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  5. /Fee schedule
CPT G9877

2 em core ms mo 10-12 no wl

Reported by 18 hospitals in the network under the fee schedule methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

$18

Average

$166

Median

$213

High

$213

Hospitals reporting this code

#HospitalLocationApproximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price.
1IHC Health Services Inc., DBA Intermountain Health Intermountain Medical CenterMurray, UT$220$213$15—$193$231
2IHC Health Services Inc., DBA Intermountain Health Utah Valley HospitalProvo, UT$220$213$15—$193$231
3IHC Health Services Inc., DBA Intermountain Health McKay-Dee HospitalOgden, UT$220$213$15—$193$231
4IHC Health Services Inc., DBA Intermountain Health St George Regional HospitalSt. George, UT$193$193——$193$193
5IHC Health Services Inc., DBA Intermountain Health LDS HospitalSalt Lake City, UT$220$213$15—$193$231
6IHC Health Services Inc., DBA Intermountain Health Logan Regional HospitalLogan, UT$184$184$9—$175$193
7IHC Health Services Inc., DBA Intermountain Health American Fork HospitalAmerican Fork, UT$220$213$15—$193$231
8IHC Health Services Inc., DBA Intermountain Health Layton HospitalLayton, UT$220$213$15—$193$231
9IHC Health Services, Inc,. DBA Intermountain Health Alta View HospitalSandy, UT$220$213$15—$193$231
10IHC Health Services Inc., DBA Intermountain Health Riverton HospitalRiverton, UT$220$213$15—$193$231
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