|
COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 99487
|
| Hospital Charge Code |
99487
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$86.73
|
| Rate for Payer: Beech Street Commercial |
$232.75
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: First Choice Health Commercial |
$220.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.73
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$73.72
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$232.75
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.73
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$86.73
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
|
|
COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
51741
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Beech Street Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: First Choice Health Commercial |
$50.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$53.20
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
| Rate for Payer: WINHealth Partners Commercial |
$47.60
|
|
|
COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 51741 26
|
| Hospital Charge Code |
51741
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$8.02
|
| Rate for Payer: Beech Street Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: First Choice Health Commercial |
$50.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.02
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$6.82
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$53.20
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$8.02
|
| Rate for Payer: WINHealth Partners Commercial |
$47.60
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 51729
|
| Hospital Charge Code |
51729
|
| Min. Negotiated Rate |
$318.25 |
| Max. Negotiated Rate |
$1,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,544.48
|
| Rate for Payer: Aetna of WY Medicare |
$374.41
|
| Rate for Payer: Beech Street Commercial |
$1,497.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,528.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,544.48
|
| Rate for Payer: First Choice Health Commercial |
$1,418.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,497.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$374.41
|
| Rate for Payer: HealthUtah PPO |
$1,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,528.72
|
| Rate for Payer: Multiplan Medicare/VA |
$318.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,544.48
|
| Rate for Payer: PacificSource Commercial |
$1,418.40
|
| Rate for Payer: PHCS PPO |
$1,497.20
|
| Rate for Payer: Three Rivers PPO |
$1,182.00
|
| Rate for Payer: TriWest Veterans Administration |
$374.41
|
| Rate for Payer: United Healthcare Commercial |
$1,371.12
|
| Rate for Payer: United Healthcare Medicare |
$374.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,339.60
|
|
|
COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 92557
|
| Hospital Charge Code |
92557
|
| Min. Negotiated Rate |
$26.02 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$30.61
|
| Rate for Payer: Beech Street Commercial |
$119.70
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: First Choice Health Commercial |
$113.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.61
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$26.02
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$119.70
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$30.61
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Medicare |
$30.61
|
| Rate for Payer: WINHealth Partners Commercial |
$119.70
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
80053
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Beech Street Commercial |
$95.95
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: First Choice Health Commercial |
$90.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$8.98
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$95.95
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
|
|
COMPRESSION STOCKING BK18-30
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS A6530
|
| Hospital Charge Code |
A6530
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$36.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$36.93
|
| 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 |
$36.93
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$31.39
|
| 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 |
$36.93
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$36.93
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
|
|
COMPRESS STKING BK30-40 SURG
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS A6531
|
| Hospital Charge Code |
A6531
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Beech Street Commercial |
$205.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: First Choice Health Commercial |
$194.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$205.20
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: WINHealth Partners Commercial |
$205.20
|
|
|
CONFORMITY EVALUATION
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS V5020
|
| Hospital Charge Code |
V5020
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Beech Street Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$47.50
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
|
|
CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
57522
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,203.04
|
| Rate for Payer: Aetna of WY Medicare |
$248.23
|
| Rate for Payer: Beech Street Commercial |
$2,135.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,180.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,203.04
|
| Rate for Payer: First Choice Health Commercial |
$2,023.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,135.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$248.23
|
| Rate for Payer: HealthUtah PPO |
$2,248.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,180.56
|
| Rate for Payer: Multiplan Medicare/VA |
$211.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,203.04
|
| Rate for Payer: PacificSource Commercial |
$2,023.20
|
| Rate for Payer: PHCS PPO |
$2,135.60
|
| Rate for Payer: Three Rivers PPO |
$1,686.00
|
| Rate for Payer: TriWest Veterans Administration |
$248.23
|
| Rate for Payer: United Healthcare Commercial |
$1,955.76
|
| Rate for Payer: United Healthcare Medicare |
$248.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,910.80
|
|
|
CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
57520
|
| Min. Negotiated Rate |
$245.41 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,967.84
|
| Rate for Payer: Aetna of WY Medicare |
$288.72
|
| Rate for Payer: Beech Street Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,947.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,967.84
|
| Rate for Payer: First Choice Health Commercial |
$1,807.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,907.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$288.72
|
| Rate for Payer: HealthUtah PPO |
$2,008.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,947.76
|
| Rate for Payer: Multiplan Medicare/VA |
$245.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,967.84
|
| Rate for Payer: PacificSource Commercial |
$1,807.20
|
| Rate for Payer: PHCS PPO |
$1,907.60
|
| Rate for Payer: Three Rivers PPO |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration |
$288.72
|
| Rate for Payer: United Healthcare Commercial |
$1,746.96
|
| Rate for Payer: United Healthcare Medicare |
$288.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,706.80
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [20300]
|
Facility
|
IP
|
$391.88
|
|
|
Service Code
|
HCPCS J1410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.71 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$384.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$376.20
|
| Rate for Payer: Altius Commercial |
$376.20
|
| Rate for Payer: Beech Street Commercial |
$384.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$321.73
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$380.12
|
| Rate for Payer: Cigna of WY Commercial |
$384.04
|
| Rate for Payer: Entrust Commercial |
$372.29
|
| Rate for Payer: First Choice Health Commercial |
$372.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$372.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.64
|
| Rate for Payer: HealthUtah PPO |
$391.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$380.12
|
| Rate for Payer: Multiplan Medicare/VA |
$245.71
|
| Rate for Payer: One Health Plan of WY PPO |
$384.04
|
| Rate for Payer: PacificSource Commercial |
$352.69
|
| Rate for Payer: PHCS PPO |
$384.04
|
| Rate for Payer: Three Rivers PPO |
$293.91
|
| Rate for Payer: TriWest Veterans Administration |
$258.64
|
| Rate for Payer: United Healthcare Commercial |
$340.94
|
| Rate for Payer: United Healthcare Medicare |
$258.64
|
| Rate for Payer: WINHealth Partners Commercial |
$372.29
|
| Rate for Payer: Wise Provider Network Commercial |
$372.29
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [20300]
|
Facility
|
OP
|
$391.88
|
|
|
Service Code
|
HCPCS J1410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$215.93 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$384.04
|
| Rate for Payer: Aetna of WY Medicare |
$258.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$376.20
|
| Rate for Payer: Altius Commercial |
$376.20
|
| Rate for Payer: Beech Street Commercial |
$384.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$321.73
|
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$380.12
|
| Rate for Payer: Cigna of WY Commercial |
$384.04
|
| Rate for Payer: Entrust Commercial |
$372.29
|
| Rate for Payer: First Choice Health Commercial |
$372.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$372.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.29
|
| Rate for Payer: HealthUtah PPO |
$391.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$380.12
|
| Rate for Payer: Multiplan Medicare/VA |
$215.93
|
| Rate for Payer: One Health Plan of WY PPO |
$384.04
|
| Rate for Payer: PacificSource Commercial |
$352.69
|
| Rate for Payer: PHCS PPO |
$384.04
|
| Rate for Payer: Three Rivers PPO |
$293.91
|
| Rate for Payer: TriWest Veterans Administration |
$227.29
|
| Rate for Payer: United Healthcare Commercial |
$340.94
|
| Rate for Payer: United Healthcare Medicare |
$227.29
|
| Rate for Payer: WINHealth Partners Commercial |
$384.04
|
| Rate for Payer: Wise Provider Network Commercial |
$372.29
|
|
|
CONTAMINATION SLEEVE 80CM
|
Facility
|
OP
|
$38.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.07
|
| Rate for Payer: Aetna of WY Medicare |
$25.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.30
|
| Rate for Payer: Altius Commercial |
$37.30
|
| Rate for Payer: Beech Street Commercial |
$38.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.90
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.68
|
| Rate for Payer: Cigna of WY Commercial |
$38.07
|
| Rate for Payer: Entrust Commercial |
$36.91
|
| Rate for Payer: First Choice Health Commercial |
$36.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.53
|
| Rate for Payer: HealthUtah PPO |
$38.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.68
|
| Rate for Payer: Multiplan Medicare/VA |
$21.41
|
| Rate for Payer: One Health Plan of WY PPO |
$38.07
|
| Rate for Payer: PacificSource Commercial |
$34.96
|
| Rate for Payer: PHCS PPO |
$38.07
|
| Rate for Payer: Three Rivers PPO |
$29.14
|
| Rate for Payer: TriWest Veterans Administration |
$22.53
|
| Rate for Payer: United Healthcare Commercial |
$33.80
|
| Rate for Payer: United Healthcare Medicare |
$22.53
|
| Rate for Payer: WINHealth Partners Commercial |
$38.07
|
| Rate for Payer: Wise Provider Network Commercial |
$36.91
|
|
|
CONTAMINATION SLEEVE 80CM
|
Facility
|
IP
|
$38.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.30
|
| Rate for Payer: Altius Commercial |
$37.30
|
| Rate for Payer: Beech Street Commercial |
$38.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.90
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.68
|
| Rate for Payer: Cigna of WY Commercial |
$38.07
|
| Rate for Payer: Entrust Commercial |
$36.91
|
| Rate for Payer: First Choice Health Commercial |
$36.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.64
|
| Rate for Payer: HealthUtah PPO |
$38.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.68
|
| Rate for Payer: Multiplan Medicare/VA |
$24.36
|
| Rate for Payer: One Health Plan of WY PPO |
$38.07
|
| Rate for Payer: PacificSource Commercial |
$34.96
|
| Rate for Payer: PHCS PPO |
$38.07
|
| Rate for Payer: Three Rivers PPO |
$29.14
|
| Rate for Payer: TriWest Veterans Administration |
$25.64
|
| Rate for Payer: United Healthcare Commercial |
$33.80
|
| Rate for Payer: United Healthcare Medicare |
$25.64
|
| Rate for Payer: WINHealth Partners Commercial |
$36.91
|
| Rate for Payer: Wise Provider Network Commercial |
$36.91
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 30903 50
|
| Hospital Charge Code |
30903
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,660.12
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$1,609.30
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,643.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,660.12
|
| Rate for Payer: First Choice Health Commercial |
$1,524.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,609.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$1,694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,643.18
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,660.12
|
| Rate for Payer: PacificSource Commercial |
$1,524.60
|
| Rate for Payer: PHCS PPO |
$1,609.30
|
| Rate for Payer: Three Rivers PPO |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$1,473.78
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,439.90
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
30903
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$830.06
|
| Rate for Payer: Aetna of WY Medicare |
$73.09
|
| Rate for Payer: Beech Street Commercial |
$804.65
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$821.59
|
| Rate for Payer: Cigna of WY Commercial |
$830.06
|
| Rate for Payer: First Choice Health Commercial |
$762.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.09
|
| Rate for Payer: HealthUtah PPO |
$847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$821.59
|
| Rate for Payer: Multiplan Medicare/VA |
$62.13
|
| Rate for Payer: One Health Plan of WY PPO |
$830.06
|
| Rate for Payer: PacificSource Commercial |
$762.30
|
| Rate for Payer: PHCS PPO |
$804.65
|
| Rate for Payer: Three Rivers PPO |
$635.25
|
| Rate for Payer: TriWest Veterans Administration |
$73.09
|
| Rate for Payer: United Healthcare Commercial |
$736.89
|
| Rate for Payer: United Healthcare Medicare |
$73.09
|
| Rate for Payer: WINHealth Partners Commercial |
$719.95
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30901
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$532.14
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$515.85
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.71
|
| Rate for Payer: Cigna of WY Commercial |
$532.14
|
| Rate for Payer: First Choice Health Commercial |
$488.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.71
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$532.14
|
| Rate for Payer: PacificSource Commercial |
$488.70
|
| Rate for Payer: PHCS PPO |
$515.85
|
| Rate for Payer: Three Rivers PPO |
$407.25
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$472.41
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$461.55
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
30901
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$1,086.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,064.28
|
| Rate for Payer: Aetna of WY Medicare |
$53.71
|
| Rate for Payer: Beech Street Commercial |
$1,031.70
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,053.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,064.28
|
| Rate for Payer: First Choice Health Commercial |
$977.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.71
|
| Rate for Payer: HealthUtah PPO |
$1,086.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,053.42
|
| Rate for Payer: Multiplan Medicare/VA |
$45.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,064.28
|
| Rate for Payer: PacificSource Commercial |
$977.40
|
| Rate for Payer: PHCS PPO |
$1,031.70
|
| Rate for Payer: Three Rivers PPO |
$814.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.71
|
| Rate for Payer: United Healthcare Commercial |
$944.82
|
| Rate for Payer: United Healthcare Medicare |
$53.71
|
| Rate for Payer: WINHealth Partners Commercial |
$923.10
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Professional
|
Both
|
$807.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
42960
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Aetna of WY Medicare |
$156.39
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.39
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: Multiplan Medicare/VA |
$132.93
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: TriWest Veterans Administration |
$156.39
|
| Rate for Payer: United Healthcare Commercial |
$702.09
|
| Rate for Payer: United Healthcare Medicare |
$156.39
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$8,646.00
|
|
|
Service Code
|
HCPCS 27132 80
|
| Hospital Charge Code |
27132
|
| Min. Negotiated Rate |
$1,357.72 |
| Max. Negotiated Rate |
$8,646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,473.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.32
|
| Rate for Payer: Beech Street Commercial |
$8,213.70
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,386.62
|
| Rate for Payer: Cigna of WY Commercial |
$8,473.08
|
| Rate for Payer: First Choice Health Commercial |
$7,781.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,213.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.32
|
| Rate for Payer: HealthUtah PPO |
$8,646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,386.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,357.72
|
| Rate for Payer: One Health Plan of WY PPO |
$8,473.08
|
| Rate for Payer: PacificSource Commercial |
$7,781.40
|
| Rate for Payer: PHCS PPO |
$8,213.70
|
| Rate for Payer: Three Rivers PPO |
$6,484.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.32
|
| Rate for Payer: United Healthcare Commercial |
$7,522.02
|
| Rate for Payer: United Healthcare Medicare |
$1,597.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7,349.10
|
|
|
CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$8,646.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
27132
|
| Min. Negotiated Rate |
$1,357.72 |
| Max. Negotiated Rate |
$8,646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,473.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.32
|
| Rate for Payer: Beech Street Commercial |
$8,213.70
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,386.62
|
| Rate for Payer: Cigna of WY Commercial |
$8,473.08
|
| Rate for Payer: First Choice Health Commercial |
$7,781.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,213.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.32
|
| Rate for Payer: HealthUtah PPO |
$8,646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,386.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,357.72
|
| Rate for Payer: One Health Plan of WY PPO |
$8,473.08
|
| Rate for Payer: PacificSource Commercial |
$7,781.40
|
| Rate for Payer: PHCS PPO |
$8,213.70
|
| Rate for Payer: Three Rivers PPO |
$6,484.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.32
|
| Rate for Payer: United Healthcare Commercial |
$7,522.02
|
| Rate for Payer: United Healthcare Medicare |
$1,597.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7,349.10
|
|
|
CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$8,646.00
|
|
|
Service Code
|
HCPCS 27132 AS
|
| Hospital Charge Code |
27132
|
| Min. Negotiated Rate |
$1,357.72 |
| Max. Negotiated Rate |
$8,646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,473.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.32
|
| Rate for Payer: Beech Street Commercial |
$8,213.70
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,386.62
|
| Rate for Payer: Cigna of WY Commercial |
$8,473.08
|
| Rate for Payer: First Choice Health Commercial |
$7,781.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,213.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.32
|
| Rate for Payer: HealthUtah PPO |
$8,646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,386.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,357.72
|
| Rate for Payer: One Health Plan of WY PPO |
$8,473.08
|
| Rate for Payer: PacificSource Commercial |
$7,781.40
|
| Rate for Payer: PHCS PPO |
$8,213.70
|
| Rate for Payer: Three Rivers PPO |
$6,484.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.32
|
| Rate for Payer: United Healthcare Commercial |
$7,522.02
|
| Rate for Payer: United Healthcare Medicare |
$1,597.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7,349.10
|
|
|
COOK FIXED CORE SWAN GUIDEWIRE J-TIP 180CM
|
Facility
|
OP
|
$59.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$59.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.28
|
| Rate for Payer: Aetna of WY Medicare |
$39.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.09
|
| Rate for Payer: Altius Commercial |
$57.09
|
| Rate for Payer: Beech Street Commercial |
$58.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.82
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.69
|
| Rate for Payer: Cigna of WY Commercial |
$58.28
|
| Rate for Payer: Entrust Commercial |
$56.50
|
| Rate for Payer: First Choice Health Commercial |
$56.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.49
|
| Rate for Payer: HealthUtah PPO |
$59.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.69
|
| Rate for Payer: Multiplan Medicare/VA |
$32.77
|
| Rate for Payer: One Health Plan of WY PPO |
$58.28
|
| Rate for Payer: PacificSource Commercial |
$53.52
|
| Rate for Payer: PHCS PPO |
$58.28
|
| Rate for Payer: Three Rivers PPO |
$44.60
|
| Rate for Payer: TriWest Veterans Administration |
$34.49
|
| Rate for Payer: United Healthcare Commercial |
$51.74
|
| Rate for Payer: United Healthcare Medicare |
$34.49
|
| Rate for Payer: WINHealth Partners Commercial |
$58.28
|
| Rate for Payer: Wise Provider Network Commercial |
$56.50
|
|
|
COOK FIXED CORE SWAN GUIDEWIRE J-TIP 180CM
|
Facility
|
IP
|
$59.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$59.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.09
|
| Rate for Payer: Altius Commercial |
$57.09
|
| Rate for Payer: Beech Street Commercial |
$58.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.82
|
| Rate for Payer: Cash Price |
$41.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.69
|
| Rate for Payer: Cigna of WY Commercial |
$58.28
|
| Rate for Payer: Entrust Commercial |
$56.50
|
| Rate for Payer: First Choice Health Commercial |
$56.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.25
|
| Rate for Payer: HealthUtah PPO |
$59.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.69
|
| Rate for Payer: Multiplan Medicare/VA |
$37.29
|
| Rate for Payer: One Health Plan of WY PPO |
$58.28
|
| Rate for Payer: PacificSource Commercial |
$53.52
|
| Rate for Payer: PHCS PPO |
$58.28
|
| Rate for Payer: Three Rivers PPO |
$44.60
|
| Rate for Payer: TriWest Veterans Administration |
$39.25
|
| Rate for Payer: United Healthcare Commercial |
$51.74
|
| Rate for Payer: United Healthcare Medicare |
$39.25
|
| Rate for Payer: WINHealth Partners Commercial |
$56.50
|
| Rate for Payer: Wise Provider Network Commercial |
$56.50
|
|
