|
HC PRO INJECTION FOR WRIST ARTHROGRAM
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
9832524601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$59.03 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$69.45
|
| Rate for Payer: Beech Street Commercial |
$608.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: First Choice Health Commercial |
$576.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.45
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$59.03
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$608.00
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.45
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$69.45
|
| Rate for Payer: WINHealth Partners Commercial |
$544.00
|
|
|
HC PRO INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
9832709301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$54.85 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.52
|
| Rate for Payer: Aetna of WY Medicare |
$64.53
|
| Rate for Payer: Beech Street Commercial |
$1,067.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: Cash Price |
$786.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.52
|
| Rate for Payer: First Choice Health Commercial |
$1,011.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.53
|
| Rate for Payer: HealthUtah PPO |
$1,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.28
|
| Rate for Payer: Multiplan Medicare/VA |
$54.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.52
|
| Rate for Payer: PacificSource Commercial |
$1,011.60
|
| Rate for Payer: PHCS PPO |
$1,067.80
|
| Rate for Payer: Three Rivers PPO |
$843.00
|
| Rate for Payer: TriWest Veterans Administration |
$64.53
|
| Rate for Payer: United Healthcare Commercial |
$977.88
|
| Rate for Payer: United Healthcare Medicare |
$64.53
|
| Rate for Payer: WINHealth Partners Commercial |
$955.40
|
|
|
HC PRO INJECTION INJECT ANES/STEROID GENICUL NRV BRANCH W/IMG
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
9646445401
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$757.54
|
| Rate for Payer: Aetna of WY Medicare |
$79.03
|
| Rate for Payer: Beech Street Commercial |
$734.35
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$749.81
|
| Rate for Payer: Cigna of WY Commercial |
$757.54
|
| Rate for Payer: First Choice Health Commercial |
$695.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$734.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.03
|
| Rate for Payer: HealthUtah PPO |
$773.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$749.81
|
| Rate for Payer: Multiplan Medicare/VA |
$67.18
|
| Rate for Payer: One Health Plan of WY PPO |
$757.54
|
| Rate for Payer: PacificSource Commercial |
$695.70
|
| Rate for Payer: PHCS PPO |
$734.35
|
| Rate for Payer: Three Rivers PPO |
$579.75
|
| Rate for Payer: TriWest Veterans Administration |
$79.03
|
| Rate for Payer: United Healthcare Commercial |
$672.51
|
| Rate for Payer: United Healthcare Medicare |
$79.03
|
| Rate for Payer: WINHealth Partners Commercial |
$657.05
|
|
|
HC PRO INJECTION INJECT ANES/STEROID GENICUL NRV BRANCH W/IMG
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 64454 50
|
| Hospital Charge Code |
9646445401
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$1,546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,515.08
|
| Rate for Payer: Aetna of WY Medicare |
$79.03
|
| Rate for Payer: Beech Street Commercial |
$1,468.70
|
| Rate for Payer: Cash Price |
$1,082.20
|
| Rate for Payer: Cash Price |
$1,082.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,499.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,515.08
|
| Rate for Payer: First Choice Health Commercial |
$1,391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,468.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.03
|
| Rate for Payer: HealthUtah PPO |
$1,546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,499.62
|
| Rate for Payer: Multiplan Medicare/VA |
$67.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,515.08
|
| Rate for Payer: PacificSource Commercial |
$1,391.40
|
| Rate for Payer: PHCS PPO |
$1,468.70
|
| Rate for Payer: Three Rivers PPO |
$1,159.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.03
|
| Rate for Payer: United Healthcare Commercial |
$1,345.02
|
| Rate for Payer: United Healthcare Medicare |
$79.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,314.10
|
|
|
HC PRO INJECTION INTRALESIONAL 1-7 LESIONS
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
9831190001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$28.63
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.63
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.63
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$28.63
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
HC PRO INJECTION INTRALESIONAL 1-7 LESIONS
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 11900 NONPBBPAYER
|
| Hospital Charge Code |
9831190001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$28.63
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.63
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.63
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$28.63
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
HC PRO INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
9832055301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Aetna of WY Medicare |
$40.16
|
| Rate for Payer: Aetna of WY Medicare |
$40.16
|
| Rate for Payer: Beech Street Commercial |
$164.35
|
| Rate for Payer: Beech Street Commercial |
$340.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: First Choice Health Commercial |
$155.70
|
| Rate for Payer: First Choice Health Commercial |
$322.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.16
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: Multiplan Medicare/VA |
$34.14
|
| Rate for Payer: Multiplan Medicare/VA |
$34.14
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$340.10
|
| Rate for Payer: PHCS PPO |
$164.35
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: TriWest Veterans Administration |
$40.16
|
| Rate for Payer: TriWest Veterans Administration |
$40.16
|
| Rate for Payer: United Healthcare Commercial |
$150.51
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
| Rate for Payer: WINHealth Partners Commercial |
$304.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.05
|
|
|
HC PRO INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 20553 NONPBBPAYER
|
| Hospital Charge Code |
9832055301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$40.16
|
| Rate for Payer: Beech Street Commercial |
$205.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: First Choice Health Commercial |
$194.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.16
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$34.14
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$205.20
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$40.16
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
| Rate for Payer: WINHealth Partners Commercial |
$183.60
|
|
|
HC PRO INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
9832052601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$54.21
|
| 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 |
$54.21
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$46.08
|
| 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 |
$54.21
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
| Rate for Payer: WINHealth Partners Commercial |
$195.50
|
|
|
HC PRO INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 20526 NONPBBPAYER
|
| Hospital Charge Code |
9832052601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$54.21
|
| Rate for Payer: Beech Street Commercial |
$272.65
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: First Choice Health Commercial |
$258.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.21
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$46.08
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$272.65
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$54.21
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
| Rate for Payer: WINHealth Partners Commercial |
$243.95
|
|
|
HC PRO INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 20526 50,NONPBBPAYER
|
| Hospital Charge Code |
9832052601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$54.21
|
| Rate for Payer: Beech Street Commercial |
$545.30
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: First Choice Health Commercial |
$516.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.21
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$46.08
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$545.30
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.21
|
| Rate for Payer: United Healthcare Commercial |
$499.38
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
| Rate for Payer: WINHealth Partners Commercial |
$487.90
|
|
|
HC PRO INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 20526 50
|
| Hospital Charge Code |
9832052601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$54.21
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.21
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$46.08
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$54.21
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
HC PRO INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
9839637201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$206.78
|
| Rate for Payer: Aetna of WY Medicare |
$13.99
|
| Rate for Payer: Beech Street Commercial |
$200.45
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$204.67
|
| Rate for Payer: Cigna of WY Commercial |
$206.78
|
| Rate for Payer: First Choice Health Commercial |
$189.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.99
|
| Rate for Payer: HealthUtah PPO |
$211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$204.67
|
| Rate for Payer: Multiplan Medicare/VA |
$11.89
|
| Rate for Payer: One Health Plan of WY PPO |
$206.78
|
| Rate for Payer: PacificSource Commercial |
$189.90
|
| Rate for Payer: PHCS PPO |
$200.45
|
| Rate for Payer: Three Rivers PPO |
$158.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.99
|
| Rate for Payer: United Healthcare Commercial |
$183.57
|
| Rate for Payer: United Healthcare Medicare |
$13.99
|
| Rate for Payer: WINHealth Partners Commercial |
$200.45
|
|
|
HC PRO INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
9409637401
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Aetna of WY Medicare |
$35.85
|
| Rate for Payer: Beech Street Commercial |
$403.75
|
| Rate for Payer: Cash Price |
$297.50
|
| 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: First Choice Health Commercial |
$382.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.85
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$30.47
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$403.75
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$35.85
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$35.85
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
|
|
HC PRO INJECT NERV BLCK,AXILLARY NERV
|
Professional
|
Both
|
$1,116.00
|
|
|
Service Code
|
HCPCS 64417 50
|
| Hospital Charge Code |
9836441701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,093.68
|
| Rate for Payer: Aetna of WY Medicare |
$61.10
|
| Rate for Payer: Beech Street Commercial |
$1,060.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,082.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,093.68
|
| Rate for Payer: First Choice Health Commercial |
$1,004.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,060.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.10
|
| Rate for Payer: HealthUtah PPO |
$1,116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,082.52
|
| Rate for Payer: Multiplan Medicare/VA |
$51.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,093.68
|
| Rate for Payer: PacificSource Commercial |
$1,004.40
|
| Rate for Payer: PHCS PPO |
$1,060.20
|
| Rate for Payer: Three Rivers PPO |
$837.00
|
| Rate for Payer: TriWest Veterans Administration |
$61.10
|
| Rate for Payer: United Healthcare Commercial |
$970.92
|
| Rate for Payer: United Healthcare Medicare |
$61.10
|
| Rate for Payer: WINHealth Partners Commercial |
$948.60
|
|
|
HC PRO INJECT NERV BLCK,AXILLARY NERV
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 64417
|
| Hospital Charge Code |
9836441701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$546.84
|
| Rate for Payer: Aetna of WY Medicare |
$61.10
|
| Rate for Payer: Beech Street Commercial |
$530.10
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$541.26
|
| Rate for Payer: Cigna of WY Commercial |
$546.84
|
| Rate for Payer: First Choice Health Commercial |
$502.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$530.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.10
|
| Rate for Payer: HealthUtah PPO |
$558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$541.26
|
| Rate for Payer: Multiplan Medicare/VA |
$51.94
|
| Rate for Payer: One Health Plan of WY PPO |
$546.84
|
| Rate for Payer: PacificSource Commercial |
$502.20
|
| Rate for Payer: PHCS PPO |
$530.10
|
| Rate for Payer: Three Rivers PPO |
$418.50
|
| Rate for Payer: TriWest Veterans Administration |
$61.10
|
| Rate for Payer: United Healthcare Commercial |
$485.46
|
| Rate for Payer: United Healthcare Medicare |
$61.10
|
| Rate for Payer: WINHealth Partners Commercial |
$474.30
|
|
|
HC PRO INJECT NERV BLCK,CELIAC PLEXUS
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
9836453001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Aetna of WY Medicare |
$91.06
|
| Rate for Payer: Beech Street Commercial |
$1,030.75
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: First Choice Health Commercial |
$976.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.06
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$77.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,030.75
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$91.06
|
| Rate for Payer: United Healthcare Commercial |
$943.95
|
| Rate for Payer: United Healthcare Medicare |
$91.06
|
| Rate for Payer: WINHealth Partners Commercial |
$922.25
|
|
|
HC PRO INJECT NERV BLCK,GREAT OCCIPTL
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
9836440501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$49.86
|
| Rate for Payer: Beech Street Commercial |
$422.75
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: First Choice Health Commercial |
$400.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.86
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$42.38
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$422.75
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.86
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$49.86
|
| Rate for Payer: WINHealth Partners Commercial |
$378.25
|
|
|
HC PRO INJECT NERV BLCK,OTHR PERIPH NERV
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
9836445001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$40.16
|
| Rate for Payer: Aetna of WY Medicare |
$40.16
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Beech Street Commercial |
$247.95
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$182.70
|
| 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: First Choice Health Commercial |
$885.60
|
| Rate for Payer: First Choice Health Commercial |
$234.90
|
| 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 |
$40.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.16
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Multiplan Medicare/VA |
$34.14
|
| Rate for Payer: Multiplan Medicare/VA |
$34.14
|
| 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 |
$234.90
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$247.95
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$40.16
|
| Rate for Payer: TriWest Veterans Administration |
$40.16
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
| Rate for Payer: United Healthcare Medicare |
$40.16
|
| Rate for Payer: WINHealth Partners Commercial |
$221.85
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
HC PRO INJECT NERV BLCK,PARAVERT SYMPATH
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
9836452001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
HC PRO INJECT NERV BLCK,PARAVERT SYMPATH
|
Professional
|
Both
|
$1,610.00
|
|
|
Service Code
|
HCPCS 64520 50
|
| Hospital Charge Code |
9836452001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,577.80
|
| Rate for Payer: Beech Street Commercial |
$1,529.50
|
| Rate for Payer: Cash Price |
$1,127.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,561.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,577.80
|
| Rate for Payer: First Choice Health Commercial |
$1,449.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,529.50
|
| Rate for Payer: HealthUtah PPO |
$1,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,561.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,577.80
|
| Rate for Payer: PacificSource Commercial |
$1,449.00
|
| Rate for Payer: PHCS PPO |
$1,529.50
|
| Rate for Payer: Three Rivers PPO |
$1,207.50
|
| Rate for Payer: United Healthcare Commercial |
$1,400.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,368.50
|
|
|
HC PRO INJECT NERV BLCK,STELLATE GANGLION
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
9836451001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.15 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$74.29
|
| Rate for Payer: Beech Street Commercial |
$484.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: First Choice Health Commercial |
$459.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.29
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$63.15
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$484.50
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.29
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$74.29
|
| Rate for Payer: WINHealth Partners Commercial |
$433.50
|
|
|
HC PRO INJECT NERV BLCK,STELLATE GANGLION
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 64510 50
|
| Hospital Charge Code |
9836451001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.15 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$999.60
|
| Rate for Payer: Aetna of WY Medicare |
$74.29
|
| Rate for Payer: Beech Street Commercial |
$969.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$989.40
|
| Rate for Payer: Cigna of WY Commercial |
$999.60
|
| Rate for Payer: First Choice Health Commercial |
$918.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.29
|
| Rate for Payer: HealthUtah PPO |
$1,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$989.40
|
| Rate for Payer: Multiplan Medicare/VA |
$63.15
|
| Rate for Payer: One Health Plan of WY PPO |
$999.60
|
| Rate for Payer: PacificSource Commercial |
$918.00
|
| Rate for Payer: PHCS PPO |
$969.00
|
| Rate for Payer: Three Rivers PPO |
$765.00
|
| Rate for Payer: TriWest Veterans Administration |
$74.29
|
| Rate for Payer: United Healthcare Commercial |
$887.40
|
| Rate for Payer: United Healthcare Medicare |
$74.29
|
| Rate for Payer: WINHealth Partners Commercial |
$867.00
|
|
|
HC PRO INJECT NERV BLCK,SUPRASCAP N.
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
9836441801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$53.00
|
| Rate for Payer: Beech Street Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: First Choice Health Commercial |
$270.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$45.05
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$285.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$53.00
|
| Rate for Payer: WINHealth Partners Commercial |
$255.00
|
|
|
HC PRO INJECT NERV BLCK,SUPRASCAP N.
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 64418 50
|
| Hospital Charge Code |
9836441801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$53.00
|
| Rate for Payer: Beech Street Commercial |
$570.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: First Choice Health Commercial |
$540.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$45.05
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$570.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$53.00
|
| Rate for Payer: WINHealth Partners Commercial |
$510.00
|
|
