TUBING STRAIGHTSHOT TO XPS
|
Facility
|
OP
|
$109.42
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$60.29 |
Max. Negotiated Rate |
$109.42 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.23
|
Rate for Payer: Aetna of WY Medicare |
$72.22
|
Rate for Payer: Altius Auto/Workers Compensation |
$105.04
|
Rate for Payer: Altius Commercial |
$105.04
|
Rate for Payer: Beech Street Commercial |
$107.23
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.83
|
Rate for Payer: Cash Price |
$76.59
|
Rate for Payer: ChoiceCare Network Commercial |
$106.14
|
Rate for Payer: Cigna of WY Commercial |
$107.23
|
Rate for Payer: Entrust Commercial |
$103.95
|
Rate for Payer: First Choice Health Commercial |
$103.95
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.46
|
Rate for Payer: HealthUtah PPO |
$109.42
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.14
|
Rate for Payer: Multiplan Medicare/VA |
$60.29
|
Rate for Payer: One Health Plan of WY PPO |
$107.23
|
Rate for Payer: PacificSource Commercial |
$98.48
|
Rate for Payer: PHCS PPO |
$107.23
|
Rate for Payer: Three Rivers PPO |
$82.06
|
Rate for Payer: TriWest Veterans Administration |
$63.46
|
Rate for Payer: United Healthcare Commercial |
$95.20
|
Rate for Payer: United Healthcare Medicare |
$63.46
|
Rate for Payer: WINHealth Partners Commercial |
$107.23
|
Rate for Payer: Wise Provider Network Commercial |
$103.95
|
|
TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,955.00
|
|
Service Code
|
HCPCS 59120
|
Hospital Charge Code |
59120
|
Min. Negotiated Rate |
$660.95 |
Max. Negotiated Rate |
$1,955.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,915.90
|
Rate for Payer: Aetna of WY Medicare |
$777.59
|
Rate for Payer: Beech Street Commercial |
$1,857.25
|
Rate for Payer: Cash Price |
$1,368.50
|
Rate for Payer: Cash Price |
$1,368.50
|
Rate for Payer: ChoiceCare Network Commercial |
$1,896.35
|
Rate for Payer: Cigna of WY Commercial |
$1,915.90
|
Rate for Payer: First Choice Health Commercial |
$1,759.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,857.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$777.59
|
Rate for Payer: HealthUtah PPO |
$1,955.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,896.35
|
Rate for Payer: Multiplan Medicare/VA |
$660.95
|
Rate for Payer: One Health Plan of WY PPO |
$1,915.90
|
Rate for Payer: PacificSource Commercial |
$1,759.50
|
Rate for Payer: PHCS PPO |
$1,857.25
|
Rate for Payer: Three Rivers PPO |
$1,466.25
|
Rate for Payer: TriWest Veterans Administration |
$777.59
|
Rate for Payer: United Healthcare Commercial |
$1,700.85
|
Rate for Payer: United Healthcare Medicare |
$777.59
|
Rate for Payer: WINHealth Partners Commercial |
$1,661.75
|
|
TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION
|
Professional
|
Both
|
$995.00
|
|
Service Code
|
HCPCS 59140
|
Hospital Charge Code |
59140
|
Min. Negotiated Rate |
$340.05 |
Max. Negotiated Rate |
$995.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$975.10
|
Rate for Payer: Aetna of WY Medicare |
$400.06
|
Rate for Payer: Beech Street Commercial |
$945.25
|
Rate for Payer: Cash Price |
$696.50
|
Rate for Payer: Cash Price |
$696.50
|
Rate for Payer: ChoiceCare Network Commercial |
$965.15
|
Rate for Payer: Cigna of WY Commercial |
$975.10
|
Rate for Payer: First Choice Health Commercial |
$895.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$945.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.06
|
Rate for Payer: HealthUtah PPO |
$995.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$965.15
|
Rate for Payer: Multiplan Medicare/VA |
$340.05
|
Rate for Payer: One Health Plan of WY PPO |
$975.10
|
Rate for Payer: PacificSource Commercial |
$895.50
|
Rate for Payer: PHCS PPO |
$945.25
|
Rate for Payer: Three Rivers PPO |
$746.25
|
Rate for Payer: TriWest Veterans Administration |
$400.06
|
Rate for Payer: United Healthcare Commercial |
$865.65
|
Rate for Payer: United Healthcare Medicare |
$400.06
|
Rate for Payer: WINHealth Partners Commercial |
$845.75
|
|
TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,956.00
|
|
Service Code
|
HCPCS 59121
|
Hospital Charge Code |
59121
|
Min. Negotiated Rate |
$661.08 |
Max. Negotiated Rate |
$1,956.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,916.88
|
Rate for Payer: Aetna of WY Medicare |
$777.74
|
Rate for Payer: Beech Street Commercial |
$1,858.20
|
Rate for Payer: Cash Price |
$1,369.20
|
Rate for Payer: Cash Price |
$1,369.20
|
Rate for Payer: ChoiceCare Network Commercial |
$1,897.32
|
Rate for Payer: Cigna of WY Commercial |
$1,916.88
|
Rate for Payer: First Choice Health Commercial |
$1,760.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,858.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$777.74
|
Rate for Payer: HealthUtah PPO |
$1,956.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,897.32
|
Rate for Payer: Multiplan Medicare/VA |
$661.08
|
Rate for Payer: One Health Plan of WY PPO |
$1,916.88
|
Rate for Payer: PacificSource Commercial |
$1,760.40
|
Rate for Payer: PHCS PPO |
$1,858.20
|
Rate for Payer: Three Rivers PPO |
$1,467.00
|
Rate for Payer: TriWest Veterans Administration |
$777.74
|
Rate for Payer: United Healthcare Commercial |
$1,701.72
|
Rate for Payer: United Healthcare Medicare |
$777.74
|
Rate for Payer: WINHealth Partners Commercial |
$1,662.60
|
|
TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$4,432.00
|
|
Service Code
|
HCPCS 24516 AS
|
Hospital Charge Code |
24516
|
Min. Negotiated Rate |
$706.54 |
Max. Negotiated Rate |
$4,432.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,343.36
|
Rate for Payer: Aetna of WY Medicare |
$831.22
|
Rate for Payer: Beech Street Commercial |
$4,210.40
|
Rate for Payer: Cash Price |
$3,102.40
|
Rate for Payer: Cash Price |
$3,102.40
|
Rate for Payer: ChoiceCare Network Commercial |
$4,299.04
|
Rate for Payer: Cigna of WY Commercial |
$4,343.36
|
Rate for Payer: First Choice Health Commercial |
$3,988.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,210.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.22
|
Rate for Payer: HealthUtah PPO |
$4,432.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,299.04
|
Rate for Payer: Multiplan Medicare/VA |
$706.54
|
Rate for Payer: One Health Plan of WY PPO |
$4,343.36
|
Rate for Payer: PacificSource Commercial |
$3,988.80
|
Rate for Payer: PHCS PPO |
$4,210.40
|
Rate for Payer: Three Rivers PPO |
$3,324.00
|
Rate for Payer: TriWest Veterans Administration |
$831.22
|
Rate for Payer: United Healthcare Commercial |
$3,855.84
|
Rate for Payer: United Healthcare Medicare |
$831.22
|
Rate for Payer: WINHealth Partners Commercial |
$3,767.20
|
|
TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$4,432.00
|
|
Service Code
|
HCPCS 24516
|
Hospital Charge Code |
24516
|
Min. Negotiated Rate |
$706.54 |
Max. Negotiated Rate |
$4,432.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,343.36
|
Rate for Payer: Aetna of WY Medicare |
$831.22
|
Rate for Payer: Beech Street Commercial |
$4,210.40
|
Rate for Payer: Cash Price |
$3,102.40
|
Rate for Payer: Cash Price |
$3,102.40
|
Rate for Payer: ChoiceCare Network Commercial |
$4,299.04
|
Rate for Payer: Cigna of WY Commercial |
$4,343.36
|
Rate for Payer: First Choice Health Commercial |
$3,988.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,210.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.22
|
Rate for Payer: HealthUtah PPO |
$4,432.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,299.04
|
Rate for Payer: Multiplan Medicare/VA |
$706.54
|
Rate for Payer: One Health Plan of WY PPO |
$4,343.36
|
Rate for Payer: PacificSource Commercial |
$3,988.80
|
Rate for Payer: PHCS PPO |
$4,210.40
|
Rate for Payer: Three Rivers PPO |
$3,324.00
|
Rate for Payer: TriWest Veterans Administration |
$831.22
|
Rate for Payer: United Healthcare Commercial |
$3,855.84
|
Rate for Payer: United Healthcare Medicare |
$831.22
|
Rate for Payer: WINHealth Partners Commercial |
$3,767.20
|
|
TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$909.00
|
|
Service Code
|
HCPCS 59812
|
Hospital Charge Code |
59812
|
Min. Negotiated Rate |
$250.43 |
Max. Negotiated Rate |
$909.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$890.82
|
Rate for Payer: Aetna of WY Medicare |
$294.62
|
Rate for Payer: Beech Street Commercial |
$863.55
|
Rate for Payer: Cash Price |
$636.30
|
Rate for Payer: Cash Price |
$636.30
|
Rate for Payer: ChoiceCare Network Commercial |
$881.73
|
Rate for Payer: Cigna of WY Commercial |
$890.82
|
Rate for Payer: First Choice Health Commercial |
$818.10
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$863.55
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.62
|
Rate for Payer: HealthUtah PPO |
$909.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$881.73
|
Rate for Payer: Multiplan Medicare/VA |
$250.43
|
Rate for Payer: One Health Plan of WY PPO |
$890.82
|
Rate for Payer: PacificSource Commercial |
$818.10
|
Rate for Payer: PHCS PPO |
$863.55
|
Rate for Payer: Three Rivers PPO |
$681.75
|
Rate for Payer: TriWest Veterans Administration |
$294.62
|
Rate for Payer: United Healthcare Commercial |
$790.83
|
Rate for Payer: United Healthcare Medicare |
$294.62
|
Rate for Payer: WINHealth Partners Commercial |
$772.65
|
|
TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,996.00
|
|
Service Code
|
HCPCS 27245 80
|
Hospital Charge Code |
27245
|
Min. Negotiated Rate |
$1,001.54 |
Max. Negotiated Rate |
$4,996.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,896.08
|
Rate for Payer: Aetna of WY Medicare |
$1,178.28
|
Rate for Payer: Beech Street Commercial |
$4,746.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: ChoiceCare Network Commercial |
$4,846.12
|
Rate for Payer: Cigna of WY Commercial |
$4,896.08
|
Rate for Payer: First Choice Health Commercial |
$4,496.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,746.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,178.28
|
Rate for Payer: HealthUtah PPO |
$4,996.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,846.12
|
Rate for Payer: Multiplan Medicare/VA |
$1,001.54
|
Rate for Payer: One Health Plan of WY PPO |
$4,896.08
|
Rate for Payer: PacificSource Commercial |
$4,496.40
|
Rate for Payer: PHCS PPO |
$4,746.20
|
Rate for Payer: Three Rivers PPO |
$3,747.00
|
Rate for Payer: TriWest Veterans Administration |
$1,178.28
|
Rate for Payer: United Healthcare Commercial |
$4,346.52
|
Rate for Payer: United Healthcare Medicare |
$1,178.28
|
Rate for Payer: WINHealth Partners Commercial |
$4,246.60
|
|
TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,996.00
|
|
Service Code
|
HCPCS 27245 AS
|
Hospital Charge Code |
27245
|
Min. Negotiated Rate |
$1,001.54 |
Max. Negotiated Rate |
$4,996.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,896.08
|
Rate for Payer: Aetna of WY Medicare |
$1,178.28
|
Rate for Payer: Beech Street Commercial |
$4,746.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: ChoiceCare Network Commercial |
$4,846.12
|
Rate for Payer: Cigna of WY Commercial |
$4,896.08
|
Rate for Payer: First Choice Health Commercial |
$4,496.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,746.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,178.28
|
Rate for Payer: HealthUtah PPO |
$4,996.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,846.12
|
Rate for Payer: Multiplan Medicare/VA |
$1,001.54
|
Rate for Payer: One Health Plan of WY PPO |
$4,896.08
|
Rate for Payer: PacificSource Commercial |
$4,496.40
|
Rate for Payer: PHCS PPO |
$4,746.20
|
Rate for Payer: Three Rivers PPO |
$3,747.00
|
Rate for Payer: TriWest Veterans Administration |
$1,178.28
|
Rate for Payer: United Healthcare Commercial |
$4,346.52
|
Rate for Payer: United Healthcare Medicare |
$1,178.28
|
Rate for Payer: WINHealth Partners Commercial |
$4,246.60
|
|
TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,996.00
|
|
Service Code
|
HCPCS 27245
|
Hospital Charge Code |
27245
|
Min. Negotiated Rate |
$1,001.54 |
Max. Negotiated Rate |
$4,996.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,896.08
|
Rate for Payer: Aetna of WY Medicare |
$1,178.28
|
Rate for Payer: Beech Street Commercial |
$4,746.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: Cash Price |
$3,497.20
|
Rate for Payer: ChoiceCare Network Commercial |
$4,846.12
|
Rate for Payer: Cigna of WY Commercial |
$4,896.08
|
Rate for Payer: First Choice Health Commercial |
$4,496.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,746.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,178.28
|
Rate for Payer: HealthUtah PPO |
$4,996.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,846.12
|
Rate for Payer: Multiplan Medicare/VA |
$1,001.54
|
Rate for Payer: One Health Plan of WY PPO |
$4,896.08
|
Rate for Payer: PacificSource Commercial |
$4,496.40
|
Rate for Payer: PHCS PPO |
$4,746.20
|
Rate for Payer: Three Rivers PPO |
$3,747.00
|
Rate for Payer: TriWest Veterans Administration |
$1,178.28
|
Rate for Payer: United Healthcare Commercial |
$4,346.52
|
Rate for Payer: United Healthcare Medicare |
$1,178.28
|
Rate for Payer: WINHealth Partners Commercial |
$4,246.60
|
|
TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$2,362.00
|
|
Service Code
|
HCPCS 27244 AS
|
Hospital Charge Code |
27244
|
Min. Negotiated Rate |
$1,002.78 |
Max. Negotiated Rate |
$2,362.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,314.76
|
Rate for Payer: Aetna of WY Medicare |
$1,179.74
|
Rate for Payer: Beech Street Commercial |
$2,243.90
|
Rate for Payer: Cash Price |
$1,653.40
|
Rate for Payer: Cash Price |
$1,653.40
|
Rate for Payer: ChoiceCare Network Commercial |
$2,291.14
|
Rate for Payer: Cigna of WY Commercial |
$2,314.76
|
Rate for Payer: First Choice Health Commercial |
$2,125.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,243.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,179.74
|
Rate for Payer: HealthUtah PPO |
$2,362.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,291.14
|
Rate for Payer: Multiplan Medicare/VA |
$1,002.78
|
Rate for Payer: One Health Plan of WY PPO |
$2,314.76
|
Rate for Payer: PacificSource Commercial |
$2,125.80
|
Rate for Payer: PHCS PPO |
$2,243.90
|
Rate for Payer: Three Rivers PPO |
$1,771.50
|
Rate for Payer: TriWest Veterans Administration |
$1,179.74
|
Rate for Payer: United Healthcare Commercial |
$2,054.94
|
Rate for Payer: United Healthcare Medicare |
$1,179.74
|
Rate for Payer: WINHealth Partners Commercial |
$2,007.70
|
|
TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$2,362.00
|
|
Service Code
|
HCPCS 27244
|
Hospital Charge Code |
27244
|
Min. Negotiated Rate |
$1,002.78 |
Max. Negotiated Rate |
$2,362.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,314.76
|
Rate for Payer: Aetna of WY Medicare |
$1,179.74
|
Rate for Payer: Beech Street Commercial |
$2,243.90
|
Rate for Payer: Cash Price |
$1,653.40
|
Rate for Payer: Cash Price |
$1,653.40
|
Rate for Payer: ChoiceCare Network Commercial |
$2,291.14
|
Rate for Payer: Cigna of WY Commercial |
$2,314.76
|
Rate for Payer: First Choice Health Commercial |
$2,125.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,243.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,179.74
|
Rate for Payer: HealthUtah PPO |
$2,362.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,291.14
|
Rate for Payer: Multiplan Medicare/VA |
$1,002.78
|
Rate for Payer: One Health Plan of WY PPO |
$2,314.76
|
Rate for Payer: PacificSource Commercial |
$2,125.80
|
Rate for Payer: PHCS PPO |
$2,243.90
|
Rate for Payer: Three Rivers PPO |
$1,771.50
|
Rate for Payer: TriWest Veterans Administration |
$1,179.74
|
Rate for Payer: United Healthcare Commercial |
$2,054.94
|
Rate for Payer: United Healthcare Medicare |
$1,179.74
|
Rate for Payer: WINHealth Partners Commercial |
$2,007.70
|
|
TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$1,117.00
|
|
Service Code
|
HCPCS 59820
|
Hospital Charge Code |
59820
|
Min. Negotiated Rate |
$316.91 |
Max. Negotiated Rate |
$1,117.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,094.66
|
Rate for Payer: Aetna of WY Medicare |
$372.84
|
Rate for Payer: Beech Street Commercial |
$1,061.15
|
Rate for Payer: Cash Price |
$781.90
|
Rate for Payer: Cash Price |
$781.90
|
Rate for Payer: ChoiceCare Network Commercial |
$1,083.49
|
Rate for Payer: Cigna of WY Commercial |
$1,094.66
|
Rate for Payer: First Choice Health Commercial |
$1,005.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,061.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.84
|
Rate for Payer: HealthUtah PPO |
$1,117.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,083.49
|
Rate for Payer: Multiplan Medicare/VA |
$316.91
|
Rate for Payer: One Health Plan of WY PPO |
$1,094.66
|
Rate for Payer: PacificSource Commercial |
$1,005.30
|
Rate for Payer: PHCS PPO |
$1,061.15
|
Rate for Payer: Three Rivers PPO |
$837.75
|
Rate for Payer: TriWest Veterans Administration |
$372.84
|
Rate for Payer: United Healthcare Commercial |
$971.79
|
Rate for Payer: United Healthcare Medicare |
$372.84
|
Rate for Payer: WINHealth Partners Commercial |
$949.45
|
|
TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$1,104.00
|
|
Service Code
|
HCPCS 59821
|
Hospital Charge Code |
59821
|
Min. Negotiated Rate |
$308.75 |
Max. Negotiated Rate |
$1,104.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,081.92
|
Rate for Payer: Aetna of WY Medicare |
$363.23
|
Rate for Payer: Beech Street Commercial |
$1,048.80
|
Rate for Payer: Cash Price |
$772.80
|
Rate for Payer: Cash Price |
$772.80
|
Rate for Payer: ChoiceCare Network Commercial |
$1,070.88
|
Rate for Payer: Cigna of WY Commercial |
$1,081.92
|
Rate for Payer: First Choice Health Commercial |
$993.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,048.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.23
|
Rate for Payer: HealthUtah PPO |
$1,104.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,070.88
|
Rate for Payer: Multiplan Medicare/VA |
$308.75
|
Rate for Payer: One Health Plan of WY PPO |
$1,081.92
|
Rate for Payer: PacificSource Commercial |
$993.60
|
Rate for Payer: PHCS PPO |
$1,048.80
|
Rate for Payer: Three Rivers PPO |
$828.00
|
Rate for Payer: TriWest Veterans Administration |
$363.23
|
Rate for Payer: United Healthcare Commercial |
$960.48
|
Rate for Payer: United Healthcare Medicare |
$363.23
|
Rate for Payer: WINHealth Partners Commercial |
$938.40
|
|
TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$1,252.00
|
|
Service Code
|
HCPCS 28232
|
Hospital Charge Code |
28232
|
Min. Negotiated Rate |
$201.41 |
Max. Negotiated Rate |
$1,252.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,226.96
|
Rate for Payer: Aetna of WY Medicare |
$236.95
|
Rate for Payer: Beech Street Commercial |
$1,189.40
|
Rate for Payer: Cash Price |
$876.40
|
Rate for Payer: Cash Price |
$876.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1,214.44
|
Rate for Payer: Cigna of WY Commercial |
$1,226.96
|
Rate for Payer: First Choice Health Commercial |
$1,126.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,189.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$236.95
|
Rate for Payer: HealthUtah PPO |
$1,252.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,214.44
|
Rate for Payer: Multiplan Medicare/VA |
$201.41
|
Rate for Payer: One Health Plan of WY PPO |
$1,226.96
|
Rate for Payer: PacificSource Commercial |
$1,126.80
|
Rate for Payer: PHCS PPO |
$1,189.40
|
Rate for Payer: Three Rivers PPO |
$939.00
|
Rate for Payer: TriWest Veterans Administration |
$236.95
|
Rate for Payer: United Healthcare Commercial |
$1,089.24
|
Rate for Payer: United Healthcare Medicare |
$236.95
|
Rate for Payer: WINHealth Partners Commercial |
$1,064.20
|
|
TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$945.00
|
|
Service Code
|
HCPCS 12020
|
Hospital Charge Code |
12020
|
Min. Negotiated Rate |
$154.48 |
Max. Negotiated Rate |
$945.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
Rate for Payer: Aetna of WY Medicare |
$181.74
|
Rate for Payer: Beech Street Commercial |
$897.75
|
Rate for Payer: Cash Price |
$661.50
|
Rate for Payer: Cash Price |
$661.50
|
Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
Rate for Payer: Cigna of WY Commercial |
$926.10
|
Rate for Payer: First Choice Health Commercial |
$850.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.74
|
Rate for Payer: HealthUtah PPO |
$945.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
Rate for Payer: Multiplan Medicare/VA |
$154.48
|
Rate for Payer: One Health Plan of WY PPO |
$926.10
|
Rate for Payer: PacificSource Commercial |
$850.50
|
Rate for Payer: PHCS PPO |
$897.75
|
Rate for Payer: Three Rivers PPO |
$708.75
|
Rate for Payer: TriWest Veterans Administration |
$181.74
|
Rate for Payer: United Healthcare Commercial |
$822.15
|
Rate for Payer: United Healthcare Medicare |
$181.74
|
Rate for Payer: WINHealth Partners Commercial |
$803.25
|
|
TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$698.00
|
|
Service Code
|
HCPCS 12021
|
Hospital Charge Code |
12021
|
Min. Negotiated Rate |
$116.03 |
Max. Negotiated Rate |
$698.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$684.04
|
Rate for Payer: Aetna of WY Medicare |
$136.51
|
Rate for Payer: Beech Street Commercial |
$663.10
|
Rate for Payer: Cash Price |
$488.60
|
Rate for Payer: Cash Price |
$488.60
|
Rate for Payer: ChoiceCare Network Commercial |
$677.06
|
Rate for Payer: Cigna of WY Commercial |
$684.04
|
Rate for Payer: First Choice Health Commercial |
$628.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.51
|
Rate for Payer: HealthUtah PPO |
$698.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$677.06
|
Rate for Payer: Multiplan Medicare/VA |
$116.03
|
Rate for Payer: One Health Plan of WY PPO |
$684.04
|
Rate for Payer: PacificSource Commercial |
$628.20
|
Rate for Payer: PHCS PPO |
$663.10
|
Rate for Payer: Three Rivers PPO |
$523.50
|
Rate for Payer: TriWest Veterans Administration |
$136.51
|
Rate for Payer: United Healthcare Commercial |
$607.26
|
Rate for Payer: United Healthcare Medicare |
$136.51
|
Rate for Payer: WINHealth Partners Commercial |
$593.30
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$1,330.00
|
|
Service Code
|
HCPCS 28455
|
Hospital Charge Code |
28455
|
Min. Negotiated Rate |
$193.57 |
Max. Negotiated Rate |
$1,330.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
Rate for Payer: Aetna of WY Medicare |
$227.73
|
Rate for Payer: Beech Street Commercial |
$1,263.50
|
Rate for Payer: Cash Price |
$931.00
|
Rate for Payer: Cash Price |
$931.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
Rate for Payer: First Choice Health Commercial |
$1,197.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.73
|
Rate for Payer: HealthUtah PPO |
$1,330.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
Rate for Payer: Multiplan Medicare/VA |
$193.57
|
Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
Rate for Payer: PacificSource Commercial |
$1,197.00
|
Rate for Payer: PHCS PPO |
$1,263.50
|
Rate for Payer: Three Rivers PPO |
$997.50
|
Rate for Payer: TriWest Veterans Administration |
$227.73
|
Rate for Payer: United Healthcare Commercial |
$1,157.10
|
Rate for Payer: United Healthcare Medicare |
$227.73
|
Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$984.00
|
|
Service Code
|
HCPCS 28450
|
Hospital Charge Code |
28450
|
Min. Negotiated Rate |
$163.36 |
Max. Negotiated Rate |
$984.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
Rate for Payer: Aetna of WY Medicare |
$192.19
|
Rate for Payer: Beech Street Commercial |
$934.80
|
Rate for Payer: Cash Price |
$688.80
|
Rate for Payer: Cash Price |
$688.80
|
Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
Rate for Payer: Cigna of WY Commercial |
$964.32
|
Rate for Payer: First Choice Health Commercial |
$885.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.19
|
Rate for Payer: HealthUtah PPO |
$984.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
Rate for Payer: Multiplan Medicare/VA |
$163.36
|
Rate for Payer: One Health Plan of WY PPO |
$964.32
|
Rate for Payer: PacificSource Commercial |
$885.60
|
Rate for Payer: PHCS PPO |
$934.80
|
Rate for Payer: Three Rivers PPO |
$738.00
|
Rate for Payer: TriWest Veterans Administration |
$192.19
|
Rate for Payer: United Healthcare Commercial |
$856.08
|
Rate for Payer: United Healthcare Medicare |
$192.19
|
Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$5,155.00
|
|
Service Code
|
HCPCS 27759 80
|
Hospital Charge Code |
27759
|
Min. Negotiated Rate |
$817.24 |
Max. Negotiated Rate |
$5,155.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,051.90
|
Rate for Payer: Aetna of WY Medicare |
$961.46
|
Rate for Payer: Beech Street Commercial |
$4,897.25
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: ChoiceCare Network Commercial |
$5,000.35
|
Rate for Payer: Cigna of WY Commercial |
$5,051.90
|
Rate for Payer: First Choice Health Commercial |
$4,639.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,897.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$961.46
|
Rate for Payer: HealthUtah PPO |
$5,155.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,000.35
|
Rate for Payer: Multiplan Medicare/VA |
$817.24
|
Rate for Payer: One Health Plan of WY PPO |
$5,051.90
|
Rate for Payer: PacificSource Commercial |
$4,639.50
|
Rate for Payer: PHCS PPO |
$4,897.25
|
Rate for Payer: Three Rivers PPO |
$3,866.25
|
Rate for Payer: TriWest Veterans Administration |
$961.46
|
Rate for Payer: United Healthcare Commercial |
$4,484.85
|
Rate for Payer: United Healthcare Medicare |
$961.46
|
Rate for Payer: WINHealth Partners Commercial |
$4,381.75
|
|
TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$5,155.00
|
|
Service Code
|
HCPCS 27759 AS
|
Hospital Charge Code |
27759
|
Min. Negotiated Rate |
$817.24 |
Max. Negotiated Rate |
$5,155.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,051.90
|
Rate for Payer: Aetna of WY Medicare |
$961.46
|
Rate for Payer: Beech Street Commercial |
$4,897.25
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: ChoiceCare Network Commercial |
$5,000.35
|
Rate for Payer: Cigna of WY Commercial |
$5,051.90
|
Rate for Payer: First Choice Health Commercial |
$4,639.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,897.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$961.46
|
Rate for Payer: HealthUtah PPO |
$5,155.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,000.35
|
Rate for Payer: Multiplan Medicare/VA |
$817.24
|
Rate for Payer: One Health Plan of WY PPO |
$5,051.90
|
Rate for Payer: PacificSource Commercial |
$4,639.50
|
Rate for Payer: PHCS PPO |
$4,897.25
|
Rate for Payer: Three Rivers PPO |
$3,866.25
|
Rate for Payer: TriWest Veterans Administration |
$961.46
|
Rate for Payer: United Healthcare Commercial |
$4,484.85
|
Rate for Payer: United Healthcare Medicare |
$961.46
|
Rate for Payer: WINHealth Partners Commercial |
$4,381.75
|
|
TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$5,155.00
|
|
Service Code
|
HCPCS 27759
|
Hospital Charge Code |
27759
|
Min. Negotiated Rate |
$817.24 |
Max. Negotiated Rate |
$5,155.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,051.90
|
Rate for Payer: Aetna of WY Medicare |
$961.46
|
Rate for Payer: Beech Street Commercial |
$4,897.25
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: Cash Price |
$3,608.50
|
Rate for Payer: ChoiceCare Network Commercial |
$5,000.35
|
Rate for Payer: Cigna of WY Commercial |
$5,051.90
|
Rate for Payer: First Choice Health Commercial |
$4,639.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,897.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$961.46
|
Rate for Payer: HealthUtah PPO |
$5,155.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,000.35
|
Rate for Payer: Multiplan Medicare/VA |
$817.24
|
Rate for Payer: One Health Plan of WY PPO |
$5,051.90
|
Rate for Payer: PacificSource Commercial |
$4,639.50
|
Rate for Payer: PHCS PPO |
$4,897.25
|
Rate for Payer: Three Rivers PPO |
$3,866.25
|
Rate for Payer: TriWest Veterans Administration |
$961.46
|
Rate for Payer: United Healthcare Commercial |
$4,484.85
|
Rate for Payer: United Healthcare Medicare |
$961.46
|
Rate for Payer: WINHealth Partners Commercial |
$4,381.75
|
|
TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$1,478.00
|
|
Service Code
|
HCPCS 69610
|
Hospital Charge Code |
69610
|
Min. Negotiated Rate |
$236.51 |
Max. Negotiated Rate |
$1,478.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,448.44
|
Rate for Payer: Aetna of WY Medicare |
$278.25
|
Rate for Payer: Beech Street Commercial |
$1,404.10
|
Rate for Payer: Cash Price |
$1,034.60
|
Rate for Payer: Cash Price |
$1,034.60
|
Rate for Payer: ChoiceCare Network Commercial |
$1,433.66
|
Rate for Payer: Cigna of WY Commercial |
$1,448.44
|
Rate for Payer: First Choice Health Commercial |
$1,330.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,404.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.25
|
Rate for Payer: HealthUtah PPO |
$1,478.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,433.66
|
Rate for Payer: Multiplan Medicare/VA |
$236.51
|
Rate for Payer: One Health Plan of WY PPO |
$1,448.44
|
Rate for Payer: PacificSource Commercial |
$1,330.20
|
Rate for Payer: PHCS PPO |
$1,404.10
|
Rate for Payer: Three Rivers PPO |
$1,108.50
|
Rate for Payer: TriWest Veterans Administration |
$278.25
|
Rate for Payer: United Healthcare Commercial |
$1,285.86
|
Rate for Payer: United Healthcare Medicare |
$278.25
|
Rate for Payer: WINHealth Partners Commercial |
$1,256.30
|
|
TYMPANOMETRY
|
Professional
|
Both
|
$84.00
|
|
Service Code
|
HCPCS 92567
|
Hospital Charge Code |
92567
|
Min. Negotiated Rate |
$8.83 |
Max. Negotiated Rate |
$84.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
Rate for Payer: Aetna of WY Medicare |
$10.39
|
Rate for Payer: Beech Street Commercial |
$79.80
|
Rate for Payer: Cash Price |
$58.80
|
Rate for Payer: Cash Price |
$58.80
|
Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
Rate for Payer: Cigna of WY Commercial |
$82.32
|
Rate for Payer: First Choice Health Commercial |
$75.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.39
|
Rate for Payer: HealthUtah PPO |
$84.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
Rate for Payer: Multiplan Medicare/VA |
$8.83
|
Rate for Payer: One Health Plan of WY PPO |
$82.32
|
Rate for Payer: PacificSource Commercial |
$75.60
|
Rate for Payer: PHCS PPO |
$79.80
|
Rate for Payer: Three Rivers PPO |
$63.00
|
Rate for Payer: TriWest Veterans Administration |
$10.39
|
Rate for Payer: United Healthcare Commercial |
$73.08
|
Rate for Payer: United Healthcare Medicare |
$10.39
|
Rate for Payer: WINHealth Partners Commercial |
$79.80
|
|
TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$65.00
|
|
Service Code
|
HCPCS 92550
|
Hospital Charge Code |
92550
|
Min. Negotiated Rate |
$18.02 |
Max. Negotiated Rate |
$65.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
Rate for Payer: Aetna of WY Medicare |
$21.20
|
Rate for Payer: Beech Street Commercial |
$61.75
|
Rate for Payer: Cash Price |
$45.50
|
Rate for Payer: Cash Price |
$45.50
|
Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
Rate for Payer: Cigna of WY Commercial |
$63.70
|
Rate for Payer: First Choice Health Commercial |
$58.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.20
|
Rate for Payer: HealthUtah PPO |
$65.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
Rate for Payer: Multiplan Medicare/VA |
$18.02
|
Rate for Payer: One Health Plan of WY PPO |
$63.70
|
Rate for Payer: PacificSource Commercial |
$58.50
|
Rate for Payer: PHCS PPO |
$61.75
|
Rate for Payer: Three Rivers PPO |
$48.75
|
Rate for Payer: TriWest Veterans Administration |
$21.20
|
Rate for Payer: United Healthcare Commercial |
$56.55
|
Rate for Payer: United Healthcare Medicare |
$21.20
|
Rate for Payer: WINHealth Partners Commercial |
$61.75
|
|