|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5109637401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$280.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$266.48
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$280.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$280.50
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5109637401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.18 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Aetna of WY Medicare |
$280.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$234.18
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$246.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$246.50
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$234.18 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Aetna of WY Medicare |
$280.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$234.18
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$246.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$246.50
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$266.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$280.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$266.48
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$280.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$280.50
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
7616440501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
7616440501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS 64405 50
|
| Hospital Charge Code |
5106440501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$346.10 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$529.92
|
| Rate for Payer: Altius Commercial |
$529.92
|
| Rate for Payer: Beech Street Commercial |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$453.19
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: Entrust Commercial |
$524.40
|
| Rate for Payer: First Choice Health Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$364.32
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$346.10
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$540.96
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$364.32
|
| Rate for Payer: United Healthcare Commercial |
$480.24
|
| Rate for Payer: United Healthcare Medicare |
$364.32
|
| Rate for Payer: WINHealth Partners Commercial |
$524.40
|
| Rate for Payer: Wise Provider Network Commercial |
$524.40
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 64405 50
|
| Hospital Charge Code |
5106440501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$304.15 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$364.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$529.92
|
| Rate for Payer: Altius Commercial |
$529.92
|
| Rate for Payer: Beech Street Commercial |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$453.19
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: Entrust Commercial |
$524.40
|
| Rate for Payer: First Choice Health Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.16
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$304.15
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$540.96
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.16
|
| Rate for Payer: United Healthcare Commercial |
$480.24
|
| Rate for Payer: United Healthcare Medicare |
$320.16
|
| Rate for Payer: WINHealth Partners Commercial |
$540.96
|
| Rate for Payer: Wise Provider Network Commercial |
$524.40
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
5106440501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Aetna of WY Medicare |
$182.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.96
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.08
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$152.08
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$160.08
|
| Rate for Payer: United Healthcare Commercial |
$240.12
|
| Rate for Payer: United Healthcare Medicare |
$160.08
|
| Rate for Payer: WINHealth Partners Commercial |
$270.48
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
5106440501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.05 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.96
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.16
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$173.05
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$240.12
|
| Rate for Payer: United Healthcare Medicare |
$182.16
|
| Rate for Payer: WINHealth Partners Commercial |
$262.20
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
5106442001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
5106442001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS 64420 50
|
| Hospital Charge Code |
5106442001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$375.23 |
| Max. Negotiated Rate |
$681.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$667.38
|
| Rate for Payer: Aetna of WY Medicare |
$449.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$653.76
|
| Rate for Payer: Altius Commercial |
$653.76
|
| Rate for Payer: Beech Street Commercial |
$667.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$559.10
|
| Rate for Payer: Cash Price |
$476.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$660.57
|
| Rate for Payer: Cigna of WY Commercial |
$667.38
|
| Rate for Payer: Entrust Commercial |
$646.95
|
| Rate for Payer: First Choice Health Commercial |
$646.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.98
|
| Rate for Payer: HealthUtah PPO |
$681.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$660.57
|
| Rate for Payer: Multiplan Medicare/VA |
$375.23
|
| Rate for Payer: One Health Plan of WY PPO |
$667.38
|
| Rate for Payer: PacificSource Commercial |
$612.90
|
| Rate for Payer: PHCS PPO |
$667.38
|
| Rate for Payer: Three Rivers PPO |
$510.75
|
| Rate for Payer: TriWest Veterans Administration |
$394.98
|
| Rate for Payer: United Healthcare Commercial |
$592.47
|
| Rate for Payer: United Healthcare Medicare |
$394.98
|
| Rate for Payer: WINHealth Partners Commercial |
$667.38
|
| Rate for Payer: Wise Provider Network Commercial |
$646.95
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS 64420 50
|
| Hospital Charge Code |
5106442001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$426.99 |
| Max. Negotiated Rate |
$681.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$667.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$653.76
|
| Rate for Payer: Altius Commercial |
$653.76
|
| Rate for Payer: Beech Street Commercial |
$667.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$559.10
|
| Rate for Payer: Cash Price |
$476.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$660.57
|
| Rate for Payer: Cigna of WY Commercial |
$667.38
|
| Rate for Payer: Entrust Commercial |
$646.95
|
| Rate for Payer: First Choice Health Commercial |
$646.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.46
|
| Rate for Payer: HealthUtah PPO |
$681.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$660.57
|
| Rate for Payer: Multiplan Medicare/VA |
$426.99
|
| Rate for Payer: One Health Plan of WY PPO |
$667.38
|
| Rate for Payer: PacificSource Commercial |
$612.90
|
| Rate for Payer: PHCS PPO |
$667.38
|
| Rate for Payer: Three Rivers PPO |
$510.75
|
| Rate for Payer: TriWest Veterans Administration |
$449.46
|
| Rate for Payer: United Healthcare Commercial |
$592.47
|
| Rate for Payer: United Healthcare Medicare |
$449.46
|
| Rate for Payer: WINHealth Partners Commercial |
$646.95
|
| Rate for Payer: Wise Provider Network Commercial |
$646.95
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
7616445001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
7616445001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$542.18 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Aetna of WY Medicare |
$649.44
|
| Rate for Payer: Aetna of WY Medicare |
$172.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$944.64
|
| Rate for Payer: Altius Commercial |
$944.64
|
| Rate for Payer: Altius Commercial |
$250.56
|
| Rate for Payer: Beech Street Commercial |
$255.78
|
| Rate for Payer: Beech Street Commercial |
$964.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$807.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.28
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.17
|
| Rate for Payer: Cigna of WY Commercial |
$255.78
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: Entrust Commercial |
$934.80
|
| Rate for Payer: Entrust Commercial |
$247.95
|
| Rate for Payer: First Choice Health Commercial |
$247.95
|
| Rate for Payer: First Choice Health Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$570.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.38
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$542.18
|
| Rate for Payer: Multiplan Medicare/VA |
$143.81
|
| Rate for Payer: One Health Plan of WY PPO |
$255.78
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PacificSource Commercial |
$234.90
|
| Rate for Payer: PHCS PPO |
$255.78
|
| Rate for Payer: PHCS PPO |
$964.32
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$570.72
|
| Rate for Payer: TriWest Veterans Administration |
$151.38
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$570.72
|
| Rate for Payer: United Healthcare Medicare |
$151.38
|
| Rate for Payer: WINHealth Partners Commercial |
$255.78
|
| Rate for Payer: WINHealth Partners Commercial |
$964.32
|
| Rate for Payer: Wise Provider Network Commercial |
$247.95
|
| Rate for Payer: Wise Provider Network Commercial |
$934.80
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$616.97 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$944.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.56
|
| Rate for Payer: Altius Commercial |
$250.56
|
| Rate for Payer: Altius Commercial |
$944.64
|
| Rate for Payer: Beech Street Commercial |
$964.32
|
| Rate for Payer: Beech Street Commercial |
$255.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$807.86
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: Cigna of WY Commercial |
$255.78
|
| Rate for Payer: Entrust Commercial |
$247.95
|
| Rate for Payer: Entrust Commercial |
$934.80
|
| Rate for Payer: First Choice Health Commercial |
$247.95
|
| Rate for Payer: First Choice Health Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.26
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$616.97
|
| Rate for Payer: Multiplan Medicare/VA |
$163.65
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: One Health Plan of WY PPO |
$255.78
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PacificSource Commercial |
$234.90
|
| Rate for Payer: PHCS PPO |
$255.78
|
| Rate for Payer: PHCS PPO |
$964.32
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.44
|
| Rate for Payer: TriWest Veterans Administration |
$172.26
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$649.44
|
| Rate for Payer: United Healthcare Medicare |
$172.26
|
| Rate for Payer: WINHealth Partners Commercial |
$247.95
|
| Rate for Payer: WINHealth Partners Commercial |
$934.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.95
|
| Rate for Payer: Wise Provider Network Commercial |
$934.80
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 64450 50
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.29 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$501.12
|
| Rate for Payer: Altius Commercial |
$501.12
|
| Rate for Payer: Beech Street Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$428.56
|
| 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: Entrust Commercial |
$495.90
|
| Rate for Payer: First Choice Health Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$344.52
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$327.29
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$511.56
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$344.52
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$344.52
|
| Rate for Payer: WINHealth Partners Commercial |
$495.90
|
| Rate for Payer: Wise Provider Network Commercial |
$495.90
|
|
|
HC INJECT NERV BLCK,OTHR PERIPH NERV
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 64450 50
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.62 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$344.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$501.12
|
| Rate for Payer: Altius Commercial |
$501.12
|
| Rate for Payer: Beech Street Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$428.56
|
| 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: Entrust Commercial |
$495.90
|
| Rate for Payer: First Choice Health Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.76
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$287.62
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$511.56
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$302.76
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$302.76
|
| Rate for Payer: WINHealth Partners Commercial |
$511.56
|
| Rate for Payer: Wise Provider Network Commercial |
$495.90
|
|
|
HC INJECT NERV BLCK,TRIGEMINAL
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
7616440001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT NERV BLCK,TRIGEMINAL
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
7616440001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECT TENDON ORIGIN/INSERT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
7612055101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
