|
LAP CHOLE PACK
|
Facility
|
OP
|
$274.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$274.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.14
|
| Rate for Payer: Aetna of WY Medicare |
$181.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$263.64
|
| Rate for Payer: Altius Commercial |
$263.64
|
| Rate for Payer: Beech Street Commercial |
$269.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.47
|
| Rate for Payer: Cash Price |
$192.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.39
|
| Rate for Payer: Cigna of WY Commercial |
$269.14
|
| Rate for Payer: Entrust Commercial |
$260.90
|
| Rate for Payer: First Choice Health Commercial |
$260.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.29
|
| Rate for Payer: HealthUtah PPO |
$274.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.39
|
| Rate for Payer: Multiplan Medicare/VA |
$151.32
|
| Rate for Payer: One Health Plan of WY PPO |
$269.14
|
| Rate for Payer: PacificSource Commercial |
$247.17
|
| Rate for Payer: PHCS PPO |
$269.14
|
| Rate for Payer: Three Rivers PPO |
$205.97
|
| Rate for Payer: TriWest Veterans Administration |
$159.29
|
| Rate for Payer: United Healthcare Commercial |
$238.93
|
| Rate for Payer: United Healthcare Medicare |
$159.29
|
| Rate for Payer: WINHealth Partners Commercial |
$269.14
|
| Rate for Payer: Wise Provider Network Commercial |
$260.90
|
|
|
LAP CHOLE PACK
|
Facility
|
IP
|
$274.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$274.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$263.64
|
| Rate for Payer: Altius Commercial |
$263.64
|
| Rate for Payer: Beech Street Commercial |
$269.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.47
|
| Rate for Payer: Cash Price |
$192.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.39
|
| Rate for Payer: Cigna of WY Commercial |
$269.14
|
| Rate for Payer: Entrust Commercial |
$260.90
|
| Rate for Payer: First Choice Health Commercial |
$260.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.26
|
| Rate for Payer: HealthUtah PPO |
$274.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.39
|
| Rate for Payer: Multiplan Medicare/VA |
$172.19
|
| Rate for Payer: One Health Plan of WY PPO |
$269.14
|
| Rate for Payer: PacificSource Commercial |
$247.17
|
| Rate for Payer: PHCS PPO |
$269.14
|
| Rate for Payer: Three Rivers PPO |
$205.97
|
| Rate for Payer: TriWest Veterans Administration |
$181.26
|
| Rate for Payer: United Healthcare Commercial |
$238.93
|
| Rate for Payer: United Healthcare Medicare |
$181.26
|
| Rate for Payer: WINHealth Partners Commercial |
$260.90
|
| Rate for Payer: Wise Provider Network Commercial |
$260.90
|
|
|
LAP RHRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,816.00
|
|
|
Service Code
|
HCPCS 49653
|
| Hospital Charge Code |
49653
|
| Min. Negotiated Rate |
$3,612.00 |
| Max. Negotiated Rate |
$4,816.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,719.68
|
| Rate for Payer: Beech Street Commercial |
$4,575.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,671.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,719.68
|
| Rate for Payer: First Choice Health Commercial |
$4,334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,575.20
|
| Rate for Payer: HealthUtah PPO |
$4,816.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,671.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,719.68
|
| Rate for Payer: PacificSource Commercial |
$4,334.40
|
| Rate for Payer: PHCS PPO |
$4,575.20
|
| Rate for Payer: Three Rivers PPO |
$3,612.00
|
| Rate for Payer: United Healthcare Commercial |
$4,189.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,093.60
|
|
|
LAP RHRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,816.00
|
|
|
Service Code
|
HCPCS 49653 AS
|
| Hospital Charge Code |
49653
|
| Min. Negotiated Rate |
$3,612.00 |
| Max. Negotiated Rate |
$4,816.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,719.68
|
| Rate for Payer: Beech Street Commercial |
$4,575.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,671.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,719.68
|
| Rate for Payer: First Choice Health Commercial |
$4,334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,575.20
|
| Rate for Payer: HealthUtah PPO |
$4,816.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,671.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,719.68
|
| Rate for Payer: PacificSource Commercial |
$4,334.40
|
| Rate for Payer: PHCS PPO |
$4,575.20
|
| Rate for Payer: Three Rivers PPO |
$3,612.00
|
| Rate for Payer: United Healthcare Commercial |
$4,189.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,093.60
|
|
|
LAP RHRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,816.00
|
|
|
Service Code
|
HCPCS 49653 80
|
| Hospital Charge Code |
49653
|
| Min. Negotiated Rate |
$3,612.00 |
| Max. Negotiated Rate |
$4,816.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,719.68
|
| Rate for Payer: Beech Street Commercial |
$4,575.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,671.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,719.68
|
| Rate for Payer: First Choice Health Commercial |
$4,334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,575.20
|
| Rate for Payer: HealthUtah PPO |
$4,816.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,671.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,719.68
|
| Rate for Payer: PacificSource Commercial |
$4,334.40
|
| Rate for Payer: PHCS PPO |
$4,575.20
|
| Rate for Payer: Three Rivers PPO |
$3,612.00
|
| Rate for Payer: United Healthcare Commercial |
$4,189.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,093.60
|
|
|
LAPROSCOPIC L-HOOK ELECT 36CM
|
Facility
|
IP
|
$155.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$155.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.60
|
| Rate for Payer: Altius Commercial |
$149.60
|
| Rate for Payer: Beech Street Commercial |
$152.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.94
|
| Rate for Payer: Cash Price |
$109.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.16
|
| Rate for Payer: Cigna of WY Commercial |
$152.71
|
| Rate for Payer: Entrust Commercial |
$148.04
|
| Rate for Payer: First Choice Health Commercial |
$148.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.85
|
| Rate for Payer: HealthUtah PPO |
$155.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.16
|
| Rate for Payer: Multiplan Medicare/VA |
$97.71
|
| Rate for Payer: One Health Plan of WY PPO |
$152.71
|
| Rate for Payer: PacificSource Commercial |
$140.25
|
| Rate for Payer: PHCS PPO |
$152.71
|
| Rate for Payer: Three Rivers PPO |
$116.87
|
| Rate for Payer: TriWest Veterans Administration |
$102.85
|
| Rate for Payer: United Healthcare Commercial |
$135.57
|
| Rate for Payer: United Healthcare Medicare |
$102.85
|
| Rate for Payer: WINHealth Partners Commercial |
$148.04
|
| Rate for Payer: Wise Provider Network Commercial |
$148.04
|
|
|
LAPROSCOPIC L-HOOK ELECT 36CM
|
Facility
|
OP
|
$155.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$155.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.71
|
| Rate for Payer: Aetna of WY Medicare |
$102.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.60
|
| Rate for Payer: Altius Commercial |
$149.60
|
| Rate for Payer: Beech Street Commercial |
$152.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.94
|
| Rate for Payer: Cash Price |
$109.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.16
|
| Rate for Payer: Cigna of WY Commercial |
$152.71
|
| Rate for Payer: Entrust Commercial |
$148.04
|
| Rate for Payer: First Choice Health Commercial |
$148.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.38
|
| Rate for Payer: HealthUtah PPO |
$155.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.16
|
| Rate for Payer: Multiplan Medicare/VA |
$85.86
|
| Rate for Payer: One Health Plan of WY PPO |
$152.71
|
| Rate for Payer: PacificSource Commercial |
$140.25
|
| Rate for Payer: PHCS PPO |
$152.71
|
| Rate for Payer: Three Rivers PPO |
$116.87
|
| Rate for Payer: TriWest Veterans Administration |
$90.38
|
| Rate for Payer: United Healthcare Commercial |
$135.57
|
| Rate for Payer: United Healthcare Medicare |
$90.38
|
| Rate for Payer: WINHealth Partners Commercial |
$152.71
|
| Rate for Payer: Wise Provider Network Commercial |
$148.04
|
|
|
LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 49320 AS
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$267.79 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$315.05
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.05
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$267.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$315.05
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$315.05
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 49320 80
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$267.79 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$315.05
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.05
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$267.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$315.05
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$315.05
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$267.79 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$315.05
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.05
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$267.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$315.05
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$315.05
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,749.00
|
|
|
Service Code
|
HCPCS 44227 80
|
| Hospital Charge Code |
44227
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$7,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,594.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,563.17
|
| Rate for Payer: Beech Street Commercial |
$7,361.55
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,516.53
|
| Rate for Payer: Cigna of WY Commercial |
$7,594.02
|
| Rate for Payer: First Choice Health Commercial |
$6,974.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,361.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,563.17
|
| Rate for Payer: HealthUtah PPO |
$7,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,516.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,328.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,594.02
|
| Rate for Payer: PacificSource Commercial |
$6,974.10
|
| Rate for Payer: PHCS PPO |
$7,361.55
|
| Rate for Payer: Three Rivers PPO |
$5,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,563.17
|
| Rate for Payer: United Healthcare Commercial |
$6,741.63
|
| Rate for Payer: United Healthcare Medicare |
$1,563.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6,586.65
|
|
|
LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,749.00
|
|
|
Service Code
|
HCPCS 44227 81
|
| Hospital Charge Code |
44227
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$7,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,594.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,563.17
|
| Rate for Payer: Beech Street Commercial |
$7,361.55
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,516.53
|
| Rate for Payer: Cigna of WY Commercial |
$7,594.02
|
| Rate for Payer: First Choice Health Commercial |
$6,974.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,361.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,563.17
|
| Rate for Payer: HealthUtah PPO |
$7,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,516.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,328.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,594.02
|
| Rate for Payer: PacificSource Commercial |
$6,974.10
|
| Rate for Payer: PHCS PPO |
$7,361.55
|
| Rate for Payer: Three Rivers PPO |
$5,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,563.17
|
| Rate for Payer: United Healthcare Commercial |
$6,741.63
|
| Rate for Payer: United Healthcare Medicare |
$1,563.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6,586.65
|
|
|
LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,749.00
|
|
|
Service Code
|
HCPCS 44227 AS
|
| Hospital Charge Code |
44227
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$7,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,594.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,563.17
|
| Rate for Payer: Beech Street Commercial |
$7,361.55
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,516.53
|
| Rate for Payer: Cigna of WY Commercial |
$7,594.02
|
| Rate for Payer: First Choice Health Commercial |
$6,974.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,361.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,563.17
|
| Rate for Payer: HealthUtah PPO |
$7,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,516.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,328.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,594.02
|
| Rate for Payer: PacificSource Commercial |
$6,974.10
|
| Rate for Payer: PHCS PPO |
$7,361.55
|
| Rate for Payer: Three Rivers PPO |
$5,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,563.17
|
| Rate for Payer: United Healthcare Commercial |
$6,741.63
|
| Rate for Payer: United Healthcare Medicare |
$1,563.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6,586.65
|
|
|
LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,749.00
|
|
|
Service Code
|
HCPCS 44227
|
| Hospital Charge Code |
44227
|
| Min. Negotiated Rate |
$1,328.69 |
| Max. Negotiated Rate |
$7,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,594.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,563.17
|
| Rate for Payer: Beech Street Commercial |
$7,361.55
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: Cash Price |
$5,424.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,516.53
|
| Rate for Payer: Cigna of WY Commercial |
$7,594.02
|
| Rate for Payer: First Choice Health Commercial |
$6,974.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,361.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,563.17
|
| Rate for Payer: HealthUtah PPO |
$7,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,516.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,328.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,594.02
|
| Rate for Payer: PacificSource Commercial |
$6,974.10
|
| Rate for Payer: PHCS PPO |
$7,361.55
|
| Rate for Payer: Three Rivers PPO |
$5,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,563.17
|
| Rate for Payer: United Healthcare Commercial |
$6,741.63
|
| Rate for Payer: United Healthcare Medicare |
$1,563.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6,586.65
|
|
|
LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$10,229.00
|
|
|
Service Code
|
HCPCS 44208
|
| Hospital Charge Code |
44208
|
| Min. Negotiated Rate |
$1,582.22 |
| Max. Negotiated Rate |
$10,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,024.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,861.44
|
| Rate for Payer: Beech Street Commercial |
$9,717.55
|
| Rate for Payer: Cash Price |
$7,160.30
|
| Rate for Payer: Cash Price |
$7,160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,922.13
|
| Rate for Payer: Cigna of WY Commercial |
$10,024.42
|
| Rate for Payer: First Choice Health Commercial |
$9,206.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,717.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,861.44
|
| Rate for Payer: HealthUtah PPO |
$10,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,922.13
|
| Rate for Payer: Multiplan Medicare/VA |
$1,582.22
|
| Rate for Payer: One Health Plan of WY PPO |
$10,024.42
|
| Rate for Payer: PacificSource Commercial |
$9,206.10
|
| Rate for Payer: PHCS PPO |
$9,717.55
|
| Rate for Payer: Three Rivers PPO |
$7,671.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,861.44
|
| Rate for Payer: United Healthcare Commercial |
$8,899.23
|
| Rate for Payer: United Healthcare Medicare |
$1,861.44
|
| Rate for Payer: WINHealth Partners Commercial |
$8,694.65
|
|
|
LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 58662
|
| Hospital Charge Code |
58662
|
| Min. Negotiated Rate |
$583.50 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,613.26
|
| Rate for Payer: Aetna of WY Medicare |
$686.47
|
| Rate for Payer: Beech Street Commercial |
$3,502.65
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,576.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,613.26
|
| Rate for Payer: First Choice Health Commercial |
$3,318.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,502.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.47
|
| Rate for Payer: HealthUtah PPO |
$3,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,576.39
|
| Rate for Payer: Multiplan Medicare/VA |
$583.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,613.26
|
| Rate for Payer: PacificSource Commercial |
$3,318.30
|
| Rate for Payer: PHCS PPO |
$3,502.65
|
| Rate for Payer: Three Rivers PPO |
$2,765.25
|
| Rate for Payer: TriWest Veterans Administration |
$686.47
|
| Rate for Payer: United Healthcare Commercial |
$3,207.69
|
| Rate for Payer: United Healthcare Medicare |
$686.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,133.95
|
|
|
LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 58662 AS
|
| Hospital Charge Code |
58662
|
| Min. Negotiated Rate |
$583.50 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,613.26
|
| Rate for Payer: Aetna of WY Medicare |
$686.47
|
| Rate for Payer: Beech Street Commercial |
$3,502.65
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,576.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,613.26
|
| Rate for Payer: First Choice Health Commercial |
$3,318.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,502.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.47
|
| Rate for Payer: HealthUtah PPO |
$3,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,576.39
|
| Rate for Payer: Multiplan Medicare/VA |
$583.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,613.26
|
| Rate for Payer: PacificSource Commercial |
$3,318.30
|
| Rate for Payer: PHCS PPO |
$3,502.65
|
| Rate for Payer: Three Rivers PPO |
$2,765.25
|
| Rate for Payer: TriWest Veterans Administration |
$686.47
|
| Rate for Payer: United Healthcare Commercial |
$3,207.69
|
| Rate for Payer: United Healthcare Medicare |
$686.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,133.95
|
|
|
LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 58662 80
|
| Hospital Charge Code |
58662
|
| Min. Negotiated Rate |
$583.50 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,613.26
|
| Rate for Payer: Aetna of WY Medicare |
$686.47
|
| Rate for Payer: Beech Street Commercial |
$3,502.65
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: Cash Price |
$2,580.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,576.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,613.26
|
| Rate for Payer: First Choice Health Commercial |
$3,318.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,502.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.47
|
| Rate for Payer: HealthUtah PPO |
$3,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,576.39
|
| Rate for Payer: Multiplan Medicare/VA |
$583.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,613.26
|
| Rate for Payer: PacificSource Commercial |
$3,318.30
|
| Rate for Payer: PHCS PPO |
$3,502.65
|
| Rate for Payer: Three Rivers PPO |
$2,765.25
|
| Rate for Payer: TriWest Veterans Administration |
$686.47
|
| Rate for Payer: United Healthcare Commercial |
$3,207.69
|
| Rate for Payer: United Healthcare Medicare |
$686.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,133.95
|
|
|
LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 43770
|
| Hospital Charge Code |
43770
|
| Min. Negotiated Rate |
$909.41 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.89
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.89
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$909.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.89
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$1,069.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 43770 AS
|
| Hospital Charge Code |
43770
|
| Min. Negotiated Rate |
$909.41 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.89
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.89
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$909.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.89
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$1,069.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 43770 80
|
| Hospital Charge Code |
43770
|
| Min. Negotiated Rate |
$909.41 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.89
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.89
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$909.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.89
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$1,069.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 43772 AS
|
| Hospital Charge Code |
43772
|
| Min. Negotiated Rate |
$766.05 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$901.23
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.23
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$766.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$901.23
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$901.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 43772 80
|
| Hospital Charge Code |
43772
|
| Min. Negotiated Rate |
$766.05 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$901.23
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.23
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$766.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$901.23
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$901.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 43772
|
| Hospital Charge Code |
43772
|
| Min. Negotiated Rate |
$766.05 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$901.23
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.23
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$766.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$901.23
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$901.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 43774 AS
|
| Hospital Charge Code |
43774
|
| Min. Negotiated Rate |
$775.16 |
| Max. Negotiated Rate |
$3,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,188.92
|
| Rate for Payer: Aetna of WY Medicare |
$911.95
|
| Rate for Payer: Beech Street Commercial |
$3,091.30
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,156.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,188.92
|
| Rate for Payer: First Choice Health Commercial |
$2,928.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,091.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$911.95
|
| Rate for Payer: HealthUtah PPO |
$3,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,156.38
|
| Rate for Payer: Multiplan Medicare/VA |
$775.16
|
| Rate for Payer: One Health Plan of WY PPO |
$3,188.92
|
| Rate for Payer: PacificSource Commercial |
$2,928.60
|
| Rate for Payer: PHCS PPO |
$3,091.30
|
| Rate for Payer: Three Rivers PPO |
$2,440.50
|
| Rate for Payer: TriWest Veterans Administration |
$911.95
|
| Rate for Payer: United Healthcare Commercial |
$2,830.98
|
| Rate for Payer: United Healthcare Medicare |
$911.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,765.90
|
|
