|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 2ND LVL
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
9836449401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.68
|
| Rate for Payer: Aetna of WY Medicare |
$48.59
|
| Rate for Payer: Beech Street Commercial |
$300.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.52
|
| Rate for Payer: Cigna of WY Commercial |
$309.68
|
| Rate for Payer: First Choice Health Commercial |
$284.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.59
|
| Rate for Payer: HealthUtah PPO |
$316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.52
|
| Rate for Payer: Multiplan Medicare/VA |
$41.30
|
| Rate for Payer: One Health Plan of WY PPO |
$309.68
|
| Rate for Payer: PacificSource Commercial |
$284.40
|
| Rate for Payer: PHCS PPO |
$300.20
|
| Rate for Payer: Three Rivers PPO |
$237.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.59
|
| Rate for Payer: United Healthcare Commercial |
$274.92
|
| Rate for Payer: United Healthcare Medicare |
$48.59
|
| Rate for Payer: WINHealth Partners Commercial |
$268.60
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 2ND LVL
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 64494 50
|
| Hospital Charge Code |
9836449401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.36
|
| Rate for Payer: Aetna of WY Medicare |
$48.59
|
| Rate for Payer: Beech Street Commercial |
$600.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.04
|
| Rate for Payer: Cigna of WY Commercial |
$619.36
|
| Rate for Payer: First Choice Health Commercial |
$568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.59
|
| Rate for Payer: HealthUtah PPO |
$632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.04
|
| Rate for Payer: Multiplan Medicare/VA |
$41.30
|
| Rate for Payer: One Health Plan of WY PPO |
$619.36
|
| Rate for Payer: PacificSource Commercial |
$568.80
|
| Rate for Payer: PHCS PPO |
$600.40
|
| Rate for Payer: Three Rivers PPO |
$474.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.59
|
| Rate for Payer: United Healthcare Commercial |
$549.84
|
| Rate for Payer: United Healthcare Medicare |
$48.59
|
| Rate for Payer: WINHealth Partners Commercial |
$537.20
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, ADD LEVEL
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
9836449501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.68
|
| Rate for Payer: Aetna of WY Medicare |
$49.57
|
| Rate for Payer: Beech Street Commercial |
$300.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.52
|
| Rate for Payer: Cigna of WY Commercial |
$309.68
|
| Rate for Payer: First Choice Health Commercial |
$284.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.57
|
| Rate for Payer: HealthUtah PPO |
$316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.52
|
| Rate for Payer: Multiplan Medicare/VA |
$42.13
|
| Rate for Payer: One Health Plan of WY PPO |
$309.68
|
| Rate for Payer: PacificSource Commercial |
$284.40
|
| Rate for Payer: PHCS PPO |
$300.20
|
| Rate for Payer: Three Rivers PPO |
$237.00
|
| Rate for Payer: TriWest Veterans Administration |
$49.57
|
| Rate for Payer: United Healthcare Commercial |
$274.92
|
| Rate for Payer: United Healthcare Medicare |
$49.57
|
| Rate for Payer: WINHealth Partners Commercial |
$268.60
|
|
|
HC PRO INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, ADD LEVEL
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 64495 50
|
| Hospital Charge Code |
9836449501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.36
|
| Rate for Payer: Aetna of WY Medicare |
$49.57
|
| Rate for Payer: Beech Street Commercial |
$600.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.04
|
| Rate for Payer: Cigna of WY Commercial |
$619.36
|
| Rate for Payer: First Choice Health Commercial |
$568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.57
|
| Rate for Payer: HealthUtah PPO |
$632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.04
|
| Rate for Payer: Multiplan Medicare/VA |
$42.13
|
| Rate for Payer: One Health Plan of WY PPO |
$619.36
|
| Rate for Payer: PacificSource Commercial |
$568.80
|
| Rate for Payer: PHCS PPO |
$600.40
|
| Rate for Payer: Three Rivers PPO |
$474.00
|
| Rate for Payer: TriWest Veterans Administration |
$49.57
|
| Rate for Payer: United Healthcare Commercial |
$549.84
|
| Rate for Payer: United Healthcare Medicare |
$49.57
|
| Rate for Payer: WINHealth Partners Commercial |
$537.20
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 64479 50
|
| Hospital Charge Code |
9836447901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,813.00
|
| Rate for Payer: Aetna of WY Medicare |
$125.58
|
| Rate for Payer: Beech Street Commercial |
$1,757.50
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,794.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,813.00
|
| Rate for Payer: First Choice Health Commercial |
$1,665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,757.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.58
|
| Rate for Payer: HealthUtah PPO |
$1,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,794.50
|
| Rate for Payer: Multiplan Medicare/VA |
$106.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,813.00
|
| Rate for Payer: PacificSource Commercial |
$1,665.00
|
| Rate for Payer: PHCS PPO |
$1,757.50
|
| Rate for Payer: Three Rivers PPO |
$1,387.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.58
|
| Rate for Payer: United Healthcare Commercial |
$1,609.50
|
| Rate for Payer: United Healthcare Medicare |
$125.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,572.50
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,1 LEVEL
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 64479
|
| Hospital Charge Code |
9836447901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$906.50
|
| Rate for Payer: Aetna of WY Medicare |
$125.58
|
| Rate for Payer: Beech Street Commercial |
$878.75
|
| Rate for Payer: Cash Price |
$647.50
|
| Rate for Payer: Cash Price |
$647.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$897.25
|
| Rate for Payer: Cigna of WY Commercial |
$906.50
|
| Rate for Payer: First Choice Health Commercial |
$832.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$878.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.58
|
| Rate for Payer: HealthUtah PPO |
$925.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$897.25
|
| Rate for Payer: Multiplan Medicare/VA |
$106.74
|
| Rate for Payer: One Health Plan of WY PPO |
$906.50
|
| Rate for Payer: PacificSource Commercial |
$832.50
|
| Rate for Payer: PHCS PPO |
$878.75
|
| Rate for Payer: Three Rivers PPO |
$693.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.58
|
| Rate for Payer: United Healthcare Commercial |
$804.75
|
| Rate for Payer: United Healthcare Medicare |
$125.58
|
| Rate for Payer: WINHealth Partners Commercial |
$786.25
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
9836448301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.09 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.82
|
| Rate for Payer: Aetna of WY Medicare |
$107.17
|
| Rate for Payer: Beech Street Commercial |
$816.05
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: Cash Price |
$601.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$833.23
|
| Rate for Payer: Cigna of WY Commercial |
$841.82
|
| Rate for Payer: First Choice Health Commercial |
$773.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$816.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.17
|
| Rate for Payer: HealthUtah PPO |
$859.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$833.23
|
| Rate for Payer: Multiplan Medicare/VA |
$91.09
|
| Rate for Payer: One Health Plan of WY PPO |
$841.82
|
| Rate for Payer: PacificSource Commercial |
$773.10
|
| Rate for Payer: PHCS PPO |
$816.05
|
| Rate for Payer: Three Rivers PPO |
$644.25
|
| Rate for Payer: TriWest Veterans Administration |
$107.17
|
| Rate for Payer: United Healthcare Commercial |
$747.33
|
| Rate for Payer: United Healthcare Medicare |
$107.17
|
| Rate for Payer: WINHealth Partners Commercial |
$730.15
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Professional
|
Both
|
$1,718.00
|
|
|
Service Code
|
HCPCS 64483 50
|
| Hospital Charge Code |
9836448301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$91.09 |
| Max. Negotiated Rate |
$1,718.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,683.64
|
| Rate for Payer: Aetna of WY Medicare |
$107.17
|
| Rate for Payer: Beech Street Commercial |
$1,632.10
|
| Rate for Payer: Cash Price |
$1,202.60
|
| Rate for Payer: Cash Price |
$1,202.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,666.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,683.64
|
| Rate for Payer: First Choice Health Commercial |
$1,546.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,632.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.17
|
| Rate for Payer: HealthUtah PPO |
$1,718.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,666.46
|
| Rate for Payer: Multiplan Medicare/VA |
$91.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,683.64
|
| Rate for Payer: PacificSource Commercial |
$1,546.20
|
| Rate for Payer: PHCS PPO |
$1,632.10
|
| Rate for Payer: Three Rivers PPO |
$1,288.50
|
| Rate for Payer: TriWest Veterans Administration |
$107.17
|
| Rate for Payer: United Healthcare Commercial |
$1,494.66
|
| Rate for Payer: United Healthcare Medicare |
$107.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,460.30
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 64484 50
|
| Hospital Charge Code |
9836448401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$758.52
|
| Rate for Payer: Aetna of WY Medicare |
$49.24
|
| Rate for Payer: Beech Street Commercial |
$735.30
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$750.78
|
| Rate for Payer: Cigna of WY Commercial |
$758.52
|
| Rate for Payer: First Choice Health Commercial |
$696.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$735.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.24
|
| Rate for Payer: HealthUtah PPO |
$774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$750.78
|
| Rate for Payer: Multiplan Medicare/VA |
$41.85
|
| Rate for Payer: One Health Plan of WY PPO |
$758.52
|
| Rate for Payer: PacificSource Commercial |
$696.60
|
| Rate for Payer: PHCS PPO |
$735.30
|
| Rate for Payer: Three Rivers PPO |
$580.50
|
| Rate for Payer: TriWest Veterans Administration |
$49.24
|
| Rate for Payer: United Healthcare Commercial |
$673.38
|
| Rate for Payer: United Healthcare Medicare |
$49.24
|
| Rate for Payer: WINHealth Partners Commercial |
$657.90
|
|
|
HC PRO INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 64484
|
| Hospital Charge Code |
9836448401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$49.24
|
| Rate for Payer: Beech Street Commercial |
$367.65
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: First Choice Health Commercial |
$348.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.24
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$41.85
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$367.65
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.24
|
| Rate for Payer: United Healthcare Commercial |
$336.69
|
| Rate for Payer: United Healthcare Medicare |
$49.24
|
| Rate for Payer: WINHealth Partners Commercial |
$328.95
|
|
|
HC PRO INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 64505
|
| Hospital Charge Code |
9826450501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$488.04
|
| Rate for Payer: Aetna of WY Medicare |
$100.64
|
| Rate for Payer: Beech Street Commercial |
$473.10
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$483.06
|
| Rate for Payer: Cigna of WY Commercial |
$488.04
|
| Rate for Payer: First Choice Health Commercial |
$448.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$473.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.64
|
| Rate for Payer: HealthUtah PPO |
$498.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$483.06
|
| Rate for Payer: Multiplan Medicare/VA |
$85.54
|
| Rate for Payer: One Health Plan of WY PPO |
$488.04
|
| Rate for Payer: PacificSource Commercial |
$448.20
|
| Rate for Payer: PHCS PPO |
$473.10
|
| Rate for Payer: Three Rivers PPO |
$373.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.64
|
| Rate for Payer: United Healthcare Commercial |
$433.26
|
| Rate for Payer: United Healthcare Medicare |
$100.64
|
| Rate for Payer: WINHealth Partners Commercial |
$423.30
|
|
|
HC PRO INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 64505 50
|
| Hospital Charge Code |
9826450501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$997.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$977.06
|
| Rate for Payer: Aetna of WY Medicare |
$100.64
|
| Rate for Payer: Beech Street Commercial |
$947.15
|
| Rate for Payer: Cash Price |
$697.90
|
| Rate for Payer: Cash Price |
$697.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$967.09
|
| Rate for Payer: Cigna of WY Commercial |
$977.06
|
| Rate for Payer: First Choice Health Commercial |
$897.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$947.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.64
|
| Rate for Payer: HealthUtah PPO |
$997.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$967.09
|
| Rate for Payer: Multiplan Medicare/VA |
$85.54
|
| Rate for Payer: One Health Plan of WY PPO |
$977.06
|
| Rate for Payer: PacificSource Commercial |
$897.30
|
| Rate for Payer: PHCS PPO |
$947.15
|
| Rate for Payer: Three Rivers PPO |
$747.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.64
|
| Rate for Payer: United Healthcare Commercial |
$867.39
|
| Rate for Payer: United Healthcare Medicare |
$100.64
|
| Rate for Payer: WINHealth Partners Commercial |
$847.45
|
|
|
HC PRO INJECTION ANES FEMORAL NERVE CONT INFUSION CATH
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 64448 50
|
| Hospital Charge Code |
9836444801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$626.22
|
| Rate for Payer: Aetna of WY Medicare |
$68.55
|
| Rate for Payer: Beech Street Commercial |
$607.05
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$619.83
|
| Rate for Payer: Cigna of WY Commercial |
$626.22
|
| Rate for Payer: First Choice Health Commercial |
$575.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$607.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.55
|
| Rate for Payer: HealthUtah PPO |
$639.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$619.83
|
| Rate for Payer: Multiplan Medicare/VA |
$58.27
|
| Rate for Payer: One Health Plan of WY PPO |
$626.22
|
| Rate for Payer: PacificSource Commercial |
$575.10
|
| Rate for Payer: PHCS PPO |
$607.05
|
| Rate for Payer: Three Rivers PPO |
$479.25
|
| Rate for Payer: TriWest Veterans Administration |
$68.55
|
| Rate for Payer: United Healthcare Commercial |
$555.93
|
| Rate for Payer: United Healthcare Medicare |
$68.55
|
| Rate for Payer: WINHealth Partners Commercial |
$543.15
|
|
|
HC PRO INJECTION ANES FEMORAL NERVE CONT INFUSION CATH
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 64448
|
| Hospital Charge Code |
9836444801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$68.55
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.55
|
| Rate for Payer: HealthUtah PPO |
$319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$58.27
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: TriWest Veterans Administration |
$68.55
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$68.55
|
| Rate for Payer: WINHealth Partners Commercial |
$271.15
|
|
|
HC PRO INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
9836442501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$52.19
|
| Rate for Payer: Beech Street Commercial |
$365.75
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: First Choice Health Commercial |
$346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.19
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$44.36
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$365.75
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$52.19
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$52.19
|
| Rate for Payer: WINHealth Partners Commercial |
$327.25
|
|
|
HC PRO INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 64425 50
|
| Hospital Charge Code |
9836442501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$52.19
|
| Rate for Payer: Beech Street Commercial |
$731.50
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: First Choice Health Commercial |
$693.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.19
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$44.36
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$731.50
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.19
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$52.19
|
| Rate for Payer: WINHealth Partners Commercial |
$654.50
|
|
|
HC PRO INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
9836443501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.51 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.22
|
| Rate for Payer: Aetna of WY Medicare |
$41.78
|
| Rate for Payer: Beech Street Commercial |
$322.05
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.83
|
| Rate for Payer: Cigna of WY Commercial |
$332.22
|
| Rate for Payer: First Choice Health Commercial |
$305.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.78
|
| Rate for Payer: HealthUtah PPO |
$339.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.83
|
| Rate for Payer: Multiplan Medicare/VA |
$35.51
|
| Rate for Payer: One Health Plan of WY PPO |
$332.22
|
| Rate for Payer: PacificSource Commercial |
$305.10
|
| Rate for Payer: PHCS PPO |
$322.05
|
| Rate for Payer: Three Rivers PPO |
$254.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.78
|
| Rate for Payer: United Healthcare Commercial |
$294.93
|
| Rate for Payer: United Healthcare Medicare |
$41.78
|
| Rate for Payer: WINHealth Partners Commercial |
$288.15
|
|
|
HC PRO INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 64435 50
|
| Hospital Charge Code |
9836443501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.51 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$665.42
|
| Rate for Payer: Aetna of WY Medicare |
$41.78
|
| Rate for Payer: Beech Street Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$658.63
|
| Rate for Payer: Cigna of WY Commercial |
$665.42
|
| Rate for Payer: First Choice Health Commercial |
$611.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.78
|
| Rate for Payer: HealthUtah PPO |
$679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$658.63
|
| Rate for Payer: Multiplan Medicare/VA |
$35.51
|
| Rate for Payer: One Health Plan of WY PPO |
$665.42
|
| Rate for Payer: PacificSource Commercial |
$611.10
|
| Rate for Payer: PHCS PPO |
$645.05
|
| Rate for Payer: Three Rivers PPO |
$509.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.78
|
| Rate for Payer: United Healthcare Commercial |
$590.73
|
| Rate for Payer: United Healthcare Medicare |
$41.78
|
| Rate for Payer: WINHealth Partners Commercial |
$577.15
|
|
|
HC PRO INJECTION DIAG/THERAP C/T EPIDUR WO IMAG
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
9836232001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$95.44
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.44
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$81.12
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$95.44
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$95.44
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
HC PRO INJECTION DIAG/THERAP C/T EPIDUR WO IMAG
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
HCPCS 62320 50
|
| Hospital Charge Code |
9836232001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$1,027.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,006.46
|
| Rate for Payer: Aetna of WY Medicare |
$95.44
|
| Rate for Payer: Beech Street Commercial |
$975.65
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$996.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,006.46
|
| Rate for Payer: First Choice Health Commercial |
$924.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$975.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.44
|
| Rate for Payer: HealthUtah PPO |
$1,027.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$996.19
|
| Rate for Payer: Multiplan Medicare/VA |
$81.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,006.46
|
| Rate for Payer: PacificSource Commercial |
$924.30
|
| Rate for Payer: PHCS PPO |
$975.65
|
| Rate for Payer: Three Rivers PPO |
$770.25
|
| Rate for Payer: TriWest Veterans Administration |
$95.44
|
| Rate for Payer: United Healthcare Commercial |
$893.49
|
| Rate for Payer: United Healthcare Medicare |
$95.44
|
| Rate for Payer: WINHealth Partners Commercial |
$872.95
|
|
|
HC PRO INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 20527
|
| Hospital Charge Code |
9832052701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$258.72
|
| Rate for Payer: Aetna of WY Medicare |
$62.88
|
| Rate for Payer: Beech Street Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$256.08
|
| Rate for Payer: Cigna of WY Commercial |
$258.72
|
| Rate for Payer: First Choice Health Commercial |
$237.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$250.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.88
|
| Rate for Payer: HealthUtah PPO |
$264.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$256.08
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$258.72
|
| Rate for Payer: PacificSource Commercial |
$237.60
|
| Rate for Payer: PHCS PPO |
$250.80
|
| Rate for Payer: Three Rivers PPO |
$198.00
|
| Rate for Payer: TriWest Veterans Administration |
$62.88
|
| Rate for Payer: United Healthcare Commercial |
$229.68
|
| Rate for Payer: United Healthcare Medicare |
$62.88
|
| Rate for Payer: WINHealth Partners Commercial |
$224.40
|
|
|
HC PRO INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 20527 50,NONPBBPAYER
|
| Hospital Charge Code |
9832052701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$62.88
|
| Rate for Payer: Beech Street Commercial |
$627.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: First Choice Health Commercial |
$594.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.88
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$627.00
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$62.88
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$62.88
|
| Rate for Payer: WINHealth Partners Commercial |
$561.00
|
|
|
HC PRO INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 20527 NONPBBPAYER
|
| Hospital Charge Code |
9832052701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$62.88
|
| Rate for Payer: Beech Street Commercial |
$313.50
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: First Choice Health Commercial |
$297.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.88
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$313.50
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.88
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$62.88
|
| Rate for Payer: WINHealth Partners Commercial |
$280.50
|
|
|
HC PRO INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 20527 50
|
| Hospital Charge Code |
9832052701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$517.44
|
| Rate for Payer: Aetna of WY Medicare |
$62.88
|
| Rate for Payer: Beech Street Commercial |
$501.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$512.16
|
| Rate for Payer: Cigna of WY Commercial |
$517.44
|
| Rate for Payer: First Choice Health Commercial |
$475.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$501.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.88
|
| Rate for Payer: HealthUtah PPO |
$528.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$512.16
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$517.44
|
| Rate for Payer: PacificSource Commercial |
$475.20
|
| Rate for Payer: PHCS PPO |
$501.60
|
| Rate for Payer: Three Rivers PPO |
$396.00
|
| Rate for Payer: TriWest Veterans Administration |
$62.88
|
| Rate for Payer: United Healthcare Commercial |
$459.36
|
| Rate for Payer: United Healthcare Medicare |
$62.88
|
| Rate for Payer: WINHealth Partners Commercial |
$448.80
|
|
|
HC PRO INJECTION FOR ELBOW ARTHROGRAM
|
Professional
|
Both
|
$801.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
9832422001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.98
|
| Rate for Payer: Aetna of WY Medicare |
$63.07
|
| Rate for Payer: Beech Street Commercial |
$760.95
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: Cash Price |
$560.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.97
|
| Rate for Payer: Cigna of WY Commercial |
$784.98
|
| Rate for Payer: First Choice Health Commercial |
$720.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.07
|
| Rate for Payer: HealthUtah PPO |
$801.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| Rate for Payer: One Health Plan of WY PPO |
$784.98
|
| Rate for Payer: PacificSource Commercial |
$720.90
|
| Rate for Payer: PHCS PPO |
$760.95
|
| Rate for Payer: Three Rivers PPO |
$600.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.07
|
| Rate for Payer: United Healthcare Commercial |
$696.87
|
| Rate for Payer: United Healthcare Medicare |
$63.07
|
| Rate for Payer: WINHealth Partners Commercial |
$680.85
|
|
