|
CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 23545
|
| Min. Negotiated Rate |
$276.56 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,293.60
|
| Rate for Payer: Aetna of WY Medicare |
$325.37
|
| Rate for Payer: Beech Street Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,280.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,293.60
|
| Rate for Payer: First Choice Health Commercial |
$1,188.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,254.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.37
|
| Rate for Payer: HealthUtah PPO |
$1,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,280.40
|
| Rate for Payer: Multiplan Medicare/VA |
$276.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,293.60
|
| Rate for Payer: PacificSource Commercial |
$1,188.00
|
| Rate for Payer: PHCS PPO |
$1,254.00
|
| Rate for Payer: Three Rivers PPO |
$990.00
|
| Rate for Payer: TriWest Veterans Administration |
$325.37
|
| Rate for Payer: United Healthcare Commercial |
$1,254.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,122.00
|
|
|
CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$239.27
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: First Choice Health Commercial |
$885.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.27
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$203.38
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$239.27
|
| Rate for Payer: United Healthcare Commercial |
$934.80
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.88
|
| Rate for Payer: Aetna of WY Medicare |
$231.34
|
| Rate for Payer: Beech Street Commercial |
$908.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$927.32
|
| Rate for Payer: Cigna of WY Commercial |
$936.88
|
| Rate for Payer: First Choice Health Commercial |
$860.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$908.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.34
|
| Rate for Payer: HealthUtah PPO |
$956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$927.32
|
| Rate for Payer: Multiplan Medicare/VA |
$196.64
|
| Rate for Payer: One Health Plan of WY PPO |
$936.88
|
| Rate for Payer: PacificSource Commercial |
$860.40
|
| Rate for Payer: PHCS PPO |
$908.20
|
| Rate for Payer: Three Rivers PPO |
$717.00
|
| Rate for Payer: TriWest Veterans Administration |
$231.34
|
| Rate for Payer: United Healthcare Commercial |
$908.20
|
| Rate for Payer: WINHealth Partners Commercial |
$812.60
|
|
|
CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$286.67 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Aetna of WY Medicare |
$337.26
|
| Rate for Payer: Beech Street Commercial |
$1,378.45
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: First Choice Health Commercial |
$1,305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.26
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$286.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PHCS PPO |
$1,378.45
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$337.26
|
| Rate for Payer: United Healthcare Commercial |
$1,378.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,233.35
|
|
|
CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 27197
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.72
|
| Rate for Payer: Aetna of WY Medicare |
$129.64
|
| Rate for Payer: Beech Street Commercial |
$535.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$547.08
|
| Rate for Payer: Cigna of WY Commercial |
$552.72
|
| Rate for Payer: First Choice Health Commercial |
$507.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.64
|
| Rate for Payer: HealthUtah PPO |
$564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$547.08
|
| Rate for Payer: Multiplan Medicare/VA |
$110.19
|
| Rate for Payer: One Health Plan of WY PPO |
$552.72
|
| Rate for Payer: PacificSource Commercial |
$507.60
|
| Rate for Payer: PHCS PPO |
$535.80
|
| Rate for Payer: Three Rivers PPO |
$423.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
| Rate for Payer: WINHealth Partners Commercial |
$479.40
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$1,722.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,687.56
|
| Rate for Payer: Aetna of WY Medicare |
$404.29
|
| Rate for Payer: Beech Street Commercial |
$1,635.90
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,670.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,687.56
|
| Rate for Payer: First Choice Health Commercial |
$1,549.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,635.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.29
|
| Rate for Payer: HealthUtah PPO |
$1,722.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,670.34
|
| Rate for Payer: Multiplan Medicare/VA |
$343.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,687.56
|
| Rate for Payer: PacificSource Commercial |
$1,549.80
|
| Rate for Payer: PHCS PPO |
$1,635.90
|
| Rate for Payer: Three Rivers PPO |
$1,291.50
|
| Rate for Payer: TriWest Veterans Administration |
$404.29
|
| Rate for Payer: United Healthcare Commercial |
$1,635.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,463.70
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,210.30
|
| Rate for Payer: Aetna of WY Medicare |
$301.56
|
| Rate for Payer: Beech Street Commercial |
$1,173.25
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,197.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,210.30
|
| Rate for Payer: First Choice Health Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,173.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.56
|
| Rate for Payer: HealthUtah PPO |
$1,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,197.95
|
| Rate for Payer: Multiplan Medicare/VA |
$256.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,210.30
|
| Rate for Payer: PacificSource Commercial |
$1,111.50
|
| Rate for Payer: PHCS PPO |
$1,173.25
|
| Rate for Payer: Three Rivers PPO |
$926.25
|
| Rate for Payer: TriWest Veterans Administration |
$301.56
|
| Rate for Payer: United Healthcare Commercial |
$1,173.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.75
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$4,477.00
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$4,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,387.46
|
| Rate for Payer: Aetna of WY Medicare |
$958.48
|
| Rate for Payer: Beech Street Commercial |
$4,253.15
|
| Rate for Payer: Cash Price |
$3,133.90
|
| Rate for Payer: Cash Price |
$3,133.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,342.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,387.46
|
| Rate for Payer: First Choice Health Commercial |
$4,029.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,253.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$958.48
|
| Rate for Payer: HealthUtah PPO |
$4,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,342.69
|
| Rate for Payer: Multiplan Medicare/VA |
$814.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4,387.46
|
| Rate for Payer: PacificSource Commercial |
$4,029.30
|
| Rate for Payer: PHCS PPO |
$4,253.15
|
| Rate for Payer: Three Rivers PPO |
$3,357.75
|
| Rate for Payer: TriWest Veterans Administration |
$958.48
|
| Rate for Payer: United Healthcare Commercial |
$4,253.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3,805.45
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$4,477.00
|
|
|
Service Code
|
HCPCS 44625 AS
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$4,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,387.46
|
| Rate for Payer: Beech Street Commercial |
$4,253.15
|
| Rate for Payer: Cash Price |
$3,133.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,342.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,387.46
|
| Rate for Payer: First Choice Health Commercial |
$4,029.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,253.15
|
| Rate for Payer: HealthUtah PPO |
$4,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,342.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,387.46
|
| Rate for Payer: PacificSource Commercial |
$4,029.30
|
| Rate for Payer: PHCS PPO |
$4,253.15
|
| Rate for Payer: Three Rivers PPO |
$3,357.75
|
| Rate for Payer: United Healthcare Commercial |
$4,253.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3,805.45
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$4,477.00
|
|
|
Service Code
|
HCPCS 44625 80
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$4,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,387.46
|
| Rate for Payer: Beech Street Commercial |
$4,253.15
|
| Rate for Payer: Cash Price |
$3,133.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,342.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,387.46
|
| Rate for Payer: First Choice Health Commercial |
$4,029.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,253.15
|
| Rate for Payer: HealthUtah PPO |
$4,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,342.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,387.46
|
| Rate for Payer: PacificSource Commercial |
$4,029.30
|
| Rate for Payer: PHCS PPO |
$4,253.15
|
| Rate for Payer: Three Rivers PPO |
$3,357.75
|
| Rate for Payer: United Healthcare Commercial |
$4,253.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3,805.45
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 44626 80
|
| Min. Negotiated Rate |
$785.25 |
| Max. Negotiated Rate |
$1,047.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,026.06
|
| Rate for Payer: Beech Street Commercial |
$994.65
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,015.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,026.06
|
| Rate for Payer: First Choice Health Commercial |
$942.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$994.65
|
| Rate for Payer: HealthUtah PPO |
$1,047.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,015.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,026.06
|
| Rate for Payer: PacificSource Commercial |
$942.30
|
| Rate for Payer: PHCS PPO |
$994.65
|
| Rate for Payer: Three Rivers PPO |
$785.25
|
| Rate for Payer: United Healthcare Commercial |
$994.65
|
| Rate for Payer: WINHealth Partners Commercial |
$889.95
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$4,838.00
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$4,838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,741.24
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$4,596.10
|
| Rate for Payer: Cash Price |
$3,386.60
|
| Rate for Payer: Cash Price |
$3,386.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,692.86
|
| Rate for Payer: Cigna of WY Commercial |
$4,741.24
|
| Rate for Payer: First Choice Health Commercial |
$4,354.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,596.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$4,838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,692.86
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$4,741.24
|
| Rate for Payer: PacificSource Commercial |
$4,354.20
|
| Rate for Payer: PHCS PPO |
$4,596.10
|
| Rate for Payer: Three Rivers PPO |
$3,628.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,596.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,112.30
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$841.00
|
|
|
Service Code
|
HCPCS 44626 81
|
| Min. Negotiated Rate |
$630.75 |
| Max. Negotiated Rate |
$841.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$824.18
|
| Rate for Payer: Beech Street Commercial |
$798.95
|
| Rate for Payer: Cash Price |
$588.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$815.77
|
| Rate for Payer: Cigna of WY Commercial |
$824.18
|
| Rate for Payer: First Choice Health Commercial |
$756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.95
|
| Rate for Payer: HealthUtah PPO |
$841.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$815.77
|
| Rate for Payer: One Health Plan of WY PPO |
$824.18
|
| Rate for Payer: PacificSource Commercial |
$756.90
|
| Rate for Payer: PHCS PPO |
$798.95
|
| Rate for Payer: Three Rivers PPO |
$630.75
|
| Rate for Payer: United Healthcare Commercial |
$798.95
|
| Rate for Payer: WINHealth Partners Commercial |
$714.85
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 44626 AS
|
| Min. Negotiated Rate |
$785.25 |
| Max. Negotiated Rate |
$1,047.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,026.06
|
| Rate for Payer: Beech Street Commercial |
$994.65
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,015.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,026.06
|
| Rate for Payer: First Choice Health Commercial |
$942.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$994.65
|
| Rate for Payer: HealthUtah PPO |
$1,047.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,015.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,026.06
|
| Rate for Payer: PacificSource Commercial |
$942.30
|
| Rate for Payer: PHCS PPO |
$994.65
|
| Rate for Payer: Three Rivers PPO |
$785.25
|
| Rate for Payer: United Healthcare Commercial |
$994.65
|
| Rate for Payer: WINHealth Partners Commercial |
$889.95
|
|
|
CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 57305
|
| Min. Negotiated Rate |
$798.88 |
| Max. Negotiated Rate |
$1,563.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,531.74
|
| Rate for Payer: Aetna of WY Medicare |
$939.86
|
| Rate for Payer: Beech Street Commercial |
$1,484.85
|
| Rate for Payer: Cash Price |
$1,094.10
|
| Rate for Payer: Cash Price |
$1,094.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,516.11
|
| Rate for Payer: Cigna of WY Commercial |
$1,531.74
|
| Rate for Payer: First Choice Health Commercial |
$1,406.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,484.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.86
|
| Rate for Payer: HealthUtah PPO |
$1,563.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,516.11
|
| Rate for Payer: Multiplan Medicare/VA |
$798.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,531.74
|
| Rate for Payer: PacificSource Commercial |
$1,406.70
|
| Rate for Payer: PHCS PPO |
$1,484.85
|
| Rate for Payer: Three Rivers PPO |
$1,172.25
|
| Rate for Payer: TriWest Veterans Administration |
$939.86
|
| Rate for Payer: United Healthcare Commercial |
$1,484.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,328.55
|
|
|
CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57305 80
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.76
|
| Rate for Payer: Beech Street Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.64
|
| Rate for Payer: Cigna of WY Commercial |
$305.76
|
| Rate for Payer: First Choice Health Commercial |
$280.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.40
|
| Rate for Payer: HealthUtah PPO |
$312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.64
|
| Rate for Payer: One Health Plan of WY PPO |
$305.76
|
| Rate for Payer: PacificSource Commercial |
$280.80
|
| Rate for Payer: PHCS PPO |
$296.40
|
| Rate for Payer: Three Rivers PPO |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
| Rate for Payer: WINHealth Partners Commercial |
$265.20
|
|
|
CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$804.11 |
| Max. Negotiated Rate |
$3,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,870.02
|
| Rate for Payer: Aetna of WY Medicare |
$946.01
|
| Rate for Payer: Beech Street Commercial |
$3,751.55
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,830.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,870.02
|
| Rate for Payer: First Choice Health Commercial |
$3,554.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,751.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.01
|
| Rate for Payer: HealthUtah PPO |
$3,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,830.53
|
| Rate for Payer: Multiplan Medicare/VA |
$804.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,870.02
|
| Rate for Payer: PacificSource Commercial |
$3,554.10
|
| Rate for Payer: PHCS PPO |
$3,751.55
|
| Rate for Payer: Three Rivers PPO |
$2,961.75
|
| Rate for Payer: TriWest Veterans Administration |
$946.01
|
| Rate for Payer: United Healthcare Commercial |
$3,751.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,356.65
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 27220 80
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Beech Street Commercial |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: First Choice Health Commercial |
$1,683.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,776.50
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: United Healthcare Commercial |
$1,776.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,589.50
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 27220 AS
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Beech Street Commercial |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: First Choice Health Commercial |
$1,683.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,776.50
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: United Healthcare Commercial |
$1,776.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,589.50
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 27220
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: First Choice Health Commercial |
$1,683.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,776.50
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,776.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,589.50
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$2,168.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$411.54 |
| Max. Negotiated Rate |
$2,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,124.64
|
| Rate for Payer: Aetna of WY Medicare |
$484.17
|
| Rate for Payer: Beech Street Commercial |
$2,059.60
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: Cash Price |
$1,517.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,102.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,124.64
|
| Rate for Payer: First Choice Health Commercial |
$1,951.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,059.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.17
|
| Rate for Payer: HealthUtah PPO |
$2,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,102.96
|
| Rate for Payer: Multiplan Medicare/VA |
$411.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,124.64
|
| Rate for Payer: PacificSource Commercial |
$1,951.20
|
| Rate for Payer: PHCS PPO |
$2,059.60
|
| Rate for Payer: Three Rivers PPO |
$1,626.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.17
|
| Rate for Payer: United Healthcare Commercial |
$2,059.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,842.80
|
|
|
CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$335.18
|
| Rate for Payer: Beech Street Commercial |
$1,363.25
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: First Choice Health Commercial |
$1,291.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.18
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$284.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,363.25
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$335.18
|
| Rate for Payer: United Healthcare Commercial |
$1,363.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,219.75
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$933.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$914.34
|
| Rate for Payer: Aetna of WY Medicare |
$223.91
|
| Rate for Payer: Beech Street Commercial |
$886.35
|
| Rate for Payer: Cash Price |
$653.10
|
| Rate for Payer: Cash Price |
$653.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$905.01
|
| Rate for Payer: Cigna of WY Commercial |
$914.34
|
| Rate for Payer: First Choice Health Commercial |
$839.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$886.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.91
|
| Rate for Payer: HealthUtah PPO |
$933.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$905.01
|
| Rate for Payer: Multiplan Medicare/VA |
$190.32
|
| Rate for Payer: One Health Plan of WY PPO |
$914.34
|
| Rate for Payer: PacificSource Commercial |
$839.70
|
| Rate for Payer: PHCS PPO |
$886.35
|
| Rate for Payer: Three Rivers PPO |
$699.75
|
| Rate for Payer: TriWest Veterans Administration |
$223.91
|
| Rate for Payer: United Healthcare Commercial |
$886.35
|
| Rate for Payer: WINHealth Partners Commercial |
$793.05
|
|
|
CLTX CARPAL BONE FX W/O MANJ EACH BONE
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$243.77 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,220.10
|
| Rate for Payer: Aetna of WY Medicare |
$286.79
|
| Rate for Payer: Beech Street Commercial |
$1,182.75
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,207.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,220.10
|
| Rate for Payer: First Choice Health Commercial |
$1,120.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,182.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$286.79
|
| Rate for Payer: HealthUtah PPO |
$1,245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,207.65
|
| Rate for Payer: Multiplan Medicare/VA |
$243.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,220.10
|
| Rate for Payer: PacificSource Commercial |
$1,120.50
|
| Rate for Payer: PHCS PPO |
$1,182.75
|
| Rate for Payer: Three Rivers PPO |
$933.75
|
| Rate for Payer: TriWest Veterans Administration |
$286.79
|
| Rate for Payer: United Healthcare Commercial |
$1,182.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,058.25
|
|
|
CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$1,733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,698.34
|
| Rate for Payer: Aetna of WY Medicare |
$394.31
|
| Rate for Payer: Beech Street Commercial |
$1,646.35
|
| Rate for Payer: Cash Price |
$1,213.10
|
| Rate for Payer: Cash Price |
$1,213.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,681.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,698.34
|
| Rate for Payer: First Choice Health Commercial |
$1,559.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,646.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.31
|
| Rate for Payer: HealthUtah PPO |
$1,733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,681.01
|
| Rate for Payer: Multiplan Medicare/VA |
$335.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,698.34
|
| Rate for Payer: PacificSource Commercial |
$1,559.70
|
| Rate for Payer: PHCS PPO |
$1,646.35
|
| Rate for Payer: Three Rivers PPO |
$1,299.75
|
| Rate for Payer: TriWest Veterans Administration |
$394.31
|
| Rate for Payer: United Healthcare Commercial |
$1,646.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,473.05
|
|
