|
LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$5,594.00
|
|
|
Service Code
|
HCPCS 43280
|
| 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
|
|
|
LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$5,594.00
|
|
|
Service Code
|
HCPCS 43280 80
|
| 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
|
|
|
LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 38570 80
|
| Hospital Charge Code |
38570
|
| Min. Negotiated Rate |
$421.41 |
| Max. Negotiated Rate |
$2,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,503.90
|
| Rate for Payer: Aetna of WY Medicare |
$495.78
|
| Rate for Payer: Beech Street Commercial |
$2,427.25
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,478.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,503.90
|
| Rate for Payer: First Choice Health Commercial |
$2,299.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,427.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.78
|
| Rate for Payer: HealthUtah PPO |
$2,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,478.35
|
| Rate for Payer: Multiplan Medicare/VA |
$421.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,503.90
|
| Rate for Payer: PacificSource Commercial |
$2,299.50
|
| Rate for Payer: PHCS PPO |
$2,427.25
|
| Rate for Payer: Three Rivers PPO |
$1,916.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.78
|
| Rate for Payer: United Healthcare Commercial |
$2,222.85
|
| Rate for Payer: United Healthcare Medicare |
$495.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2,171.75
|
|
|
LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
38570
|
| Min. Negotiated Rate |
$421.41 |
| Max. Negotiated Rate |
$2,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,503.90
|
| Rate for Payer: Aetna of WY Medicare |
$495.78
|
| Rate for Payer: Beech Street Commercial |
$2,427.25
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,478.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,503.90
|
| Rate for Payer: First Choice Health Commercial |
$2,299.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,427.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.78
|
| Rate for Payer: HealthUtah PPO |
$2,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,478.35
|
| Rate for Payer: Multiplan Medicare/VA |
$421.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,503.90
|
| Rate for Payer: PacificSource Commercial |
$2,299.50
|
| Rate for Payer: PHCS PPO |
$2,427.25
|
| Rate for Payer: Three Rivers PPO |
$1,916.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.78
|
| Rate for Payer: United Healthcare Commercial |
$2,222.85
|
| Rate for Payer: United Healthcare Medicare |
$495.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2,171.75
|
|
|
LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,899.00
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
49651
|
| Min. Negotiated Rate |
$461.02 |
| Max. Negotiated Rate |
$2,899.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,841.02
|
| Rate for Payer: Aetna of WY Medicare |
$542.38
|
| Rate for Payer: Beech Street Commercial |
$2,754.05
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,812.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,841.02
|
| Rate for Payer: First Choice Health Commercial |
$2,609.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,754.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$542.38
|
| Rate for Payer: HealthUtah PPO |
$2,899.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,812.03
|
| Rate for Payer: Multiplan Medicare/VA |
$461.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,841.02
|
| Rate for Payer: PacificSource Commercial |
$2,609.10
|
| Rate for Payer: PHCS PPO |
$2,754.05
|
| Rate for Payer: Three Rivers PPO |
$2,174.25
|
| Rate for Payer: TriWest Veterans Administration |
$542.38
|
| Rate for Payer: United Healthcare Commercial |
$2,522.13
|
| Rate for Payer: United Healthcare Medicare |
$542.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,464.15
|
|
|
LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 49322 AS
|
| Hospital Charge Code |
49322
|
| Min. Negotiated Rate |
$304.41 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$358.13
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.13
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$304.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$358.13
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$358.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 49322 80
|
| Hospital Charge Code |
49322
|
| Min. Negotiated Rate |
$304.41 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$358.13
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.13
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$304.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$358.13
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$358.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 49322
|
| Hospital Charge Code |
49322
|
| Min. Negotiated Rate |
$304.41 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$358.13
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.13
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$304.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$358.13
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$358.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$3,649.00
|
|
|
Service Code
|
HCPCS 58571 AS
|
| Hospital Charge Code |
58571
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,576.02
|
| Rate for Payer: Aetna of WY Medicare |
$876.47
|
| Rate for Payer: Beech Street Commercial |
$3,466.55
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,539.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,576.02
|
| Rate for Payer: First Choice Health Commercial |
$3,284.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.47
|
| Rate for Payer: HealthUtah PPO |
$3,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,539.53
|
| Rate for Payer: Multiplan Medicare/VA |
$745.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,576.02
|
| Rate for Payer: PacificSource Commercial |
$3,284.10
|
| Rate for Payer: PHCS PPO |
$3,466.55
|
| Rate for Payer: Three Rivers PPO |
$2,736.75
|
| Rate for Payer: TriWest Veterans Administration |
$876.47
|
| Rate for Payer: United Healthcare Commercial |
$3,174.63
|
| Rate for Payer: United Healthcare Medicare |
$876.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,101.65
|
|
|
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$3,649.00
|
|
|
Service Code
|
HCPCS 58571
|
| Hospital Charge Code |
58571
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,576.02
|
| Rate for Payer: Aetna of WY Medicare |
$876.47
|
| Rate for Payer: Beech Street Commercial |
$3,466.55
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,539.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,576.02
|
| Rate for Payer: First Choice Health Commercial |
$3,284.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.47
|
| Rate for Payer: HealthUtah PPO |
$3,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,539.53
|
| Rate for Payer: Multiplan Medicare/VA |
$745.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,576.02
|
| Rate for Payer: PacificSource Commercial |
$3,284.10
|
| Rate for Payer: PHCS PPO |
$3,466.55
|
| Rate for Payer: Three Rivers PPO |
$2,736.75
|
| Rate for Payer: TriWest Veterans Administration |
$876.47
|
| Rate for Payer: United Healthcare Commercial |
$3,174.63
|
| Rate for Payer: United Healthcare Medicare |
$876.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,101.65
|
|
|
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$3,649.00
|
|
|
Service Code
|
HCPCS 58571 80
|
| Hospital Charge Code |
58571
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,576.02
|
| Rate for Payer: Aetna of WY Medicare |
$876.47
|
| Rate for Payer: Beech Street Commercial |
$3,466.55
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,539.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,576.02
|
| Rate for Payer: First Choice Health Commercial |
$3,284.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.47
|
| Rate for Payer: HealthUtah PPO |
$3,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,539.53
|
| Rate for Payer: Multiplan Medicare/VA |
$745.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,576.02
|
| Rate for Payer: PacificSource Commercial |
$3,284.10
|
| Rate for Payer: PHCS PPO |
$3,466.55
|
| Rate for Payer: Three Rivers PPO |
$2,736.75
|
| Rate for Payer: TriWest Veterans Administration |
$876.47
|
| Rate for Payer: United Healthcare Commercial |
$3,174.63
|
| Rate for Payer: United Healthcare Medicare |
$876.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,101.65
|
|
|
LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 59150
|
| Hospital Charge Code |
59150
|
| Min. Negotiated Rate |
$641.22 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,308.88
|
| Rate for Payer: Aetna of WY Medicare |
$754.38
|
| Rate for Payer: Beech Street Commercial |
$2,238.20
|
| Rate for Payer: Cash Price |
$1,649.20
|
| Rate for Payer: Cash Price |
$1,649.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,285.32
|
| Rate for Payer: Cigna of WY Commercial |
$2,308.88
|
| Rate for Payer: First Choice Health Commercial |
$2,120.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,238.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$754.38
|
| Rate for Payer: HealthUtah PPO |
$2,356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,285.32
|
| Rate for Payer: Multiplan Medicare/VA |
$641.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,308.88
|
| Rate for Payer: PacificSource Commercial |
$2,120.40
|
| Rate for Payer: PHCS PPO |
$2,238.20
|
| Rate for Payer: Three Rivers PPO |
$1,767.00
|
| Rate for Payer: TriWest Veterans Administration |
$754.38
|
| Rate for Payer: United Healthcare Commercial |
$2,049.72
|
| Rate for Payer: United Healthcare Medicare |
$754.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,002.60
|
|
|
LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 59151
|
| Hospital Charge Code |
59151
|
| Min. Negotiated Rate |
$627.11 |
| Max. Negotiated Rate |
$2,303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,256.94
|
| Rate for Payer: Aetna of WY Medicare |
$737.78
|
| Rate for Payer: Beech Street Commercial |
$2,187.85
|
| Rate for Payer: Cash Price |
$1,612.10
|
| Rate for Payer: Cash Price |
$1,612.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,233.91
|
| Rate for Payer: Cigna of WY Commercial |
$2,256.94
|
| Rate for Payer: First Choice Health Commercial |
$2,072.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,187.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$737.78
|
| Rate for Payer: HealthUtah PPO |
$2,303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,233.91
|
| Rate for Payer: Multiplan Medicare/VA |
$627.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,256.94
|
| Rate for Payer: PacificSource Commercial |
$2,072.70
|
| Rate for Payer: PHCS PPO |
$2,187.85
|
| Rate for Payer: Three Rivers PPO |
$1,727.25
|
| Rate for Payer: TriWest Veterans Administration |
$737.78
|
| Rate for Payer: United Healthcare Commercial |
$2,003.61
|
| Rate for Payer: United Healthcare Medicare |
$737.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,957.55
|
|
|
LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$4,468.00
|
|
|
Service Code
|
HCPCS 58554
|
| Hospital Charge Code |
58554
|
| Min. Negotiated Rate |
$1,064.45 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,378.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,252.29
|
| Rate for Payer: Beech Street Commercial |
$4,244.60
|
| Rate for Payer: Cash Price |
$3,127.60
|
| Rate for Payer: Cash Price |
$3,127.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,333.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,378.64
|
| Rate for Payer: First Choice Health Commercial |
$4,021.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,244.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,252.29
|
| Rate for Payer: HealthUtah PPO |
$4,468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,333.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1,064.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4,378.64
|
| Rate for Payer: PacificSource Commercial |
$4,021.20
|
| Rate for Payer: PHCS PPO |
$4,244.60
|
| Rate for Payer: Three Rivers PPO |
$3,351.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,252.29
|
| Rate for Payer: United Healthcare Commercial |
$3,887.16
|
| Rate for Payer: United Healthcare Medicare |
$1,252.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,797.80
|
|
|
LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$6,423.00
|
|
|
Service Code
|
HCPCS 58550
|
| Hospital Charge Code |
58550
|
| Min. Negotiated Rate |
$721.90 |
| 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 |
$849.29
|
| 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 |
$849.29
|
| Rate for Payer: HealthUtah PPO |
$6,423.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,230.31
|
| Rate for Payer: Multiplan Medicare/VA |
$721.90
|
| 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 |
$849.29
|
| Rate for Payer: United Healthcare Commercial |
$5,588.01
|
| Rate for Payer: United Healthcare Medicare |
$849.29
|
| Rate for Payer: WINHealth Partners Commercial |
$5,459.55
|
|
|
LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$3,944.00
|
|
|
Service Code
|
HCPCS 58552 AS
|
| Hospital Charge Code |
58552
|
| Min. Negotiated Rate |
$801.62 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,865.12
|
| Rate for Payer: Aetna of WY Medicare |
$943.08
|
| Rate for Payer: Beech Street Commercial |
$3,746.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,825.68
|
| Rate for Payer: Cigna of WY Commercial |
$3,865.12
|
| Rate for Payer: First Choice Health Commercial |
$3,549.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,746.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.08
|
| Rate for Payer: HealthUtah PPO |
$3,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,825.68
|
| Rate for Payer: Multiplan Medicare/VA |
$801.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,865.12
|
| Rate for Payer: PacificSource Commercial |
$3,549.60
|
| Rate for Payer: PHCS PPO |
$3,746.80
|
| Rate for Payer: Three Rivers PPO |
$2,958.00
|
| Rate for Payer: TriWest Veterans Administration |
$943.08
|
| Rate for Payer: United Healthcare Commercial |
$3,431.28
|
| Rate for Payer: United Healthcare Medicare |
$943.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.40
|
|
|
LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$3,944.00
|
|
|
Service Code
|
HCPCS 58552 80
|
| Hospital Charge Code |
58552
|
| Min. Negotiated Rate |
$801.62 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,865.12
|
| Rate for Payer: Aetna of WY Medicare |
$943.08
|
| Rate for Payer: Beech Street Commercial |
$3,746.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,825.68
|
| Rate for Payer: Cigna of WY Commercial |
$3,865.12
|
| Rate for Payer: First Choice Health Commercial |
$3,549.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,746.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.08
|
| Rate for Payer: HealthUtah PPO |
$3,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,825.68
|
| Rate for Payer: Multiplan Medicare/VA |
$801.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,865.12
|
| Rate for Payer: PacificSource Commercial |
$3,549.60
|
| Rate for Payer: PHCS PPO |
$3,746.80
|
| Rate for Payer: Three Rivers PPO |
$2,958.00
|
| Rate for Payer: TriWest Veterans Administration |
$943.08
|
| Rate for Payer: United Healthcare Commercial |
$3,431.28
|
| Rate for Payer: United Healthcare Medicare |
$943.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.40
|
|
|
LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$3,944.00
|
|
|
Service Code
|
HCPCS 58552
|
| Hospital Charge Code |
58552
|
| Min. Negotiated Rate |
$801.62 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,865.12
|
| Rate for Payer: Aetna of WY Medicare |
$943.08
|
| Rate for Payer: Beech Street Commercial |
$3,746.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: Cash Price |
$2,760.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,825.68
|
| Rate for Payer: Cigna of WY Commercial |
$3,865.12
|
| Rate for Payer: First Choice Health Commercial |
$3,549.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,746.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.08
|
| Rate for Payer: HealthUtah PPO |
$3,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,825.68
|
| Rate for Payer: Multiplan Medicare/VA |
$801.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,865.12
|
| Rate for Payer: PacificSource Commercial |
$3,549.60
|
| Rate for Payer: PHCS PPO |
$3,746.80
|
| Rate for Payer: Three Rivers PPO |
$2,958.00
|
| Rate for Payer: TriWest Veterans Administration |
$943.08
|
| Rate for Payer: United Healthcare Commercial |
$3,431.28
|
| Rate for Payer: United Healthcare Medicare |
$943.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.40
|
|
|
LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS
|
Professional
|
Both
|
$3,833.00
|
|
|
Service Code
|
HCPCS 58553
|
| Hospital Charge Code |
58553
|
| Min. Negotiated Rate |
$912.98 |
| Max. Negotiated Rate |
$3,833.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,756.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,074.09
|
| Rate for Payer: Beech Street Commercial |
$3,641.35
|
| Rate for Payer: Cash Price |
$2,683.10
|
| Rate for Payer: Cash Price |
$2,683.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,718.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,756.34
|
| Rate for Payer: First Choice Health Commercial |
$3,449.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,641.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,074.09
|
| Rate for Payer: HealthUtah PPO |
$3,833.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,718.01
|
| Rate for Payer: Multiplan Medicare/VA |
$912.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,756.34
|
| Rate for Payer: PacificSource Commercial |
$3,449.70
|
| Rate for Payer: PHCS PPO |
$3,641.35
|
| Rate for Payer: Three Rivers PPO |
$2,874.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,074.09
|
| Rate for Payer: United Healthcare Commercial |
$3,334.71
|
| Rate for Payer: United Healthcare Medicare |
$1,074.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.05
|
|
|
LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK
|
Professional
|
Both
|
$4,025.00
|
|
|
Service Code
|
HCPCS 58960
|
| Hospital Charge Code |
58960
|
| Min. Negotiated Rate |
$818.92 |
| Max. Negotiated Rate |
$4,025.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,944.50
|
| Rate for Payer: Aetna of WY Medicare |
$963.44
|
| Rate for Payer: Beech Street Commercial |
$3,823.75
|
| Rate for Payer: Cash Price |
$2,817.50
|
| Rate for Payer: Cash Price |
$2,817.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,904.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,944.50
|
| Rate for Payer: First Choice Health Commercial |
$3,622.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,823.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$963.44
|
| Rate for Payer: HealthUtah PPO |
$4,025.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,904.25
|
| Rate for Payer: Multiplan Medicare/VA |
$818.92
|
| Rate for Payer: One Health Plan of WY PPO |
$3,944.50
|
| Rate for Payer: PacificSource Commercial |
$3,622.50
|
| Rate for Payer: PHCS PPO |
$3,823.75
|
| Rate for Payer: Three Rivers PPO |
$3,018.75
|
| Rate for Payer: TriWest Veterans Administration |
$963.44
|
| Rate for Payer: United Healthcare Commercial |
$3,501.75
|
| Rate for Payer: United Healthcare Medicare |
$963.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3,421.25
|
|
|
LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
HCPCS 31541
|
| Hospital Charge Code |
31541
|
| Min. Negotiated Rate |
$213.14 |
| Max. Negotiated Rate |
$1,347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,320.06
|
| Rate for Payer: Aetna of WY Medicare |
$250.75
|
| Rate for Payer: Beech Street Commercial |
$1,279.65
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,306.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,320.06
|
| Rate for Payer: First Choice Health Commercial |
$1,212.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,279.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.75
|
| Rate for Payer: HealthUtah PPO |
$1,347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,306.59
|
| Rate for Payer: Multiplan Medicare/VA |
$213.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,320.06
|
| Rate for Payer: PacificSource Commercial |
$1,212.30
|
| Rate for Payer: PHCS PPO |
$1,279.65
|
| Rate for Payer: Three Rivers PPO |
$1,010.25
|
| Rate for Payer: TriWest Veterans Administration |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$1,171.89
|
| Rate for Payer: United Healthcare Medicare |
$250.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,144.95
|
|
|
LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 31571
|
| Hospital Charge Code |
31571
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$237.34
|
| Rate for Payer: Beech Street Commercial |
$803.70
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$820.62
|
| Rate for Payer: Cigna of WY Commercial |
$829.08
|
| Rate for Payer: First Choice Health Commercial |
$761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.34
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$201.74
|
| Rate for Payer: One Health Plan of WY PPO |
$829.08
|
| Rate for Payer: PacificSource Commercial |
$761.40
|
| Rate for Payer: PHCS PPO |
$803.70
|
| Rate for Payer: Three Rivers PPO |
$634.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.34
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$237.34
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
LARYN BLADE MILLER 0 DISP
|
Facility
|
OP
|
$13.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.24
|
| Rate for Payer: Aetna of WY Medicare |
$8.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.97
|
| Rate for Payer: Altius Commercial |
$12.97
|
| Rate for Payer: Beech Street Commercial |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.10
|
| Rate for Payer: Cigna of WY Commercial |
$13.24
|
| Rate for Payer: Entrust Commercial |
$12.83
|
| Rate for Payer: First Choice Health Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.84
|
| Rate for Payer: HealthUtah PPO |
$13.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.10
|
| Rate for Payer: Multiplan Medicare/VA |
$7.44
|
| Rate for Payer: One Health Plan of WY PPO |
$13.24
|
| Rate for Payer: PacificSource Commercial |
$12.16
|
| Rate for Payer: PHCS PPO |
$13.24
|
| Rate for Payer: Three Rivers PPO |
$10.13
|
| Rate for Payer: TriWest Veterans Administration |
$7.84
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$7.84
|
| Rate for Payer: WINHealth Partners Commercial |
$13.24
|
| Rate for Payer: Wise Provider Network Commercial |
$12.83
|
|
|
LARYN BLADE MILLER 0 DISP
|
Facility
|
IP
|
$13.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.97
|
| Rate for Payer: Altius Commercial |
$12.97
|
| Rate for Payer: Beech Street Commercial |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.10
|
| Rate for Payer: Cigna of WY Commercial |
$13.24
|
| Rate for Payer: Entrust Commercial |
$12.83
|
| Rate for Payer: First Choice Health Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.92
|
| Rate for Payer: HealthUtah PPO |
$13.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.10
|
| Rate for Payer: Multiplan Medicare/VA |
$8.47
|
| Rate for Payer: One Health Plan of WY PPO |
$13.24
|
| Rate for Payer: PacificSource Commercial |
$12.16
|
| Rate for Payer: PHCS PPO |
$13.24
|
| Rate for Payer: Three Rivers PPO |
$10.13
|
| Rate for Payer: TriWest Veterans Administration |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$8.92
|
| Rate for Payer: WINHealth Partners Commercial |
$12.83
|
| Rate for Payer: Wise Provider Network Commercial |
$12.83
|
|
|
LARYN BLADE MILLER 1 DISP
|
Facility
|
OP
|
$13.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.24
|
| Rate for Payer: Aetna of WY Medicare |
$8.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.97
|
| Rate for Payer: Altius Commercial |
$12.97
|
| Rate for Payer: Beech Street Commercial |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.10
|
| Rate for Payer: Cigna of WY Commercial |
$13.24
|
| Rate for Payer: Entrust Commercial |
$12.83
|
| Rate for Payer: First Choice Health Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.84
|
| Rate for Payer: HealthUtah PPO |
$13.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.10
|
| Rate for Payer: Multiplan Medicare/VA |
$7.44
|
| Rate for Payer: One Health Plan of WY PPO |
$13.24
|
| Rate for Payer: PacificSource Commercial |
$12.16
|
| Rate for Payer: PHCS PPO |
$13.24
|
| Rate for Payer: Three Rivers PPO |
$10.13
|
| Rate for Payer: TriWest Veterans Administration |
$7.84
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$7.84
|
| Rate for Payer: WINHealth Partners Commercial |
$13.24
|
| Rate for Payer: Wise Provider Network Commercial |
$12.83
|
|
