|
NASAL CO2 SAMPLE LINE PED
|
Facility
|
IP
|
$26.43
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.37
|
| Rate for Payer: Altius Commercial |
$25.37
|
| Rate for Payer: Beech Street Commercial |
$25.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.70
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.64
|
| Rate for Payer: Cigna of WY Commercial |
$25.90
|
| Rate for Payer: Entrust Commercial |
$25.11
|
| Rate for Payer: First Choice Health Commercial |
$25.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.44
|
| Rate for Payer: HealthUtah PPO |
$26.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.64
|
| Rate for Payer: Multiplan Medicare/VA |
$16.57
|
| Rate for Payer: One Health Plan of WY PPO |
$25.90
|
| Rate for Payer: PacificSource Commercial |
$23.79
|
| Rate for Payer: PHCS PPO |
$25.90
|
| Rate for Payer: Three Rivers PPO |
$19.82
|
| Rate for Payer: TriWest Veterans Administration |
$17.44
|
| Rate for Payer: United Healthcare Commercial |
$22.99
|
| Rate for Payer: United Healthcare Medicare |
$17.44
|
| Rate for Payer: WINHealth Partners Commercial |
$25.11
|
| Rate for Payer: Wise Provider Network Commercial |
$25.11
|
|
|
NASAL CO2 SAMPLE LINE PED
|
Facility
|
OP
|
$26.43
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.90
|
| Rate for Payer: Aetna of WY Medicare |
$17.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.37
|
| Rate for Payer: Altius Commercial |
$25.37
|
| Rate for Payer: Beech Street Commercial |
$25.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.70
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.64
|
| Rate for Payer: Cigna of WY Commercial |
$25.90
|
| Rate for Payer: Entrust Commercial |
$25.11
|
| Rate for Payer: First Choice Health Commercial |
$25.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.33
|
| Rate for Payer: HealthUtah PPO |
$26.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.64
|
| Rate for Payer: Multiplan Medicare/VA |
$14.56
|
| Rate for Payer: One Health Plan of WY PPO |
$25.90
|
| Rate for Payer: PacificSource Commercial |
$23.79
|
| Rate for Payer: PHCS PPO |
$25.90
|
| Rate for Payer: Three Rivers PPO |
$19.82
|
| Rate for Payer: TriWest Veterans Administration |
$15.33
|
| Rate for Payer: United Healthcare Commercial |
$22.99
|
| Rate for Payer: United Healthcare Medicare |
$15.33
|
| Rate for Payer: WINHealth Partners Commercial |
$25.90
|
| Rate for Payer: Wise Provider Network Commercial |
$25.11
|
|
|
NASAL ENDO EUSTACHIAN TUBE
|
Professional
|
Both
|
$3,686.00
|
|
|
Service Code
|
HCPCS C9745 50
|
| Hospital Charge Code |
C9745
|
| Min. Negotiated Rate |
$2,764.50 |
| Max. Negotiated Rate |
$3,686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,612.28
|
| Rate for Payer: Beech Street Commercial |
$3,501.70
|
| Rate for Payer: Cash Price |
$2,580.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,575.42
|
| Rate for Payer: Cigna of WY Commercial |
$3,612.28
|
| Rate for Payer: First Choice Health Commercial |
$3,317.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,501.70
|
| Rate for Payer: HealthUtah PPO |
$3,686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,575.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,612.28
|
| Rate for Payer: PacificSource Commercial |
$3,317.40
|
| Rate for Payer: PHCS PPO |
$3,501.70
|
| Rate for Payer: Three Rivers PPO |
$2,764.50
|
| Rate for Payer: United Healthcare Commercial |
$3,206.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,501.70
|
|
|
NASAL ENDO EUSTACHIAN TUBE
|
Professional
|
Both
|
$2,386.00
|
|
|
Service Code
|
HCPCS C9745
|
| Hospital Charge Code |
C9745
|
| Min. Negotiated Rate |
$1,789.50 |
| Max. Negotiated Rate |
$2,386.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,338.28
|
| Rate for Payer: Beech Street Commercial |
$2,266.70
|
| Rate for Payer: Cash Price |
$1,670.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,314.42
|
| Rate for Payer: Cigna of WY Commercial |
$2,338.28
|
| Rate for Payer: First Choice Health Commercial |
$2,147.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,266.70
|
| Rate for Payer: HealthUtah PPO |
$2,386.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,314.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,338.28
|
| Rate for Payer: PacificSource Commercial |
$2,147.40
|
| Rate for Payer: PHCS PPO |
$2,266.70
|
| Rate for Payer: Three Rivers PPO |
$1,789.50
|
| Rate for Payer: United Healthcare Commercial |
$2,075.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,266.70
|
|
|
NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
31231
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$61.83
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.83
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Multiplan Medicare/VA |
$52.56
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$61.83
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Medicare |
$61.83
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
NASAL SEPTAL BUTTON ELLIPTICAL POST LG
|
Facility
|
OP
|
$752.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.63 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$737.45
|
| Rate for Payer: Aetna of WY Medicare |
$496.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$722.40
|
| Rate for Payer: Altius Commercial |
$722.40
|
| Rate for Payer: Beech Street Commercial |
$737.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$617.80
|
| Rate for Payer: Cash Price |
$526.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$729.92
|
| Rate for Payer: Cigna of WY Commercial |
$737.45
|
| Rate for Payer: Entrust Commercial |
$714.88
|
| Rate for Payer: First Choice Health Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.45
|
| Rate for Payer: HealthUtah PPO |
$752.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$729.92
|
| Rate for Payer: Multiplan Medicare/VA |
$414.63
|
| Rate for Payer: One Health Plan of WY PPO |
$737.45
|
| Rate for Payer: PacificSource Commercial |
$677.25
|
| Rate for Payer: PHCS PPO |
$737.45
|
| Rate for Payer: Three Rivers PPO |
$564.38
|
| Rate for Payer: TriWest Veterans Administration |
$436.45
|
| Rate for Payer: United Healthcare Commercial |
$654.68
|
| Rate for Payer: United Healthcare Medicare |
$436.45
|
| Rate for Payer: WINHealth Partners Commercial |
$737.45
|
| Rate for Payer: Wise Provider Network Commercial |
$714.88
|
|
|
NASAL SEPTAL BUTTON ELLIPTICAL POST LG
|
Facility
|
IP
|
$752.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.82 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$737.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$722.40
|
| Rate for Payer: Altius Commercial |
$722.40
|
| Rate for Payer: Beech Street Commercial |
$737.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$617.80
|
| Rate for Payer: Cash Price |
$526.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$729.92
|
| Rate for Payer: Cigna of WY Commercial |
$737.45
|
| Rate for Payer: Entrust Commercial |
$714.88
|
| Rate for Payer: First Choice Health Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$496.65
|
| Rate for Payer: HealthUtah PPO |
$752.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$729.92
|
| Rate for Payer: Multiplan Medicare/VA |
$471.82
|
| Rate for Payer: One Health Plan of WY PPO |
$737.45
|
| Rate for Payer: PacificSource Commercial |
$677.25
|
| Rate for Payer: PHCS PPO |
$737.45
|
| Rate for Payer: Three Rivers PPO |
$564.38
|
| Rate for Payer: TriWest Veterans Administration |
$496.65
|
| Rate for Payer: United Healthcare Commercial |
$654.68
|
| Rate for Payer: United Healthcare Medicare |
$496.65
|
| Rate for Payer: WINHealth Partners Commercial |
$714.88
|
| Rate for Payer: Wise Provider Network Commercial |
$714.88
|
|
|
NASAL SEPTAL BUTTON ELLIPTICAL POST REG
|
Facility
|
IP
|
$647.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$634.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$621.60
|
| Rate for Payer: Altius Commercial |
$621.60
|
| Rate for Payer: Beech Street Commercial |
$634.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$453.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$628.08
|
| Rate for Payer: Cigna of WY Commercial |
$634.55
|
| Rate for Payer: Entrust Commercial |
$615.12
|
| Rate for Payer: First Choice Health Commercial |
$615.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$615.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.35
|
| Rate for Payer: HealthUtah PPO |
$647.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$628.08
|
| Rate for Payer: Multiplan Medicare/VA |
$405.98
|
| Rate for Payer: One Health Plan of WY PPO |
$634.55
|
| Rate for Payer: PacificSource Commercial |
$582.75
|
| Rate for Payer: PHCS PPO |
$634.55
|
| Rate for Payer: Three Rivers PPO |
$485.62
|
| Rate for Payer: TriWest Veterans Administration |
$427.35
|
| Rate for Payer: United Healthcare Commercial |
$563.32
|
| Rate for Payer: United Healthcare Medicare |
$427.35
|
| Rate for Payer: WINHealth Partners Commercial |
$615.12
|
| Rate for Payer: Wise Provider Network Commercial |
$615.12
|
|
|
NASAL SEPTAL BUTTON ELLIPTICAL POST REG
|
Facility
|
OP
|
$647.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.77 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$634.55
|
| Rate for Payer: Aetna of WY Medicare |
$427.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$621.60
|
| Rate for Payer: Altius Commercial |
$621.60
|
| Rate for Payer: Beech Street Commercial |
$634.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$453.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$628.08
|
| Rate for Payer: Cigna of WY Commercial |
$634.55
|
| Rate for Payer: Entrust Commercial |
$615.12
|
| Rate for Payer: First Choice Health Commercial |
$615.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$615.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$375.55
|
| Rate for Payer: HealthUtah PPO |
$647.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$628.08
|
| Rate for Payer: Multiplan Medicare/VA |
$356.77
|
| Rate for Payer: One Health Plan of WY PPO |
$634.55
|
| Rate for Payer: PacificSource Commercial |
$582.75
|
| Rate for Payer: PHCS PPO |
$634.55
|
| Rate for Payer: Three Rivers PPO |
$485.62
|
| Rate for Payer: TriWest Veterans Administration |
$375.55
|
| Rate for Payer: United Healthcare Commercial |
$563.32
|
| Rate for Payer: United Healthcare Medicare |
$375.55
|
| Rate for Payer: WINHealth Partners Commercial |
$634.55
|
| Rate for Payer: Wise Provider Network Commercial |
$615.12
|
|
|
NASAL SEPTAL BUTTON ROCHESTER STANDARD
|
Facility
|
OP
|
$297.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.92 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.55
|
| Rate for Payer: Aetna of WY Medicare |
$196.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$285.60
|
| Rate for Payer: Altius Commercial |
$285.60
|
| Rate for Payer: Beech Street Commercial |
$291.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.25
|
| Rate for Payer: Cash Price |
$208.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.58
|
| Rate for Payer: Cigna of WY Commercial |
$291.55
|
| Rate for Payer: Entrust Commercial |
$282.62
|
| Rate for Payer: First Choice Health Commercial |
$282.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.55
|
| Rate for Payer: HealthUtah PPO |
$297.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.58
|
| Rate for Payer: Multiplan Medicare/VA |
$163.92
|
| Rate for Payer: One Health Plan of WY PPO |
$291.55
|
| Rate for Payer: PacificSource Commercial |
$267.75
|
| Rate for Payer: PHCS PPO |
$291.55
|
| Rate for Payer: Three Rivers PPO |
$223.12
|
| Rate for Payer: TriWest Veterans Administration |
$172.55
|
| Rate for Payer: United Healthcare Commercial |
$258.82
|
| Rate for Payer: United Healthcare Medicare |
$172.55
|
| Rate for Payer: WINHealth Partners Commercial |
$291.55
|
| Rate for Payer: Wise Provider Network Commercial |
$282.62
|
|
|
NASAL SEPTAL BUTTON ROCHESTER STANDARD
|
Facility
|
IP
|
$297.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.53 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$285.60
|
| Rate for Payer: Altius Commercial |
$285.60
|
| Rate for Payer: Beech Street Commercial |
$291.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.25
|
| Rate for Payer: Cash Price |
$208.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.58
|
| Rate for Payer: Cigna of WY Commercial |
$291.55
|
| Rate for Payer: Entrust Commercial |
$282.62
|
| Rate for Payer: First Choice Health Commercial |
$282.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.35
|
| Rate for Payer: HealthUtah PPO |
$297.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.58
|
| Rate for Payer: Multiplan Medicare/VA |
$186.53
|
| Rate for Payer: One Health Plan of WY PPO |
$291.55
|
| Rate for Payer: PacificSource Commercial |
$267.75
|
| Rate for Payer: PHCS PPO |
$291.55
|
| Rate for Payer: Three Rivers PPO |
$223.12
|
| Rate for Payer: TriWest Veterans Administration |
$196.35
|
| Rate for Payer: United Healthcare Commercial |
$258.82
|
| Rate for Payer: United Healthcare Medicare |
$196.35
|
| Rate for Payer: WINHealth Partners Commercial |
$282.62
|
| Rate for Payer: Wise Provider Network Commercial |
$282.62
|
|
|
NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$1,567.00
|
|
|
Service Code
|
HCPCS 31233
|
| Hospital Charge Code |
31233
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$1,567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,535.66
|
| Rate for Payer: Aetna of WY Medicare |
$130.21
|
| Rate for Payer: Beech Street Commercial |
$1,488.65
|
| Rate for Payer: Cash Price |
$1,096.90
|
| Rate for Payer: Cash Price |
$1,096.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,519.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,535.66
|
| Rate for Payer: First Choice Health Commercial |
$1,410.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,488.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.21
|
| Rate for Payer: HealthUtah PPO |
$1,567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,519.99
|
| Rate for Payer: Multiplan Medicare/VA |
$110.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,535.66
|
| Rate for Payer: PacificSource Commercial |
$1,410.30
|
| Rate for Payer: PHCS PPO |
$1,488.65
|
| Rate for Payer: Three Rivers PPO |
$1,175.25
|
| Rate for Payer: TriWest Veterans Administration |
$130.21
|
| Rate for Payer: United Healthcare Commercial |
$1,363.29
|
| Rate for Payer: United Healthcare Medicare |
$130.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,331.95
|
|
|
NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
31256
|
| Min. Negotiated Rate |
$146.27 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$601.72
|
| Rate for Payer: Aetna of WY Medicare |
$172.08
|
| Rate for Payer: Beech Street Commercial |
$583.30
|
| Rate for Payer: Cash Price |
$429.80
|
| Rate for Payer: Cash Price |
$429.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$595.58
|
| Rate for Payer: Cigna of WY Commercial |
$601.72
|
| Rate for Payer: First Choice Health Commercial |
$552.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$583.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.08
|
| Rate for Payer: HealthUtah PPO |
$614.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$595.58
|
| Rate for Payer: Multiplan Medicare/VA |
$146.27
|
| Rate for Payer: One Health Plan of WY PPO |
$601.72
|
| Rate for Payer: PacificSource Commercial |
$552.60
|
| Rate for Payer: PHCS PPO |
$583.30
|
| Rate for Payer: Three Rivers PPO |
$460.50
|
| Rate for Payer: TriWest Veterans Administration |
$172.08
|
| Rate for Payer: United Healthcare Commercial |
$534.18
|
| Rate for Payer: United Healthcare Medicare |
$172.08
|
| Rate for Payer: WINHealth Partners Commercial |
$521.90
|
|
|
NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 31256 50
|
| Hospital Charge Code |
31256
|
| Min. Negotiated Rate |
$146.27 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,204.42
|
| Rate for Payer: Aetna of WY Medicare |
$172.08
|
| Rate for Payer: Beech Street Commercial |
$1,167.55
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,192.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,204.42
|
| Rate for Payer: First Choice Health Commercial |
$1,106.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,167.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.08
|
| Rate for Payer: HealthUtah PPO |
$1,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,192.13
|
| Rate for Payer: Multiplan Medicare/VA |
$146.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,204.42
|
| Rate for Payer: PacificSource Commercial |
$1,106.10
|
| Rate for Payer: PHCS PPO |
$1,167.55
|
| Rate for Payer: Three Rivers PPO |
$921.75
|
| Rate for Payer: TriWest Veterans Administration |
$172.08
|
| Rate for Payer: United Healthcare Commercial |
$1,069.23
|
| Rate for Payer: United Healthcare Medicare |
$172.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,044.65
|
|
|
NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 31287
|
| Hospital Charge Code |
31287
|
| Min. Negotiated Rate |
$163.36 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$672.28
|
| Rate for Payer: Aetna of WY Medicare |
$192.19
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Cash Price |
$480.20
|
| Rate for Payer: Cash Price |
$480.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$665.42
|
| Rate for Payer: Cigna of WY Commercial |
$672.28
|
| Rate for Payer: First Choice Health Commercial |
$617.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$651.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.19
|
| Rate for Payer: HealthUtah PPO |
$686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$665.42
|
| Rate for Payer: Multiplan Medicare/VA |
$163.36
|
| Rate for Payer: One Health Plan of WY PPO |
$672.28
|
| Rate for Payer: PacificSource Commercial |
$617.40
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$514.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.19
|
| Rate for Payer: United Healthcare Commercial |
$596.82
|
| Rate for Payer: United Healthcare Medicare |
$192.19
|
| Rate for Payer: WINHealth Partners Commercial |
$583.10
|
|
|
NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 31287 50
|
| Hospital Charge Code |
31287
|
| Min. Negotiated Rate |
$163.36 |
| Max. Negotiated Rate |
$1,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,343.58
|
| Rate for Payer: Aetna of WY Medicare |
$192.19
|
| Rate for Payer: Beech Street Commercial |
$1,302.45
|
| Rate for Payer: Cash Price |
$959.70
|
| Rate for Payer: Cash Price |
$959.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,329.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,343.58
|
| Rate for Payer: First Choice Health Commercial |
$1,233.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,302.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.19
|
| Rate for Payer: HealthUtah PPO |
$1,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,329.87
|
| Rate for Payer: Multiplan Medicare/VA |
$163.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,343.58
|
| Rate for Payer: PacificSource Commercial |
$1,233.90
|
| Rate for Payer: PHCS PPO |
$1,302.45
|
| Rate for Payer: Three Rivers PPO |
$1,028.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.19
|
| Rate for Payer: United Healthcare Commercial |
$1,192.77
|
| Rate for Payer: United Healthcare Medicare |
$192.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1,165.35
|
|
|
NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 31237 50
|
| Hospital Charge Code |
31237
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,749.30
|
| Rate for Payer: Aetna of WY Medicare |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,731.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,749.30
|
| Rate for Payer: First Choice Health Commercial |
$1,606.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,695.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.60
|
| Rate for Payer: HealthUtah PPO |
$1,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,731.45
|
| Rate for Payer: Multiplan Medicare/VA |
$130.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,749.30
|
| Rate for Payer: PacificSource Commercial |
$1,606.50
|
| Rate for Payer: PHCS PPO |
$1,695.75
|
| Rate for Payer: Three Rivers PPO |
$1,338.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.60
|
| Rate for Payer: United Healthcare Commercial |
$1,552.95
|
| Rate for Payer: United Healthcare Medicare |
$153.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,517.25
|
|
|
NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
31237
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$875.14
|
| Rate for Payer: Aetna of WY Medicare |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$848.35
|
| Rate for Payer: Cash Price |
$625.10
|
| Rate for Payer: Cash Price |
$625.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$866.21
|
| Rate for Payer: Cigna of WY Commercial |
$875.14
|
| Rate for Payer: First Choice Health Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$848.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.60
|
| Rate for Payer: HealthUtah PPO |
$893.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$866.21
|
| Rate for Payer: Multiplan Medicare/VA |
$130.56
|
| Rate for Payer: One Health Plan of WY PPO |
$875.14
|
| Rate for Payer: PacificSource Commercial |
$803.70
|
| Rate for Payer: PHCS PPO |
$848.35
|
| Rate for Payer: Three Rivers PPO |
$669.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.60
|
| Rate for Payer: United Healthcare Commercial |
$776.91
|
| Rate for Payer: United Healthcare Medicare |
$153.60
|
| Rate for Payer: WINHealth Partners Commercial |
$759.05
|
|
|
NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 31240 50
|
| Hospital Charge Code |
31240
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$152.61
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.61
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$129.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.61
|
| Rate for Payer: United Healthcare Commercial |
$946.56
|
| Rate for Payer: United Healthcare Medicare |
$152.61
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 31240
|
| Hospital Charge Code |
31240
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$533.12
|
| Rate for Payer: Aetna of WY Medicare |
$152.61
|
| Rate for Payer: Beech Street Commercial |
$516.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$527.68
|
| Rate for Payer: Cigna of WY Commercial |
$533.12
|
| Rate for Payer: First Choice Health Commercial |
$489.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$516.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.61
|
| Rate for Payer: HealthUtah PPO |
$544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$527.68
|
| Rate for Payer: Multiplan Medicare/VA |
$129.72
|
| Rate for Payer: One Health Plan of WY PPO |
$533.12
|
| Rate for Payer: PacificSource Commercial |
$489.60
|
| Rate for Payer: PHCS PPO |
$516.80
|
| Rate for Payer: Three Rivers PPO |
$408.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.61
|
| Rate for Payer: United Healthcare Commercial |
$473.28
|
| Rate for Payer: United Healthcare Medicare |
$152.61
|
| Rate for Payer: WINHealth Partners Commercial |
$462.40
|
|
|
NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
31238
|
| Min. Negotiated Rate |
$136.54 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$849.66
|
| Rate for Payer: Aetna of WY Medicare |
$160.63
|
| Rate for Payer: Beech Street Commercial |
$823.65
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$840.99
|
| Rate for Payer: Cigna of WY Commercial |
$849.66
|
| Rate for Payer: First Choice Health Commercial |
$780.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$823.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.63
|
| Rate for Payer: HealthUtah PPO |
$867.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$840.99
|
| Rate for Payer: Multiplan Medicare/VA |
$136.54
|
| Rate for Payer: One Health Plan of WY PPO |
$849.66
|
| Rate for Payer: PacificSource Commercial |
$780.30
|
| Rate for Payer: PHCS PPO |
$823.65
|
| Rate for Payer: Three Rivers PPO |
$650.25
|
| Rate for Payer: TriWest Veterans Administration |
$160.63
|
| Rate for Payer: United Healthcare Commercial |
$754.29
|
| Rate for Payer: United Healthcare Medicare |
$160.63
|
| Rate for Payer: WINHealth Partners Commercial |
$736.95
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$5,834.00
|
|
|
Service Code
|
HCPCS 31296
|
| Hospital Charge Code |
31296
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$5,834.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,717.32
|
| Rate for Payer: Aetna of WY Medicare |
$171.42
|
| Rate for Payer: Beech Street Commercial |
$5,542.30
|
| Rate for Payer: Cash Price |
$4,083.80
|
| Rate for Payer: Cash Price |
$4,083.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,658.98
|
| Rate for Payer: Cigna of WY Commercial |
$5,717.32
|
| Rate for Payer: First Choice Health Commercial |
$5,250.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,542.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.42
|
| Rate for Payer: HealthUtah PPO |
$5,834.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,658.98
|
| Rate for Payer: Multiplan Medicare/VA |
$145.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,717.32
|
| Rate for Payer: PacificSource Commercial |
$5,250.60
|
| Rate for Payer: PHCS PPO |
$5,542.30
|
| Rate for Payer: Three Rivers PPO |
$4,375.50
|
| Rate for Payer: TriWest Veterans Administration |
$171.42
|
| Rate for Payer: United Healthcare Commercial |
$5,075.58
|
| Rate for Payer: United Healthcare Medicare |
$171.42
|
| Rate for Payer: WINHealth Partners Commercial |
$4,958.90
|
|
|
NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 31241
|
| Hospital Charge Code |
31241
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,459.22
|
| Rate for Payer: Aetna of WY Medicare |
$424.26
|
| Rate for Payer: Beech Street Commercial |
$1,414.55
|
| Rate for Payer: Cash Price |
$1,042.30
|
| Rate for Payer: Cash Price |
$1,042.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,444.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,459.22
|
| Rate for Payer: First Choice Health Commercial |
$1,340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,414.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.26
|
| Rate for Payer: HealthUtah PPO |
$1,489.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,444.33
|
| Rate for Payer: Multiplan Medicare/VA |
$360.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,459.22
|
| Rate for Payer: PacificSource Commercial |
$1,340.10
|
| Rate for Payer: PHCS PPO |
$1,414.55
|
| Rate for Payer: Three Rivers PPO |
$1,116.75
|
| Rate for Payer: TriWest Veterans Administration |
$424.26
|
| Rate for Payer: United Healthcare Commercial |
$1,295.43
|
| Rate for Payer: United Healthcare Medicare |
$424.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,265.65
|
|
|
NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
HCPCS 31257
|
| Hospital Charge Code |
31257
|
| Min. Negotiated Rate |
$361.05 |
| Max. Negotiated Rate |
$2,293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,247.14
|
| Rate for Payer: Aetna of WY Medicare |
$424.76
|
| Rate for Payer: Beech Street Commercial |
$2,178.35
|
| Rate for Payer: Cash Price |
$1,605.10
|
| Rate for Payer: Cash Price |
$1,605.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,224.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,247.14
|
| Rate for Payer: First Choice Health Commercial |
$2,063.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,178.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.76
|
| Rate for Payer: HealthUtah PPO |
$2,293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,224.21
|
| Rate for Payer: Multiplan Medicare/VA |
$361.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,247.14
|
| Rate for Payer: PacificSource Commercial |
$2,063.70
|
| Rate for Payer: PHCS PPO |
$2,178.35
|
| Rate for Payer: Three Rivers PPO |
$1,719.75
|
| Rate for Payer: TriWest Veterans Administration |
$424.76
|
| Rate for Payer: United Healthcare Commercial |
$1,994.91
|
| Rate for Payer: United Healthcare Medicare |
$424.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,949.05
|
|
|
NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$4,586.00
|
|
|
Service Code
|
HCPCS 31257 50
|
| Hospital Charge Code |
31257
|
| Min. Negotiated Rate |
$361.05 |
| Max. Negotiated Rate |
$4,586.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,494.28
|
| Rate for Payer: Aetna of WY Medicare |
$424.76
|
| Rate for Payer: Beech Street Commercial |
$4,356.70
|
| Rate for Payer: Cash Price |
$3,210.20
|
| Rate for Payer: Cash Price |
$3,210.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,448.42
|
| Rate for Payer: Cigna of WY Commercial |
$4,494.28
|
| Rate for Payer: First Choice Health Commercial |
$4,127.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,356.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.76
|
| Rate for Payer: HealthUtah PPO |
$4,586.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,448.42
|
| Rate for Payer: Multiplan Medicare/VA |
$361.05
|
| Rate for Payer: One Health Plan of WY PPO |
$4,494.28
|
| Rate for Payer: PacificSource Commercial |
$4,127.40
|
| Rate for Payer: PHCS PPO |
$4,356.70
|
| Rate for Payer: Three Rivers PPO |
$3,439.50
|
| Rate for Payer: TriWest Veterans Administration |
$424.76
|
| Rate for Payer: United Healthcare Commercial |
$3,989.82
|
| Rate for Payer: United Healthcare Medicare |
$424.76
|
| Rate for Payer: WINHealth Partners Commercial |
$3,898.10
|
|
