|
HC PRO INJECT NERV BLCK,TRIGEMINAL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
9836440001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$408.66
|
| Rate for Payer: Aetna of WY Medicare |
$48.96
|
| Rate for Payer: Aetna of WY Medicare |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$396.15
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$404.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Cigna of WY Commercial |
$408.66
|
| Rate for Payer: First Choice Health Commercial |
$375.30
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$396.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.96
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: HealthUtah PPO |
$417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$404.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$41.62
|
| Rate for Payer: Multiplan Medicare/VA |
$41.62
|
| Rate for Payer: One Health Plan of WY PPO |
$408.66
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PacificSource Commercial |
$375.30
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: PHCS PPO |
$396.15
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: Three Rivers PPO |
$312.75
|
| Rate for Payer: TriWest Veterans Administration |
$48.96
|
| Rate for Payer: TriWest Veterans Administration |
$48.96
|
| Rate for Payer: United Healthcare Commercial |
$362.79
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$48.96
|
| Rate for Payer: United Healthcare Medicare |
$48.96
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
| Rate for Payer: WINHealth Partners Commercial |
$354.45
|
|
|
HC PRO INJECT NERV BLCK,TRIGEMINAL
|
Professional
|
Both
|
$786.00
|
|
|
Service Code
|
HCPCS 64400 50
|
| Hospital Charge Code |
9836440001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$770.28
|
| Rate for Payer: Aetna of WY Medicare |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$746.70
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$762.42
|
| Rate for Payer: Cigna of WY Commercial |
$770.28
|
| Rate for Payer: First Choice Health Commercial |
$707.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$746.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.96
|
| Rate for Payer: HealthUtah PPO |
$786.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$762.42
|
| Rate for Payer: Multiplan Medicare/VA |
$41.62
|
| Rate for Payer: One Health Plan of WY PPO |
$770.28
|
| Rate for Payer: PacificSource Commercial |
$707.40
|
| Rate for Payer: PHCS PPO |
$746.70
|
| Rate for Payer: Three Rivers PPO |
$589.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.96
|
| Rate for Payer: United Healthcare Commercial |
$683.82
|
| Rate for Payer: United Healthcare Medicare |
$48.96
|
| Rate for Payer: WINHealth Partners Commercial |
$668.10
|
|
|
HC PRO INJECT RX CELIAC PLEXUS NERVE
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
9646468001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$131.43 |
| Max. Negotiated Rate |
$1,689.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,655.22
|
| Rate for Payer: Aetna of WY Medicare |
$154.62
|
| Rate for Payer: Beech Street Commercial |
$1,604.55
|
| Rate for Payer: Cash Price |
$1,182.30
|
| Rate for Payer: Cash Price |
$1,182.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,638.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,655.22
|
| Rate for Payer: First Choice Health Commercial |
$1,520.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,604.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.62
|
| Rate for Payer: HealthUtah PPO |
$1,689.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,638.33
|
| Rate for Payer: Multiplan Medicare/VA |
$131.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,655.22
|
| Rate for Payer: PacificSource Commercial |
$1,520.10
|
| Rate for Payer: PHCS PPO |
$1,604.55
|
| Rate for Payer: Three Rivers PPO |
$1,266.75
|
| Rate for Payer: TriWest Veterans Administration |
$154.62
|
| Rate for Payer: United Healthcare Commercial |
$1,469.43
|
| Rate for Payer: United Healthcare Medicare |
$154.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,435.65
|
|
|
HC PRO INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
9832709601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.68
|
| Rate for Payer: Aetna of WY Medicare |
$79.68
|
| Rate for Payer: Beech Street Commercial |
$589.00
|
| Rate for Payer: Beech Street Commercial |
$543.40
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$554.84
|
| Rate for Payer: Cigna of WY Commercial |
$560.56
|
| Rate for Payer: Cigna of WY Commercial |
$607.60
|
| Rate for Payer: First Choice Health Commercial |
$558.00
|
| Rate for Payer: First Choice Health Commercial |
$514.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.68
|
| Rate for Payer: HealthUtah PPO |
$572.00
|
| Rate for Payer: HealthUtah PPO |
$620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$554.84
|
| Rate for Payer: Multiplan Medicare/VA |
$67.73
|
| Rate for Payer: Multiplan Medicare/VA |
$67.73
|
| Rate for Payer: One Health Plan of WY PPO |
$607.60
|
| Rate for Payer: One Health Plan of WY PPO |
$560.56
|
| Rate for Payer: PacificSource Commercial |
$514.80
|
| Rate for Payer: PacificSource Commercial |
$558.00
|
| Rate for Payer: PHCS PPO |
$543.40
|
| Rate for Payer: PHCS PPO |
$589.00
|
| Rate for Payer: Three Rivers PPO |
$429.00
|
| Rate for Payer: Three Rivers PPO |
$465.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.68
|
| Rate for Payer: TriWest Veterans Administration |
$79.68
|
| Rate for Payer: United Healthcare Commercial |
$539.40
|
| Rate for Payer: United Healthcare Commercial |
$497.64
|
| Rate for Payer: United Healthcare Medicare |
$79.68
|
| Rate for Payer: United Healthcare Medicare |
$79.68
|
| Rate for Payer: WINHealth Partners Commercial |
$486.20
|
| Rate for Payer: WINHealth Partners Commercial |
$527.00
|
|
|
HC PRO INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 27096 50
|
| Hospital Charge Code |
9832709601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,121.12
|
| Rate for Payer: Aetna of WY Medicare |
$79.68
|
| Rate for Payer: Beech Street Commercial |
$1,086.80
|
| Rate for Payer: Cash Price |
$800.80
|
| Rate for Payer: Cash Price |
$800.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,109.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,121.12
|
| Rate for Payer: First Choice Health Commercial |
$1,029.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,086.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.68
|
| Rate for Payer: HealthUtah PPO |
$1,144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,109.68
|
| Rate for Payer: Multiplan Medicare/VA |
$67.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1,121.12
|
| Rate for Payer: PacificSource Commercial |
$1,029.60
|
| Rate for Payer: PHCS PPO |
$1,086.80
|
| Rate for Payer: Three Rivers PPO |
$858.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.68
|
| Rate for Payer: United Healthcare Commercial |
$995.28
|
| Rate for Payer: United Healthcare Medicare |
$79.68
|
| Rate for Payer: WINHealth Partners Commercial |
$972.40
|
|
|
HC PRO INJECT TENDON ORIGIN/INSERT
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 20551 NONPBBPAYER
|
| Hospital Charge Code |
9832055101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$36.89
|
| Rate for Payer: Beech Street Commercial |
$50.35
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: First Choice Health Commercial |
$47.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.89
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$31.36
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$50.35
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$36.89
|
| Rate for Payer: United Healthcare Commercial |
$46.11
|
| Rate for Payer: United Healthcare Medicare |
$36.89
|
| Rate for Payer: WINHealth Partners Commercial |
$45.05
|
|
|
HC PRO INJECT TENDON ORIGIN/INSERT
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
9832055101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Aetna of WY Medicare |
$36.89
|
| Rate for Payer: Aetna of WY Medicare |
$36.89
|
| Rate for Payer: Beech Street Commercial |
$311.60
|
| Rate for Payer: Beech Street Commercial |
$39.90
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: First Choice Health Commercial |
$295.20
|
| Rate for Payer: First Choice Health Commercial |
$37.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.89
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$31.36
|
| Rate for Payer: Multiplan Medicare/VA |
$31.36
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$39.90
|
| Rate for Payer: PHCS PPO |
$311.60
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$36.89
|
| Rate for Payer: TriWest Veterans Administration |
$36.89
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$36.89
|
| Rate for Payer: United Healthcare Medicare |
$36.89
|
| Rate for Payer: WINHealth Partners Commercial |
$35.70
|
| Rate for Payer: WINHealth Partners Commercial |
$278.80
|
|
|
HC PRO INJECT TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 20550 NONPBBPAYER
|
| Hospital Charge Code |
9832055001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$425.32
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Beech Street Commercial |
$412.30
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.98
|
| Rate for Payer: Cigna of WY Commercial |
$425.32
|
| Rate for Payer: First Choice Health Commercial |
$390.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$412.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: HealthUtah PPO |
$434.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.98
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: One Health Plan of WY PPO |
$425.32
|
| Rate for Payer: PacificSource Commercial |
$390.60
|
| Rate for Payer: PHCS PPO |
$412.30
|
| Rate for Payer: Three Rivers PPO |
$325.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$377.58
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
| Rate for Payer: WINHealth Partners Commercial |
$368.90
|
|
|
HC PRO INJECT TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
9832055001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.48
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Beech Street Commercial |
$309.70
|
| Rate for Payer: Beech Street Commercial |
$329.65
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.22
|
| Rate for Payer: Cigna of WY Commercial |
$319.48
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: First Choice Health Commercial |
$293.40
|
| Rate for Payer: First Choice Health Commercial |
$312.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$309.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: HealthUtah PPO |
$326.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.22
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: One Health Plan of WY PPO |
$319.48
|
| Rate for Payer: PacificSource Commercial |
$293.40
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$329.65
|
| Rate for Payer: PHCS PPO |
$309.70
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: Three Rivers PPO |
$244.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$283.62
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
| Rate for Payer: WINHealth Partners Commercial |
$294.95
|
| Rate for Payer: WINHealth Partners Commercial |
$277.10
|
|
|
HC PRO INJECT TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 20550 50,NONPBBPAYER
|
| Hospital Charge Code |
9832055001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$850.64
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Beech Street Commercial |
$824.60
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: Cash Price |
$607.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$841.96
|
| Rate for Payer: Cigna of WY Commercial |
$850.64
|
| Rate for Payer: First Choice Health Commercial |
$781.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$824.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: HealthUtah PPO |
$868.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$841.96
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: One Health Plan of WY PPO |
$850.64
|
| Rate for Payer: PacificSource Commercial |
$781.20
|
| Rate for Payer: PHCS PPO |
$824.60
|
| Rate for Payer: Three Rivers PPO |
$651.00
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$755.16
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
| Rate for Payer: WINHealth Partners Commercial |
$737.80
|
|
|
HC PRO INJECT TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 20550 50
|
| Hospital Charge Code |
9832055001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$680.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.13
|
| Rate for Payer: Beech Street Commercial |
$659.30
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: Cash Price |
$485.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$673.18
|
| Rate for Payer: Cigna of WY Commercial |
$680.12
|
| Rate for Payer: First Choice Health Commercial |
$624.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$659.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.13
|
| Rate for Payer: HealthUtah PPO |
$694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$673.18
|
| Rate for Payer: Multiplan Medicare/VA |
$31.56
|
| Rate for Payer: One Health Plan of WY PPO |
$680.12
|
| Rate for Payer: PacificSource Commercial |
$624.60
|
| Rate for Payer: PHCS PPO |
$659.30
|
| Rate for Payer: Three Rivers PPO |
$520.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.13
|
| Rate for Payer: United Healthcare Commercial |
$603.78
|
| Rate for Payer: United Healthcare Medicare |
$37.13
|
| Rate for Payer: WINHealth Partners Commercial |
$589.90
|
|
|
HC PRO INJECT TRIGGER POINT, 1 OR 2
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
9832055201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$310.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.33
|
| Rate for Payer: Aetna of WY Medicare |
$35.33
|
| Rate for Payer: Beech Street Commercial |
$146.30
|
| Rate for Payer: Beech Street Commercial |
$301.15
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$307.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Cigna of WY Commercial |
$310.66
|
| Rate for Payer: First Choice Health Commercial |
$138.60
|
| Rate for Payer: First Choice Health Commercial |
$285.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.33
|
| Rate for Payer: HealthUtah PPO |
$317.00
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$307.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$30.03
|
| Rate for Payer: Multiplan Medicare/VA |
$30.03
|
| Rate for Payer: One Health Plan of WY PPO |
$310.66
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PacificSource Commercial |
$285.30
|
| Rate for Payer: PHCS PPO |
$301.15
|
| Rate for Payer: PHCS PPO |
$146.30
|
| Rate for Payer: Three Rivers PPO |
$237.75
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.33
|
| Rate for Payer: TriWest Veterans Administration |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Commercial |
$275.79
|
| Rate for Payer: United Healthcare Medicare |
$35.33
|
| Rate for Payer: United Healthcare Medicare |
$35.33
|
| Rate for Payer: WINHealth Partners Commercial |
$269.45
|
| Rate for Payer: WINHealth Partners Commercial |
$130.90
|
|
|
HC PRO INJECT TRIGGER POINT, 1 OR 2
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 20552 NONPBBPAYER
|
| Hospital Charge Code |
9832055201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$35.33
|
| Rate for Payer: Beech Street Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: First Choice Health Commercial |
$172.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.33
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$30.03
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$182.40
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: United Healthcare Medicare |
$35.33
|
| Rate for Payer: WINHealth Partners Commercial |
$163.20
|
|
|
HC PRO INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS G0260 50
|
| Hospital Charge Code |
983G026001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3,372.00 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: WINHealth Partners Commercial |
$4,271.20
|
|
|
HC PRO INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
983G026001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.56
|
| Rate for Payer: Beech Street Commercial |
$543.40
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$554.84
|
| Rate for Payer: Cigna of WY Commercial |
$560.56
|
| Rate for Payer: First Choice Health Commercial |
$514.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.40
|
| Rate for Payer: HealthUtah PPO |
$572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$554.84
|
| Rate for Payer: One Health Plan of WY PPO |
$560.56
|
| Rate for Payer: PacificSource Commercial |
$514.80
|
| Rate for Payer: PHCS PPO |
$543.40
|
| Rate for Payer: Three Rivers PPO |
$429.00
|
| Rate for Payer: United Healthcare Commercial |
$497.64
|
| Rate for Payer: WINHealth Partners Commercial |
$543.40
|
|
|
HC PRO INJ,LUMB EPIDUR,BLOOD/CLOT PATCH
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
9836227301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$108.47
|
| Rate for Payer: Beech Street Commercial |
$555.75
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: First Choice Health Commercial |
$526.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.47
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$92.20
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$555.75
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.47
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$108.47
|
| Rate for Payer: WINHealth Partners Commercial |
$497.25
|
|
|
HC PRO INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
9832335001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$1,018.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$997.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$47.28
|
| Rate for Payer: Aetna of WY Medicare |
$47.28
|
| Rate for Payer: Beech Street Commercial |
$597.55
|
| Rate for Payer: Beech Street Commercial |
$967.10
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: Cash Price |
$712.60
|
| Rate for Payer: Cash Price |
$712.60
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$987.46
|
| Rate for Payer: Cigna of WY Commercial |
$997.64
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: First Choice Health Commercial |
$566.10
|
| Rate for Payer: First Choice Health Commercial |
$916.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$967.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.28
|
| Rate for Payer: HealthUtah PPO |
$1,018.00
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$987.46
|
| Rate for Payer: Multiplan Medicare/VA |
$40.19
|
| Rate for Payer: Multiplan Medicare/VA |
$40.19
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: One Health Plan of WY PPO |
$997.64
|
| Rate for Payer: PacificSource Commercial |
$916.20
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$967.10
|
| Rate for Payer: PHCS PPO |
$597.55
|
| Rate for Payer: Three Rivers PPO |
$763.50
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$47.28
|
| Rate for Payer: TriWest Veterans Administration |
$47.28
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Commercial |
$885.66
|
| Rate for Payer: United Healthcare Medicare |
$47.28
|
| Rate for Payer: United Healthcare Medicare |
$47.28
|
| Rate for Payer: WINHealth Partners Commercial |
$865.30
|
| Rate for Payer: WINHealth Partners Commercial |
$534.65
|
|
|
HC PRO INSERT CATH ARTERIAL PERCUTANEOUS
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
9833662001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$41.80
|
| Rate for Payer: Beech Street Commercial |
$156.75
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: First Choice Health Commercial |
$148.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.80
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.53
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$156.75
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$41.80
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$41.80
|
| Rate for Payer: WINHealth Partners Commercial |
$140.25
|
|
|
HC PRO INSERT DRUG IMPLANT DEVICE
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
9831198101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$50.52 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$59.44
|
| Rate for Payer: Beech Street Commercial |
$305.90
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: First Choice Health Commercial |
$289.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.44
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$50.52
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$305.90
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.44
|
| Rate for Payer: United Healthcare Commercial |
$280.14
|
| Rate for Payer: United Healthcare Medicare |
$59.44
|
| Rate for Payer: WINHealth Partners Commercial |
$273.70
|
|
|
HC PRO INSERT EMERGENCY ENDOTRACH AIRWAY
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
9833150001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$638.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$132.87
|
| Rate for Payer: Aetna of WY Medicare |
$132.87
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Beech Street Commercial |
$619.40
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$632.44
|
| Rate for Payer: Cigna of WY Commercial |
$638.96
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: First Choice Health Commercial |
$586.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$619.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.87
|
| Rate for Payer: HealthUtah PPO |
$652.00
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$632.44
|
| Rate for Payer: Multiplan Medicare/VA |
$112.94
|
| Rate for Payer: Multiplan Medicare/VA |
$112.94
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: One Health Plan of WY PPO |
$638.96
|
| Rate for Payer: PacificSource Commercial |
$586.80
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$619.40
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$489.00
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.87
|
| Rate for Payer: TriWest Veterans Administration |
$132.87
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
| Rate for Payer: United Healthcare Medicare |
$132.87
|
| Rate for Payer: United Healthcare Medicare |
$132.87
|
| Rate for Payer: WINHealth Partners Commercial |
$554.20
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
HC PRO INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
9835830001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$261.75 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.02
|
| Rate for Payer: Beech Street Commercial |
$331.55
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$338.53
|
| Rate for Payer: Cigna of WY Commercial |
$342.02
|
| Rate for Payer: First Choice Health Commercial |
$314.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$331.55
|
| Rate for Payer: HealthUtah PPO |
$349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$338.53
|
| Rate for Payer: One Health Plan of WY PPO |
$342.02
|
| Rate for Payer: PacificSource Commercial |
$314.10
|
| Rate for Payer: PHCS PPO |
$331.55
|
| Rate for Payer: Three Rivers PPO |
$261.75
|
| Rate for Payer: United Healthcare Commercial |
$303.63
|
| Rate for Payer: WINHealth Partners Commercial |
$296.65
|
|
|
HC PRO INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 58300 NONPBBPAYER
|
| Hospital Charge Code |
9835830001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.28
|
| Rate for Payer: Beech Street Commercial |
$414.20
|
| Rate for Payer: Cash Price |
$305.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$422.92
|
| Rate for Payer: Cigna of WY Commercial |
$427.28
|
| Rate for Payer: First Choice Health Commercial |
$392.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.20
|
| Rate for Payer: HealthUtah PPO |
$436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.92
|
| Rate for Payer: One Health Plan of WY PPO |
$427.28
|
| Rate for Payer: PacificSource Commercial |
$392.40
|
| Rate for Payer: PHCS PPO |
$414.20
|
| Rate for Payer: Three Rivers PPO |
$327.00
|
| Rate for Payer: United Healthcare Commercial |
$379.32
|
| Rate for Payer: WINHealth Partners Commercial |
$370.60
|
|
|
HC PRO INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
9835920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.58
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$35.34
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$41.58
|
| Rate for Payer: United Healthcare Commercial |
$93.96
|
| Rate for Payer: United Healthcare Medicare |
$41.58
|
| Rate for Payer: WINHealth Partners Commercial |
$91.80
|
|
|
HC PRO INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 59200 NONPBBPAYER
|
| Hospital Charge Code |
9835920001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Beech Street Commercial |
$128.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: First Choice Health Commercial |
$121.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.58
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$35.34
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$128.25
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.58
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$41.58
|
| Rate for Payer: WINHealth Partners Commercial |
$114.75
|
|
|
HC PRO INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 20650 NONPBBPAYER
|
| Hospital Charge Code |
9832065001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Aetna of WY Medicare |
$162.52
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.52
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: Multiplan Medicare/VA |
$138.14
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.52
|
| Rate for Payer: United Healthcare Commercial |
$702.96
|
| Rate for Payer: United Healthcare Medicare |
$162.52
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
