|
REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
69209
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$15.63
|
| Rate for Payer: Beech Street Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: First Choice Health Commercial |
$63.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.63
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$13.29
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$66.50
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.63
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$15.63
|
| Rate for Payer: WINHealth Partners Commercial |
$59.50
|
|
|
REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$464.52
|
| Rate for Payer: Aetna of WY Medicare |
$88.14
|
| Rate for Payer: Beech Street Commercial |
$450.30
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$459.78
|
| Rate for Payer: Cigna of WY Commercial |
$464.52
|
| Rate for Payer: First Choice Health Commercial |
$426.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$450.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.14
|
| Rate for Payer: HealthUtah PPO |
$474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$459.78
|
| Rate for Payer: Multiplan Medicare/VA |
$74.92
|
| Rate for Payer: One Health Plan of WY PPO |
$464.52
|
| Rate for Payer: PacificSource Commercial |
$426.60
|
| Rate for Payer: PHCS PPO |
$450.30
|
| Rate for Payer: Three Rivers PPO |
$355.50
|
| Rate for Payer: TriWest Veterans Administration |
$88.14
|
| Rate for Payer: United Healthcare Commercial |
$412.38
|
| Rate for Payer: United Healthcare Medicare |
$88.14
|
| Rate for Payer: WINHealth Partners Commercial |
$402.90
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$346.05 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Aetna of WY Medicare |
$407.12
|
| Rate for Payer: Beech Street Commercial |
$2,047.25
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: First Choice Health Commercial |
$1,939.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.12
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$346.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,047.25
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.12
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$407.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,831.75
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 20680 AS
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$346.05 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Aetna of WY Medicare |
$407.12
|
| Rate for Payer: Beech Street Commercial |
$2,047.25
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: First Choice Health Commercial |
$1,939.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.12
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$346.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,047.25
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.12
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$407.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,831.75
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 20680 80
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$346.05 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Aetna of WY Medicare |
$407.12
|
| Rate for Payer: Beech Street Commercial |
$2,047.25
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: First Choice Health Commercial |
$1,939.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.12
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$346.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,047.25
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.12
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$407.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,831.75
|
|
|
REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$5,900.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
26320
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$5,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,782.00
|
| Rate for Payer: Aetna of WY Medicare |
$345.18
|
| Rate for Payer: Beech Street Commercial |
$5,605.00
|
| Rate for Payer: Cash Price |
$4,130.00
|
| Rate for Payer: Cash Price |
$4,130.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,723.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,782.00
|
| Rate for Payer: First Choice Health Commercial |
$5,310.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,605.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$345.18
|
| Rate for Payer: HealthUtah PPO |
$5,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,723.00
|
| Rate for Payer: Multiplan Medicare/VA |
$293.40
|
| Rate for Payer: One Health Plan of WY PPO |
$5,782.00
|
| Rate for Payer: PacificSource Commercial |
$5,310.00
|
| Rate for Payer: PHCS PPO |
$5,605.00
|
| Rate for Payer: Three Rivers PPO |
$4,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$345.18
|
| Rate for Payer: United Healthcare Commercial |
$5,133.00
|
| Rate for Payer: United Healthcare Medicare |
$345.18
|
| Rate for Payer: WINHealth Partners Commercial |
$5,015.00
|
|
|
REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$731.08
|
| Rate for Payer: Aetna of WY Medicare |
$141.11
|
| Rate for Payer: Beech Street Commercial |
$708.70
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$723.62
|
| Rate for Payer: Cigna of WY Commercial |
$731.08
|
| Rate for Payer: First Choice Health Commercial |
$671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$708.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.11
|
| Rate for Payer: HealthUtah PPO |
$746.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$723.62
|
| Rate for Payer: Multiplan Medicare/VA |
$119.94
|
| Rate for Payer: One Health Plan of WY PPO |
$731.08
|
| Rate for Payer: PacificSource Commercial |
$671.40
|
| Rate for Payer: PHCS PPO |
$708.70
|
| Rate for Payer: Three Rivers PPO |
$559.50
|
| Rate for Payer: TriWest Veterans Administration |
$141.11
|
| Rate for Payer: United Healthcare Commercial |
$649.02
|
| Rate for Payer: United Healthcare Medicare |
$141.11
|
| Rate for Payer: WINHealth Partners Commercial |
$634.10
|
|
|
REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
20705
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$582.12
|
| Rate for Payer: Aetna of WY Medicare |
$117.15
|
| Rate for Payer: Beech Street Commercial |
$564.30
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$576.18
|
| Rate for Payer: Cigna of WY Commercial |
$582.12
|
| Rate for Payer: First Choice Health Commercial |
$534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.15
|
| Rate for Payer: HealthUtah PPO |
$594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$576.18
|
| Rate for Payer: Multiplan Medicare/VA |
$99.58
|
| Rate for Payer: One Health Plan of WY PPO |
$582.12
|
| Rate for Payer: PacificSource Commercial |
$534.60
|
| Rate for Payer: PHCS PPO |
$564.30
|
| Rate for Payer: Three Rivers PPO |
$445.50
|
| Rate for Payer: TriWest Veterans Administration |
$117.15
|
| Rate for Payer: United Healthcare Commercial |
$516.78
|
| Rate for Payer: United Healthcare Medicare |
$117.15
|
| Rate for Payer: WINHealth Partners Commercial |
$504.90
|
|
|
REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 20705 80
|
| Hospital Charge Code |
20705
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$582.12
|
| Rate for Payer: Aetna of WY Medicare |
$117.15
|
| Rate for Payer: Beech Street Commercial |
$564.30
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$576.18
|
| Rate for Payer: Cigna of WY Commercial |
$582.12
|
| Rate for Payer: First Choice Health Commercial |
$534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.15
|
| Rate for Payer: HealthUtah PPO |
$594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$576.18
|
| Rate for Payer: Multiplan Medicare/VA |
$99.58
|
| Rate for Payer: One Health Plan of WY PPO |
$582.12
|
| Rate for Payer: PacificSource Commercial |
$534.60
|
| Rate for Payer: PHCS PPO |
$564.30
|
| Rate for Payer: Three Rivers PPO |
$445.50
|
| Rate for Payer: TriWest Veterans Administration |
$117.15
|
| Rate for Payer: United Healthcare Commercial |
$516.78
|
| Rate for Payer: United Healthcare Medicare |
$117.15
|
| Rate for Payer: WINHealth Partners Commercial |
$504.90
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
58301
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$63.04
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.04
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$53.58
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.04
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$63.04
|
| Rate for Payer: WINHealth Partners Commercial |
$198.05
|
|
|
REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
11982
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$379.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.42
|
| Rate for Payer: Aetna of WY Medicare |
$69.33
|
| Rate for Payer: Beech Street Commercial |
$360.05
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.63
|
| Rate for Payer: Cigna of WY Commercial |
$371.42
|
| Rate for Payer: First Choice Health Commercial |
$341.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.33
|
| Rate for Payer: HealthUtah PPO |
$379.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.63
|
| Rate for Payer: Multiplan Medicare/VA |
$58.93
|
| Rate for Payer: One Health Plan of WY PPO |
$371.42
|
| Rate for Payer: PacificSource Commercial |
$341.10
|
| Rate for Payer: PHCS PPO |
$360.05
|
| Rate for Payer: Three Rivers PPO |
$284.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.33
|
| Rate for Payer: United Healthcare Commercial |
$329.73
|
| Rate for Payer: United Healthcare Medicare |
$69.33
|
| Rate for Payer: WINHealth Partners Commercial |
$322.15
|
|
|
REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY
|
Professional
|
Both
|
$4,433.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
49402
|
| Min. Negotiated Rate |
$689.83 |
| Max. Negotiated Rate |
$4,433.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,344.34
|
| Rate for Payer: Aetna of WY Medicare |
$811.56
|
| Rate for Payer: Beech Street Commercial |
$4,211.35
|
| Rate for Payer: Cash Price |
$3,103.10
|
| Rate for Payer: Cash Price |
$3,103.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,300.01
|
| Rate for Payer: Cigna of WY Commercial |
$4,344.34
|
| Rate for Payer: First Choice Health Commercial |
$3,989.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,211.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.56
|
| Rate for Payer: HealthUtah PPO |
$4,433.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,300.01
|
| Rate for Payer: Multiplan Medicare/VA |
$689.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4,344.34
|
| Rate for Payer: PacificSource Commercial |
$3,989.70
|
| Rate for Payer: PHCS PPO |
$4,211.35
|
| Rate for Payer: Three Rivers PPO |
$3,324.75
|
| Rate for Payer: TriWest Veterans Administration |
$811.56
|
| Rate for Payer: United Healthcare Commercial |
$3,856.71
|
| Rate for Payer: United Healthcare Medicare |
$811.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,768.05
|
|
|
REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 22850 AS
|
| Hospital Charge Code |
22850
|
| Min. Negotiated Rate |
$601.32 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,152.48
|
| Rate for Payer: Aetna of WY Medicare |
$707.43
|
| Rate for Payer: Beech Street Commercial |
$1,117.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,140.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,152.48
|
| Rate for Payer: First Choice Health Commercial |
$1,058.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,117.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.43
|
| Rate for Payer: HealthUtah PPO |
$1,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,140.72
|
| Rate for Payer: Multiplan Medicare/VA |
$601.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,152.48
|
| Rate for Payer: PacificSource Commercial |
$1,058.40
|
| Rate for Payer: PHCS PPO |
$1,117.20
|
| Rate for Payer: Three Rivers PPO |
$882.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.43
|
| Rate for Payer: United Healthcare Commercial |
$1,023.12
|
| Rate for Payer: United Healthcare Medicare |
$707.43
|
| Rate for Payer: WINHealth Partners Commercial |
$999.60
|
|
|
REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,578.00
|
|
|
Service Code
|
HCPCS 22852 80
|
| Hospital Charge Code |
22852
|
| Min. Negotiated Rate |
$580.00 |
| Max. Negotiated Rate |
$3,578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,506.44
|
| Rate for Payer: Aetna of WY Medicare |
$682.35
|
| Rate for Payer: Beech Street Commercial |
$3,399.10
|
| Rate for Payer: Cash Price |
$2,504.60
|
| Rate for Payer: Cash Price |
$2,504.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,470.66
|
| Rate for Payer: Cigna of WY Commercial |
$3,506.44
|
| Rate for Payer: First Choice Health Commercial |
$3,220.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,399.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$682.35
|
| Rate for Payer: HealthUtah PPO |
$3,578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,470.66
|
| Rate for Payer: Multiplan Medicare/VA |
$580.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,506.44
|
| Rate for Payer: PacificSource Commercial |
$3,220.20
|
| Rate for Payer: PHCS PPO |
$3,399.10
|
| Rate for Payer: Three Rivers PPO |
$2,683.50
|
| Rate for Payer: TriWest Veterans Administration |
$682.35
|
| Rate for Payer: United Healthcare Commercial |
$3,112.86
|
| Rate for Payer: United Healthcare Medicare |
$682.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,041.30
|
|
|
REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,578.00
|
|
|
Service Code
|
HCPCS 22852
|
| Hospital Charge Code |
22852
|
| Min. Negotiated Rate |
$580.00 |
| Max. Negotiated Rate |
$3,578.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,506.44
|
| Rate for Payer: Aetna of WY Medicare |
$682.35
|
| Rate for Payer: Beech Street Commercial |
$3,399.10
|
| Rate for Payer: Cash Price |
$2,504.60
|
| Rate for Payer: Cash Price |
$2,504.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,470.66
|
| Rate for Payer: Cigna of WY Commercial |
$3,506.44
|
| Rate for Payer: First Choice Health Commercial |
$3,220.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,399.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$682.35
|
| Rate for Payer: HealthUtah PPO |
$3,578.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,470.66
|
| Rate for Payer: Multiplan Medicare/VA |
$580.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,506.44
|
| Rate for Payer: PacificSource Commercial |
$3,220.20
|
| Rate for Payer: PHCS PPO |
$3,399.10
|
| Rate for Payer: Three Rivers PPO |
$2,683.50
|
| Rate for Payer: TriWest Veterans Administration |
$682.35
|
| Rate for Payer: United Healthcare Commercial |
$3,112.86
|
| Rate for Payer: United Healthcare Medicare |
$682.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,041.30
|
|
|
REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN
|
Professional
|
Both
|
$4,335.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
23000
|
| Min. Negotiated Rate |
$298.60 |
| Max. Negotiated Rate |
$4,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,248.30
|
| Rate for Payer: Aetna of WY Medicare |
$351.30
|
| Rate for Payer: Beech Street Commercial |
$4,118.25
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,204.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,248.30
|
| Rate for Payer: First Choice Health Commercial |
$3,901.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,118.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.30
|
| Rate for Payer: HealthUtah PPO |
$4,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,204.95
|
| Rate for Payer: Multiplan Medicare/VA |
$298.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,248.30
|
| Rate for Payer: PacificSource Commercial |
$3,901.50
|
| Rate for Payer: PHCS PPO |
$4,118.25
|
| Rate for Payer: Three Rivers PPO |
$3,251.25
|
| Rate for Payer: TriWest Veterans Administration |
$351.30
|
| Rate for Payer: United Healthcare Commercial |
$3,771.45
|
| Rate for Payer: United Healthcare Medicare |
$351.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,684.75
|
|
|
REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN
|
Professional
|
Both
|
$4,335.00
|
|
|
Service Code
|
HCPCS 23000 AS
|
| Hospital Charge Code |
23000
|
| Min. Negotiated Rate |
$298.60 |
| Max. Negotiated Rate |
$4,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,248.30
|
| Rate for Payer: Aetna of WY Medicare |
$351.30
|
| Rate for Payer: Beech Street Commercial |
$4,118.25
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,204.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,248.30
|
| Rate for Payer: First Choice Health Commercial |
$3,901.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,118.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.30
|
| Rate for Payer: HealthUtah PPO |
$4,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,204.95
|
| Rate for Payer: Multiplan Medicare/VA |
$298.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,248.30
|
| Rate for Payer: PacificSource Commercial |
$3,901.50
|
| Rate for Payer: PHCS PPO |
$4,118.25
|
| Rate for Payer: Three Rivers PPO |
$3,251.25
|
| Rate for Payer: TriWest Veterans Administration |
$351.30
|
| Rate for Payer: United Healthcare Commercial |
$3,771.45
|
| Rate for Payer: United Healthcare Medicare |
$351.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,684.75
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
15853
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: First Choice Health Commercial |
$36.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$38.00
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$34.00
|
|
|
REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 15850
|
| Hospital Charge Code |
15850
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.38
|
| Rate for Payer: Beech Street Commercial |
$124.45
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.07
|
| Rate for Payer: Cigna of WY Commercial |
$128.38
|
| Rate for Payer: First Choice Health Commercial |
$117.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.45
|
| Rate for Payer: HealthUtah PPO |
$131.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.07
|
| Rate for Payer: One Health Plan of WY PPO |
$128.38
|
| Rate for Payer: PacificSource Commercial |
$117.90
|
| Rate for Payer: PHCS PPO |
$124.45
|
| Rate for Payer: Three Rivers PPO |
$98.25
|
| Rate for Payer: United Healthcare Commercial |
$113.97
|
| Rate for Payer: WINHealth Partners Commercial |
$111.35
|
|
|
REMOVE DEEP SHOULDER FOREIGN BODY
|
Professional
|
Both
|
$2,551.00
|
|
|
Service Code
|
HCPCS 23331
|
| Hospital Charge Code |
23331
|
| Min. Negotiated Rate |
$1,913.25 |
| Max. Negotiated Rate |
$2,551.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,499.98
|
| Rate for Payer: Beech Street Commercial |
$2,423.45
|
| Rate for Payer: Cash Price |
$1,785.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,474.47
|
| Rate for Payer: Cigna of WY Commercial |
$2,499.98
|
| Rate for Payer: First Choice Health Commercial |
$2,295.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,423.45
|
| Rate for Payer: HealthUtah PPO |
$2,551.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,474.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,499.98
|
| Rate for Payer: PacificSource Commercial |
$2,295.90
|
| Rate for Payer: PHCS PPO |
$2,423.45
|
| Rate for Payer: Three Rivers PPO |
$1,913.25
|
| Rate for Payer: United Healthcare Commercial |
$2,219.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,168.35
|
|
|
REMV TISSUE FOR GRAFT OTHR
|
Professional
|
Both
|
$1,926.00
|
|
|
Service Code
|
HCPCS 20926
|
| Hospital Charge Code |
20926
|
| Min. Negotiated Rate |
$1,444.50 |
| Max. Negotiated Rate |
$1,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,887.48
|
| Rate for Payer: Beech Street Commercial |
$1,829.70
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,868.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,887.48
|
| Rate for Payer: First Choice Health Commercial |
$1,733.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,829.70
|
| Rate for Payer: HealthUtah PPO |
$1,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,868.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,887.48
|
| Rate for Payer: PacificSource Commercial |
$1,733.40
|
| Rate for Payer: PHCS PPO |
$1,829.70
|
| Rate for Payer: Three Rivers PPO |
$1,444.50
|
| Rate for Payer: United Healthcare Commercial |
$1,675.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,637.10
|
|
|
REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49002
|
| Hospital Charge Code |
49002
|
| Min. Negotiated Rate |
$838.69 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$986.69
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.69
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$838.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$986.69
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$986.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49002 80
|
| Hospital Charge Code |
49002
|
| Min. Negotiated Rate |
$838.69 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$986.69
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.69
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$838.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$986.69
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$986.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49002 62
|
| Hospital Charge Code |
49002
|
| Min. Negotiated Rate |
$838.69 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$986.69
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.69
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$838.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$986.69
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$986.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49002 AS
|
| Hospital Charge Code |
49002
|
| Min. Negotiated Rate |
$838.69 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$986.69
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.69
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$838.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$986.69
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$986.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
