|
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
|
|
|
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 43774 80
|
| 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
|
|
|
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$3,701.00
|
|
|
Service Code
|
HCPCS 43775 AS
|
| Hospital Charge Code |
43775
|
| Min. Negotiated Rate |
$881.54 |
| Max. Negotiated Rate |
$3,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,626.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,037.10
|
| Rate for Payer: Beech Street Commercial |
$3,515.95
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,589.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,626.98
|
| Rate for Payer: First Choice Health Commercial |
$3,330.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,515.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,037.10
|
| Rate for Payer: HealthUtah PPO |
$3,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,589.97
|
| Rate for Payer: Multiplan Medicare/VA |
$881.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,626.98
|
| Rate for Payer: PacificSource Commercial |
$3,330.90
|
| Rate for Payer: PHCS PPO |
$3,515.95
|
| Rate for Payer: Three Rivers PPO |
$2,775.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,037.10
|
| Rate for Payer: United Healthcare Commercial |
$3,219.87
|
| Rate for Payer: United Healthcare Medicare |
$1,037.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,145.85
|
|
|
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$3,701.00
|
|
|
Service Code
|
HCPCS 43775
|
| Hospital Charge Code |
43775
|
| Min. Negotiated Rate |
$881.54 |
| Max. Negotiated Rate |
$3,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,626.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,037.10
|
| Rate for Payer: Beech Street Commercial |
$3,515.95
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,589.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,626.98
|
| Rate for Payer: First Choice Health Commercial |
$3,330.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,515.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,037.10
|
| Rate for Payer: HealthUtah PPO |
$3,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,589.97
|
| Rate for Payer: Multiplan Medicare/VA |
$881.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,626.98
|
| Rate for Payer: PacificSource Commercial |
$3,330.90
|
| Rate for Payer: PHCS PPO |
$3,515.95
|
| Rate for Payer: Three Rivers PPO |
$2,775.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,037.10
|
| Rate for Payer: United Healthcare Commercial |
$3,219.87
|
| Rate for Payer: United Healthcare Medicare |
$1,037.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,145.85
|
|
|
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$3,701.00
|
|
|
Service Code
|
HCPCS 43775 80
|
| Hospital Charge Code |
43775
|
| Min. Negotiated Rate |
$881.54 |
| Max. Negotiated Rate |
$3,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,626.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,037.10
|
| Rate for Payer: Beech Street Commercial |
$3,515.95
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: Cash Price |
$2,590.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,589.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,626.98
|
| Rate for Payer: First Choice Health Commercial |
$3,330.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,515.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,037.10
|
| Rate for Payer: HealthUtah PPO |
$3,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,589.97
|
| Rate for Payer: Multiplan Medicare/VA |
$881.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,626.98
|
| Rate for Payer: PacificSource Commercial |
$3,330.90
|
| Rate for Payer: PHCS PPO |
$3,515.95
|
| Rate for Payer: Three Rivers PPO |
$2,775.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,037.10
|
| Rate for Payer: United Healthcare Commercial |
$3,219.87
|
| Rate for Payer: United Healthcare Medicare |
$1,037.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,145.85
|
|
|
LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 44213
|
| Hospital Charge Code |
44213
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Medicare |
$174.35
|
| Rate for Payer: Beech Street Commercial |
$917.70
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.02
|
| Rate for Payer: Cigna of WY Commercial |
$946.68
|
| Rate for Payer: First Choice Health Commercial |
$869.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.35
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Multiplan Medicare/VA |
$148.20
|
| Rate for Payer: One Health Plan of WY PPO |
$946.68
|
| Rate for Payer: PacificSource Commercial |
$869.40
|
| Rate for Payer: PHCS PPO |
$917.70
|
| Rate for Payer: Three Rivers PPO |
$724.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.35
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$174.35
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
|
|
LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 44213 AS
|
| Hospital Charge Code |
44213
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Medicare |
$174.35
|
| Rate for Payer: Beech Street Commercial |
$917.70
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.02
|
| Rate for Payer: Cigna of WY Commercial |
$946.68
|
| Rate for Payer: First Choice Health Commercial |
$869.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.35
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Multiplan Medicare/VA |
$148.20
|
| Rate for Payer: One Health Plan of WY PPO |
$946.68
|
| Rate for Payer: PacificSource Commercial |
$869.40
|
| Rate for Payer: PHCS PPO |
$917.70
|
| Rate for Payer: Three Rivers PPO |
$724.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.35
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$174.35
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
|
|
LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 44213 80
|
| Hospital Charge Code |
44213
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.68
|
| Rate for Payer: Aetna of WY Medicare |
$174.35
|
| Rate for Payer: Beech Street Commercial |
$917.70
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.02
|
| Rate for Payer: Cigna of WY Commercial |
$946.68
|
| Rate for Payer: First Choice Health Commercial |
$869.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.35
|
| Rate for Payer: HealthUtah PPO |
$966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.02
|
| Rate for Payer: Multiplan Medicare/VA |
$148.20
|
| Rate for Payer: One Health Plan of WY PPO |
$946.68
|
| Rate for Payer: PacificSource Commercial |
$869.40
|
| Rate for Payer: PHCS PPO |
$917.70
|
| Rate for Payer: Three Rivers PPO |
$724.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.35
|
| Rate for Payer: United Healthcare Commercial |
$840.42
|
| Rate for Payer: United Healthcare Medicare |
$174.35
|
| Rate for Payer: WINHealth Partners Commercial |
$821.10
|
|
|
LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$4,139.00
|
|
|
Service Code
|
HCPCS 58545
|
| Hospital Charge Code |
58545
|
| Min. Negotiated Rate |
$737.15 |
| Max. Negotiated Rate |
$4,139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,056.22
|
| Rate for Payer: Aetna of WY Medicare |
$867.24
|
| Rate for Payer: Beech Street Commercial |
$3,932.05
|
| Rate for Payer: Cash Price |
$2,897.30
|
| Rate for Payer: Cash Price |
$2,897.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,014.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,056.22
|
| Rate for Payer: First Choice Health Commercial |
$3,725.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,932.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.24
|
| Rate for Payer: HealthUtah PPO |
$4,139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,014.83
|
| Rate for Payer: Multiplan Medicare/VA |
$737.15
|
| Rate for Payer: One Health Plan of WY PPO |
$4,056.22
|
| Rate for Payer: PacificSource Commercial |
$3,725.10
|
| Rate for Payer: PHCS PPO |
$3,932.05
|
| Rate for Payer: Three Rivers PPO |
$3,104.25
|
| Rate for Payer: TriWest Veterans Administration |
$867.24
|
| Rate for Payer: United Healthcare Commercial |
$3,600.93
|
| Rate for Payer: United Healthcare Medicare |
$867.24
|
| Rate for Payer: WINHealth Partners Commercial |
$3,518.15
|
|
|
LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$3,856.00
|
|
|
Service Code
|
HCPCS 49652
|
| Hospital Charge Code |
49652
|
| Min. Negotiated Rate |
$2,892.00 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,778.88
|
| Rate for Payer: Beech Street Commercial |
$3,663.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,740.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,778.88
|
| Rate for Payer: First Choice Health Commercial |
$3,470.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,663.20
|
| Rate for Payer: HealthUtah PPO |
$3,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,740.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,778.88
|
| Rate for Payer: PacificSource Commercial |
$3,470.40
|
| Rate for Payer: PHCS PPO |
$3,663.20
|
| Rate for Payer: Three Rivers PPO |
$2,892.00
|
| Rate for Payer: United Healthcare Commercial |
$3,354.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.60
|
|
|
LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$3,856.00
|
|
|
Service Code
|
HCPCS 49652 AS
|
| Hospital Charge Code |
49652
|
| Min. Negotiated Rate |
$2,892.00 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,778.88
|
| Rate for Payer: Beech Street Commercial |
$3,663.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,740.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,778.88
|
| Rate for Payer: First Choice Health Commercial |
$3,470.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,663.20
|
| Rate for Payer: HealthUtah PPO |
$3,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,740.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,778.88
|
| Rate for Payer: PacificSource Commercial |
$3,470.40
|
| Rate for Payer: PHCS PPO |
$3,663.20
|
| Rate for Payer: Three Rivers PPO |
$2,892.00
|
| Rate for Payer: United Healthcare Commercial |
$3,354.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.60
|
|
|
LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$3,856.00
|
|
|
Service Code
|
HCPCS 49652 80
|
| Hospital Charge Code |
49652
|
| Min. Negotiated Rate |
$2,892.00 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,778.88
|
| Rate for Payer: Beech Street Commercial |
$3,663.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,740.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,778.88
|
| Rate for Payer: First Choice Health Commercial |
$3,470.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,663.20
|
| Rate for Payer: HealthUtah PPO |
$3,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,740.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,778.88
|
| Rate for Payer: PacificSource Commercial |
$3,470.40
|
| Rate for Payer: PHCS PPO |
$3,663.20
|
| Rate for Payer: Three Rivers PPO |
$2,892.00
|
| Rate for Payer: United Healthcare Commercial |
$3,354.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.60
|
|
|
LAPS RINCISIONAL HERNIA NCRC8/STRANGULATED
|
Professional
|
Both
|
$5,354.00
|
|
|
Service Code
|
HCPCS 49655
|
| Hospital Charge Code |
49655
|
| Min. Negotiated Rate |
$4,015.50 |
| Max. Negotiated Rate |
$5,354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,246.92
|
| Rate for Payer: Beech Street Commercial |
$5,086.30
|
| Rate for Payer: Cash Price |
$3,747.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,193.38
|
| Rate for Payer: Cigna of WY Commercial |
$5,246.92
|
| Rate for Payer: First Choice Health Commercial |
$4,818.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,086.30
|
| Rate for Payer: HealthUtah PPO |
$5,354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,193.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,246.92
|
| Rate for Payer: PacificSource Commercial |
$4,818.60
|
| Rate for Payer: PHCS PPO |
$5,086.30
|
| Rate for Payer: Three Rivers PPO |
$4,015.50
|
| Rate for Payer: United Healthcare Commercial |
$4,657.98
|
| Rate for Payer: WINHealth Partners Commercial |
$4,550.90
|
|
|
LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$7,993.00
|
|
|
Service Code
|
HCPCS 43281
|
| Hospital Charge Code |
43281
|
| Min. Negotiated Rate |
$1,229.81 |
| Max. Negotiated Rate |
$7,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,833.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,446.84
|
| Rate for Payer: Beech Street Commercial |
$7,593.35
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,753.21
|
| Rate for Payer: Cigna of WY Commercial |
$7,833.14
|
| Rate for Payer: First Choice Health Commercial |
$7,193.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,593.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,446.84
|
| Rate for Payer: HealthUtah PPO |
$7,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,753.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,229.81
|
| Rate for Payer: One Health Plan of WY PPO |
$7,833.14
|
| Rate for Payer: PacificSource Commercial |
$7,193.70
|
| Rate for Payer: PHCS PPO |
$7,593.35
|
| Rate for Payer: Three Rivers PPO |
$5,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,446.84
|
| Rate for Payer: United Healthcare Commercial |
$6,953.91
|
| Rate for Payer: United Healthcare Medicare |
$1,446.84
|
| Rate for Payer: WINHealth Partners Commercial |
$6,794.05
|
|
|
LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$7,993.00
|
|
|
Service Code
|
HCPCS 43281 80
|
| Hospital Charge Code |
43281
|
| Min. Negotiated Rate |
$1,229.81 |
| Max. Negotiated Rate |
$7,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,833.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,446.84
|
| Rate for Payer: Beech Street Commercial |
$7,593.35
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,753.21
|
| Rate for Payer: Cigna of WY Commercial |
$7,833.14
|
| Rate for Payer: First Choice Health Commercial |
$7,193.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,593.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,446.84
|
| Rate for Payer: HealthUtah PPO |
$7,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,753.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,229.81
|
| Rate for Payer: One Health Plan of WY PPO |
$7,833.14
|
| Rate for Payer: PacificSource Commercial |
$7,193.70
|
| Rate for Payer: PHCS PPO |
$7,593.35
|
| Rate for Payer: Three Rivers PPO |
$5,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,446.84
|
| Rate for Payer: United Healthcare Commercial |
$6,953.91
|
| Rate for Payer: United Healthcare Medicare |
$1,446.84
|
| Rate for Payer: WINHealth Partners Commercial |
$6,794.05
|
|
|
LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$7,993.00
|
|
|
Service Code
|
HCPCS 43281 AS
|
| Hospital Charge Code |
43281
|
| Min. Negotiated Rate |
$1,229.81 |
| Max. Negotiated Rate |
$7,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,833.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,446.84
|
| Rate for Payer: Beech Street Commercial |
$7,593.35
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: Cash Price |
$5,595.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,753.21
|
| Rate for Payer: Cigna of WY Commercial |
$7,833.14
|
| Rate for Payer: First Choice Health Commercial |
$7,193.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,593.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,446.84
|
| Rate for Payer: HealthUtah PPO |
$7,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,753.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,229.81
|
| Rate for Payer: One Health Plan of WY PPO |
$7,833.14
|
| Rate for Payer: PacificSource Commercial |
$7,193.70
|
| Rate for Payer: PHCS PPO |
$7,593.35
|
| Rate for Payer: Three Rivers PPO |
$5,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,446.84
|
| Rate for Payer: United Healthcare Commercial |
$6,953.91
|
| Rate for Payer: United Healthcare Medicare |
$1,446.84
|
| Rate for Payer: WINHealth Partners Commercial |
$6,794.05
|
|
|
LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$5,540.00
|
|
|
Service Code
|
HCPCS 58543
|
| Hospital Charge Code |
58543
|
| Min. Negotiated Rate |
$689.57 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,429.20
|
| Rate for Payer: Aetna of WY Medicare |
$811.26
|
| Rate for Payer: Beech Street Commercial |
$5,263.00
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,373.80
|
| Rate for Payer: Cigna of WY Commercial |
$5,429.20
|
| Rate for Payer: First Choice Health Commercial |
$4,986.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.26
|
| Rate for Payer: HealthUtah PPO |
$5,540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,373.80
|
| Rate for Payer: Multiplan Medicare/VA |
$689.57
|
| Rate for Payer: One Health Plan of WY PPO |
$5,429.20
|
| Rate for Payer: PacificSource Commercial |
$4,986.00
|
| Rate for Payer: PHCS PPO |
$5,263.00
|
| Rate for Payer: Three Rivers PPO |
$4,155.00
|
| Rate for Payer: TriWest Veterans Administration |
$811.26
|
| Rate for Payer: United Healthcare Commercial |
$4,819.80
|
| Rate for Payer: United Healthcare Medicare |
$811.26
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.00
|
|
|
LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$6,423.00
|
|
|
Service Code
|
HCPCS 58544
|
| Hospital Charge Code |
58544
|
| Min. Negotiated Rate |
$740.65 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,294.54
|
| Rate for Payer: Aetna of WY Medicare |
$871.35
|
| Rate for Payer: Beech Street Commercial |
$6,101.85
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: Cash Price |
$4,496.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,230.31
|
| Rate for Payer: Cigna of WY Commercial |
$6,294.54
|
| Rate for Payer: First Choice Health Commercial |
$5,780.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,101.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$871.35
|
| Rate for Payer: HealthUtah PPO |
$6,423.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,230.31
|
| Rate for Payer: Multiplan Medicare/VA |
$740.65
|
| Rate for Payer: One Health Plan of WY PPO |
$6,294.54
|
| Rate for Payer: PacificSource Commercial |
$5,780.70
|
| Rate for Payer: PHCS PPO |
$6,101.85
|
| Rate for Payer: Three Rivers PPO |
$4,817.25
|
| Rate for Payer: TriWest Veterans Administration |
$871.35
|
| Rate for Payer: United Healthcare Commercial |
$5,588.01
|
| Rate for Payer: United Healthcare Medicare |
$871.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,459.55
|
|
|
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 58542
|
| Hospital Charge Code |
58542
|
| Min. Negotiated Rate |
$679.59 |
| Max. Negotiated Rate |
$2,852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,794.96
|
| Rate for Payer: Aetna of WY Medicare |
$799.52
|
| Rate for Payer: Beech Street Commercial |
$2,709.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,766.44
|
| Rate for Payer: Cigna of WY Commercial |
$2,794.96
|
| Rate for Payer: First Choice Health Commercial |
$2,566.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,709.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$799.52
|
| Rate for Payer: HealthUtah PPO |
$2,852.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,766.44
|
| Rate for Payer: Multiplan Medicare/VA |
$679.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,794.96
|
| Rate for Payer: PacificSource Commercial |
$2,566.80
|
| Rate for Payer: PHCS PPO |
$2,709.40
|
| Rate for Payer: Three Rivers PPO |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration |
$799.52
|
| Rate for Payer: United Healthcare Commercial |
$2,481.24
|
| Rate for Payer: United Healthcare Medicare |
$799.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,424.20
|
|
|
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 58542 AS
|
| Hospital Charge Code |
58542
|
| Min. Negotiated Rate |
$679.59 |
| Max. Negotiated Rate |
$2,852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,794.96
|
| Rate for Payer: Aetna of WY Medicare |
$799.52
|
| Rate for Payer: Beech Street Commercial |
$2,709.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,766.44
|
| Rate for Payer: Cigna of WY Commercial |
$2,794.96
|
| Rate for Payer: First Choice Health Commercial |
$2,566.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,709.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$799.52
|
| Rate for Payer: HealthUtah PPO |
$2,852.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,766.44
|
| Rate for Payer: Multiplan Medicare/VA |
$679.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,794.96
|
| Rate for Payer: PacificSource Commercial |
$2,566.80
|
| Rate for Payer: PHCS PPO |
$2,709.40
|
| Rate for Payer: Three Rivers PPO |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration |
$799.52
|
| Rate for Payer: United Healthcare Commercial |
$2,481.24
|
| Rate for Payer: United Healthcare Medicare |
$799.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,424.20
|
|
|
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 58542 80
|
| Hospital Charge Code |
58542
|
| Min. Negotiated Rate |
$679.59 |
| Max. Negotiated Rate |
$2,852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,794.96
|
| Rate for Payer: Aetna of WY Medicare |
$799.52
|
| Rate for Payer: Beech Street Commercial |
$2,709.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: Cash Price |
$1,996.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,766.44
|
| Rate for Payer: Cigna of WY Commercial |
$2,794.96
|
| Rate for Payer: First Choice Health Commercial |
$2,566.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,709.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$799.52
|
| Rate for Payer: HealthUtah PPO |
$2,852.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,766.44
|
| Rate for Payer: Multiplan Medicare/VA |
$679.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,794.96
|
| Rate for Payer: PacificSource Commercial |
$2,566.80
|
| Rate for Payer: PHCS PPO |
$2,709.40
|
| Rate for Payer: Three Rivers PPO |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration |
$799.52
|
| Rate for Payer: United Healthcare Commercial |
$2,481.24
|
| Rate for Payer: United Healthcare Medicare |
$799.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,424.20
|
|
|
LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$6,187.00
|
|
|
Service Code
|
HCPCS 47563 AS
|
| Hospital Charge Code |
47563
|
| Min. Negotiated Rate |
$581.58 |
| Max. Negotiated Rate |
$6,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,063.26
|
| Rate for Payer: Aetna of WY Medicare |
$684.21
|
| Rate for Payer: Beech Street Commercial |
$5,877.65
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,001.39
|
| Rate for Payer: Cigna of WY Commercial |
$6,063.26
|
| Rate for Payer: First Choice Health Commercial |
$5,568.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,877.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.21
|
| Rate for Payer: HealthUtah PPO |
$6,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,001.39
|
| Rate for Payer: Multiplan Medicare/VA |
$581.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,063.26
|
| Rate for Payer: PacificSource Commercial |
$5,568.30
|
| Rate for Payer: PHCS PPO |
$5,877.65
|
| Rate for Payer: Three Rivers PPO |
$4,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$684.21
|
| Rate for Payer: United Healthcare Commercial |
$5,382.69
|
| Rate for Payer: United Healthcare Medicare |
$684.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5,258.95
|
|
|
LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$6,187.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
47563
|
| Min. Negotiated Rate |
$581.58 |
| Max. Negotiated Rate |
$6,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,063.26
|
| Rate for Payer: Aetna of WY Medicare |
$684.21
|
| Rate for Payer: Beech Street Commercial |
$5,877.65
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,001.39
|
| Rate for Payer: Cigna of WY Commercial |
$6,063.26
|
| Rate for Payer: First Choice Health Commercial |
$5,568.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,877.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.21
|
| Rate for Payer: HealthUtah PPO |
$6,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,001.39
|
| Rate for Payer: Multiplan Medicare/VA |
$581.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,063.26
|
| Rate for Payer: PacificSource Commercial |
$5,568.30
|
| Rate for Payer: PHCS PPO |
$5,877.65
|
| Rate for Payer: Three Rivers PPO |
$4,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$684.21
|
| Rate for Payer: United Healthcare Commercial |
$5,382.69
|
| Rate for Payer: United Healthcare Medicare |
$684.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5,258.95
|
|
|
LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$6,187.00
|
|
|
Service Code
|
HCPCS 47563 80
|
| Hospital Charge Code |
47563
|
| Min. Negotiated Rate |
$581.58 |
| Max. Negotiated Rate |
$6,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,063.26
|
| Rate for Payer: Aetna of WY Medicare |
$684.21
|
| Rate for Payer: Beech Street Commercial |
$5,877.65
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: Cash Price |
$4,330.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,001.39
|
| Rate for Payer: Cigna of WY Commercial |
$6,063.26
|
| Rate for Payer: First Choice Health Commercial |
$5,568.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,877.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.21
|
| Rate for Payer: HealthUtah PPO |
$6,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,001.39
|
| Rate for Payer: Multiplan Medicare/VA |
$581.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,063.26
|
| Rate for Payer: PacificSource Commercial |
$5,568.30
|
| Rate for Payer: PHCS PPO |
$5,877.65
|
| Rate for Payer: Three Rivers PPO |
$4,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$684.21
|
| Rate for Payer: United Healthcare Commercial |
$5,382.69
|
| Rate for Payer: United Healthcare Medicare |
$684.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5,258.95
|
|
|
LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$5,594.00
|
|
|
Service Code
|
HCPCS 43280 AS
|
| Hospital Charge Code |
43280
|
| Min. Negotiated Rate |
$866.50 |
| Max. Negotiated Rate |
$5,594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,482.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,019.41
|
| Rate for Payer: Beech Street Commercial |
$5,314.30
|
| Rate for Payer: Cash Price |
$3,915.80
|
| Rate for Payer: Cash Price |
$3,915.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,426.18
|
| Rate for Payer: Cigna of WY Commercial |
$5,482.12
|
| Rate for Payer: First Choice Health Commercial |
$5,034.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,314.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,019.41
|
| Rate for Payer: HealthUtah PPO |
$5,594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,426.18
|
| Rate for Payer: Multiplan Medicare/VA |
$866.50
|
| Rate for Payer: One Health Plan of WY PPO |
$5,482.12
|
| Rate for Payer: PacificSource Commercial |
$5,034.60
|
| Rate for Payer: PHCS PPO |
$5,314.30
|
| Rate for Payer: Three Rivers PPO |
$4,195.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,019.41
|
| Rate for Payer: United Healthcare Commercial |
$4,866.78
|
| Rate for Payer: United Healthcare Medicare |
$1,019.41
|
| Rate for Payer: WINHealth Partners Commercial |
$4,754.90
|
|
