|
UNLISTED PROCEDURE ARTHROSCOPY
|
Professional
|
Both
|
$3,487.00
|
|
|
Service Code
|
HCPCS 29999 AS
|
| Hospital Charge Code |
29999
|
| Min. Negotiated Rate |
$2,615.25 |
| Max. Negotiated Rate |
$3,487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.26
|
| Rate for Payer: Beech Street Commercial |
$3,312.65
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.26
|
| Rate for Payer: First Choice Health Commercial |
$3,138.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.65
|
| Rate for Payer: HealthUtah PPO |
$3,487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.26
|
| Rate for Payer: PacificSource Commercial |
$3,138.30
|
| Rate for Payer: PHCS PPO |
$3,312.65
|
| Rate for Payer: Three Rivers PPO |
$2,615.25
|
| Rate for Payer: United Healthcare Commercial |
$3,033.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.95
|
|
|
UNLISTED PROCEDURE ARTHROSCOPY
|
Professional
|
Both
|
$3,487.00
|
|
|
Service Code
|
HCPCS 29999 80
|
| Hospital Charge Code |
29999
|
| Min. Negotiated Rate |
$2,615.25 |
| Max. Negotiated Rate |
$3,487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.26
|
| Rate for Payer: Beech Street Commercial |
$3,312.65
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.26
|
| Rate for Payer: First Choice Health Commercial |
$3,138.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.65
|
| Rate for Payer: HealthUtah PPO |
$3,487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.26
|
| Rate for Payer: PacificSource Commercial |
$3,138.30
|
| Rate for Payer: PHCS PPO |
$3,312.65
|
| Rate for Payer: Three Rivers PPO |
$2,615.25
|
| Rate for Payer: United Healthcare Commercial |
$3,033.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.95
|
|
|
UNLISTED PROCEDURE ARTHROSCOPY
|
Professional
|
Both
|
$3,487.00
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
29999
|
| Min. Negotiated Rate |
$2,615.25 |
| Max. Negotiated Rate |
$3,487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.26
|
| Rate for Payer: Beech Street Commercial |
$3,312.65
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.26
|
| Rate for Payer: First Choice Health Commercial |
$3,138.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.65
|
| Rate for Payer: HealthUtah PPO |
$3,487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.26
|
| Rate for Payer: PacificSource Commercial |
$3,138.30
|
| Rate for Payer: PHCS PPO |
$3,312.65
|
| Rate for Payer: Three Rivers PPO |
$2,615.25
|
| Rate for Payer: United Healthcare Commercial |
$3,033.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.95
|
|
|
UNLISTED PROCEDURE HANDS/FINGERS
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
26989
|
| Min. Negotiated Rate |
$1,842.75 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,407.86
|
| Rate for Payer: Beech Street Commercial |
$2,334.15
|
| Rate for Payer: Cash Price |
$1,719.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,383.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,407.86
|
| Rate for Payer: First Choice Health Commercial |
$2,211.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,334.15
|
| Rate for Payer: HealthUtah PPO |
$2,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,407.86
|
| Rate for Payer: PacificSource Commercial |
$2,211.30
|
| Rate for Payer: PHCS PPO |
$2,334.15
|
| Rate for Payer: Three Rivers PPO |
$1,842.75
|
| Rate for Payer: United Healthcare Commercial |
$2,137.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2,088.45
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
64999
|
| Min. Negotiated Rate |
$1,132.50 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,479.80
|
| Rate for Payer: Beech Street Commercial |
$1,434.50
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,464.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,479.80
|
| Rate for Payer: First Choice Health Commercial |
$1,359.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,434.50
|
| Rate for Payer: HealthUtah PPO |
$1,510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,464.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,479.80
|
| Rate for Payer: PacificSource Commercial |
$1,359.00
|
| Rate for Payer: PHCS PPO |
$1,434.50
|
| Rate for Payer: Three Rivers PPO |
$1,132.50
|
| Rate for Payer: United Healthcare Commercial |
$1,313.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,283.50
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 64999 80
|
| Hospital Charge Code |
64999
|
| Min. Negotiated Rate |
$1,132.50 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,479.80
|
| Rate for Payer: Beech Street Commercial |
$1,434.50
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,464.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,479.80
|
| Rate for Payer: First Choice Health Commercial |
$1,359.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,434.50
|
| Rate for Payer: HealthUtah PPO |
$1,510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,464.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,479.80
|
| Rate for Payer: PacificSource Commercial |
$1,359.00
|
| Rate for Payer: PHCS PPO |
$1,434.50
|
| Rate for Payer: Three Rivers PPO |
$1,132.50
|
| Rate for Payer: United Healthcare Commercial |
$1,313.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,283.50
|
|
|
UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Professional
|
Both
|
$7,352.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
27299
|
| Min. Negotiated Rate |
$5,514.00 |
| Max. Negotiated Rate |
$7,352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,204.96
|
| Rate for Payer: Beech Street Commercial |
$6,984.40
|
| Rate for Payer: Cash Price |
$5,146.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,131.44
|
| Rate for Payer: Cigna of WY Commercial |
$7,204.96
|
| Rate for Payer: First Choice Health Commercial |
$6,616.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,984.40
|
| Rate for Payer: HealthUtah PPO |
$7,352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,131.44
|
| Rate for Payer: One Health Plan of WY PPO |
$7,204.96
|
| Rate for Payer: PacificSource Commercial |
$6,616.80
|
| Rate for Payer: PHCS PPO |
$6,984.40
|
| Rate for Payer: Three Rivers PPO |
$5,514.00
|
| Rate for Payer: United Healthcare Commercial |
$6,396.24
|
| Rate for Payer: WINHealth Partners Commercial |
$6,249.20
|
|
|
UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Professional
|
Both
|
$7,352.00
|
|
|
Service Code
|
HCPCS 27299 80
|
| Hospital Charge Code |
27299
|
| Min. Negotiated Rate |
$5,514.00 |
| Max. Negotiated Rate |
$7,352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,204.96
|
| Rate for Payer: Beech Street Commercial |
$6,984.40
|
| Rate for Payer: Cash Price |
$5,146.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,131.44
|
| Rate for Payer: Cigna of WY Commercial |
$7,204.96
|
| Rate for Payer: First Choice Health Commercial |
$6,616.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,984.40
|
| Rate for Payer: HealthUtah PPO |
$7,352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,131.44
|
| Rate for Payer: One Health Plan of WY PPO |
$7,204.96
|
| Rate for Payer: PacificSource Commercial |
$6,616.80
|
| Rate for Payer: PHCS PPO |
$6,984.40
|
| Rate for Payer: Three Rivers PPO |
$5,514.00
|
| Rate for Payer: United Healthcare Commercial |
$6,396.24
|
| Rate for Payer: WINHealth Partners Commercial |
$6,249.20
|
|
|
UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Professional
|
Both
|
$7,352.00
|
|
|
Service Code
|
HCPCS 27299 AS
|
| Hospital Charge Code |
27299
|
| Min. Negotiated Rate |
$5,514.00 |
| Max. Negotiated Rate |
$7,352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,204.96
|
| Rate for Payer: Beech Street Commercial |
$6,984.40
|
| Rate for Payer: Cash Price |
$5,146.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,131.44
|
| Rate for Payer: Cigna of WY Commercial |
$7,204.96
|
| Rate for Payer: First Choice Health Commercial |
$6,616.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,984.40
|
| Rate for Payer: HealthUtah PPO |
$7,352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,131.44
|
| Rate for Payer: One Health Plan of WY PPO |
$7,204.96
|
| Rate for Payer: PacificSource Commercial |
$6,616.80
|
| Rate for Payer: PHCS PPO |
$6,984.40
|
| Rate for Payer: Three Rivers PPO |
$5,514.00
|
| Rate for Payer: United Healthcare Commercial |
$6,396.24
|
| Rate for Payer: WINHealth Partners Commercial |
$6,249.20
|
|
|
UNLISTED PROCEDURE RECTUM
|
Professional
|
Both
|
$5,621.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
45999
|
| Min. Negotiated Rate |
$4,215.75 |
| Max. Negotiated Rate |
$5,621.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,508.58
|
| Rate for Payer: Beech Street Commercial |
$5,339.95
|
| Rate for Payer: Cash Price |
$3,934.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,452.37
|
| Rate for Payer: Cigna of WY Commercial |
$5,508.58
|
| Rate for Payer: First Choice Health Commercial |
$5,058.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,339.95
|
| Rate for Payer: HealthUtah PPO |
$5,621.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,452.37
|
| Rate for Payer: One Health Plan of WY PPO |
$5,508.58
|
| Rate for Payer: PacificSource Commercial |
$5,058.90
|
| Rate for Payer: PHCS PPO |
$5,339.95
|
| Rate for Payer: Three Rivers PPO |
$4,215.75
|
| Rate for Payer: United Healthcare Commercial |
$4,890.27
|
| Rate for Payer: WINHealth Partners Commercial |
$4,777.85
|
|
|
UP EXT FX ORTHOS HUMERAL NOS
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
L3980
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: WINHealth Partners Commercial |
$167.20
|
|
|
UPPER LIMB ORTHOSIS NOS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
L3999
|
| Min. Negotiated Rate |
$171.75 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$224.42
|
| Rate for Payer: Beech Street Commercial |
$217.55
|
| Rate for Payer: Cash Price |
$160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$222.13
|
| Rate for Payer: Cigna of WY Commercial |
$224.42
|
| Rate for Payer: First Choice Health Commercial |
$206.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.55
|
| Rate for Payer: HealthUtah PPO |
$229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$222.13
|
| Rate for Payer: One Health Plan of WY PPO |
$224.42
|
| Rate for Payer: PacificSource Commercial |
$206.10
|
| Rate for Payer: PHCS PPO |
$217.55
|
| Rate for Payer: Three Rivers PPO |
$171.75
|
| Rate for Payer: United Healthcare Commercial |
$199.23
|
| Rate for Payer: WINHealth Partners Commercial |
$217.55
|
|
|
URETERAL ACCESS SHEATH 45CM
|
Facility
|
IP
|
$640.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.90 |
| Max. Negotiated Rate |
$640.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$628.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$615.35
|
| Rate for Payer: Altius Commercial |
$615.35
|
| Rate for Payer: Beech Street Commercial |
$628.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$526.25
|
| Rate for Payer: Cash Price |
$448.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$621.76
|
| Rate for Payer: Cigna of WY Commercial |
$628.17
|
| Rate for Payer: Entrust Commercial |
$608.94
|
| Rate for Payer: First Choice Health Commercial |
$608.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.05
|
| Rate for Payer: HealthUtah PPO |
$640.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$621.76
|
| Rate for Payer: Multiplan Medicare/VA |
$401.90
|
| Rate for Payer: One Health Plan of WY PPO |
$628.17
|
| Rate for Payer: PacificSource Commercial |
$576.89
|
| Rate for Payer: PHCS PPO |
$628.17
|
| Rate for Payer: Three Rivers PPO |
$480.74
|
| Rate for Payer: TriWest Veterans Administration |
$423.05
|
| Rate for Payer: United Healthcare Commercial |
$557.66
|
| Rate for Payer: United Healthcare Medicare |
$423.05
|
| Rate for Payer: WINHealth Partners Commercial |
$608.94
|
| Rate for Payer: Wise Provider Network Commercial |
$608.94
|
|
|
URETERAL ACCESS SHEATH 45CM
|
Facility
|
OP
|
$640.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.19 |
| Max. Negotiated Rate |
$640.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$628.17
|
| Rate for Payer: Aetna of WY Medicare |
$423.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$615.35
|
| Rate for Payer: Altius Commercial |
$615.35
|
| Rate for Payer: Beech Street Commercial |
$628.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$526.25
|
| Rate for Payer: Cash Price |
$448.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$621.76
|
| Rate for Payer: Cigna of WY Commercial |
$628.17
|
| Rate for Payer: Entrust Commercial |
$608.94
|
| Rate for Payer: First Choice Health Commercial |
$608.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.77
|
| Rate for Payer: HealthUtah PPO |
$640.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$621.76
|
| Rate for Payer: Multiplan Medicare/VA |
$353.19
|
| Rate for Payer: One Health Plan of WY PPO |
$628.17
|
| Rate for Payer: PacificSource Commercial |
$576.89
|
| Rate for Payer: PHCS PPO |
$628.17
|
| Rate for Payer: Three Rivers PPO |
$480.74
|
| Rate for Payer: TriWest Veterans Administration |
$371.77
|
| Rate for Payer: United Healthcare Commercial |
$557.66
|
| Rate for Payer: United Healthcare Medicare |
$371.77
|
| Rate for Payer: WINHealth Partners Commercial |
$628.17
|
| Rate for Payer: Wise Provider Network Commercial |
$608.94
|
|
|
URETERAL OPENEND 5FR 70CM
|
Facility
|
OP
|
$49.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$49.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.05
|
| Rate for Payer: Aetna of WY Medicare |
$32.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.07
|
| Rate for Payer: Altius Commercial |
$47.07
|
| Rate for Payer: Beech Street Commercial |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.25
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.56
|
| Rate for Payer: Cigna of WY Commercial |
$48.05
|
| Rate for Payer: Entrust Commercial |
$46.58
|
| Rate for Payer: First Choice Health Commercial |
$46.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.44
|
| Rate for Payer: HealthUtah PPO |
$49.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.56
|
| Rate for Payer: Multiplan Medicare/VA |
$27.02
|
| Rate for Payer: One Health Plan of WY PPO |
$48.05
|
| Rate for Payer: PacificSource Commercial |
$44.13
|
| Rate for Payer: PHCS PPO |
$48.05
|
| Rate for Payer: Three Rivers PPO |
$36.77
|
| Rate for Payer: TriWest Veterans Administration |
$28.44
|
| Rate for Payer: United Healthcare Commercial |
$42.66
|
| Rate for Payer: United Healthcare Medicare |
$28.44
|
| Rate for Payer: WINHealth Partners Commercial |
$48.05
|
| Rate for Payer: Wise Provider Network Commercial |
$46.58
|
|
|
URETERAL OPENEND 5FR 70CM
|
Facility
|
IP
|
$49.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$49.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.07
|
| Rate for Payer: Altius Commercial |
$47.07
|
| Rate for Payer: Beech Street Commercial |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.25
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.56
|
| Rate for Payer: Cigna of WY Commercial |
$48.05
|
| Rate for Payer: Entrust Commercial |
$46.58
|
| Rate for Payer: First Choice Health Commercial |
$46.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.36
|
| Rate for Payer: HealthUtah PPO |
$49.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.74
|
| Rate for Payer: One Health Plan of WY PPO |
$48.05
|
| Rate for Payer: PacificSource Commercial |
$44.13
|
| Rate for Payer: PHCS PPO |
$48.05
|
| Rate for Payer: Three Rivers PPO |
$36.77
|
| Rate for Payer: TriWest Veterans Administration |
$32.36
|
| Rate for Payer: United Healthcare Commercial |
$42.66
|
| Rate for Payer: United Healthcare Medicare |
$32.36
|
| Rate for Payer: WINHealth Partners Commercial |
$46.58
|
| Rate for Payer: Wise Provider Network Commercial |
$46.58
|
|
|
URETERAL SHEATH 12FR 28CM
|
Facility
|
IP
|
$495.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.74 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.78
|
| Rate for Payer: Altius Commercial |
$475.78
|
| Rate for Payer: Beech Street Commercial |
$485.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.89
|
| Rate for Payer: Cash Price |
$346.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.73
|
| Rate for Payer: Cigna of WY Commercial |
$485.69
|
| Rate for Payer: Entrust Commercial |
$470.82
|
| Rate for Payer: First Choice Health Commercial |
$470.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.10
|
| Rate for Payer: HealthUtah PPO |
$495.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.73
|
| Rate for Payer: Multiplan Medicare/VA |
$310.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.69
|
| Rate for Payer: PacificSource Commercial |
$446.04
|
| Rate for Payer: PHCS PPO |
$485.69
|
| Rate for Payer: Three Rivers PPO |
$371.70
|
| Rate for Payer: TriWest Veterans Administration |
$327.10
|
| Rate for Payer: United Healthcare Commercial |
$431.17
|
| Rate for Payer: United Healthcare Medicare |
$327.10
|
| Rate for Payer: WINHealth Partners Commercial |
$470.82
|
| Rate for Payer: Wise Provider Network Commercial |
$470.82
|
|
|
URETERAL SHEATH 12FR 28CM
|
Facility
|
OP
|
$495.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.08 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.69
|
| Rate for Payer: Aetna of WY Medicare |
$327.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.78
|
| Rate for Payer: Altius Commercial |
$475.78
|
| Rate for Payer: Beech Street Commercial |
$485.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.89
|
| Rate for Payer: Cash Price |
$346.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.73
|
| Rate for Payer: Cigna of WY Commercial |
$485.69
|
| Rate for Payer: Entrust Commercial |
$470.82
|
| Rate for Payer: First Choice Health Commercial |
$470.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.45
|
| Rate for Payer: HealthUtah PPO |
$495.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.73
|
| Rate for Payer: Multiplan Medicare/VA |
$273.08
|
| Rate for Payer: One Health Plan of WY PPO |
$485.69
|
| Rate for Payer: PacificSource Commercial |
$446.04
|
| Rate for Payer: PHCS PPO |
$485.69
|
| Rate for Payer: Three Rivers PPO |
$371.70
|
| Rate for Payer: TriWest Veterans Administration |
$287.45
|
| Rate for Payer: United Healthcare Commercial |
$431.17
|
| Rate for Payer: United Healthcare Medicare |
$287.45
|
| Rate for Payer: WINHealth Partners Commercial |
$485.69
|
| Rate for Payer: Wise Provider Network Commercial |
$470.82
|
|
|
URINAL SPILLPROOF ANTIREFLUX
|
Facility
|
IP
|
$125.16
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$125.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.15
|
| Rate for Payer: Altius Commercial |
$120.15
|
| Rate for Payer: Beech Street Commercial |
$122.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.76
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.41
|
| Rate for Payer: Cigna of WY Commercial |
$122.66
|
| Rate for Payer: Entrust Commercial |
$118.90
|
| Rate for Payer: First Choice Health Commercial |
$118.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.61
|
| Rate for Payer: HealthUtah PPO |
$125.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.41
|
| Rate for Payer: Multiplan Medicare/VA |
$78.48
|
| Rate for Payer: One Health Plan of WY PPO |
$122.66
|
| Rate for Payer: PacificSource Commercial |
$112.64
|
| Rate for Payer: PHCS PPO |
$122.66
|
| Rate for Payer: Three Rivers PPO |
$93.87
|
| Rate for Payer: TriWest Veterans Administration |
$82.61
|
| Rate for Payer: United Healthcare Commercial |
$108.89
|
| Rate for Payer: United Healthcare Medicare |
$82.61
|
| Rate for Payer: WINHealth Partners Commercial |
$118.90
|
| Rate for Payer: Wise Provider Network Commercial |
$118.90
|
|
|
URINAL SPILLPROOF ANTIREFLUX
|
Facility
|
OP
|
$125.16
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$125.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.66
|
| Rate for Payer: Aetna of WY Medicare |
$82.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.15
|
| Rate for Payer: Altius Commercial |
$120.15
|
| Rate for Payer: Beech Street Commercial |
$122.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.76
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.41
|
| Rate for Payer: Cigna of WY Commercial |
$122.66
|
| Rate for Payer: Entrust Commercial |
$118.90
|
| Rate for Payer: First Choice Health Commercial |
$118.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.59
|
| Rate for Payer: HealthUtah PPO |
$125.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.41
|
| Rate for Payer: Multiplan Medicare/VA |
$68.96
|
| Rate for Payer: One Health Plan of WY PPO |
$122.66
|
| Rate for Payer: PacificSource Commercial |
$112.64
|
| Rate for Payer: PHCS PPO |
$122.66
|
| Rate for Payer: Three Rivers PPO |
$93.87
|
| Rate for Payer: TriWest Veterans Administration |
$72.59
|
| Rate for Payer: United Healthcare Commercial |
$108.89
|
| Rate for Payer: United Healthcare Medicare |
$72.59
|
| Rate for Payer: WINHealth Partners Commercial |
$122.66
|
| Rate for Payer: Wise Provider Network Commercial |
$118.90
|
|
|
URINAL SPILLPROOF BAFFLE
|
Facility
|
IP
|
$40.95
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.31
|
| Rate for Payer: Altius Commercial |
$39.31
|
| Rate for Payer: Beech Street Commercial |
$40.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.72
|
| Rate for Payer: Cigna of WY Commercial |
$40.13
|
| Rate for Payer: Entrust Commercial |
$38.90
|
| Rate for Payer: First Choice Health Commercial |
$38.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.03
|
| Rate for Payer: HealthUtah PPO |
$40.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.72
|
| Rate for Payer: Multiplan Medicare/VA |
$25.68
|
| Rate for Payer: One Health Plan of WY PPO |
$40.13
|
| Rate for Payer: PacificSource Commercial |
$36.86
|
| Rate for Payer: PHCS PPO |
$40.13
|
| Rate for Payer: Three Rivers PPO |
$30.71
|
| Rate for Payer: TriWest Veterans Administration |
$27.03
|
| Rate for Payer: United Healthcare Commercial |
$35.63
|
| Rate for Payer: United Healthcare Medicare |
$27.03
|
| Rate for Payer: WINHealth Partners Commercial |
$38.90
|
| Rate for Payer: Wise Provider Network Commercial |
$38.90
|
|
|
URINAL SPILLPROOF BAFFLE
|
Facility
|
OP
|
$40.95
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.13
|
| Rate for Payer: Aetna of WY Medicare |
$27.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.31
|
| Rate for Payer: Altius Commercial |
$39.31
|
| Rate for Payer: Beech Street Commercial |
$40.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.72
|
| Rate for Payer: Cigna of WY Commercial |
$40.13
|
| Rate for Payer: Entrust Commercial |
$38.90
|
| Rate for Payer: First Choice Health Commercial |
$38.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.75
|
| Rate for Payer: HealthUtah PPO |
$40.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.72
|
| Rate for Payer: Multiplan Medicare/VA |
$22.56
|
| Rate for Payer: One Health Plan of WY PPO |
$40.13
|
| Rate for Payer: PacificSource Commercial |
$36.86
|
| Rate for Payer: PHCS PPO |
$40.13
|
| Rate for Payer: Three Rivers PPO |
$30.71
|
| Rate for Payer: TriWest Veterans Administration |
$23.75
|
| Rate for Payer: United Healthcare Commercial |
$35.63
|
| Rate for Payer: United Healthcare Medicare |
$23.75
|
| Rate for Payer: WINHealth Partners Commercial |
$40.13
|
| Rate for Payer: Wise Provider Network Commercial |
$38.90
|
|
|
URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
81025
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Aetna of WY Medicare |
$8.61
|
| Rate for Payer: Beech Street Commercial |
$57.95
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: First Choice Health Commercial |
$54.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.61
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: Multiplan Medicare/VA |
$7.32
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$57.95
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.61
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: United Healthcare Medicare |
$8.61
|
| Rate for Payer: WINHealth Partners Commercial |
$57.95
|
|
|
URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
81003
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$2.25
|
| Rate for Payer: Beech Street Commercial |
$31.35
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: First Choice Health Commercial |
$29.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.25
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.91
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$31.35
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$2.25
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
|
|
URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
81002
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$3.48
|
| Rate for Payer: Beech Street Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: First Choice Health Commercial |
$24.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.48
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$2.96
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$25.65
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$3.48
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
|
