|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 44140 AS
|
| Hospital Charge Code |
44140
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$6,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,810.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,269.94
|
| Rate for Payer: Beech Street Commercial |
$6,601.55
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,740.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,810.02
|
| Rate for Payer: First Choice Health Commercial |
$6,254.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,601.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,269.94
|
| Rate for Payer: HealthUtah PPO |
$6,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,740.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.45
|
| Rate for Payer: One Health Plan of WY PPO |
$6,810.02
|
| Rate for Payer: PacificSource Commercial |
$6,254.10
|
| Rate for Payer: PHCS PPO |
$6,601.55
|
| Rate for Payer: Three Rivers PPO |
$5,211.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,269.94
|
| Rate for Payer: United Healthcare Commercial |
$6,045.63
|
| Rate for Payer: United Healthcare Medicare |
$1,269.94
|
| Rate for Payer: WINHealth Partners Commercial |
$5,906.65
|
|
|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
44140
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$6,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,810.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,269.94
|
| Rate for Payer: Beech Street Commercial |
$6,601.55
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,740.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,810.02
|
| Rate for Payer: First Choice Health Commercial |
$6,254.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,601.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,269.94
|
| Rate for Payer: HealthUtah PPO |
$6,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,740.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.45
|
| Rate for Payer: One Health Plan of WY PPO |
$6,810.02
|
| Rate for Payer: PacificSource Commercial |
$6,254.10
|
| Rate for Payer: PHCS PPO |
$6,601.55
|
| Rate for Payer: Three Rivers PPO |
$5,211.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,269.94
|
| Rate for Payer: United Healthcare Commercial |
$6,045.63
|
| Rate for Payer: United Healthcare Medicare |
$1,269.94
|
| Rate for Payer: WINHealth Partners Commercial |
$5,906.65
|
|
|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 44140 80
|
| Hospital Charge Code |
44140
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$6,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,810.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,269.94
|
| Rate for Payer: Beech Street Commercial |
$6,601.55
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: Cash Price |
$4,864.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,740.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,810.02
|
| Rate for Payer: First Choice Health Commercial |
$6,254.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,601.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,269.94
|
| Rate for Payer: HealthUtah PPO |
$6,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,740.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.45
|
| Rate for Payer: One Health Plan of WY PPO |
$6,810.02
|
| Rate for Payer: PacificSource Commercial |
$6,254.10
|
| Rate for Payer: PHCS PPO |
$6,601.55
|
| Rate for Payer: Three Rivers PPO |
$5,211.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,269.94
|
| Rate for Payer: United Healthcare Commercial |
$6,045.63
|
| Rate for Payer: United Healthcare Medicare |
$1,269.94
|
| Rate for Payer: WINHealth Partners Commercial |
$5,906.65
|
|
|
COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA
|
Professional
|
Both
|
$5,078.00
|
|
|
Service Code
|
HCPCS 44144
|
| Hospital Charge Code |
44144
|
| Min. Negotiated Rate |
$1,415.25 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,976.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,665.00
|
| Rate for Payer: Beech Street Commercial |
$4,824.10
|
| Rate for Payer: Cash Price |
$3,554.60
|
| Rate for Payer: Cash Price |
$3,554.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,925.66
|
| Rate for Payer: Cigna of WY Commercial |
$4,976.44
|
| Rate for Payer: First Choice Health Commercial |
$4,570.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,824.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,665.00
|
| Rate for Payer: HealthUtah PPO |
$5,078.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,925.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,415.25
|
| Rate for Payer: One Health Plan of WY PPO |
$4,976.44
|
| Rate for Payer: PacificSource Commercial |
$4,570.20
|
| Rate for Payer: PHCS PPO |
$4,824.10
|
| Rate for Payer: Three Rivers PPO |
$3,808.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,665.00
|
| Rate for Payer: United Healthcare Commercial |
$4,417.86
|
| Rate for Payer: United Healthcare Medicare |
$1,665.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,316.30
|
|
|
COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT
|
Professional
|
Both
|
$8,610.00
|
|
|
Service Code
|
HCPCS 44143
|
| Hospital Charge Code |
44143
|
| Min. Negotiated Rate |
$1,325.68 |
| Max. Negotiated Rate |
$8,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,437.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,559.62
|
| Rate for Payer: Beech Street Commercial |
$8,179.50
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,351.70
|
| Rate for Payer: Cigna of WY Commercial |
$8,437.80
|
| Rate for Payer: First Choice Health Commercial |
$7,749.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,179.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,559.62
|
| Rate for Payer: HealthUtah PPO |
$8,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,351.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,325.68
|
| Rate for Payer: One Health Plan of WY PPO |
$8,437.80
|
| Rate for Payer: PacificSource Commercial |
$7,749.00
|
| Rate for Payer: PHCS PPO |
$8,179.50
|
| Rate for Payer: Three Rivers PPO |
$6,457.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,559.62
|
| Rate for Payer: United Healthcare Commercial |
$7,490.70
|
| Rate for Payer: United Healthcare Medicare |
$1,559.62
|
| Rate for Payer: WINHealth Partners Commercial |
$7,318.50
|
|
|
COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT
|
Professional
|
Both
|
$8,610.00
|
|
|
Service Code
|
HCPCS 44143 AS
|
| Hospital Charge Code |
44143
|
| Min. Negotiated Rate |
$1,325.68 |
| Max. Negotiated Rate |
$8,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,437.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,559.62
|
| Rate for Payer: Beech Street Commercial |
$8,179.50
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,351.70
|
| Rate for Payer: Cigna of WY Commercial |
$8,437.80
|
| Rate for Payer: First Choice Health Commercial |
$7,749.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,179.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,559.62
|
| Rate for Payer: HealthUtah PPO |
$8,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,351.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,325.68
|
| Rate for Payer: One Health Plan of WY PPO |
$8,437.80
|
| Rate for Payer: PacificSource Commercial |
$7,749.00
|
| Rate for Payer: PHCS PPO |
$8,179.50
|
| Rate for Payer: Three Rivers PPO |
$6,457.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,559.62
|
| Rate for Payer: United Healthcare Commercial |
$7,490.70
|
| Rate for Payer: United Healthcare Medicare |
$1,559.62
|
| Rate for Payer: WINHealth Partners Commercial |
$7,318.50
|
|
|
COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT
|
Professional
|
Both
|
$8,610.00
|
|
|
Service Code
|
HCPCS 44143 80
|
| Hospital Charge Code |
44143
|
| Min. Negotiated Rate |
$1,325.68 |
| Max. Negotiated Rate |
$8,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,437.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,559.62
|
| Rate for Payer: Beech Street Commercial |
$8,179.50
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: Cash Price |
$6,027.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,351.70
|
| Rate for Payer: Cigna of WY Commercial |
$8,437.80
|
| Rate for Payer: First Choice Health Commercial |
$7,749.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,179.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,559.62
|
| Rate for Payer: HealthUtah PPO |
$8,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,351.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,325.68
|
| Rate for Payer: One Health Plan of WY PPO |
$8,437.80
|
| Rate for Payer: PacificSource Commercial |
$7,749.00
|
| Rate for Payer: PHCS PPO |
$8,179.50
|
| Rate for Payer: Three Rivers PPO |
$6,457.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,559.62
|
| Rate for Payer: United Healthcare Commercial |
$7,490.70
|
| Rate for Payer: United Healthcare Medicare |
$1,559.62
|
| Rate for Payer: WINHealth Partners Commercial |
$7,318.50
|
|
|
COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS
|
Professional
|
Both
|
$6,428.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
44160
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$6,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,299.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,175.65
|
| Rate for Payer: Beech Street Commercial |
$6,106.60
|
| Rate for Payer: Cash Price |
$4,499.60
|
| Rate for Payer: Cash Price |
$4,499.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,235.16
|
| Rate for Payer: Cigna of WY Commercial |
$6,299.44
|
| Rate for Payer: First Choice Health Commercial |
$5,785.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,106.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,175.65
|
| Rate for Payer: HealthUtah PPO |
$6,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,235.16
|
| Rate for Payer: Multiplan Medicare/VA |
$999.30
|
| Rate for Payer: One Health Plan of WY PPO |
$6,299.44
|
| Rate for Payer: PacificSource Commercial |
$5,785.20
|
| Rate for Payer: PHCS PPO |
$6,106.60
|
| Rate for Payer: Three Rivers PPO |
$4,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,175.65
|
| Rate for Payer: United Healthcare Commercial |
$5,592.36
|
| Rate for Payer: United Healthcare Medicare |
$1,175.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,463.80
|
|
|
COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS
|
Professional
|
Both
|
$6,428.00
|
|
|
Service Code
|
HCPCS 44160 80
|
| Hospital Charge Code |
44160
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$6,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,299.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,175.65
|
| Rate for Payer: Beech Street Commercial |
$6,106.60
|
| Rate for Payer: Cash Price |
$4,499.60
|
| Rate for Payer: Cash Price |
$4,499.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,235.16
|
| Rate for Payer: Cigna of WY Commercial |
$6,299.44
|
| Rate for Payer: First Choice Health Commercial |
$5,785.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,106.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,175.65
|
| Rate for Payer: HealthUtah PPO |
$6,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,235.16
|
| Rate for Payer: Multiplan Medicare/VA |
$999.30
|
| Rate for Payer: One Health Plan of WY PPO |
$6,299.44
|
| Rate for Payer: PacificSource Commercial |
$5,785.20
|
| Rate for Payer: PHCS PPO |
$6,106.60
|
| Rate for Payer: Three Rivers PPO |
$4,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,175.65
|
| Rate for Payer: United Healthcare Commercial |
$5,592.36
|
| Rate for Payer: United Healthcare Medicare |
$1,175.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,463.80
|
|
|
COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY
|
Professional
|
Both
|
$3,707.00
|
|
|
Service Code
|
HCPCS 44141 80
|
| Hospital Charge Code |
44141
|
| Min. Negotiated Rate |
$1,456.19 |
| Max. Negotiated Rate |
$3,707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,632.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,713.16
|
| Rate for Payer: Beech Street Commercial |
$3,521.65
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,595.79
|
| Rate for Payer: Cigna of WY Commercial |
$3,632.86
|
| Rate for Payer: First Choice Health Commercial |
$3,336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,521.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,713.16
|
| Rate for Payer: HealthUtah PPO |
$3,707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,595.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,456.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,632.86
|
| Rate for Payer: PacificSource Commercial |
$3,336.30
|
| Rate for Payer: PHCS PPO |
$3,521.65
|
| Rate for Payer: Three Rivers PPO |
$2,780.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,713.16
|
| Rate for Payer: United Healthcare Commercial |
$3,225.09
|
| Rate for Payer: United Healthcare Medicare |
$1,713.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3,150.95
|
|
|
COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY
|
Professional
|
Both
|
$3,707.00
|
|
|
Service Code
|
HCPCS 44141
|
| Hospital Charge Code |
44141
|
| Min. Negotiated Rate |
$1,456.19 |
| Max. Negotiated Rate |
$3,707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,632.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,713.16
|
| Rate for Payer: Beech Street Commercial |
$3,521.65
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: Cash Price |
$2,594.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,595.79
|
| Rate for Payer: Cigna of WY Commercial |
$3,632.86
|
| Rate for Payer: First Choice Health Commercial |
$3,336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,521.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,713.16
|
| Rate for Payer: HealthUtah PPO |
$3,707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,595.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,456.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,632.86
|
| Rate for Payer: PacificSource Commercial |
$3,336.30
|
| Rate for Payer: PHCS PPO |
$3,521.65
|
| Rate for Payer: Three Rivers PPO |
$2,780.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,713.16
|
| Rate for Payer: United Healthcare Commercial |
$3,225.09
|
| Rate for Payer: United Healthcare Medicare |
$1,713.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3,150.95
|
|
|
COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$2,349.00
|
|
|
Service Code
|
HCPCS 44155
|
| Hospital Charge Code |
44155
|
| Min. Negotiated Rate |
$1,662.61 |
| Max. Negotiated Rate |
$2,349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,302.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,956.01
|
| Rate for Payer: Beech Street Commercial |
$2,231.55
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,278.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,302.02
|
| Rate for Payer: First Choice Health Commercial |
$2,114.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,231.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,956.01
|
| Rate for Payer: HealthUtah PPO |
$2,349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,278.53
|
| Rate for Payer: Multiplan Medicare/VA |
$1,662.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2,302.02
|
| Rate for Payer: PacificSource Commercial |
$2,114.10
|
| Rate for Payer: PHCS PPO |
$2,231.55
|
| Rate for Payer: Three Rivers PPO |
$1,761.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,956.01
|
| Rate for Payer: United Healthcare Commercial |
$2,043.63
|
| Rate for Payer: United Healthcare Medicare |
$1,956.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,996.65
|
|
|
COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 44155 80
|
| Hospital Charge Code |
44155
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,956.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$458.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,956.01
|
| Rate for Payer: Beech Street Commercial |
$444.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$453.96
|
| Rate for Payer: Cigna of WY Commercial |
$458.64
|
| Rate for Payer: First Choice Health Commercial |
$421.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,956.01
|
| Rate for Payer: HealthUtah PPO |
$468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$453.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1,662.61
|
| Rate for Payer: One Health Plan of WY PPO |
$458.64
|
| Rate for Payer: PacificSource Commercial |
$421.20
|
| Rate for Payer: PHCS PPO |
$444.60
|
| Rate for Payer: Three Rivers PPO |
$351.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,956.01
|
| Rate for Payer: United Healthcare Commercial |
$407.16
|
| Rate for Payer: United Healthcare Medicare |
$1,956.01
|
| Rate for Payer: WINHealth Partners Commercial |
$397.80
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
HCPCS 44157 80
|
| Hospital Charge Code |
44157
|
| Min. Negotiated Rate |
$1,751.95 |
| Max. Negotiated Rate |
$2,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,061.12
|
| Rate for Payer: Beech Street Commercial |
$2,303.75
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
| Rate for Payer: First Choice Health Commercial |
$2,182.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,061.12
|
| Rate for Payer: HealthUtah PPO |
$2,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,751.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
| Rate for Payer: PacificSource Commercial |
$2,182.50
|
| Rate for Payer: PHCS PPO |
$2,303.75
|
| Rate for Payer: Three Rivers PPO |
$1,818.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,061.12
|
| Rate for Payer: United Healthcare Commercial |
$2,109.75
|
| Rate for Payer: United Healthcare Medicare |
$2,061.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
HCPCS 44157 AS
|
| Hospital Charge Code |
44157
|
| Min. Negotiated Rate |
$1,751.95 |
| Max. Negotiated Rate |
$2,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,061.12
|
| Rate for Payer: Beech Street Commercial |
$2,303.75
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
| Rate for Payer: First Choice Health Commercial |
$2,182.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,061.12
|
| Rate for Payer: HealthUtah PPO |
$2,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,751.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
| Rate for Payer: PacificSource Commercial |
$2,182.50
|
| Rate for Payer: PHCS PPO |
$2,303.75
|
| Rate for Payer: Three Rivers PPO |
$1,818.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,061.12
|
| Rate for Payer: United Healthcare Commercial |
$2,109.75
|
| Rate for Payer: United Healthcare Medicare |
$2,061.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
HCPCS 44157
|
| Hospital Charge Code |
44157
|
| Min. Negotiated Rate |
$1,751.95 |
| Max. Negotiated Rate |
$2,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,061.12
|
| Rate for Payer: Beech Street Commercial |
$2,303.75
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
| Rate for Payer: First Choice Health Commercial |
$2,182.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,061.12
|
| Rate for Payer: HealthUtah PPO |
$2,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,751.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
| Rate for Payer: PacificSource Commercial |
$2,182.50
|
| Rate for Payer: PHCS PPO |
$2,303.75
|
| Rate for Payer: Three Rivers PPO |
$1,818.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,061.12
|
| Rate for Payer: United Healthcare Commercial |
$2,109.75
|
| Rate for Payer: United Healthcare Medicare |
$2,061.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
|
COLLAGENASE, CLOST HIST INJ
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
J0775
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$68.97
|
| Rate for Payer: Beech Street Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: First Choice Health Commercial |
$93.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.97
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$58.62
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$98.80
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$68.97
|
| Rate for Payer: WINHealth Partners Commercial |
$98.80
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 0.9 MG SOLUTION FOR INJECTION [89023]
|
Facility
|
IP
|
$10,276.82
|
|
|
Service Code
|
HCPCS J0775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,443.57 |
| Max. Negotiated Rate |
$10,276.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,071.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,865.75
|
| Rate for Payer: Altius Commercial |
$9,865.75
|
| Rate for Payer: Beech Street Commercial |
$10,071.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,437.27
|
| Rate for Payer: Cash Price |
$7,193.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,968.52
|
| Rate for Payer: Cigna of WY Commercial |
$10,071.28
|
| Rate for Payer: Entrust Commercial |
$9,762.98
|
| Rate for Payer: First Choice Health Commercial |
$9,762.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,762.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,782.70
|
| Rate for Payer: HealthUtah PPO |
$10,276.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,968.52
|
| Rate for Payer: Multiplan Medicare/VA |
$6,443.57
|
| Rate for Payer: One Health Plan of WY PPO |
$10,071.28
|
| Rate for Payer: PacificSource Commercial |
$9,249.14
|
| Rate for Payer: PHCS PPO |
$10,071.28
|
| Rate for Payer: Three Rivers PPO |
$7,707.62
|
| Rate for Payer: TriWest Veterans Administration |
$6,782.70
|
| Rate for Payer: United Healthcare Commercial |
$8,940.83
|
| Rate for Payer: United Healthcare Medicare |
$6,782.70
|
| Rate for Payer: WINHealth Partners Commercial |
$9,762.98
|
| Rate for Payer: Wise Provider Network Commercial |
$9,762.98
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 0.9 MG SOLUTION FOR INJECTION [89023]
|
Facility
|
OP
|
$10,276.82
|
|
|
Service Code
|
HCPCS J0775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,662.53 |
| Max. Negotiated Rate |
$10,276.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,071.28
|
| Rate for Payer: Aetna of WY Medicare |
$6,782.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,865.75
|
| Rate for Payer: Altius Commercial |
$9,865.75
|
| Rate for Payer: Beech Street Commercial |
$10,071.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,437.27
|
| Rate for Payer: Cash Price |
$7,193.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,968.52
|
| Rate for Payer: Cigna of WY Commercial |
$10,071.28
|
| Rate for Payer: Entrust Commercial |
$9,762.98
|
| Rate for Payer: First Choice Health Commercial |
$9,762.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,762.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,960.56
|
| Rate for Payer: HealthUtah PPO |
$10,276.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,968.52
|
| Rate for Payer: Multiplan Medicare/VA |
$5,662.53
|
| Rate for Payer: One Health Plan of WY PPO |
$10,071.28
|
| Rate for Payer: PacificSource Commercial |
$9,249.14
|
| Rate for Payer: PHCS PPO |
$10,071.28
|
| Rate for Payer: Three Rivers PPO |
$7,707.62
|
| Rate for Payer: TriWest Veterans Administration |
$5,960.56
|
| Rate for Payer: United Healthcare Commercial |
$8,940.83
|
| Rate for Payer: United Healthcare Medicare |
$5,960.56
|
| Rate for Payer: WINHealth Partners Commercial |
$10,071.28
|
| Rate for Payer: Wise Provider Network Commercial |
$9,762.98
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [17020]
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
NDC 5048401030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$31.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.48
|
| Rate for Payer: Altius Commercial |
$30.48
|
| Rate for Payer: Beech Street Commercial |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.07
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.80
|
| Rate for Payer: Cigna of WY Commercial |
$31.12
|
| Rate for Payer: Entrust Commercial |
$30.16
|
| Rate for Payer: First Choice Health Commercial |
$30.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.96
|
| Rate for Payer: HealthUtah PPO |
$31.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.80
|
| Rate for Payer: Multiplan Medicare/VA |
$19.91
|
| Rate for Payer: One Health Plan of WY PPO |
$31.12
|
| Rate for Payer: PacificSource Commercial |
$28.58
|
| Rate for Payer: PHCS PPO |
$31.12
|
| Rate for Payer: Three Rivers PPO |
$23.81
|
| Rate for Payer: TriWest Veterans Administration |
$20.96
|
| Rate for Payer: United Healthcare Commercial |
$27.62
|
| Rate for Payer: United Healthcare Medicare |
$20.96
|
| Rate for Payer: WINHealth Partners Commercial |
$30.16
|
| Rate for Payer: Wise Provider Network Commercial |
$30.16
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT [17020]
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 5048401030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$31.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.12
|
| Rate for Payer: Aetna of WY Medicare |
$20.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.48
|
| Rate for Payer: Altius Commercial |
$30.48
|
| Rate for Payer: Beech Street Commercial |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.07
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.80
|
| Rate for Payer: Cigna of WY Commercial |
$31.12
|
| Rate for Payer: Entrust Commercial |
$30.16
|
| Rate for Payer: First Choice Health Commercial |
$30.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.42
|
| Rate for Payer: HealthUtah PPO |
$31.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.80
|
| Rate for Payer: Multiplan Medicare/VA |
$17.49
|
| Rate for Payer: One Health Plan of WY PPO |
$31.12
|
| Rate for Payer: PacificSource Commercial |
$28.58
|
| Rate for Payer: PHCS PPO |
$31.12
|
| Rate for Payer: Three Rivers PPO |
$23.81
|
| Rate for Payer: TriWest Veterans Administration |
$18.42
|
| Rate for Payer: United Healthcare Commercial |
$27.62
|
| Rate for Payer: United Healthcare Medicare |
$18.42
|
| Rate for Payer: WINHealth Partners Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$30.16
|
|
|
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
36591
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$27.09
|
| Rate for Payer: Beech Street Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: First Choice Health Commercial |
$20.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.09
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$23.03
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$21.85
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.09
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$27.09
|
| Rate for Payer: WINHealth Partners Commercial |
$19.55
|
|
|
COLLECTION VENOUS BLOOD VENIPUNCTURE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
36415
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$8.83
|
| Rate for Payer: Beech Street Commercial |
$33.25
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: First Choice Health Commercial |
$31.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.83
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$7.51
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$33.25
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.83
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$8.83
|
| Rate for Payer: WINHealth Partners Commercial |
$29.75
|
|
|
COLON CA SCRN NOT HI RSK IND
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
G0121
|
| Min. Negotiated Rate |
$148.84 |
| Max. Negotiated Rate |
$1,846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,809.08
|
| Rate for Payer: Aetna of WY Medicare |
$175.11
|
| Rate for Payer: Beech Street Commercial |
$1,753.70
|
| Rate for Payer: Cash Price |
$1,292.20
|
| Rate for Payer: Cash Price |
$1,292.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,790.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,809.08
|
| Rate for Payer: First Choice Health Commercial |
$1,661.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,753.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.11
|
| Rate for Payer: HealthUtah PPO |
$1,846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,790.62
|
| Rate for Payer: Multiplan Medicare/VA |
$148.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,809.08
|
| Rate for Payer: PacificSource Commercial |
$1,661.40
|
| Rate for Payer: PHCS PPO |
$1,753.70
|
| Rate for Payer: Three Rivers PPO |
$1,384.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.11
|
| Rate for Payer: United Healthcare Commercial |
$1,606.02
|
| Rate for Payer: United Healthcare Medicare |
$175.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,753.70
|
|
|
COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES
|
Professional
|
Both
|
$3,755.00
|
|
|
Service Code
|
HCPCS 45388
|
| Hospital Charge Code |
45388
|
| Min. Negotiated Rate |
$217.25 |
| Max. Negotiated Rate |
$3,755.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,679.90
|
| Rate for Payer: Aetna of WY Medicare |
$255.59
|
| Rate for Payer: Beech Street Commercial |
$3,567.25
|
| Rate for Payer: Cash Price |
$2,628.50
|
| Rate for Payer: Cash Price |
$2,628.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,642.35
|
| Rate for Payer: Cigna of WY Commercial |
$3,679.90
|
| Rate for Payer: First Choice Health Commercial |
$3,379.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,567.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.59
|
| Rate for Payer: HealthUtah PPO |
$3,755.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,642.35
|
| Rate for Payer: Multiplan Medicare/VA |
$217.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,679.90
|
| Rate for Payer: PacificSource Commercial |
$3,379.50
|
| Rate for Payer: PHCS PPO |
$3,567.25
|
| Rate for Payer: Three Rivers PPO |
$2,816.25
|
| Rate for Payer: TriWest Veterans Administration |
$255.59
|
| Rate for Payer: United Healthcare Commercial |
$3,266.85
|
| Rate for Payer: United Healthcare Medicare |
$255.59
|
| Rate for Payer: WINHealth Partners Commercial |
$3,191.75
|
|
