|
PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS
|
Professional
|
Both
|
$4,985.00
|
|
|
Service Code
|
HCPCS 60500 AS
|
| Hospital Charge Code |
60500
|
| Min. Negotiated Rate |
$787.94 |
| Max. Negotiated Rate |
$4,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,885.30
|
| Rate for Payer: Aetna of WY Medicare |
$926.99
|
| Rate for Payer: Beech Street Commercial |
$4,735.75
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,835.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,885.30
|
| Rate for Payer: First Choice Health Commercial |
$4,486.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,735.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$926.99
|
| Rate for Payer: HealthUtah PPO |
$4,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,835.45
|
| Rate for Payer: Multiplan Medicare/VA |
$787.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,885.30
|
| Rate for Payer: PacificSource Commercial |
$4,486.50
|
| Rate for Payer: PHCS PPO |
$4,735.75
|
| Rate for Payer: Three Rivers PPO |
$3,738.75
|
| Rate for Payer: TriWest Veterans Administration |
$926.99
|
| Rate for Payer: United Healthcare Commercial |
$4,336.95
|
| Rate for Payer: United Healthcare Medicare |
$926.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.25
|
|
|
PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS
|
Professional
|
Both
|
$4,985.00
|
|
|
Service Code
|
HCPCS 60500 80
|
| Hospital Charge Code |
60500
|
| Min. Negotiated Rate |
$787.94 |
| Max. Negotiated Rate |
$4,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,885.30
|
| Rate for Payer: Aetna of WY Medicare |
$926.99
|
| Rate for Payer: Beech Street Commercial |
$4,735.75
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,835.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,885.30
|
| Rate for Payer: First Choice Health Commercial |
$4,486.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,735.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$926.99
|
| Rate for Payer: HealthUtah PPO |
$4,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,835.45
|
| Rate for Payer: Multiplan Medicare/VA |
$787.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,885.30
|
| Rate for Payer: PacificSource Commercial |
$4,486.50
|
| Rate for Payer: PHCS PPO |
$4,735.75
|
| Rate for Payer: Three Rivers PPO |
$3,738.75
|
| Rate for Payer: TriWest Veterans Administration |
$926.99
|
| Rate for Payer: United Healthcare Commercial |
$4,336.95
|
| Rate for Payer: United Healthcare Medicare |
$926.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.25
|
|
|
PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH
|
Professional
|
Both
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57423
|
| Hospital Charge Code |
57423
|
| Min. Negotiated Rate |
$758.55 |
| Max. Negotiated Rate |
$3,731.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,656.38
|
| Rate for Payer: Aetna of WY Medicare |
$892.41
|
| Rate for Payer: Beech Street Commercial |
$3,544.45
|
| Rate for Payer: Cash Price |
$2,611.70
|
| Rate for Payer: Cash Price |
$2,611.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,619.07
|
| Rate for Payer: Cigna of WY Commercial |
$3,656.38
|
| Rate for Payer: First Choice Health Commercial |
$3,357.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,544.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$892.41
|
| Rate for Payer: HealthUtah PPO |
$3,731.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,619.07
|
| Rate for Payer: Multiplan Medicare/VA |
$758.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,656.38
|
| Rate for Payer: PacificSource Commercial |
$3,357.90
|
| Rate for Payer: PHCS PPO |
$3,544.45
|
| Rate for Payer: Three Rivers PPO |
$2,798.25
|
| Rate for Payer: TriWest Veterans Administration |
$892.41
|
| Rate for Payer: United Healthcare Commercial |
$3,245.97
|
| Rate for Payer: United Healthcare Medicare |
$892.41
|
| Rate for Payer: WINHealth Partners Commercial |
$3,171.35
|
|
|
PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
11055
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$14.81
|
| Rate for Payer: Beech Street Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: First Choice Health Commercial |
$72.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.81
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$12.59
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$76.95
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.81
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$14.81
|
| Rate for Payer: WINHealth Partners Commercial |
$68.85
|
|
|
PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
11056
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$20.94
|
| Rate for Payer: Beech Street Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: First Choice Health Commercial |
$104.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.94
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$17.80
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$110.20
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.94
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$20.94
|
| Rate for Payer: WINHealth Partners Commercial |
$98.60
|
|
|
PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
11057
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$27.41
|
| Rate for Payer: Beech Street Commercial |
$141.55
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: First Choice Health Commercial |
$134.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.41
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$23.30
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$141.55
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.41
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$27.41
|
| Rate for Payer: WINHealth Partners Commercial |
$126.65
|
|
|
PAROXETINE 20 MG TABLET [12113]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 6808404501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.24
|
| Rate for Payer: Altius Commercial |
$1.24
|
| Rate for Payer: Beech Street Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.25
|
| Rate for Payer: Cigna of WY Commercial |
$1.26
|
| Rate for Payer: Entrust Commercial |
$1.23
|
| Rate for Payer: First Choice Health Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1.26
|
| Rate for Payer: PacificSource Commercial |
$1.16
|
| Rate for Payer: PHCS PPO |
$1.26
|
| Rate for Payer: Three Rivers PPO |
$0.97
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.23
|
| Rate for Payer: Wise Provider Network Commercial |
$1.23
|
|
|
PAROXETINE 20 MG TABLET [12113]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 6808404511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.26
|
| Rate for Payer: Aetna of WY Medicare |
$0.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.24
|
| Rate for Payer: Altius Commercial |
$1.24
|
| Rate for Payer: Beech Street Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.25
|
| Rate for Payer: Cigna of WY Commercial |
$1.26
|
| Rate for Payer: Entrust Commercial |
$1.23
|
| Rate for Payer: First Choice Health Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.26
|
| Rate for Payer: PacificSource Commercial |
$1.16
|
| Rate for Payer: PHCS PPO |
$1.26
|
| Rate for Payer: Three Rivers PPO |
$0.97
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.26
|
| Rate for Payer: Wise Provider Network Commercial |
$1.23
|
|
|
PAROXETINE 20 MG TABLET [12113]
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
NDC 6808404501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.26
|
| Rate for Payer: Aetna of WY Medicare |
$0.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.24
|
| Rate for Payer: Altius Commercial |
$1.24
|
| Rate for Payer: Beech Street Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.25
|
| Rate for Payer: Cigna of WY Commercial |
$1.26
|
| Rate for Payer: Entrust Commercial |
$1.23
|
| Rate for Payer: First Choice Health Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.26
|
| Rate for Payer: PacificSource Commercial |
$1.16
|
| Rate for Payer: PHCS PPO |
$1.26
|
| Rate for Payer: Three Rivers PPO |
$0.97
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.26
|
| Rate for Payer: Wise Provider Network Commercial |
$1.23
|
|
|
PAROXETINE 20 MG TABLET [12113]
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 6808404511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.24
|
| Rate for Payer: Altius Commercial |
$1.24
|
| Rate for Payer: Beech Street Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.25
|
| Rate for Payer: Cigna of WY Commercial |
$1.26
|
| Rate for Payer: Entrust Commercial |
$1.23
|
| Rate for Payer: First Choice Health Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1.26
|
| Rate for Payer: PacificSource Commercial |
$1.16
|
| Rate for Payer: PHCS PPO |
$1.26
|
| Rate for Payer: Three Rivers PPO |
$0.97
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.23
|
| Rate for Payer: Wise Provider Network Commercial |
$1.23
|
|
|
PARTIAL EXCISION BONE FIBULA
|
Professional
|
Both
|
$2,260.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
27641
|
| Min. Negotiated Rate |
$538.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$633.44
|
| Rate for Payer: Beech Street Commercial |
$2,147.00
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: First Choice Health Commercial |
$2,034.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.44
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$538.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,147.00
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$633.44
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$633.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,921.00
|
|
|
PARTIAL EXCISION BONE HUMERUS
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
HCPCS 24140
|
| Hospital Charge Code |
24140
|
| Min. Negotiated Rate |
$581.88 |
| Max. Negotiated Rate |
$2,443.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,394.14
|
| Rate for Payer: Aetna of WY Medicare |
$684.57
|
| Rate for Payer: Beech Street Commercial |
$2,320.85
|
| Rate for Payer: Cash Price |
$1,710.10
|
| Rate for Payer: Cash Price |
$1,710.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,369.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,394.14
|
| Rate for Payer: First Choice Health Commercial |
$2,198.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,320.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.57
|
| Rate for Payer: HealthUtah PPO |
$2,443.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,369.71
|
| Rate for Payer: Multiplan Medicare/VA |
$581.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,394.14
|
| Rate for Payer: PacificSource Commercial |
$2,198.70
|
| Rate for Payer: PHCS PPO |
$2,320.85
|
| Rate for Payer: Three Rivers PPO |
$1,832.25
|
| Rate for Payer: TriWest Veterans Administration |
$684.57
|
| Rate for Payer: United Healthcare Commercial |
$2,125.41
|
| Rate for Payer: United Healthcare Medicare |
$684.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,076.55
|
|
|
PARTIAL EXCISION BONE METACARPAL
|
Professional
|
Both
|
$3,243.00
|
|
|
Service Code
|
HCPCS 26230 AS
|
| Hospital Charge Code |
26230
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$3,243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,178.14
|
| Rate for Payer: Aetna of WY Medicare |
$490.80
|
| Rate for Payer: Beech Street Commercial |
$3,080.85
|
| Rate for Payer: Cash Price |
$2,270.10
|
| Rate for Payer: Cash Price |
$2,270.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,145.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,178.14
|
| Rate for Payer: First Choice Health Commercial |
$2,918.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,080.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$490.80
|
| Rate for Payer: HealthUtah PPO |
$3,243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,145.71
|
| Rate for Payer: Multiplan Medicare/VA |
$417.18
|
| Rate for Payer: One Health Plan of WY PPO |
$3,178.14
|
| Rate for Payer: PacificSource Commercial |
$2,918.70
|
| Rate for Payer: PHCS PPO |
$3,080.85
|
| Rate for Payer: Three Rivers PPO |
$2,432.25
|
| Rate for Payer: TriWest Veterans Administration |
$490.80
|
| Rate for Payer: United Healthcare Commercial |
$2,821.41
|
| Rate for Payer: United Healthcare Medicare |
$490.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,756.55
|
|
|
PARTIAL EXCISION BONE METACARPAL
|
Professional
|
Both
|
$3,243.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
26230
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$3,243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,178.14
|
| Rate for Payer: Aetna of WY Medicare |
$490.80
|
| Rate for Payer: Beech Street Commercial |
$3,080.85
|
| Rate for Payer: Cash Price |
$2,270.10
|
| Rate for Payer: Cash Price |
$2,270.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,145.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,178.14
|
| Rate for Payer: First Choice Health Commercial |
$2,918.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,080.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$490.80
|
| Rate for Payer: HealthUtah PPO |
$3,243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,145.71
|
| Rate for Payer: Multiplan Medicare/VA |
$417.18
|
| Rate for Payer: One Health Plan of WY PPO |
$3,178.14
|
| Rate for Payer: PacificSource Commercial |
$2,918.70
|
| Rate for Payer: PHCS PPO |
$3,080.85
|
| Rate for Payer: Three Rivers PPO |
$2,432.25
|
| Rate for Payer: TriWest Veterans Administration |
$490.80
|
| Rate for Payer: United Healthcare Commercial |
$2,821.41
|
| Rate for Payer: United Healthcare Medicare |
$490.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,756.55
|
|
|
PARTIAL EXCISION BONE RADIUS
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
25151
|
| Min. Negotiated Rate |
$486.48 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,002.14
|
| Rate for Payer: Aetna of WY Medicare |
$572.33
|
| Rate for Payer: Beech Street Commercial |
$1,940.85
|
| Rate for Payer: Cash Price |
$1,430.10
|
| Rate for Payer: Cash Price |
$1,430.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,981.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,002.14
|
| Rate for Payer: First Choice Health Commercial |
$1,838.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,940.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$572.33
|
| Rate for Payer: HealthUtah PPO |
$2,043.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,981.71
|
| Rate for Payer: Multiplan Medicare/VA |
$486.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,002.14
|
| Rate for Payer: PacificSource Commercial |
$1,838.70
|
| Rate for Payer: PHCS PPO |
$1,940.85
|
| Rate for Payer: Three Rivers PPO |
$1,532.25
|
| Rate for Payer: TriWest Veterans Administration |
$572.33
|
| Rate for Payer: United Healthcare Commercial |
$1,777.41
|
| Rate for Payer: United Healthcare Medicare |
$572.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,736.55
|
|
|
PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$2,327.00
|
|
|
Service Code
|
HCPCS 28120 80
|
| Hospital Charge Code |
28120
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$2,327.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,280.46
|
| Rate for Payer: Aetna of WY Medicare |
$483.29
|
| Rate for Payer: Beech Street Commercial |
$2,210.65
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,257.19
|
| Rate for Payer: Cigna of WY Commercial |
$2,280.46
|
| Rate for Payer: First Choice Health Commercial |
$2,094.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,210.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.29
|
| Rate for Payer: HealthUtah PPO |
$2,327.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,257.19
|
| Rate for Payer: Multiplan Medicare/VA |
$410.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,280.46
|
| Rate for Payer: PacificSource Commercial |
$2,094.30
|
| Rate for Payer: PHCS PPO |
$2,210.65
|
| Rate for Payer: Three Rivers PPO |
$1,745.25
|
| Rate for Payer: TriWest Veterans Administration |
$483.29
|
| Rate for Payer: United Healthcare Commercial |
$2,024.49
|
| Rate for Payer: United Healthcare Medicare |
$483.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.95
|
|
|
PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$2,327.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
28120
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$2,327.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,280.46
|
| Rate for Payer: Aetna of WY Medicare |
$483.29
|
| Rate for Payer: Beech Street Commercial |
$2,210.65
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: Cash Price |
$1,628.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,257.19
|
| Rate for Payer: Cigna of WY Commercial |
$2,280.46
|
| Rate for Payer: First Choice Health Commercial |
$2,094.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,210.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.29
|
| Rate for Payer: HealthUtah PPO |
$2,327.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,257.19
|
| Rate for Payer: Multiplan Medicare/VA |
$410.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,280.46
|
| Rate for Payer: PacificSource Commercial |
$2,094.30
|
| Rate for Payer: PHCS PPO |
$2,210.65
|
| Rate for Payer: Three Rivers PPO |
$1,745.25
|
| Rate for Payer: TriWest Veterans Administration |
$483.29
|
| Rate for Payer: United Healthcare Commercial |
$2,024.49
|
| Rate for Payer: United Healthcare Medicare |
$483.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.95
|
|
|
PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$2,874.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
27640
|
| Min. Negotiated Rate |
$684.14 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,816.52
|
| Rate for Payer: Aetna of WY Medicare |
$804.87
|
| Rate for Payer: Beech Street Commercial |
$2,730.30
|
| Rate for Payer: Cash Price |
$2,011.80
|
| Rate for Payer: Cash Price |
$2,011.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,787.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,816.52
|
| Rate for Payer: First Choice Health Commercial |
$2,586.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,730.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$804.87
|
| Rate for Payer: HealthUtah PPO |
$2,874.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,787.78
|
| Rate for Payer: Multiplan Medicare/VA |
$684.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,816.52
|
| Rate for Payer: PacificSource Commercial |
$2,586.60
|
| Rate for Payer: PHCS PPO |
$2,730.30
|
| Rate for Payer: Three Rivers PPO |
$2,155.50
|
| Rate for Payer: TriWest Veterans Administration |
$804.87
|
| Rate for Payer: United Healthcare Commercial |
$2,500.38
|
| Rate for Payer: United Healthcare Medicare |
$804.87
|
| Rate for Payer: WINHealth Partners Commercial |
$2,442.90
|
|
|
PARTIAL EXCISION BONE ULNA
|
Professional
|
Both
|
$1,981.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
25150
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$1,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,941.38
|
| Rate for Payer: Aetna of WY Medicare |
$555.06
|
| Rate for Payer: Beech Street Commercial |
$1,881.95
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,921.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,941.38
|
| Rate for Payer: First Choice Health Commercial |
$1,782.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,881.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$555.06
|
| Rate for Payer: HealthUtah PPO |
$1,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,921.57
|
| Rate for Payer: Multiplan Medicare/VA |
$471.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,941.38
|
| Rate for Payer: PacificSource Commercial |
$1,782.90
|
| Rate for Payer: PHCS PPO |
$1,881.95
|
| Rate for Payer: Three Rivers PPO |
$1,485.75
|
| Rate for Payer: TriWest Veterans Administration |
$555.06
|
| Rate for Payer: United Healthcare Commercial |
$1,723.47
|
| Rate for Payer: United Healthcare Medicare |
$555.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,683.85
|
|
|
PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$1,328.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
26236
|
| Min. Negotiated Rate |
$369.99 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,301.44
|
| Rate for Payer: Aetna of WY Medicare |
$435.28
|
| Rate for Payer: Beech Street Commercial |
$1,261.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: Cash Price |
$929.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,301.44
|
| Rate for Payer: First Choice Health Commercial |
$1,195.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,261.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.28
|
| Rate for Payer: HealthUtah PPO |
$1,328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.16
|
| Rate for Payer: Multiplan Medicare/VA |
$369.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,301.44
|
| Rate for Payer: PacificSource Commercial |
$1,195.20
|
| Rate for Payer: PHCS PPO |
$1,261.60
|
| Rate for Payer: Three Rivers PPO |
$996.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.28
|
| Rate for Payer: United Healthcare Commercial |
$1,155.36
|
| Rate for Payer: United Healthcare Medicare |
$435.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,128.80
|
|
|
PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER
|
Professional
|
Both
|
$4,481.00
|
|
|
Service Code
|
HCPCS 26235
|
| Hospital Charge Code |
26235
|
| Min. Negotiated Rate |
$411.83 |
| Max. Negotiated Rate |
$4,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,391.38
|
| Rate for Payer: Aetna of WY Medicare |
$484.51
|
| Rate for Payer: Beech Street Commercial |
$4,256.95
|
| Rate for Payer: Cash Price |
$3,136.70
|
| Rate for Payer: Cash Price |
$3,136.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,346.57
|
| Rate for Payer: Cigna of WY Commercial |
$4,391.38
|
| Rate for Payer: First Choice Health Commercial |
$4,032.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,256.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.51
|
| Rate for Payer: HealthUtah PPO |
$4,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,346.57
|
| Rate for Payer: Multiplan Medicare/VA |
$411.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4,391.38
|
| Rate for Payer: PacificSource Commercial |
$4,032.90
|
| Rate for Payer: PHCS PPO |
$4,256.95
|
| Rate for Payer: Three Rivers PPO |
$3,360.75
|
| Rate for Payer: TriWest Veterans Administration |
$484.51
|
| Rate for Payer: United Healthcare Commercial |
$3,898.47
|
| Rate for Payer: United Healthcare Medicare |
$484.51
|
| Rate for Payer: WINHealth Partners Commercial |
$3,808.85
|
|
|
PARTIAL HYMENECTOMY OR REVISION HYMENAL RING
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
56700
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$1,697.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,663.06
|
| Rate for Payer: Aetna of WY Medicare |
$197.36
|
| Rate for Payer: Beech Street Commercial |
$1,612.15
|
| Rate for Payer: Cash Price |
$1,187.90
|
| Rate for Payer: Cash Price |
$1,187.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,646.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,663.06
|
| Rate for Payer: First Choice Health Commercial |
$1,527.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,612.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.36
|
| Rate for Payer: HealthUtah PPO |
$1,697.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,646.09
|
| Rate for Payer: Multiplan Medicare/VA |
$167.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,663.06
|
| Rate for Payer: PacificSource Commercial |
$1,527.30
|
| Rate for Payer: PHCS PPO |
$1,612.15
|
| Rate for Payer: Three Rivers PPO |
$1,272.75
|
| Rate for Payer: TriWest Veterans Administration |
$197.36
|
| Rate for Payer: United Healthcare Commercial |
$1,476.39
|
| Rate for Payer: United Healthcare Medicare |
$197.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,442.45
|
|
|
PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 28124
|
| Hospital Charge Code |
28124
|
| Min. Negotiated Rate |
$278.95 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$328.18
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.18
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$278.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$328.18
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$328.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
PASSPORT BUTTON 8MM 6592-08-30
|
Facility
|
IP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.35
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$86.35
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$86.35
|
| Rate for Payer: WINHealth Partners Commercial |
$124.29
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
|
PASSPORT BUTTON 8MM 6592-08-30
|
Facility
|
OP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Aetna of WY Medicare |
$86.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.88
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$72.09
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$75.88
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$75.88
|
| Rate for Payer: WINHealth Partners Commercial |
$128.21
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
