|
INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
36471
|
| Min. Negotiated Rate |
$59.89 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$386.12
|
| Rate for Payer: Aetna of WY Medicare |
$70.46
|
| Rate for Payer: Beech Street Commercial |
$374.30
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$382.18
|
| Rate for Payer: Cigna of WY Commercial |
$386.12
|
| Rate for Payer: First Choice Health Commercial |
$354.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.46
|
| Rate for Payer: HealthUtah PPO |
$394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$382.18
|
| Rate for Payer: Multiplan Medicare/VA |
$59.89
|
| Rate for Payer: One Health Plan of WY PPO |
$386.12
|
| Rate for Payer: PacificSource Commercial |
$354.60
|
| Rate for Payer: PHCS PPO |
$374.30
|
| Rate for Payer: Three Rivers PPO |
$295.50
|
| Rate for Payer: TriWest Veterans Administration |
$70.46
|
| Rate for Payer: United Healthcare Commercial |
$342.78
|
| Rate for Payer: United Healthcare Medicare |
$70.46
|
| Rate for Payer: WINHealth Partners Commercial |
$334.90
|
|
|
INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
36470
|
| Min. Negotiated Rate |
$30.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$35.39
|
| Rate for Payer: Beech Street Commercial |
$185.25
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: First Choice Health Commercial |
$175.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.39
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$30.08
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$185.25
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.39
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$35.39
|
| Rate for Payer: WINHealth Partners Commercial |
$165.75
|
|
|
INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 46500
|
| Hospital Charge Code |
46500
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,967.84
|
| Rate for Payer: Aetna of WY Medicare |
$179.18
|
| Rate for Payer: Beech Street Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,947.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,967.84
|
| Rate for Payer: First Choice Health Commercial |
$1,807.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,907.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.18
|
| Rate for Payer: HealthUtah PPO |
$2,008.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,947.76
|
| Rate for Payer: Multiplan Medicare/VA |
$152.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,967.84
|
| Rate for Payer: PacificSource Commercial |
$1,807.20
|
| Rate for Payer: PHCS PPO |
$1,907.60
|
| Rate for Payer: Three Rivers PPO |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.18
|
| Rate for Payer: United Healthcare Commercial |
$1,746.96
|
| Rate for Payer: United Healthcare Medicare |
$179.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,706.80
|
|
|
INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
23350
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$47.28
|
| Rate for Payer: Beech Street Commercial |
$597.55
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: First Choice Health Commercial |
$566.10
|
| 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: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$40.19
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$597.55
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$47.28
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Medicare |
$47.28
|
| Rate for Payer: WINHealth Partners Commercial |
$534.65
|
|
|
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
20552
|
| 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
|
|
|
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
20553
|
| 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
|
|
|
INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
20551
|
| 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
|
|
|
INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 20500
|
| Hospital Charge Code |
20500
|
| Min. Negotiated Rate |
$73.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$438.06
|
| Rate for Payer: Aetna of WY Medicare |
$86.80
|
| Rate for Payer: Beech Street Commercial |
$424.65
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.59
|
| Rate for Payer: Cigna of WY Commercial |
$438.06
|
| Rate for Payer: First Choice Health Commercial |
$402.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.80
|
| Rate for Payer: HealthUtah PPO |
$447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.59
|
| Rate for Payer: Multiplan Medicare/VA |
$73.78
|
| Rate for Payer: One Health Plan of WY PPO |
$438.06
|
| Rate for Payer: PacificSource Commercial |
$402.30
|
| Rate for Payer: PHCS PPO |
$424.65
|
| Rate for Payer: Three Rivers PPO |
$335.25
|
| Rate for Payer: TriWest Veterans Administration |
$86.80
|
| Rate for Payer: United Healthcare Commercial |
$388.89
|
| Rate for Payer: United Healthcare Medicare |
$86.80
|
| Rate for Payer: WINHealth Partners Commercial |
$379.95
|
|
|
INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
36468
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Beech Street Commercial |
$418.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: First Choice Health Commercial |
$396.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$418.00
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$374.00
|
|
|
INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 21116
|
| Hospital Charge Code |
21116
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$42.54
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.54
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Multiplan Medicare/VA |
$36.16
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.54
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Medicare |
$42.54
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 20526 50
|
| Hospital Charge Code |
20526
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$561.54
|
| Rate for Payer: Aetna of WY Medicare |
$54.21
|
| Rate for Payer: Beech Street Commercial |
$544.35
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.81
|
| Rate for Payer: Cigna of WY Commercial |
$561.54
|
| Rate for Payer: First Choice Health Commercial |
$515.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$544.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.21
|
| Rate for Payer: HealthUtah PPO |
$573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.81
|
| Rate for Payer: Multiplan Medicare/VA |
$46.08
|
| Rate for Payer: One Health Plan of WY PPO |
$561.54
|
| Rate for Payer: PacificSource Commercial |
$515.70
|
| Rate for Payer: PHCS PPO |
$544.35
|
| Rate for Payer: Three Rivers PPO |
$429.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.21
|
| Rate for Payer: United Healthcare Commercial |
$498.51
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
| Rate for Payer: WINHealth Partners Commercial |
$487.05
|
|
|
INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
20526
|
| 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
|
|
|
INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 27096 50
|
| Hospital Charge Code |
27096
|
| 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
|
|
|
INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
27096
|
| 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 Medicare |
$79.68
|
| Rate for Payer: Beech Street Commercial |
$543.40
|
| Rate for Payer: Cash Price |
$400.40
|
| 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: Government Employees Health Association (GEHA) Medicare |
$79.68
|
| Rate for Payer: HealthUtah PPO |
$572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$554.84
|
| Rate for Payer: Multiplan Medicare/VA |
$67.73
|
| 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: TriWest Veterans Administration |
$79.68
|
| Rate for Payer: United Healthcare Commercial |
$497.64
|
| Rate for Payer: United Healthcare Medicare |
$79.68
|
| Rate for Payer: WINHealth Partners Commercial |
$486.20
|
|
|
INJ ENOXAPARIN SODIUM
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
J1650
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$0.62
|
| Rate for Payer: Beech Street Commercial |
$23.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: First Choice Health Commercial |
$22.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.62
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$23.75
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
|
|
INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
G0260
|
| 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
|
|
|
INJ FOR SACROILIAC JT ANESTH
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS G0260 50
|
| Hospital Charge Code |
G0260
|
| 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
|
|
|
INJ LUMBAR/SACRAL, W/WO CNTRST
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 62311
|
| Hospital Charge Code |
62311
|
| Min. Negotiated Rate |
$1,723.50 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,252.04
|
| Rate for Payer: Beech Street Commercial |
$2,183.10
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,229.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,252.04
|
| Rate for Payer: First Choice Health Commercial |
$2,068.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,183.10
|
| Rate for Payer: HealthUtah PPO |
$2,298.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,229.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,252.04
|
| Rate for Payer: PacificSource Commercial |
$2,068.20
|
| Rate for Payer: PHCS PPO |
$2,183.10
|
| Rate for Payer: Three Rivers PPO |
$1,723.50
|
| Rate for Payer: United Healthcare Commercial |
$1,999.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,953.30
|
|
|
INJ METHOTREXATE SODIUM 50MG
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
J9260
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Beech Street Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: First Choice Health Commercial |
$12.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.19
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.30
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
|
|
INJ NALBUPHINE HYDROCHLORIDE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
J2300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$2.82
|
| Rate for Payer: Beech Street Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: First Choice Health Commercial |
$12.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.82
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.40
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.30
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.82
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$2.82
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
|
|
INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
38792
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,799.28
|
| Rate for Payer: Aetna of WY Medicare |
$30.42
|
| Rate for Payer: Beech Street Commercial |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,780.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,799.28
|
| Rate for Payer: First Choice Health Commercial |
$1,652.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,744.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.42
|
| Rate for Payer: HealthUtah PPO |
$1,836.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,780.92
|
| Rate for Payer: Multiplan Medicare/VA |
$25.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,799.28
|
| Rate for Payer: PacificSource Commercial |
$1,652.40
|
| Rate for Payer: PHCS PPO |
$1,744.20
|
| Rate for Payer: Three Rivers PPO |
$1,377.00
|
| Rate for Payer: TriWest Veterans Administration |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$1,597.32
|
| Rate for Payer: United Healthcare Medicare |
$30.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,560.60
|
|
|
INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
64530
|
| 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
|
|
|
INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 62281
|
| Hospital Charge Code |
62281
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$807.52
|
| Rate for Payer: Aetna of WY Medicare |
$149.97
|
| Rate for Payer: Beech Street Commercial |
$782.80
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$799.28
|
| Rate for Payer: Cigna of WY Commercial |
$807.52
|
| Rate for Payer: First Choice Health Commercial |
$741.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$782.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.97
|
| Rate for Payer: HealthUtah PPO |
$824.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$799.28
|
| Rate for Payer: Multiplan Medicare/VA |
$127.47
|
| Rate for Payer: One Health Plan of WY PPO |
$807.52
|
| Rate for Payer: PacificSource Commercial |
$741.60
|
| Rate for Payer: PHCS PPO |
$782.80
|
| Rate for Payer: Three Rivers PPO |
$618.00
|
| Rate for Payer: TriWest Veterans Administration |
$149.97
|
| Rate for Payer: United Healthcare Commercial |
$716.88
|
| Rate for Payer: United Healthcare Medicare |
$149.97
|
| Rate for Payer: WINHealth Partners Commercial |
$700.40
|
|
|
INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
59200
|
| 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
|
|
|
INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
11981
|
| 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
|
|
