|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
9836232701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$103.07
|
| Rate for Payer: Beech Street Commercial |
$492.10
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: First Choice Health Commercial |
$466.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.07
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$87.61
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$492.10
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.07
|
| Rate for Payer: United Healthcare Commercial |
$450.66
|
| Rate for Payer: United Healthcare Medicare |
$103.07
|
| Rate for Payer: WINHealth Partners Commercial |
$440.30
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 62327 50
|
| Hospital Charge Code |
9836232701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,016.26
|
| Rate for Payer: Aetna of WY Medicare |
$103.07
|
| Rate for Payer: Beech Street Commercial |
$985.15
|
| Rate for Payer: Cash Price |
$725.90
|
| Rate for Payer: Cash Price |
$725.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,005.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,016.26
|
| Rate for Payer: First Choice Health Commercial |
$933.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$985.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.07
|
| Rate for Payer: HealthUtah PPO |
$1,037.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,005.89
|
| Rate for Payer: Multiplan Medicare/VA |
$87.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,016.26
|
| Rate for Payer: PacificSource Commercial |
$933.30
|
| Rate for Payer: PHCS PPO |
$985.15
|
| Rate for Payer: Three Rivers PPO |
$777.75
|
| Rate for Payer: TriWest Veterans Administration |
$103.07
|
| Rate for Payer: United Healthcare Commercial |
$902.19
|
| Rate for Payer: United Healthcare Medicare |
$103.07
|
| Rate for Payer: WINHealth Partners Commercial |
$881.45
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
9836232301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.07 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$95.38
|
| 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 |
$95.38
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$81.07
|
| 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 |
$95.38
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$95.38
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
9836232201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.28
|
| Rate for Payer: Aetna of WY Medicare |
$75.82
|
| Rate for Payer: Beech Street Commercial |
$414.20
|
| Rate for Payer: Cash Price |
$305.20
|
| 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: Government Employees Health Association (GEHA) Medicare |
$75.82
|
| Rate for Payer: HealthUtah PPO |
$436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.92
|
| Rate for Payer: Multiplan Medicare/VA |
$64.45
|
| 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: TriWest Veterans Administration |
$75.82
|
| Rate for Payer: United Healthcare Commercial |
$379.32
|
| Rate for Payer: United Healthcare Medicare |
$75.82
|
| Rate for Payer: WINHealth Partners Commercial |
$370.60
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 62322 50
|
| Hospital Charge Code |
9836232201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$855.54
|
| Rate for Payer: Aetna of WY Medicare |
$75.82
|
| Rate for Payer: Beech Street Commercial |
$829.35
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$846.81
|
| Rate for Payer: Cigna of WY Commercial |
$855.54
|
| Rate for Payer: First Choice Health Commercial |
$785.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$829.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.82
|
| Rate for Payer: HealthUtah PPO |
$873.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$846.81
|
| Rate for Payer: Multiplan Medicare/VA |
$64.45
|
| Rate for Payer: One Health Plan of WY PPO |
$855.54
|
| Rate for Payer: PacificSource Commercial |
$785.70
|
| Rate for Payer: PHCS PPO |
$829.35
|
| Rate for Payer: Three Rivers PPO |
$654.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.82
|
| Rate for Payer: United Healthcare Commercial |
$759.51
|
| Rate for Payer: United Healthcare Medicare |
$75.82
|
| Rate for Payer: WINHealth Partners Commercial |
$742.05
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$1,364.00
|
|
|
Service Code
|
HCPCS 62326 50
|
| Hospital Charge Code |
9836232601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$1,364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,336.72
|
| Rate for Payer: Aetna of WY Medicare |
$81.48
|
| Rate for Payer: Beech Street Commercial |
$1,295.80
|
| Rate for Payer: Cash Price |
$954.80
|
| Rate for Payer: Cash Price |
$954.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,323.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,336.72
|
| Rate for Payer: First Choice Health Commercial |
$1,227.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,295.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.48
|
| Rate for Payer: HealthUtah PPO |
$1,364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,323.08
|
| Rate for Payer: Multiplan Medicare/VA |
$69.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,336.72
|
| Rate for Payer: PacificSource Commercial |
$1,227.60
|
| Rate for Payer: PHCS PPO |
$1,295.80
|
| Rate for Payer: Three Rivers PPO |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.48
|
| Rate for Payer: United Healthcare Commercial |
$1,186.68
|
| Rate for Payer: United Healthcare Medicare |
$81.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,159.40
|
|
|
HC PRO NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
9836232601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$81.48
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.48
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$69.26
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$81.48
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$81.48
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
HC PRO NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
9830232T01
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Beech Street Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: First Choice Health Commercial |
$450.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$475.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
|
|
HC PRO NURSING FAC DISCHRGE DAY,MORE 30 MIN
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
9839931602
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$264.10
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: First Choice Health Commercial |
$250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$264.10
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$241.86
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$264.10
|
|
|
HC PRO NURSING FAC DISCHRGE DAY,MORE 30 MIN
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
9839931601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$264.10
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: First Choice Health Commercial |
$250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$264.10
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$241.86
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$264.10
|
|
|
HC PRO OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 99217
|
| Hospital Charge Code |
9839921701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$389.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Beech Street Commercial |
$209.95
|
| Rate for Payer: Beech Street Commercial |
$377.15
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: First Choice Health Commercial |
$198.90
|
| Rate for Payer: First Choice Health Commercial |
$357.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: HealthUtah PPO |
$81.84
|
| Rate for Payer: HealthUtah PPO |
$81.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PHCS PPO |
$377.15
|
| Rate for Payer: PHCS PPO |
$209.95
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: WINHealth Partners Commercial |
$377.15
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
9839923402
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.48 |
| Max. Negotiated Rate |
$312.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$93.51
|
| 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 |
$93.51
|
| Rate for Payer: HealthUtah PPO |
$165.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$79.48
|
| 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 |
$93.51
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$93.51
|
| Rate for Payer: WINHealth Partners Commercial |
$303.05
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
9839923401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.48 |
| Max. Negotiated Rate |
$635.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$635.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$93.51
|
| Rate for Payer: Aetna of WY Medicare |
$93.51
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Beech Street Commercial |
$615.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$628.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: Cigna of WY Commercial |
$635.04
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: First Choice Health Commercial |
$583.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$615.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.51
|
| Rate for Payer: HealthUtah PPO |
$165.34
|
| Rate for Payer: HealthUtah PPO |
$165.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$628.56
|
| Rate for Payer: Multiplan Medicare/VA |
$79.48
|
| Rate for Payer: Multiplan Medicare/VA |
$79.48
|
| Rate for Payer: One Health Plan of WY PPO |
$635.04
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PacificSource Commercial |
$583.20
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: PHCS PPO |
$615.60
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: Three Rivers PPO |
$486.00
|
| Rate for Payer: TriWest Veterans Administration |
$93.51
|
| Rate for Payer: TriWest Veterans Administration |
$93.51
|
| Rate for Payer: United Healthcare Commercial |
$563.76
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$93.51
|
| Rate for Payer: United Healthcare Medicare |
$93.51
|
| Rate for Payer: WINHealth Partners Commercial |
$303.05
|
| Rate for Payer: WINHealth Partners Commercial |
$615.60
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
9839923502
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.91 |
| Max. Negotiated Rate |
$420.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$420.42
|
| Rate for Payer: Aetna of WY Medicare |
$152.83
|
| Rate for Payer: Beech Street Commercial |
$407.55
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$416.13
|
| Rate for Payer: Cigna of WY Commercial |
$420.42
|
| Rate for Payer: First Choice Health Commercial |
$386.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$407.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.83
|
| Rate for Payer: HealthUtah PPO |
$218.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$416.13
|
| Rate for Payer: Multiplan Medicare/VA |
$129.91
|
| Rate for Payer: One Health Plan of WY PPO |
$420.42
|
| Rate for Payer: PacificSource Commercial |
$386.10
|
| Rate for Payer: PHCS PPO |
$407.55
|
| Rate for Payer: Three Rivers PPO |
$321.75
|
| Rate for Payer: TriWest Veterans Administration |
$152.83
|
| Rate for Payer: United Healthcare Commercial |
$373.23
|
| Rate for Payer: United Healthcare Medicare |
$152.83
|
| Rate for Payer: WINHealth Partners Commercial |
$407.55
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
9839923501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.91 |
| Max. Negotiated Rate |
$420.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$420.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$897.68
|
| Rate for Payer: Aetna of WY Medicare |
$152.83
|
| Rate for Payer: Aetna of WY Medicare |
$152.83
|
| Rate for Payer: Beech Street Commercial |
$407.55
|
| Rate for Payer: Beech Street Commercial |
$870.20
|
| Rate for Payer: Cash Price |
$641.20
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$641.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$888.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$416.13
|
| Rate for Payer: Cigna of WY Commercial |
$897.68
|
| Rate for Payer: Cigna of WY Commercial |
$420.42
|
| Rate for Payer: First Choice Health Commercial |
$386.10
|
| Rate for Payer: First Choice Health Commercial |
$824.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$870.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$407.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.83
|
| Rate for Payer: HealthUtah PPO |
$218.89
|
| Rate for Payer: HealthUtah PPO |
$218.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$888.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$416.13
|
| Rate for Payer: Multiplan Medicare/VA |
$129.91
|
| Rate for Payer: Multiplan Medicare/VA |
$129.91
|
| Rate for Payer: One Health Plan of WY PPO |
$420.42
|
| Rate for Payer: One Health Plan of WY PPO |
$897.68
|
| Rate for Payer: PacificSource Commercial |
$824.40
|
| Rate for Payer: PacificSource Commercial |
$386.10
|
| Rate for Payer: PHCS PPO |
$407.55
|
| Rate for Payer: PHCS PPO |
$870.20
|
| Rate for Payer: Three Rivers PPO |
$687.00
|
| Rate for Payer: Three Rivers PPO |
$321.75
|
| Rate for Payer: TriWest Veterans Administration |
$152.83
|
| Rate for Payer: TriWest Veterans Administration |
$152.83
|
| Rate for Payer: United Healthcare Commercial |
$373.23
|
| Rate for Payer: United Healthcare Commercial |
$796.92
|
| Rate for Payer: United Healthcare Medicare |
$152.83
|
| Rate for Payer: United Healthcare Medicare |
$152.83
|
| Rate for Payer: WINHealth Partners Commercial |
$870.20
|
| Rate for Payer: WINHealth Partners Commercial |
$407.55
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
9839923602
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$528.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$528.22
|
| Rate for Payer: Aetna of WY Medicare |
$199.62
|
| Rate for Payer: Beech Street Commercial |
$512.05
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$522.83
|
| Rate for Payer: Cigna of WY Commercial |
$528.22
|
| Rate for Payer: First Choice Health Commercial |
$485.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$512.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.62
|
| Rate for Payer: HealthUtah PPO |
$272.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$522.83
|
| Rate for Payer: Multiplan Medicare/VA |
$169.68
|
| Rate for Payer: One Health Plan of WY PPO |
$528.22
|
| Rate for Payer: PacificSource Commercial |
$485.10
|
| Rate for Payer: PHCS PPO |
$512.05
|
| Rate for Payer: Three Rivers PPO |
$404.25
|
| Rate for Payer: TriWest Veterans Administration |
$199.62
|
| Rate for Payer: United Healthcare Commercial |
$468.93
|
| Rate for Payer: United Healthcare Medicare |
$199.62
|
| Rate for Payer: WINHealth Partners Commercial |
$512.05
|
|
|
HC PRO OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
9839923601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$1,522.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,522.92
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$528.22
|
| Rate for Payer: Aetna of WY Medicare |
$199.62
|
| Rate for Payer: Aetna of WY Medicare |
$199.62
|
| Rate for Payer: Beech Street Commercial |
$1,476.30
|
| Rate for Payer: Beech Street Commercial |
$512.05
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$1,087.80
|
| Rate for Payer: Cash Price |
$1,087.80
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$522.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,507.38
|
| Rate for Payer: Cigna of WY Commercial |
$528.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,522.92
|
| Rate for Payer: First Choice Health Commercial |
$1,398.60
|
| Rate for Payer: First Choice Health Commercial |
$485.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$512.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,476.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.62
|
| Rate for Payer: HealthUtah PPO |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$272.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$522.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,507.38
|
| Rate for Payer: Multiplan Medicare/VA |
$169.68
|
| Rate for Payer: Multiplan Medicare/VA |
$169.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,522.92
|
| Rate for Payer: One Health Plan of WY PPO |
$528.22
|
| Rate for Payer: PacificSource Commercial |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$1,398.60
|
| Rate for Payer: PHCS PPO |
$1,476.30
|
| Rate for Payer: PHCS PPO |
$512.05
|
| Rate for Payer: Three Rivers PPO |
$404.25
|
| Rate for Payer: Three Rivers PPO |
$1,165.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.62
|
| Rate for Payer: TriWest Veterans Administration |
$199.62
|
| Rate for Payer: United Healthcare Commercial |
$1,351.98
|
| Rate for Payer: United Healthcare Commercial |
$468.93
|
| Rate for Payer: United Healthcare Medicare |
$199.62
|
| Rate for Payer: United Healthcare Medicare |
$199.62
|
| Rate for Payer: WINHealth Partners Commercial |
$512.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,476.30
|
|
|
HC PRO OBSTETRICAL CARE,VAG DELIV ONLY
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
9835940901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$639.85 |
| Max. Negotiated Rate |
$2,383.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.36
|
| Rate for Payer: Aetna of WY Medicare |
$752.77
|
| Rate for Payer: Beech Street Commercial |
$2,310.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.04
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.36
|
| Rate for Payer: First Choice Health Commercial |
$2,188.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$752.77
|
| Rate for Payer: HealthUtah PPO |
$1,406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.04
|
| Rate for Payer: Multiplan Medicare/VA |
$639.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.36
|
| Rate for Payer: PacificSource Commercial |
$2,188.80
|
| Rate for Payer: PHCS PPO |
$2,310.40
|
| Rate for Payer: Three Rivers PPO |
$1,824.00
|
| Rate for Payer: TriWest Veterans Administration |
$752.77
|
| Rate for Payer: United Healthcare Commercial |
$2,115.84
|
| Rate for Payer: United Healthcare Medicare |
$752.77
|
| Rate for Payer: WINHealth Partners Commercial |
$2,067.20
|
|
|
HC PRO OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
983Q009101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$39.90
|
| 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: Cigna of WY Commercial |
$41.16
|
| 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) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$39.90
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
|
|
HC PRO OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 76805 26
|
| Hospital Charge Code |
9727680501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$396.90
|
| Rate for Payer: Aetna of WY Medicare |
$45.50
|
| Rate for Payer: Beech Street Commercial |
$384.75
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$392.85
|
| Rate for Payer: Cigna of WY Commercial |
$396.90
|
| Rate for Payer: First Choice Health Commercial |
$364.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.50
|
| Rate for Payer: HealthUtah PPO |
$405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$392.85
|
| Rate for Payer: Multiplan Medicare/VA |
$38.68
|
| Rate for Payer: One Health Plan of WY PPO |
$396.90
|
| Rate for Payer: PacificSource Commercial |
$364.50
|
| Rate for Payer: PHCS PPO |
$384.75
|
| Rate for Payer: Three Rivers PPO |
$303.75
|
| Rate for Payer: TriWest Veterans Administration |
$45.50
|
| Rate for Payer: United Healthcare Commercial |
$352.35
|
| Rate for Payer: United Healthcare Medicare |
$45.50
|
| Rate for Payer: WINHealth Partners Commercial |
$384.75
|
|
|
HC PRO OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 76816 26
|
| Hospital Charge Code |
9727681601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$39.12
|
| Rate for Payer: Beech Street Commercial |
$312.55
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: First Choice Health Commercial |
$296.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.12
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$33.25
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$312.55
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.12
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$39.12
|
| Rate for Payer: WINHealth Partners Commercial |
$312.55
|
|
|
HC PRO OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
9839924301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$402.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Beech Street Commercial |
$390.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: First Choice Health Commercial |
$369.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$390.45
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: WINHealth Partners Commercial |
$390.45
|
|
|
HC PRO OFFICE OUTPATIENT NEW 15-29 MINUTES
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 99202 NONPBBPAYER
|
| Hospital Charge Code |
9839920201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$195.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$45.49
|
| Rate for Payer: Beech Street Commercial |
$189.05
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: First Choice Health Commercial |
$179.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.49
|
| Rate for Payer: HealthUtah PPO |
$77.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$38.67
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$189.05
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$45.49
|
| Rate for Payer: United Healthcare Commercial |
$173.13
|
| Rate for Payer: United Healthcare Medicare |
$45.49
|
| Rate for Payer: WINHealth Partners Commercial |
$189.05
|
|
|
HC PRO OFFICE OUTPATIENT NEW 15-29 MINUTES
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
9839920201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$155.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$45.49
|
| Rate for Payer: Beech Street Commercial |
$151.05
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: First Choice Health Commercial |
$143.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.49
|
| Rate for Payer: HealthUtah PPO |
$77.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$38.67
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$151.05
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$45.49
|
| Rate for Payer: United Healthcare Commercial |
$138.33
|
| Rate for Payer: United Healthcare Medicare |
$45.49
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
|
|
HC PRO OFFICE OUTPATIENT NEW 30-44 MINUTES
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
9839920301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$232.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$232.26
|
| Rate for Payer: Aetna of WY Medicare |
$78.53
|
| Rate for Payer: Beech Street Commercial |
$225.15
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$229.89
|
| Rate for Payer: Cigna of WY Commercial |
$232.26
|
| Rate for Payer: First Choice Health Commercial |
$213.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$225.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.53
|
| Rate for Payer: HealthUtah PPO |
$115.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$229.89
|
| Rate for Payer: Multiplan Medicare/VA |
$66.75
|
| Rate for Payer: One Health Plan of WY PPO |
$232.26
|
| Rate for Payer: PacificSource Commercial |
$213.30
|
| Rate for Payer: PHCS PPO |
$225.15
|
| Rate for Payer: Three Rivers PPO |
$177.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.53
|
| Rate for Payer: United Healthcare Commercial |
$206.19
|
| Rate for Payer: United Healthcare Medicare |
$78.53
|
| Rate for Payer: WINHealth Partners Commercial |
$225.15
|
|
