|
HC PRO INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$2,133.00
|
|
|
Service Code
|
HCPCS 99477
|
| Hospital Charge Code |
9839947701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$275.75 |
| Max. Negotiated Rate |
$2,133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,090.34
|
| Rate for Payer: Aetna of WY Medicare |
$324.41
|
| Rate for Payer: Beech Street Commercial |
$2,026.35
|
| Rate for Payer: Cash Price |
$1,493.10
|
| Rate for Payer: Cash Price |
$1,493.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,069.01
|
| Rate for Payer: Cigna of WY Commercial |
$2,090.34
|
| Rate for Payer: First Choice Health Commercial |
$1,919.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,026.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.41
|
| Rate for Payer: HealthUtah PPO |
$2,133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,069.01
|
| Rate for Payer: Multiplan Medicare/VA |
$275.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,090.34
|
| Rate for Payer: PacificSource Commercial |
$1,919.70
|
| Rate for Payer: PHCS PPO |
$2,026.35
|
| Rate for Payer: Three Rivers PPO |
$1,599.75
|
| Rate for Payer: TriWest Veterans Administration |
$324.41
|
| Rate for Payer: United Healthcare Commercial |
$1,855.71
|
| Rate for Payer: United Healthcare Medicare |
$324.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,026.35
|
|
|
HC PRO INITIAL INPATIENT CONSULT NEW/ESTAB PT 55 MIN
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 99253
|
| Hospital Charge Code |
9839925301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$120.57 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$383.18
|
| Rate for Payer: Beech Street Commercial |
$371.45
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$379.27
|
| Rate for Payer: Cigna of WY Commercial |
$383.18
|
| Rate for Payer: First Choice Health Commercial |
$351.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$371.45
|
| Rate for Payer: HealthUtah PPO |
$120.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$379.27
|
| Rate for Payer: One Health Plan of WY PPO |
$383.18
|
| Rate for Payer: PacificSource Commercial |
$351.90
|
| Rate for Payer: PHCS PPO |
$371.45
|
| Rate for Payer: Three Rivers PPO |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$340.17
|
| Rate for Payer: WINHealth Partners Commercial |
$371.45
|
|
|
HC PRO INITIAL NURSING FACILITY CARE/DAY 45 MINUTES
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
9839930602
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$175.51
|
| Rate for Payer: Beech Street Commercial |
$314.45
|
| Rate for Payer: Cash Price |
$231.70
|
| 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: First Choice Health Commercial |
$297.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.51
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$149.18
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$314.45
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.51
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$175.51
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
|
|
HC PRO INITIAL NURSING FACILITY CARE/DAY 45 MINUTES
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
9839930601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$175.51
|
| Rate for Payer: Beech Street Commercial |
$314.45
|
| Rate for Payer: Cash Price |
$231.70
|
| 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: First Choice Health Commercial |
$297.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.51
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$149.18
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$314.45
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.51
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$175.51
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
|
|
HC PRO INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 99218
|
| Hospital Charge Code |
9839921801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$528.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$528.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.64
|
| Rate for Payer: Beech Street Commercial |
$512.05
|
| Rate for Payer: Beech Street Commercial |
$254.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$259.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$522.83
|
| Rate for Payer: Cigna of WY Commercial |
$262.64
|
| Rate for Payer: Cigna of WY Commercial |
$528.22
|
| Rate for Payer: First Choice Health Commercial |
$241.20
|
| Rate for Payer: First Choice Health Commercial |
$485.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$512.05
|
| Rate for Payer: HealthUtah PPO |
$81.84
|
| Rate for Payer: HealthUtah PPO |
$81.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$259.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$522.83
|
| Rate for Payer: One Health Plan of WY PPO |
$262.64
|
| Rate for Payer: One Health Plan of WY PPO |
$528.22
|
| Rate for Payer: PacificSource Commercial |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$241.20
|
| Rate for Payer: PHCS PPO |
$254.60
|
| Rate for Payer: PHCS PPO |
$512.05
|
| Rate for Payer: Three Rivers PPO |
$201.00
|
| Rate for Payer: Three Rivers PPO |
$404.25
|
| Rate for Payer: United Healthcare Commercial |
$468.93
|
| Rate for Payer: United Healthcare Commercial |
$233.16
|
| Rate for Payer: WINHealth Partners Commercial |
$512.05
|
| Rate for Payer: WINHealth Partners Commercial |
$254.60
|
|
|
HC PRO INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 99219
|
| Hospital Charge Code |
9839921901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$722.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$722.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Beech Street Commercial |
$700.15
|
| Rate for Payer: Beech Street Commercial |
$346.75
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: Cash Price |
$515.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$714.89
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Cigna of WY Commercial |
$722.26
|
| Rate for Payer: First Choice Health Commercial |
$328.50
|
| Rate for Payer: First Choice Health Commercial |
$663.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$700.15
|
| Rate for Payer: HealthUtah PPO |
$136.60
|
| Rate for Payer: HealthUtah PPO |
$136.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$714.89
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: One Health Plan of WY PPO |
$722.26
|
| Rate for Payer: PacificSource Commercial |
$663.30
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$346.75
|
| Rate for Payer: PHCS PPO |
$700.15
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: Three Rivers PPO |
$552.75
|
| Rate for Payer: United Healthcare Commercial |
$641.19
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: WINHealth Partners Commercial |
$700.15
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
|
|
HC PRO INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 99220
|
| Hospital Charge Code |
9839922001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$191.35 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,075.06
|
| Rate for Payer: Beech Street Commercial |
$1,042.15
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$767.90
|
| Rate for Payer: Cash Price |
$767.90
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,064.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,075.06
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: First Choice Health Commercial |
$987.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,042.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: HealthUtah PPO |
$191.35
|
| Rate for Payer: HealthUtah PPO |
$191.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,064.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,075.06
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$987.30
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$1,042.15
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: Three Rivers PPO |
$822.75
|
| Rate for Payer: United Healthcare Commercial |
$954.39
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,042.15
|
| Rate for Payer: WINHealth Partners Commercial |
$437.00
|
|
|
HC PRO INITIAL OBSERVATION CARE/DAY SUBQ 50 MINUTES
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99219
|
| Hospital Charge Code |
9839921902
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$169.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Beech Street Commercial |
$164.35
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: First Choice Health Commercial |
$155.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: HealthUtah PPO |
$136.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$164.35
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: United Healthcare Commercial |
$150.51
|
| Rate for Payer: WINHealth Partners Commercial |
$164.35
|
|
|
HC PRO INITIAL PREVENTIVE EXAM MCR EXAM
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
983G040201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$351.82
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$341.05
|
| Rate for Payer: Cash Price |
$251.30
|
| Rate for Payer: Cash Price |
$251.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$348.23
|
| Rate for Payer: Cigna of WY Commercial |
$351.82
|
| Rate for Payer: First Choice Health Commercial |
$323.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$341.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$359.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$348.23
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$351.82
|
| Rate for Payer: PacificSource Commercial |
$323.10
|
| Rate for Payer: PHCS PPO |
$341.05
|
| Rate for Payer: Three Rivers PPO |
$269.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$312.33
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$341.05
|
|
|
HC PRO INITIAL TX BURN(S) 1ST DEGREE LOCAL TX
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
9831600001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$180.32
|
| Rate for Payer: Aetna of WY Medicare |
$43.34
|
| Rate for Payer: Aetna of WY Medicare |
$43.34
|
| Rate for Payer: Beech Street Commercial |
$174.80
|
| Rate for Payer: Beech Street Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$178.48
|
| Rate for Payer: Cigna of WY Commercial |
$180.32
|
| Rate for Payer: Cigna of WY Commercial |
$337.12
|
| Rate for Payer: First Choice Health Commercial |
$165.60
|
| Rate for Payer: First Choice Health Commercial |
$309.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.34
|
| Rate for Payer: HealthUtah PPO |
$344.00
|
| Rate for Payer: HealthUtah PPO |
$184.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$178.48
|
| Rate for Payer: Multiplan Medicare/VA |
$36.84
|
| Rate for Payer: Multiplan Medicare/VA |
$36.84
|
| Rate for Payer: One Health Plan of WY PPO |
$337.12
|
| Rate for Payer: One Health Plan of WY PPO |
$180.32
|
| Rate for Payer: PacificSource Commercial |
$165.60
|
| Rate for Payer: PacificSource Commercial |
$309.60
|
| Rate for Payer: PHCS PPO |
$326.80
|
| Rate for Payer: PHCS PPO |
$174.80
|
| Rate for Payer: Three Rivers PPO |
$258.00
|
| Rate for Payer: Three Rivers PPO |
$138.00
|
| Rate for Payer: TriWest Veterans Administration |
$43.34
|
| Rate for Payer: TriWest Veterans Administration |
$43.34
|
| Rate for Payer: United Healthcare Commercial |
$160.08
|
| Rate for Payer: United Healthcare Commercial |
$299.28
|
| Rate for Payer: United Healthcare Medicare |
$43.34
|
| Rate for Payer: United Healthcare Medicare |
$43.34
|
| Rate for Payer: WINHealth Partners Commercial |
$292.40
|
| Rate for Payer: WINHealth Partners Commercial |
$156.40
|
|
|
HC PRO INITIAL TX BURN(S) 1ST DEGREE LOCAL TX
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 16000 NONPBBPAYER
|
| Hospital Charge Code |
9831600001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$43.34
|
| Rate for Payer: Beech Street Commercial |
$218.50
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: First Choice Health Commercial |
$207.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.34
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$36.84
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$218.50
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.34
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$43.34
|
| Rate for Payer: WINHealth Partners Commercial |
$195.50
|
|
|
HC PRO INJ,ANES AGENT,BRACHIAL PLEXUS,SINGLE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
9836441501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$419.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$557.62
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Beech Street Commercial |
$540.55
|
| Rate for Payer: Beech Street Commercial |
$406.60
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$551.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$415.16
|
| Rate for Payer: Cigna of WY Commercial |
$419.44
|
| Rate for Payer: Cigna of WY Commercial |
$557.62
|
| Rate for Payer: First Choice Health Commercial |
$512.10
|
| Rate for Payer: First Choice Health Commercial |
$385.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$406.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$540.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: HealthUtah PPO |
$428.00
|
| Rate for Payer: HealthUtah PPO |
$569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$551.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$415.16
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: One Health Plan of WY PPO |
$557.62
|
| Rate for Payer: One Health Plan of WY PPO |
$419.44
|
| Rate for Payer: PacificSource Commercial |
$385.20
|
| Rate for Payer: PacificSource Commercial |
$512.10
|
| Rate for Payer: PHCS PPO |
$406.60
|
| Rate for Payer: PHCS PPO |
$540.55
|
| Rate for Payer: Three Rivers PPO |
$321.00
|
| Rate for Payer: Three Rivers PPO |
$426.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: United Healthcare Commercial |
$495.03
|
| Rate for Payer: United Healthcare Commercial |
$372.36
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: WINHealth Partners Commercial |
$363.80
|
| Rate for Payer: WINHealth Partners Commercial |
$483.65
|
|
|
HC PRO INJ,ANES AGENT,BRACHIAL PLEXUS,SINGLE
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 64415 50
|
| Hospital Charge Code |
9836441501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,114.26
|
| Rate for Payer: Aetna of WY Medicare |
$66.34
|
| Rate for Payer: Beech Street Commercial |
$1,080.15
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,102.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,114.26
|
| Rate for Payer: First Choice Health Commercial |
$1,023.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,080.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.34
|
| Rate for Payer: HealthUtah PPO |
$1,137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,102.89
|
| Rate for Payer: Multiplan Medicare/VA |
$56.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,114.26
|
| Rate for Payer: PacificSource Commercial |
$1,023.30
|
| Rate for Payer: PHCS PPO |
$1,080.15
|
| Rate for Payer: Three Rivers PPO |
$852.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.34
|
| Rate for Payer: United Healthcare Commercial |
$989.19
|
| Rate for Payer: United Healthcare Medicare |
$66.34
|
| Rate for Payer: WINHealth Partners Commercial |
$966.45
|
|
|
HC PRO INJ,ANES AGENT,SCIATIC NERVE,SINGLE
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
9836444501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.55 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$68.88
|
| Rate for Payer: Beech Street Commercial |
$524.40
|
| Rate for Payer: Cash Price |
$386.40
|
| 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: First Choice Health Commercial |
$496.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.88
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$58.55
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$524.40
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.88
|
| Rate for Payer: United Healthcare Commercial |
$480.24
|
| Rate for Payer: United Healthcare Medicare |
$68.88
|
| Rate for Payer: WINHealth Partners Commercial |
$469.20
|
|
|
HC PRO INJ,ANES AGENT,SCIATIC NERVE,SINGLE
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 64445 50
|
| Hospital Charge Code |
9836444501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.55 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,081.92
|
| Rate for Payer: Aetna of WY Medicare |
$68.88
|
| Rate for Payer: Beech Street Commercial |
$1,048.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,070.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,081.92
|
| Rate for Payer: First Choice Health Commercial |
$993.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,048.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.88
|
| Rate for Payer: HealthUtah PPO |
$1,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Medicare/VA |
$58.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,081.92
|
| Rate for Payer: PacificSource Commercial |
$993.60
|
| Rate for Payer: PHCS PPO |
$1,048.80
|
| Rate for Payer: Three Rivers PPO |
$828.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.88
|
| Rate for Payer: United Healthcare Commercial |
$960.48
|
| Rate for Payer: United Healthcare Medicare |
$68.88
|
| Rate for Payer: WINHealth Partners Commercial |
$938.40
|
|
|
HC PRO INJ ANES/STEROID SACROILIAC JOING W/IMG
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
9836445101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$1,061.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,039.78
|
| Rate for Payer: Aetna of WY Medicare |
$78.37
|
| Rate for Payer: Beech Street Commercial |
$1,007.95
|
| Rate for Payer: Cash Price |
$742.70
|
| Rate for Payer: Cash Price |
$742.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,029.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,039.78
|
| Rate for Payer: First Choice Health Commercial |
$954.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,007.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.37
|
| Rate for Payer: HealthUtah PPO |
$1,061.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,029.17
|
| Rate for Payer: Multiplan Medicare/VA |
$66.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,039.78
|
| Rate for Payer: PacificSource Commercial |
$954.90
|
| Rate for Payer: PHCS PPO |
$1,007.95
|
| Rate for Payer: Three Rivers PPO |
$795.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.37
|
| Rate for Payer: United Healthcare Commercial |
$923.07
|
| Rate for Payer: United Healthcare Medicare |
$78.37
|
| Rate for Payer: WINHealth Partners Commercial |
$901.85
|
|
|
HC PRO INJ ANES/STEROID SACROILIAC JOING W/IMG
|
Professional
|
Both
|
$2,122.00
|
|
|
Service Code
|
HCPCS 64451 50
|
| Hospital Charge Code |
9836445101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$2,122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,079.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.37
|
| Rate for Payer: Beech Street Commercial |
$2,015.90
|
| Rate for Payer: Cash Price |
$1,485.40
|
| Rate for Payer: Cash Price |
$1,485.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,058.34
|
| Rate for Payer: Cigna of WY Commercial |
$2,079.56
|
| Rate for Payer: First Choice Health Commercial |
$1,909.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,015.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.37
|
| Rate for Payer: HealthUtah PPO |
$2,122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,058.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2,079.56
|
| Rate for Payer: PacificSource Commercial |
$1,909.80
|
| Rate for Payer: PHCS PPO |
$2,015.90
|
| Rate for Payer: Three Rivers PPO |
$1,591.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.37
|
| Rate for Payer: United Healthcare Commercial |
$1,846.14
|
| Rate for Payer: United Healthcare Medicare |
$78.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,803.70
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
9836449001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.09 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$101.28
|
| Rate for Payer: Beech Street Commercial |
$638.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: First Choice Health Commercial |
$604.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.28
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$86.09
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$638.40
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$101.28
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
| Rate for Payer: WINHealth Partners Commercial |
$571.20
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 64490 50
|
| Hospital Charge Code |
9836449001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.09 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,317.12
|
| Rate for Payer: Aetna of WY Medicare |
$101.28
|
| Rate for Payer: Beech Street Commercial |
$1,276.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,303.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,317.12
|
| Rate for Payer: First Choice Health Commercial |
$1,209.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,276.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.28
|
| Rate for Payer: HealthUtah PPO |
$1,344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,303.68
|
| Rate for Payer: Multiplan Medicare/VA |
$86.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,317.12
|
| Rate for Payer: PacificSource Commercial |
$1,209.60
|
| Rate for Payer: PHCS PPO |
$1,276.80
|
| Rate for Payer: Three Rivers PPO |
$1,008.00
|
| Rate for Payer: TriWest Veterans Administration |
$101.28
|
| Rate for Payer: United Healthcare Commercial |
$1,169.28
|
| Rate for Payer: United Healthcare Medicare |
$101.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,142.40
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 2ND LEVEL
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 64491 50
|
| Hospital Charge Code |
9836449101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Medicare |
$56.60
|
| Rate for Payer: Beech Street Commercial |
$640.30
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: First Choice Health Commercial |
$606.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.60
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Multiplan Medicare/VA |
$48.11
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$640.30
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.60
|
| Rate for Payer: United Healthcare Commercial |
$586.38
|
| Rate for Payer: United Healthcare Medicare |
$56.60
|
| Rate for Payer: WINHealth Partners Commercial |
$572.90
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 2ND LEVEL
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
9836449101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$330.26
|
| Rate for Payer: Aetna of WY Medicare |
$56.60
|
| Rate for Payer: Beech Street Commercial |
$320.15
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$326.89
|
| Rate for Payer: Cigna of WY Commercial |
$330.26
|
| Rate for Payer: First Choice Health Commercial |
$303.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.60
|
| Rate for Payer: HealthUtah PPO |
$337.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$326.89
|
| Rate for Payer: Multiplan Medicare/VA |
$48.11
|
| Rate for Payer: One Health Plan of WY PPO |
$330.26
|
| Rate for Payer: PacificSource Commercial |
$303.30
|
| Rate for Payer: PHCS PPO |
$320.15
|
| Rate for Payer: Three Rivers PPO |
$252.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.60
|
| Rate for Payer: United Healthcare Commercial |
$293.19
|
| Rate for Payer: United Healthcare Medicare |
$56.60
|
| Rate for Payer: WINHealth Partners Commercial |
$286.45
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, ADD LEVEL
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
9836449201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Medicare |
$57.59
|
| Rate for Payer: Beech Street Commercial |
$321.10
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: First Choice Health Commercial |
$304.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.59
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Multiplan Medicare/VA |
$48.95
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$321.10
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: TriWest Veterans Administration |
$57.59
|
| Rate for Payer: United Healthcare Commercial |
$294.06
|
| Rate for Payer: United Healthcare Medicare |
$57.59
|
| Rate for Payer: WINHealth Partners Commercial |
$287.30
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, ADD LEVEL
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
HCPCS 64492 50
|
| Hospital Charge Code |
9836449201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
| Rate for Payer: Aetna of WY Medicare |
$57.59
|
| 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 |
$57.59
|
| Rate for Payer: HealthUtah PPO |
$676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
| Rate for Payer: Multiplan Medicare/VA |
$48.95
|
| 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 |
$57.59
|
| Rate for Payer: United Healthcare Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicare |
$57.59
|
| Rate for Payer: WINHealth Partners Commercial |
$574.60
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LVL
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
HCPCS 64493 50
|
| Hospital Charge Code |
9836449301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.06 |
| Max. Negotiated Rate |
$1,236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,211.28
|
| Rate for Payer: Aetna of WY Medicare |
$87.13
|
| Rate for Payer: Beech Street Commercial |
$1,174.20
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,198.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,211.28
|
| Rate for Payer: First Choice Health Commercial |
$1,112.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,174.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.13
|
| Rate for Payer: HealthUtah PPO |
$1,236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,198.92
|
| Rate for Payer: Multiplan Medicare/VA |
$74.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,211.28
|
| Rate for Payer: PacificSource Commercial |
$1,112.40
|
| Rate for Payer: PHCS PPO |
$1,174.20
|
| Rate for Payer: Three Rivers PPO |
$927.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.13
|
| Rate for Payer: United Healthcare Commercial |
$1,075.32
|
| Rate for Payer: United Healthcare Medicare |
$87.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,050.60
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LVL
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
9836449301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.06 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$87.13
|
| 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 |
$87.13
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$74.06
|
| 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 |
$87.13
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$87.13
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
