
|
|
LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 49650 AS
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,180.50
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,158.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,180.50
|
| Rate for Payer: First Choice Health Commercial |
$2,002.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,113.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$2,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,158.25
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,180.50
|
| Rate for Payer: PacificSource Commercial |
$2,002.50
|
| Rate for Payer: PHCS PPO |
$2,113.75
|
| Rate for Payer: Three Rivers PPO |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$1,935.75
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,891.25
|
|
|
LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,180.50
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,158.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,180.50
|
| Rate for Payer: First Choice Health Commercial |
$2,002.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,113.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$2,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,158.25
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,180.50
|
| Rate for Payer: PacificSource Commercial |
$2,002.50
|
| Rate for Payer: PHCS PPO |
$2,113.75
|
| Rate for Payer: Three Rivers PPO |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$1,935.75
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,891.25
|
|
|
LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 49650 80
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,180.50
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,158.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,180.50
|
| Rate for Payer: First Choice Health Commercial |
$2,002.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,113.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$2,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,158.25
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,180.50
|
| Rate for Payer: PacificSource Commercial |
$2,002.50
|
| Rate for Payer: PHCS PPO |
$2,113.75
|
| Rate for Payer: Three Rivers PPO |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$1,935.75
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,891.25
|
|
|
LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$4,451.00
|
|
|
Service Code
|
HCPCS 49650 50
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$353.46 |
| Max. Negotiated Rate |
$4,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,361.98
|
| Rate for Payer: Aetna of WY Medicare |
$415.84
|
| Rate for Payer: Beech Street Commercial |
$4,228.45
|
| Rate for Payer: Cash Price |
$3,115.70
|
| Rate for Payer: Cash Price |
$3,115.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,317.47
|
| Rate for Payer: Cigna of WY Commercial |
$4,361.98
|
| Rate for Payer: First Choice Health Commercial |
$4,005.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,228.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.84
|
| Rate for Payer: HealthUtah PPO |
$4,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,317.47
|
| Rate for Payer: Multiplan Medicare/VA |
$353.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,361.98
|
| Rate for Payer: PacificSource Commercial |
$4,005.90
|
| Rate for Payer: PHCS PPO |
$4,228.45
|
| Rate for Payer: Three Rivers PPO |
$3,338.25
|
| Rate for Payer: TriWest Veterans Administration |
$415.84
|
| Rate for Payer: United Healthcare Commercial |
$3,872.37
|
| Rate for Payer: United Healthcare Medicare |
$415.84
|
| Rate for Payer: WINHealth Partners Commercial |
$3,783.35
|
|
|
LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 49321 80
|
| Hospital Charge Code |
49321
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.79
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.79
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$280.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$329.79
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$329.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 49321 59
|
| Hospital Charge Code |
49321
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.79
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.79
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$280.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$329.79
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$329.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
49321
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.79
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.79
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$280.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$329.79
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$329.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
HCPCS 49321 AS
|
| Hospital Charge Code |
49321
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$1,719.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,684.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.79
|
| Rate for Payer: Beech Street Commercial |
$1,633.05
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,667.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,684.62
|
| Rate for Payer: First Choice Health Commercial |
$1,547.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,633.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.79
|
| Rate for Payer: HealthUtah PPO |
$1,719.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,667.43
|
| Rate for Payer: Multiplan Medicare/VA |
$280.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,684.62
|
| Rate for Payer: PacificSource Commercial |
$1,547.10
|
| Rate for Payer: PHCS PPO |
$1,633.05
|
| Rate for Payer: Three Rivers PPO |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration |
$329.79
|
| Rate for Payer: United Healthcare Commercial |
$1,495.53
|
| Rate for Payer: United Healthcare Medicare |
$329.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,461.15
|
|
|
LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$4,246.00
|
|
|
Service Code
|
HCPCS 58573
|
| Hospital Charge Code |
58573
|
| Min. Negotiated Rate |
$996.37 |
| Max. Negotiated Rate |
$4,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,161.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,172.20
|
| Rate for Payer: Beech Street Commercial |
$4,033.70
|
| Rate for Payer: Cash Price |
$2,972.20
|
| Rate for Payer: Cash Price |
$2,972.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,118.62
|
| Rate for Payer: Cigna of WY Commercial |
$4,161.08
|
| Rate for Payer: First Choice Health Commercial |
$3,821.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,033.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,172.20
|
| Rate for Payer: HealthUtah PPO |
$4,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,118.62
|
| Rate for Payer: Multiplan Medicare/VA |
$996.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4,161.08
|
| Rate for Payer: PacificSource Commercial |
$3,821.40
|
| Rate for Payer: PHCS PPO |
$4,033.70
|
| Rate for Payer: Three Rivers PPO |
$3,184.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,172.20
|
| Rate for Payer: United Healthcare Commercial |
$3,694.02
|
| Rate for Payer: United Healthcare Medicare |
$1,172.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,609.10
|
|
|
LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 51990
|
| Hospital Charge Code |
51990
|
| Min. Negotiated Rate |
$606.24 |
| Max. Negotiated Rate |
$2,959.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,899.82
|
| Rate for Payer: Aetna of WY Medicare |
$713.22
|
| Rate for Payer: Beech Street Commercial |
$2,811.05
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: Cash Price |
$2,071.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,870.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,899.82
|
| Rate for Payer: First Choice Health Commercial |
$2,663.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,811.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$713.22
|
| Rate for Payer: HealthUtah PPO |
$2,959.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,870.23
|
| Rate for Payer: Multiplan Medicare/VA |
$606.24
|
| Rate for Payer: One Health Plan of WY PPO |
$2,899.82
|
| Rate for Payer: PacificSource Commercial |
$2,663.10
|
| Rate for Payer: PHCS PPO |
$2,811.05
|
| Rate for Payer: Three Rivers PPO |
$2,219.25
|
| Rate for Payer: TriWest Veterans Administration |
$713.22
|
| Rate for Payer: United Healthcare Commercial |
$2,574.33
|
| Rate for Payer: United Healthcare Medicare |
$713.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,515.15
|
|
|
LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS 58660
|
| Hospital Charge Code |
58660
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Aetna of WY Medicare |
$656.94
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.94
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: Multiplan Medicare/VA |
$558.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: TriWest Veterans Administration |
$656.94
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: United Healthcare Medicare |
$656.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3,821.60
|
|
|
LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS 58660 AS
|
| Hospital Charge Code |
58660
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Aetna of WY Medicare |
$656.94
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.94
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: Multiplan Medicare/VA |
$558.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: TriWest Veterans Administration |
$656.94
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: United Healthcare Medicare |
$656.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3,821.60
|
|
|
LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS 58660 80
|
| Hospital Charge Code |
58660
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Aetna of WY Medicare |
$656.94
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.94
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: Multiplan Medicare/VA |
$558.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: TriWest Veterans Administration |
$656.94
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: United Healthcare Medicare |
$656.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3,821.60
|
|
|
LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$5,882.00
|
|
|
Service Code
|
HCPCS 58671
|
| Hospital Charge Code |
58671
|
| Min. Negotiated Rate |
$305.78 |
| Max. Negotiated Rate |
$5,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,764.36
|
| Rate for Payer: Aetna of WY Medicare |
$359.74
|
| Rate for Payer: Beech Street Commercial |
$5,587.90
|
| Rate for Payer: Cash Price |
$4,117.40
|
| Rate for Payer: Cash Price |
$4,117.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,705.54
|
| Rate for Payer: Cigna of WY Commercial |
$5,764.36
|
| Rate for Payer: First Choice Health Commercial |
$5,293.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,587.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.74
|
| Rate for Payer: HealthUtah PPO |
$5,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,705.54
|
| Rate for Payer: Multiplan Medicare/VA |
$305.78
|
| Rate for Payer: One Health Plan of WY PPO |
$5,764.36
|
| Rate for Payer: PacificSource Commercial |
$5,293.80
|
| Rate for Payer: PHCS PPO |
$5,587.90
|
| Rate for Payer: Three Rivers PPO |
$4,411.50
|
| Rate for Payer: TriWest Veterans Administration |
$359.74
|
| Rate for Payer: United Healthcare Commercial |
$5,117.34
|
| Rate for Payer: United Healthcare Medicare |
$359.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4,999.70
|
|
|
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 58661 80
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 58661 AS
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$6,742.00
|
|
|
Service Code
|
HCPCS 58661 50
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$532.96 |
| Max. Negotiated Rate |
$6,742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,607.16
|
| Rate for Payer: Aetna of WY Medicare |
$627.01
|
| Rate for Payer: Beech Street Commercial |
$6,404.90
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,539.74
|
| Rate for Payer: Cigna of WY Commercial |
$6,607.16
|
| Rate for Payer: First Choice Health Commercial |
$6,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$627.01
|
| Rate for Payer: HealthUtah PPO |
$6,742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,539.74
|
| Rate for Payer: Multiplan Medicare/VA |
$532.96
|
| Rate for Payer: One Health Plan of WY PPO |
$6,607.16
|
| Rate for Payer: PacificSource Commercial |
$6,067.80
|
| Rate for Payer: PHCS PPO |
$6,404.90
|
| Rate for Payer: Three Rivers PPO |
$5,056.50
|
| Rate for Payer: TriWest Veterans Administration |
$627.01
|
| Rate for Payer: United Healthcare Commercial |
$5,865.54
|
| Rate for Payer: United Healthcare Medicare |
$627.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5,730.70
|
|
|
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,308.00
|
|
|
Service Code
|
HCPCS 58570
|
| Hospital Charge Code |
58570
|
| Min. Negotiated Rate |
$661.73 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,241.84
|
| Rate for Payer: Aetna of WY Medicare |
$778.51
|
| Rate for Payer: Beech Street Commercial |
$3,142.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,208.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,241.84
|
| Rate for Payer: First Choice Health Commercial |
$2,977.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,142.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.51
|
| Rate for Payer: HealthUtah PPO |
$3,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,208.76
|
| Rate for Payer: Multiplan Medicare/VA |
$661.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,241.84
|
| Rate for Payer: PacificSource Commercial |
$2,977.20
|
| Rate for Payer: PHCS PPO |
$3,142.60
|
| Rate for Payer: Three Rivers PPO |
$2,481.00
|
| Rate for Payer: TriWest Veterans Administration |
$778.51
|
| Rate for Payer: United Healthcare Commercial |
$2,877.96
|
| Rate for Payer: United Healthcare Medicare |
$778.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,811.80
|
|
|
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,308.00
|
|
|
Service Code
|
HCPCS 58570 80
|
| Hospital Charge Code |
58570
|
| Min. Negotiated Rate |
$661.73 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,241.84
|
| Rate for Payer: Aetna of WY Medicare |
$778.51
|
| Rate for Payer: Beech Street Commercial |
$3,142.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: Cash Price |
$2,315.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,208.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,241.84
|
| Rate for Payer: First Choice Health Commercial |
$2,977.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,142.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.51
|
| Rate for Payer: HealthUtah PPO |
$3,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,208.76
|
| Rate for Payer: Multiplan Medicare/VA |
$661.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,241.84
|
| Rate for Payer: PacificSource Commercial |
$2,977.20
|
| Rate for Payer: PHCS PPO |
$3,142.60
|
| Rate for Payer: Three Rivers PPO |
$2,481.00
|
| Rate for Payer: TriWest Veterans Administration |
$778.51
|
| Rate for Payer: United Healthcare Commercial |
$2,877.96
|
| Rate for Payer: United Healthcare Medicare |
$778.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,811.80
|
|
|
LAPAROTOMY PACK
|
Facility
|
OP
|
$209.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$209.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.86
|
| Rate for Payer: Aetna of WY Medicare |
$137.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$200.68
|
| Rate for Payer: Altius Commercial |
$200.68
|
| Rate for Payer: Beech Street Commercial |
$204.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$171.62
|
| Rate for Payer: Cash Price |
$146.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.77
|
| Rate for Payer: Cigna of WY Commercial |
$204.86
|
| Rate for Payer: Entrust Commercial |
$198.59
|
| Rate for Payer: First Choice Health Commercial |
$198.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.24
|
| Rate for Payer: HealthUtah PPO |
$209.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.77
|
| Rate for Payer: Multiplan Medicare/VA |
$115.18
|
| Rate for Payer: One Health Plan of WY PPO |
$204.86
|
| Rate for Payer: PacificSource Commercial |
$188.14
|
| Rate for Payer: PHCS PPO |
$204.86
|
| Rate for Payer: Three Rivers PPO |
$156.78
|
| Rate for Payer: TriWest Veterans Administration |
$121.24
|
| Rate for Payer: United Healthcare Commercial |
$181.86
|
| Rate for Payer: United Healthcare Medicare |
$121.24
|
| Rate for Payer: WINHealth Partners Commercial |
$204.86
|
| Rate for Payer: Wise Provider Network Commercial |
$198.59
|
|
|
LAPAROTOMY PACK
|
Facility
|
IP
|
$209.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.07 |
| Max. Negotiated Rate |
$209.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$200.68
|
| Rate for Payer: Altius Commercial |
$200.68
|
| Rate for Payer: Beech Street Commercial |
$204.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$171.62
|
| Rate for Payer: Cash Price |
$146.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.77
|
| Rate for Payer: Cigna of WY Commercial |
$204.86
|
| Rate for Payer: Entrust Commercial |
$198.59
|
| Rate for Payer: First Choice Health Commercial |
$198.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$137.97
|
| Rate for Payer: HealthUtah PPO |
$209.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.77
|
| Rate for Payer: Multiplan Medicare/VA |
$131.07
|
| Rate for Payer: One Health Plan of WY PPO |
$204.86
|
| Rate for Payer: PacificSource Commercial |
$188.14
|
| Rate for Payer: PHCS PPO |
$204.86
|
| Rate for Payer: Three Rivers PPO |
$156.78
|
| Rate for Payer: TriWest Veterans Administration |
$137.97
|
| Rate for Payer: United Healthcare Commercial |
$181.86
|
| Rate for Payer: United Healthcare Medicare |
$137.97
|
| Rate for Payer: WINHealth Partners Commercial |
$198.59
|
| Rate for Payer: Wise Provider Network Commercial |
$198.59
|
|
