|
REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
24341
|
| Min. Negotiated Rate |
$623.37 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,564.66
|
| Rate for Payer: Aetna of WY Medicare |
$733.38
|
| Rate for Payer: Beech Street Commercial |
$2,486.15
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,538.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,564.66
|
| Rate for Payer: First Choice Health Commercial |
$2,355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,486.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.38
|
| Rate for Payer: HealthUtah PPO |
$2,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,538.49
|
| Rate for Payer: Multiplan Medicare/VA |
$623.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,564.66
|
| Rate for Payer: PacificSource Commercial |
$2,355.30
|
| Rate for Payer: PHCS PPO |
$2,486.15
|
| Rate for Payer: Three Rivers PPO |
$1,962.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.38
|
| Rate for Payer: United Healthcare Commercial |
$2,276.79
|
| Rate for Payer: United Healthcare Medicare |
$733.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.45
|
|
|
REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 24341 80
|
| Hospital Charge Code |
24341
|
| Min. Negotiated Rate |
$623.37 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,564.66
|
| Rate for Payer: Aetna of WY Medicare |
$733.38
|
| Rate for Payer: Beech Street Commercial |
$2,486.15
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,538.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,564.66
|
| Rate for Payer: First Choice Health Commercial |
$2,355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,486.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.38
|
| Rate for Payer: HealthUtah PPO |
$2,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,538.49
|
| Rate for Payer: Multiplan Medicare/VA |
$623.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,564.66
|
| Rate for Payer: PacificSource Commercial |
$2,355.30
|
| Rate for Payer: PHCS PPO |
$2,486.15
|
| Rate for Payer: Three Rivers PPO |
$1,962.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.38
|
| Rate for Payer: United Healthcare Commercial |
$2,276.79
|
| Rate for Payer: United Healthcare Medicare |
$733.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.45
|
|
|
REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 24341 AS
|
| Hospital Charge Code |
24341
|
| Min. Negotiated Rate |
$623.37 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,564.66
|
| Rate for Payer: Aetna of WY Medicare |
$733.38
|
| Rate for Payer: Beech Street Commercial |
$2,486.15
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: Cash Price |
$1,831.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,538.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,564.66
|
| Rate for Payer: First Choice Health Commercial |
$2,355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,486.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.38
|
| Rate for Payer: HealthUtah PPO |
$2,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,538.49
|
| Rate for Payer: Multiplan Medicare/VA |
$623.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,564.66
|
| Rate for Payer: PacificSource Commercial |
$2,355.30
|
| Rate for Payer: PHCS PPO |
$2,486.15
|
| Rate for Payer: Three Rivers PPO |
$1,962.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.38
|
| Rate for Payer: United Healthcare Commercial |
$2,276.79
|
| Rate for Payer: United Healthcare Medicare |
$733.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.45
|
|
|
REPIGASTRIC HERNIA REDUCIBLE SPX
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 49570
|
| Hospital Charge Code |
49570
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,116.80
|
| Rate for Payer: Beech Street Commercial |
$2,052.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,095.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,116.80
|
| Rate for Payer: First Choice Health Commercial |
$1,944.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,052.00
|
| Rate for Payer: HealthUtah PPO |
$2,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,095.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,116.80
|
| Rate for Payer: PacificSource Commercial |
$1,944.00
|
| Rate for Payer: PHCS PPO |
$2,052.00
|
| Rate for Payer: Three Rivers PPO |
$1,620.00
|
| Rate for Payer: United Healthcare Commercial |
$1,879.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,836.00
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
49450
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Medicare |
$61.26
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: First Choice Health Commercial |
$308.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.26
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Multiplan Medicare/VA |
$52.07
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: TriWest Veterans Administration |
$61.26
|
| Rate for Payer: United Healthcare Commercial |
$298.41
|
| Rate for Payer: United Healthcare Medicare |
$61.26
|
| Rate for Payer: WINHealth Partners Commercial |
$291.55
|
|
|
RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO
|
Professional
|
Both
|
$4,701.00
|
|
|
Service Code
|
HCPCS 58950
|
| Hospital Charge Code |
58950
|
| Min. Negotiated Rate |
$943.75 |
| Max. Negotiated Rate |
$4,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,606.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,110.29
|
| Rate for Payer: Beech Street Commercial |
$4,465.95
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: Cash Price |
$3,290.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,559.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,606.98
|
| Rate for Payer: First Choice Health Commercial |
$4,230.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,465.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,110.29
|
| Rate for Payer: HealthUtah PPO |
$4,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,559.97
|
| Rate for Payer: Multiplan Medicare/VA |
$943.75
|
| Rate for Payer: One Health Plan of WY PPO |
$4,606.98
|
| Rate for Payer: PacificSource Commercial |
$4,230.90
|
| Rate for Payer: PHCS PPO |
$4,465.95
|
| Rate for Payer: Three Rivers PPO |
$3,525.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,110.29
|
| Rate for Payer: United Healthcare Commercial |
$4,089.87
|
| Rate for Payer: United Healthcare Medicare |
$1,110.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,995.85
|
|
|
RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING
|
Professional
|
Both
|
$6,754.00
|
|
|
Service Code
|
HCPCS 58952
|
| Hospital Charge Code |
58952
|
| Min. Negotiated Rate |
$1,348.66 |
| Max. Negotiated Rate |
$6,754.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,618.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,586.66
|
| Rate for Payer: Beech Street Commercial |
$6,416.30
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,551.38
|
| Rate for Payer: Cigna of WY Commercial |
$6,618.92
|
| Rate for Payer: First Choice Health Commercial |
$6,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,416.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,586.66
|
| Rate for Payer: HealthUtah PPO |
$6,754.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,551.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,348.66
|
| Rate for Payer: One Health Plan of WY PPO |
$6,618.92
|
| Rate for Payer: PacificSource Commercial |
$6,078.60
|
| Rate for Payer: PHCS PPO |
$6,416.30
|
| Rate for Payer: Three Rivers PPO |
$5,065.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,586.66
|
| Rate for Payer: United Healthcare Commercial |
$5,875.98
|
| Rate for Payer: United Healthcare Medicare |
$1,586.66
|
| Rate for Payer: WINHealth Partners Commercial |
$5,740.90
|
|
|
RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING
|
Professional
|
Both
|
$6,754.00
|
|
|
Service Code
|
HCPCS 58952 80
|
| Hospital Charge Code |
58952
|
| Min. Negotiated Rate |
$1,348.66 |
| Max. Negotiated Rate |
$6,754.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,618.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,586.66
|
| Rate for Payer: Beech Street Commercial |
$6,416.30
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,551.38
|
| Rate for Payer: Cigna of WY Commercial |
$6,618.92
|
| Rate for Payer: First Choice Health Commercial |
$6,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,416.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,586.66
|
| Rate for Payer: HealthUtah PPO |
$6,754.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,551.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,348.66
|
| Rate for Payer: One Health Plan of WY PPO |
$6,618.92
|
| Rate for Payer: PacificSource Commercial |
$6,078.60
|
| Rate for Payer: PHCS PPO |
$6,416.30
|
| Rate for Payer: Three Rivers PPO |
$5,065.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,586.66
|
| Rate for Payer: United Healthcare Commercial |
$5,875.98
|
| Rate for Payer: United Healthcare Medicare |
$1,586.66
|
| Rate for Payer: WINHealth Partners Commercial |
$5,740.90
|
|
|
RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING
|
Professional
|
Both
|
$6,754.00
|
|
|
Service Code
|
HCPCS 58952 AS
|
| Hospital Charge Code |
58952
|
| Min. Negotiated Rate |
$1,348.66 |
| Max. Negotiated Rate |
$6,754.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,618.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,586.66
|
| Rate for Payer: Beech Street Commercial |
$6,416.30
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: Cash Price |
$4,727.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,551.38
|
| Rate for Payer: Cigna of WY Commercial |
$6,618.92
|
| Rate for Payer: First Choice Health Commercial |
$6,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,416.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,586.66
|
| Rate for Payer: HealthUtah PPO |
$6,754.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,551.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,348.66
|
| Rate for Payer: One Health Plan of WY PPO |
$6,618.92
|
| Rate for Payer: PacificSource Commercial |
$6,078.60
|
| Rate for Payer: PHCS PPO |
$6,416.30
|
| Rate for Payer: Three Rivers PPO |
$5,065.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,586.66
|
| Rate for Payer: United Healthcare Commercial |
$5,875.98
|
| Rate for Payer: United Healthcare Medicare |
$1,586.66
|
| Rate for Payer: WINHealth Partners Commercial |
$5,740.90
|
|
|
RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD
|
Professional
|
Both
|
$5,947.00
|
|
|
Service Code
|
HCPCS 58951
|
| Hospital Charge Code |
58951
|
| Min. Negotiated Rate |
$1,180.10 |
| Max. Negotiated Rate |
$5,947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,828.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,388.35
|
| Rate for Payer: Beech Street Commercial |
$5,649.65
|
| Rate for Payer: Cash Price |
$4,162.90
|
| Rate for Payer: Cash Price |
$4,162.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,768.59
|
| Rate for Payer: Cigna of WY Commercial |
$5,828.06
|
| Rate for Payer: First Choice Health Commercial |
$5,352.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,649.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,388.35
|
| Rate for Payer: HealthUtah PPO |
$5,947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,768.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1,180.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,828.06
|
| Rate for Payer: PacificSource Commercial |
$5,352.30
|
| Rate for Payer: PHCS PPO |
$5,649.65
|
| Rate for Payer: Three Rivers PPO |
$4,460.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,388.35
|
| Rate for Payer: United Healthcare Commercial |
$5,173.89
|
| Rate for Payer: United Healthcare Medicare |
$1,388.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,054.95
|
|
|
RESCJ RECR OVR TBL PP UTR MAL OMNTC PEL LMPHADEC
|
Professional
|
Both
|
$7,233.00
|
|
|
Service Code
|
HCPCS 58958
|
| Hospital Charge Code |
58958
|
| Min. Negotiated Rate |
$1,350.45 |
| Max. Negotiated Rate |
$7,233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,088.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,588.77
|
| Rate for Payer: Beech Street Commercial |
$6,871.35
|
| Rate for Payer: Cash Price |
$5,063.10
|
| Rate for Payer: Cash Price |
$5,063.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,016.01
|
| Rate for Payer: Cigna of WY Commercial |
$7,088.34
|
| Rate for Payer: First Choice Health Commercial |
$6,509.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,871.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,588.77
|
| Rate for Payer: HealthUtah PPO |
$7,233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,016.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1,350.45
|
| Rate for Payer: One Health Plan of WY PPO |
$7,088.34
|
| Rate for Payer: PacificSource Commercial |
$6,509.70
|
| Rate for Payer: PHCS PPO |
$6,871.35
|
| Rate for Payer: Three Rivers PPO |
$5,424.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,588.77
|
| Rate for Payer: United Healthcare Commercial |
$6,292.71
|
| Rate for Payer: United Healthcare Medicare |
$1,588.77
|
| Rate for Payer: WINHealth Partners Commercial |
$6,148.05
|
|
|
RESCJ TEMPORAL BONE EXTERNAL APPROACH
|
Professional
|
Both
|
$9,175.00
|
|
|
Service Code
|
HCPCS 69535
|
| Hospital Charge Code |
69535
|
| Min. Negotiated Rate |
$2,185.64 |
| Max. Negotiated Rate |
$9,175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,991.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,571.34
|
| Rate for Payer: Beech Street Commercial |
$8,716.25
|
| Rate for Payer: Cash Price |
$6,422.50
|
| Rate for Payer: Cash Price |
$6,422.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,899.75
|
| Rate for Payer: Cigna of WY Commercial |
$8,991.50
|
| Rate for Payer: First Choice Health Commercial |
$8,257.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,716.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,571.34
|
| Rate for Payer: HealthUtah PPO |
$9,175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,899.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,185.64
|
| Rate for Payer: One Health Plan of WY PPO |
$8,991.50
|
| Rate for Payer: PacificSource Commercial |
$8,257.50
|
| Rate for Payer: PHCS PPO |
$8,716.25
|
| Rate for Payer: Three Rivers PPO |
$6,881.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,571.34
|
| Rate for Payer: United Healthcare Commercial |
$7,982.25
|
| Rate for Payer: United Healthcare Medicare |
$2,571.34
|
| Rate for Payer: WINHealth Partners Commercial |
$7,798.75
|
|
|
RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY
|
Professional
|
Both
|
$6,536.00
|
|
|
Service Code
|
HCPCS 58957
|
| Hospital Charge Code |
58957
|
| Min. Negotiated Rate |
$1,301.44 |
| Max. Negotiated Rate |
$6,536.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,405.28
|
| Rate for Payer: Aetna of WY Medicare |
$1,531.11
|
| Rate for Payer: Beech Street Commercial |
$6,209.20
|
| Rate for Payer: Cash Price |
$4,575.20
|
| Rate for Payer: Cash Price |
$4,575.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,339.92
|
| Rate for Payer: Cigna of WY Commercial |
$6,405.28
|
| Rate for Payer: First Choice Health Commercial |
$5,882.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,209.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,531.11
|
| Rate for Payer: HealthUtah PPO |
$6,536.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,339.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1,301.44
|
| Rate for Payer: One Health Plan of WY PPO |
$6,405.28
|
| Rate for Payer: PacificSource Commercial |
$5,882.40
|
| Rate for Payer: PHCS PPO |
$6,209.20
|
| Rate for Payer: Three Rivers PPO |
$4,902.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,531.11
|
| Rate for Payer: United Healthcare Commercial |
$5,686.32
|
| Rate for Payer: United Healthcare Medicare |
$1,531.11
|
| Rate for Payer: WINHealth Partners Commercial |
$5,555.60
|
|
|
RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 28153
|
| Hospital Charge Code |
28153
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$1,374.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,346.52
|
| Rate for Payer: Aetna of WY Medicare |
$259.29
|
| Rate for Payer: Beech Street Commercial |
$1,305.30
|
| Rate for Payer: Cash Price |
$961.80
|
| Rate for Payer: Cash Price |
$961.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,332.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,346.52
|
| Rate for Payer: First Choice Health Commercial |
$1,236.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,305.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.29
|
| Rate for Payer: HealthUtah PPO |
$1,374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,332.78
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,346.52
|
| Rate for Payer: PacificSource Commercial |
$1,236.60
|
| Rate for Payer: PHCS PPO |
$1,305.30
|
| Rate for Payer: Three Rivers PPO |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration |
$259.29
|
| Rate for Payer: United Healthcare Commercial |
$1,195.38
|
| Rate for Payer: United Healthcare Medicare |
$259.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,167.90
|
|
|
RESECTION ELBOW JOINT ARTHRECTOMY
|
Professional
|
Both
|
$4,010.00
|
|
|
Service Code
|
HCPCS 24155
|
| Hospital Charge Code |
24155
|
| Min. Negotiated Rate |
$700.82 |
| Max. Negotiated Rate |
$4,010.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,929.80
|
| Rate for Payer: Aetna of WY Medicare |
$824.50
|
| Rate for Payer: Beech Street Commercial |
$3,809.50
|
| Rate for Payer: Cash Price |
$2,807.00
|
| Rate for Payer: Cash Price |
$2,807.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,889.70
|
| Rate for Payer: Cigna of WY Commercial |
$3,929.80
|
| Rate for Payer: First Choice Health Commercial |
$3,609.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,809.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$824.50
|
| Rate for Payer: HealthUtah PPO |
$4,010.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,889.70
|
| Rate for Payer: Multiplan Medicare/VA |
$700.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,929.80
|
| Rate for Payer: PacificSource Commercial |
$3,609.00
|
| Rate for Payer: PHCS PPO |
$3,809.50
|
| Rate for Payer: Three Rivers PPO |
$3,007.50
|
| Rate for Payer: TriWest Veterans Administration |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$3,488.70
|
| Rate for Payer: United Healthcare Medicare |
$824.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,408.50
|
|
|
RESECTION ELBOW JOINT ARTHRECTOMY
|
Professional
|
Both
|
$4,010.00
|
|
|
Service Code
|
HCPCS 24155 AS
|
| Hospital Charge Code |
24155
|
| Min. Negotiated Rate |
$700.82 |
| Max. Negotiated Rate |
$4,010.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,929.80
|
| Rate for Payer: Aetna of WY Medicare |
$824.50
|
| Rate for Payer: Beech Street Commercial |
$3,809.50
|
| Rate for Payer: Cash Price |
$2,807.00
|
| Rate for Payer: Cash Price |
$2,807.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,889.70
|
| Rate for Payer: Cigna of WY Commercial |
$3,929.80
|
| Rate for Payer: First Choice Health Commercial |
$3,609.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,809.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$824.50
|
| Rate for Payer: HealthUtah PPO |
$4,010.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,889.70
|
| Rate for Payer: Multiplan Medicare/VA |
$700.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,929.80
|
| Rate for Payer: PacificSource Commercial |
$3,609.00
|
| Rate for Payer: PHCS PPO |
$3,809.50
|
| Rate for Payer: Three Rivers PPO |
$3,007.50
|
| Rate for Payer: TriWest Veterans Administration |
$824.50
|
| Rate for Payer: United Healthcare Commercial |
$3,488.70
|
| Rate for Payer: United Healthcare Medicare |
$824.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,408.50
|
|
|
RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$4,958.00
|
|
|
Service Code
|
HCPCS 28126
|
| Hospital Charge Code |
28126
|
| Min. Negotiated Rate |
$208.83 |
| Max. Negotiated Rate |
$4,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,858.84
|
| Rate for Payer: Aetna of WY Medicare |
$245.68
|
| Rate for Payer: Beech Street Commercial |
$4,710.10
|
| Rate for Payer: Cash Price |
$3,470.60
|
| Rate for Payer: Cash Price |
$3,470.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,809.26
|
| Rate for Payer: Cigna of WY Commercial |
$4,858.84
|
| Rate for Payer: First Choice Health Commercial |
$4,462.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,710.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.68
|
| Rate for Payer: HealthUtah PPO |
$4,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,809.26
|
| Rate for Payer: Multiplan Medicare/VA |
$208.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4,858.84
|
| Rate for Payer: PacificSource Commercial |
$4,462.20
|
| Rate for Payer: PHCS PPO |
$4,710.10
|
| Rate for Payer: Three Rivers PPO |
$3,718.50
|
| Rate for Payer: TriWest Veterans Administration |
$245.68
|
| Rate for Payer: United Healthcare Commercial |
$4,313.46
|
| Rate for Payer: United Healthcare Medicare |
$245.68
|
| Rate for Payer: WINHealth Partners Commercial |
$4,214.30
|
|
|
RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 23440 AS
|
| Hospital Charge Code |
23440
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$2,579.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,527.42
|
| Rate for Payer: Aetna of WY Medicare |
$734.81
|
| Rate for Payer: Beech Street Commercial |
$2,450.05
|
| Rate for Payer: Cash Price |
$1,805.30
|
| Rate for Payer: Cash Price |
$1,805.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,501.63
|
| Rate for Payer: Cigna of WY Commercial |
$2,527.42
|
| Rate for Payer: First Choice Health Commercial |
$2,321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,450.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$734.81
|
| Rate for Payer: HealthUtah PPO |
$2,579.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,501.63
|
| Rate for Payer: Multiplan Medicare/VA |
$624.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,527.42
|
| Rate for Payer: PacificSource Commercial |
$2,321.10
|
| Rate for Payer: PHCS PPO |
$2,450.05
|
| Rate for Payer: Three Rivers PPO |
$1,934.25
|
| Rate for Payer: TriWest Veterans Administration |
$734.81
|
| Rate for Payer: United Healthcare Commercial |
$2,243.73
|
| Rate for Payer: United Healthcare Medicare |
$734.81
|
| Rate for Payer: WINHealth Partners Commercial |
$2,192.15
|
|
|
RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
23440
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$2,579.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,527.42
|
| Rate for Payer: Aetna of WY Medicare |
$734.81
|
| Rate for Payer: Beech Street Commercial |
$2,450.05
|
| Rate for Payer: Cash Price |
$1,805.30
|
| Rate for Payer: Cash Price |
$1,805.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,501.63
|
| Rate for Payer: Cigna of WY Commercial |
$2,527.42
|
| Rate for Payer: First Choice Health Commercial |
$2,321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,450.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$734.81
|
| Rate for Payer: HealthUtah PPO |
$2,579.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,501.63
|
| Rate for Payer: Multiplan Medicare/VA |
$624.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,527.42
|
| Rate for Payer: PacificSource Commercial |
$2,321.10
|
| Rate for Payer: PHCS PPO |
$2,450.05
|
| Rate for Payer: Three Rivers PPO |
$1,934.25
|
| Rate for Payer: TriWest Veterans Administration |
$734.81
|
| Rate for Payer: United Healthcare Commercial |
$2,243.73
|
| Rate for Payer: United Healthcare Medicare |
$734.81
|
| Rate for Payer: WINHealth Partners Commercial |
$2,192.15
|
|
|
RESP CAPNOLINE AIRWAY ADAPTER
|
Facility
|
IP
|
$29.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.79
|
| Rate for Payer: Altius Commercial |
$28.79
|
| Rate for Payer: Beech Street Commercial |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.62
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.09
|
| Rate for Payer: Cigna of WY Commercial |
$29.39
|
| Rate for Payer: Entrust Commercial |
$28.49
|
| Rate for Payer: First Choice Health Commercial |
$28.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.79
|
| Rate for Payer: HealthUtah PPO |
$29.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.09
|
| Rate for Payer: Multiplan Medicare/VA |
$18.80
|
| Rate for Payer: One Health Plan of WY PPO |
$29.39
|
| Rate for Payer: PacificSource Commercial |
$26.99
|
| Rate for Payer: PHCS PPO |
$29.39
|
| Rate for Payer: Three Rivers PPO |
$22.49
|
| Rate for Payer: TriWest Veterans Administration |
$19.79
|
| Rate for Payer: United Healthcare Commercial |
$26.09
|
| Rate for Payer: United Healthcare Medicare |
$19.79
|
| Rate for Payer: WINHealth Partners Commercial |
$28.49
|
| Rate for Payer: Wise Provider Network Commercial |
$28.49
|
|
|
RESP CAPNOLINE AIRWAY ADAPTER
|
Facility
|
OP
|
$29.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.39
|
| Rate for Payer: Aetna of WY Medicare |
$19.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.79
|
| Rate for Payer: Altius Commercial |
$28.79
|
| Rate for Payer: Beech Street Commercial |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.62
|
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.09
|
| Rate for Payer: Cigna of WY Commercial |
$29.39
|
| Rate for Payer: Entrust Commercial |
$28.49
|
| Rate for Payer: First Choice Health Commercial |
$28.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.39
|
| Rate for Payer: HealthUtah PPO |
$29.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.09
|
| Rate for Payer: Multiplan Medicare/VA |
$16.52
|
| Rate for Payer: One Health Plan of WY PPO |
$29.39
|
| Rate for Payer: PacificSource Commercial |
$26.99
|
| Rate for Payer: PHCS PPO |
$29.39
|
| Rate for Payer: Three Rivers PPO |
$22.49
|
| Rate for Payer: TriWest Veterans Administration |
$17.39
|
| Rate for Payer: United Healthcare Commercial |
$26.09
|
| Rate for Payer: United Healthcare Medicare |
$17.39
|
| Rate for Payer: WINHealth Partners Commercial |
$29.39
|
| Rate for Payer: Wise Provider Network Commercial |
$28.49
|
|
|
RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 94375 26
|
| Hospital Charge Code |
94375
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$13.67
|
| Rate for Payer: Beech Street Commercial |
$99.75
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: First Choice Health Commercial |
$94.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.67
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$11.62
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$99.75
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.67
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$13.67
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
|
|
RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$3,346.00
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
90378
|
| Min. Negotiated Rate |
$2,509.50 |
| Max. Negotiated Rate |
$3,346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,279.08
|
| Rate for Payer: Beech Street Commercial |
$3,178.70
|
| Rate for Payer: Cash Price |
$2,342.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,245.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,279.08
|
| Rate for Payer: First Choice Health Commercial |
$3,011.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,178.70
|
| Rate for Payer: HealthUtah PPO |
$3,346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,245.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,279.08
|
| Rate for Payer: PacificSource Commercial |
$3,011.40
|
| Rate for Payer: PHCS PPO |
$3,178.70
|
| Rate for Payer: Three Rivers PPO |
$2,509.50
|
| Rate for Payer: United Healthcare Commercial |
$2,911.02
|
| Rate for Payer: WINHealth Partners Commercial |
$3,178.70
|
|
|
RESPIRATORY SYNCYTIAL VIRUS VACCINE, ANTIGEN (2 OF 2) 120 MCG IM SUSP [182048]
|
Facility
|
OP
|
$367.50
|
|
|
Service Code
|
NDC 5816072303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Aetna of WY Medicare |
$242.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$352.80
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.72
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.15
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$202.49
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$213.15
|
| Rate for Payer: United Healthcare Commercial |
$319.72
|
| Rate for Payer: United Healthcare Medicare |
$213.15
|
| Rate for Payer: WINHealth Partners Commercial |
$360.15
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
|
RESPIRATORY SYNCYTIAL VIRUS VACCINE, ANTIGEN (2 OF 2) 120 MCG IM SUSP [182048]
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 5816072303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$352.80
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.72
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$242.55
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$230.42
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$242.55
|
| Rate for Payer: United Healthcare Commercial |
$319.72
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
| Rate for Payer: WINHealth Partners Commercial |
$349.12
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
