|
COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 45378 53
|
| Hospital Charge Code |
45378
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,592.50
|
| Rate for Payer: Aetna of WY Medicare |
$87.60
|
| Rate for Payer: Beech Street Commercial |
$1,543.75
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,576.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,592.50
|
| Rate for Payer: First Choice Health Commercial |
$1,462.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,543.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.60
|
| Rate for Payer: HealthUtah PPO |
$1,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,576.25
|
| Rate for Payer: Multiplan Medicare/VA |
$74.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,592.50
|
| Rate for Payer: PacificSource Commercial |
$1,462.50
|
| Rate for Payer: PHCS PPO |
$1,543.75
|
| Rate for Payer: Three Rivers PPO |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.60
|
| Rate for Payer: United Healthcare Commercial |
$1,413.75
|
| Rate for Payer: United Healthcare Medicare |
$87.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,381.25
|
|
|
COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
45378
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,592.50
|
| Rate for Payer: Aetna of WY Medicare |
$174.87
|
| Rate for Payer: Beech Street Commercial |
$1,543.75
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,576.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,592.50
|
| Rate for Payer: First Choice Health Commercial |
$1,462.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,543.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.87
|
| Rate for Payer: HealthUtah PPO |
$1,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,576.25
|
| Rate for Payer: Multiplan Medicare/VA |
$148.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,592.50
|
| Rate for Payer: PacificSource Commercial |
$1,462.50
|
| Rate for Payer: PHCS PPO |
$1,543.75
|
| Rate for Payer: Three Rivers PPO |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.87
|
| Rate for Payer: United Healthcare Commercial |
$1,413.75
|
| Rate for Payer: United Healthcare Medicare |
$174.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,381.25
|
|
|
COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,849.00
|
|
|
Service Code
|
HCPCS 45380
|
| Hospital Charge Code |
45380
|
| Min. Negotiated Rate |
$161.58 |
| Max. Negotiated Rate |
$1,849.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,812.02
|
| Rate for Payer: Aetna of WY Medicare |
$190.09
|
| Rate for Payer: Beech Street Commercial |
$1,756.55
|
| Rate for Payer: Cash Price |
$1,294.30
|
| Rate for Payer: Cash Price |
$1,294.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,793.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,812.02
|
| Rate for Payer: First Choice Health Commercial |
$1,664.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,756.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.09
|
| Rate for Payer: HealthUtah PPO |
$1,849.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,793.53
|
| Rate for Payer: Multiplan Medicare/VA |
$161.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,812.02
|
| Rate for Payer: PacificSource Commercial |
$1,664.10
|
| Rate for Payer: PHCS PPO |
$1,756.55
|
| Rate for Payer: Three Rivers PPO |
$1,386.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.09
|
| Rate for Payer: United Healthcare Commercial |
$1,608.63
|
| Rate for Payer: United Healthcare Medicare |
$190.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,571.65
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$2,372.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
G0105
|
| Min. Negotiated Rate |
$148.64 |
| Max. Negotiated Rate |
$2,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,324.56
|
| Rate for Payer: Aetna of WY Medicare |
$174.87
|
| Rate for Payer: Beech Street Commercial |
$2,253.40
|
| Rate for Payer: Cash Price |
$1,660.40
|
| Rate for Payer: Cash Price |
$1,660.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,300.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,324.56
|
| Rate for Payer: First Choice Health Commercial |
$2,134.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,253.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.87
|
| Rate for Payer: HealthUtah PPO |
$2,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,300.84
|
| Rate for Payer: Multiplan Medicare/VA |
$148.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,324.56
|
| Rate for Payer: PacificSource Commercial |
$2,134.80
|
| Rate for Payer: PHCS PPO |
$2,253.40
|
| Rate for Payer: Three Rivers PPO |
$1,779.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.87
|
| Rate for Payer: United Healthcare Commercial |
$2,063.64
|
| Rate for Payer: United Healthcare Medicare |
$174.87
|
| Rate for Payer: WINHealth Partners Commercial |
$2,253.40
|
|
|
COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
57120
|
| Min. Negotiated Rate |
$437.05 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,799.28
|
| Rate for Payer: Aetna of WY Medicare |
$514.18
|
| Rate for Payer: Beech Street Commercial |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,780.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,799.28
|
| Rate for Payer: First Choice Health Commercial |
$1,652.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,744.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.18
|
| Rate for Payer: HealthUtah PPO |
$1,836.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,780.92
|
| Rate for Payer: Multiplan Medicare/VA |
$437.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,799.28
|
| Rate for Payer: PacificSource Commercial |
$1,652.40
|
| Rate for Payer: PHCS PPO |
$1,744.20
|
| Rate for Payer: Three Rivers PPO |
$1,377.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.18
|
| Rate for Payer: United Healthcare Commercial |
$1,597.32
|
| Rate for Payer: United Healthcare Medicare |
$514.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,560.60
|
|
|
COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 57120 80
|
| Hospital Charge Code |
57120
|
| Min. Negotiated Rate |
$437.05 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,799.28
|
| Rate for Payer: Aetna of WY Medicare |
$514.18
|
| Rate for Payer: Beech Street Commercial |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,780.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,799.28
|
| Rate for Payer: First Choice Health Commercial |
$1,652.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,744.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.18
|
| Rate for Payer: HealthUtah PPO |
$1,836.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,780.92
|
| Rate for Payer: Multiplan Medicare/VA |
$437.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,799.28
|
| Rate for Payer: PacificSource Commercial |
$1,652.40
|
| Rate for Payer: PHCS PPO |
$1,744.20
|
| Rate for Payer: Three Rivers PPO |
$1,377.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.18
|
| Rate for Payer: United Healthcare Commercial |
$1,597.32
|
| Rate for Payer: United Healthcare Medicare |
$514.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,560.60
|
|
|
COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,835.00
|
|
|
Service Code
|
HCPCS 57280
|
| Hospital Charge Code |
57280
|
| Min. Negotiated Rate |
$789.15 |
| Max. Negotiated Rate |
$3,835.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,758.30
|
| Rate for Payer: Aetna of WY Medicare |
$928.41
|
| Rate for Payer: Beech Street Commercial |
$3,643.25
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,719.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,758.30
|
| Rate for Payer: First Choice Health Commercial |
$3,451.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,643.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.41
|
| Rate for Payer: HealthUtah PPO |
$3,835.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,719.95
|
| Rate for Payer: Multiplan Medicare/VA |
$789.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,758.30
|
| Rate for Payer: PacificSource Commercial |
$3,451.50
|
| Rate for Payer: PHCS PPO |
$3,643.25
|
| Rate for Payer: Three Rivers PPO |
$2,876.25
|
| Rate for Payer: TriWest Veterans Administration |
$928.41
|
| Rate for Payer: United Healthcare Commercial |
$3,336.45
|
| Rate for Payer: United Healthcare Medicare |
$928.41
|
| Rate for Payer: WINHealth Partners Commercial |
$3,259.75
|
|
|
COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,835.00
|
|
|
Service Code
|
HCPCS 57280 80
|
| Hospital Charge Code |
57280
|
| Min. Negotiated Rate |
$789.15 |
| Max. Negotiated Rate |
$3,835.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,758.30
|
| Rate for Payer: Aetna of WY Medicare |
$928.41
|
| Rate for Payer: Beech Street Commercial |
$3,643.25
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,719.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,758.30
|
| Rate for Payer: First Choice Health Commercial |
$3,451.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,643.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.41
|
| Rate for Payer: HealthUtah PPO |
$3,835.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,719.95
|
| Rate for Payer: Multiplan Medicare/VA |
$789.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,758.30
|
| Rate for Payer: PacificSource Commercial |
$3,451.50
|
| Rate for Payer: PHCS PPO |
$3,643.25
|
| Rate for Payer: Three Rivers PPO |
$2,876.25
|
| Rate for Payer: TriWest Veterans Administration |
$928.41
|
| Rate for Payer: United Healthcare Commercial |
$3,336.45
|
| Rate for Payer: United Healthcare Medicare |
$928.41
|
| Rate for Payer: WINHealth Partners Commercial |
$3,259.75
|
|
|
COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
57200
|
| Min. Negotiated Rate |
$275.45 |
| Max. Negotiated Rate |
$1,549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,518.02
|
| Rate for Payer: Aetna of WY Medicare |
$324.06
|
| Rate for Payer: Beech Street Commercial |
$1,471.55
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,502.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,518.02
|
| Rate for Payer: First Choice Health Commercial |
$1,394.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,471.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.06
|
| Rate for Payer: HealthUtah PPO |
$1,549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,502.53
|
| Rate for Payer: Multiplan Medicare/VA |
$275.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,518.02
|
| Rate for Payer: PacificSource Commercial |
$1,394.10
|
| Rate for Payer: PHCS PPO |
$1,471.55
|
| Rate for Payer: Three Rivers PPO |
$1,161.75
|
| Rate for Payer: TriWest Veterans Administration |
$324.06
|
| Rate for Payer: United Healthcare Commercial |
$1,347.63
|
| Rate for Payer: United Healthcare Medicare |
$324.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,316.65
|
|
|
COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 57200 80
|
| Hospital Charge Code |
57200
|
| Min. Negotiated Rate |
$275.45 |
| Max. Negotiated Rate |
$1,549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,518.02
|
| Rate for Payer: Aetna of WY Medicare |
$324.06
|
| Rate for Payer: Beech Street Commercial |
$1,471.55
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: Cash Price |
$1,084.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,502.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,518.02
|
| Rate for Payer: First Choice Health Commercial |
$1,394.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,471.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.06
|
| Rate for Payer: HealthUtah PPO |
$1,549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,502.53
|
| Rate for Payer: Multiplan Medicare/VA |
$275.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,518.02
|
| Rate for Payer: PacificSource Commercial |
$1,394.10
|
| Rate for Payer: PHCS PPO |
$1,471.55
|
| Rate for Payer: Three Rivers PPO |
$1,161.75
|
| Rate for Payer: TriWest Veterans Administration |
$324.06
|
| Rate for Payer: United Healthcare Commercial |
$1,347.63
|
| Rate for Payer: United Healthcare Medicare |
$324.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,316.65
|
|
|
COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
57454
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
| Rate for Payer: Aetna of WY Medicare |
$127.97
|
| Rate for Payer: Beech Street Commercial |
$642.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$655.72
|
| Rate for Payer: Cigna of WY Commercial |
$662.48
|
| Rate for Payer: First Choice Health Commercial |
$608.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.97
|
| Rate for Payer: HealthUtah PPO |
$676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
| Rate for Payer: Multiplan Medicare/VA |
$108.77
|
| Rate for Payer: One Health Plan of WY PPO |
$662.48
|
| Rate for Payer: PacificSource Commercial |
$608.40
|
| Rate for Payer: PHCS PPO |
$642.20
|
| Rate for Payer: Three Rivers PPO |
$507.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.97
|
| Rate for Payer: United Healthcare Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicare |
$127.97
|
| Rate for Payer: WINHealth Partners Commercial |
$574.60
|
|
|
COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
57456
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$501.76
|
| Rate for Payer: Aetna of WY Medicare |
$96.57
|
| Rate for Payer: Beech Street Commercial |
$486.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$496.64
|
| Rate for Payer: Cigna of WY Commercial |
$501.76
|
| Rate for Payer: First Choice Health Commercial |
$460.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.57
|
| Rate for Payer: HealthUtah PPO |
$512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$496.64
|
| Rate for Payer: Multiplan Medicare/VA |
$82.08
|
| Rate for Payer: One Health Plan of WY PPO |
$501.76
|
| Rate for Payer: PacificSource Commercial |
$460.80
|
| Rate for Payer: PHCS PPO |
$486.40
|
| Rate for Payer: Three Rivers PPO |
$384.00
|
| Rate for Payer: TriWest Veterans Administration |
$96.57
|
| Rate for Payer: United Healthcare Commercial |
$445.44
|
| Rate for Payer: United Healthcare Medicare |
$96.57
|
| Rate for Payer: WINHealth Partners Commercial |
$435.20
|
|
|
COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
57452
|
| Min. Negotiated Rate |
$74.24 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$87.34
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.34
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$74.24
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.34
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$87.34
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
57455
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.90
|
| Rate for Payer: Aetna of WY Medicare |
$103.60
|
| Rate for Payer: Beech Street Commercial |
$527.25
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.35
|
| Rate for Payer: Cigna of WY Commercial |
$543.90
|
| Rate for Payer: First Choice Health Commercial |
$499.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.60
|
| Rate for Payer: HealthUtah PPO |
$555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.35
|
| Rate for Payer: Multiplan Medicare/VA |
$88.06
|
| Rate for Payer: One Health Plan of WY PPO |
$543.90
|
| Rate for Payer: PacificSource Commercial |
$499.50
|
| Rate for Payer: PHCS PPO |
$527.25
|
| Rate for Payer: Three Rivers PPO |
$416.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.60
|
| Rate for Payer: United Healthcare Commercial |
$482.85
|
| Rate for Payer: United Healthcare Medicare |
$103.60
|
| Rate for Payer: WINHealth Partners Commercial |
$471.75
|
|
|
COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
57461
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$917.28
|
| Rate for Payer: Aetna of WY Medicare |
$174.24
|
| Rate for Payer: Beech Street Commercial |
$889.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$907.92
|
| Rate for Payer: Cigna of WY Commercial |
$917.28
|
| Rate for Payer: First Choice Health Commercial |
$842.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$889.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.24
|
| Rate for Payer: HealthUtah PPO |
$936.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$907.92
|
| Rate for Payer: Multiplan Medicare/VA |
$148.10
|
| Rate for Payer: One Health Plan of WY PPO |
$917.28
|
| Rate for Payer: PacificSource Commercial |
$842.40
|
| Rate for Payer: PHCS PPO |
$889.20
|
| Rate for Payer: Three Rivers PPO |
$702.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.24
|
| Rate for Payer: United Healthcare Commercial |
$814.32
|
| Rate for Payer: United Healthcare Medicare |
$174.24
|
| Rate for Payer: WINHealth Partners Commercial |
$795.60
|
|
|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
57460
|
| Min. Negotiated Rate |
$129.62 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Aetna of WY Medicare |
$152.50
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.50
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: Multiplan Medicare/VA |
$129.62
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.50
|
| Rate for Payer: United Healthcare Commercial |
$702.96
|
| Rate for Payer: United Healthcare Medicare |
$152.50
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
|
COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
57420
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$85.86
|
| Rate for Payer: Beech Street Commercial |
$433.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: First Choice Health Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.86
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$72.98
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$433.20
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.86
|
| Rate for Payer: United Healthcare Commercial |
$396.72
|
| Rate for Payer: United Healthcare Medicare |
$85.86
|
| Rate for Payer: WINHealth Partners Commercial |
$387.60
|
|
|
COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
57421
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$116.27
|
| Rate for Payer: Beech Street Commercial |
$587.10
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: First Choice Health Commercial |
$556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.27
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$98.83
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$587.10
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$116.27
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
|
COLPOSCOPY VULVA
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 56820
|
| Hospital Charge Code |
56820
|
| Min. Negotiated Rate |
$68.39 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.46
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.46
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$68.39
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.46
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$80.46
|
| Rate for Payer: WINHealth Partners Commercial |
$443.70
|
|
|
COLPOSCOPY VULVA W/BIOPSY
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
56821
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$561.54
|
| Rate for Payer: Aetna of WY Medicare |
$108.34
|
| Rate for Payer: Beech Street Commercial |
$544.35
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.81
|
| Rate for Payer: Cigna of WY Commercial |
$561.54
|
| Rate for Payer: First Choice Health Commercial |
$515.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$544.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.34
|
| Rate for Payer: HealthUtah PPO |
$573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.81
|
| Rate for Payer: Multiplan Medicare/VA |
$92.09
|
| Rate for Payer: One Health Plan of WY PPO |
$561.54
|
| Rate for Payer: PacificSource Commercial |
$515.70
|
| Rate for Payer: PHCS PPO |
$544.35
|
| Rate for Payer: Three Rivers PPO |
$429.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.34
|
| Rate for Payer: United Healthcare Commercial |
$498.51
|
| Rate for Payer: United Healthcare Medicare |
$108.34
|
| Rate for Payer: WINHealth Partners Commercial |
$487.05
|
|
|
COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$2,995.00
|
|
|
Service Code
|
HCPCS 45386
|
| Hospital Charge Code |
45386
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$2,995.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,935.10
|
| Rate for Payer: Aetna of WY Medicare |
$200.55
|
| Rate for Payer: Beech Street Commercial |
$2,845.25
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,905.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,935.10
|
| Rate for Payer: First Choice Health Commercial |
$2,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,845.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.55
|
| Rate for Payer: HealthUtah PPO |
$2,995.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,905.15
|
| Rate for Payer: Multiplan Medicare/VA |
$170.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,935.10
|
| Rate for Payer: PacificSource Commercial |
$2,695.50
|
| Rate for Payer: PHCS PPO |
$2,845.25
|
| Rate for Payer: Three Rivers PPO |
$2,246.25
|
| Rate for Payer: TriWest Veterans Administration |
$200.55
|
| Rate for Payer: United Healthcare Commercial |
$2,605.65
|
| Rate for Payer: United Healthcare Medicare |
$200.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,545.75
|
|
|
COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
45381
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$1,342.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,315.16
|
| Rate for Payer: Aetna of WY Medicare |
$189.76
|
| Rate for Payer: Beech Street Commercial |
$1,274.90
|
| Rate for Payer: Cash Price |
$939.40
|
| Rate for Payer: Cash Price |
$939.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,301.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,315.16
|
| Rate for Payer: First Choice Health Commercial |
$1,207.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,274.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.76
|
| Rate for Payer: HealthUtah PPO |
$1,342.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,301.74
|
| Rate for Payer: Multiplan Medicare/VA |
$161.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,315.16
|
| Rate for Payer: PacificSource Commercial |
$1,207.80
|
| Rate for Payer: PHCS PPO |
$1,274.90
|
| Rate for Payer: Three Rivers PPO |
$1,006.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.76
|
| Rate for Payer: United Healthcare Commercial |
$1,167.54
|
| Rate for Payer: United Healthcare Medicare |
$189.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,140.70
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
45384
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$1,997.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,957.06
|
| Rate for Payer: Aetna of WY Medicare |
$215.40
|
| Rate for Payer: Beech Street Commercial |
$1,897.15
|
| Rate for Payer: Cash Price |
$1,397.90
|
| Rate for Payer: Cash Price |
$1,397.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,937.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,957.06
|
| Rate for Payer: First Choice Health Commercial |
$1,797.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,897.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$215.40
|
| Rate for Payer: HealthUtah PPO |
$1,997.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,937.09
|
| Rate for Payer: Multiplan Medicare/VA |
$183.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,957.06
|
| Rate for Payer: PacificSource Commercial |
$1,797.30
|
| Rate for Payer: PHCS PPO |
$1,897.15
|
| Rate for Payer: Three Rivers PPO |
$1,497.75
|
| Rate for Payer: TriWest Veterans Administration |
$215.40
|
| Rate for Payer: United Healthcare Commercial |
$1,737.39
|
| Rate for Payer: United Healthcare Medicare |
$215.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,697.45
|
|
|
COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$2,289.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,243.22
|
| Rate for Payer: Aetna of WY Medicare |
$240.47
|
| Rate for Payer: Beech Street Commercial |
$2,174.55
|
| Rate for Payer: Cash Price |
$1,602.30
|
| Rate for Payer: Cash Price |
$1,602.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,220.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,243.22
|
| Rate for Payer: First Choice Health Commercial |
$2,060.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,174.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.47
|
| Rate for Payer: HealthUtah PPO |
$2,289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,220.33
|
| Rate for Payer: Multiplan Medicare/VA |
$204.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,243.22
|
| Rate for Payer: PacificSource Commercial |
$2,060.10
|
| Rate for Payer: PHCS PPO |
$2,174.55
|
| Rate for Payer: Three Rivers PPO |
$1,716.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.47
|
| Rate for Payer: United Healthcare Commercial |
$1,991.43
|
| Rate for Payer: United Healthcare Medicare |
$240.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,945.65
|
|
|
COMP ASSES CARE PLAN CCM SVC
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS G0506
|
| Hospital Charge Code |
G0506
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$42.38
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.38
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$36.02
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.38
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$42.38
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
