|
CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$267.16 |
| Max. Negotiated Rate |
$1,358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,330.84
|
| Rate for Payer: Aetna of WY Medicare |
$314.31
|
| Rate for Payer: Beech Street Commercial |
$1,290.10
|
| Rate for Payer: Cash Price |
$950.60
|
| Rate for Payer: Cash Price |
$950.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,317.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,330.84
|
| Rate for Payer: First Choice Health Commercial |
$1,222.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,290.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.31
|
| Rate for Payer: HealthUtah PPO |
$1,358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,317.26
|
| Rate for Payer: Multiplan Medicare/VA |
$267.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,330.84
|
| Rate for Payer: PacificSource Commercial |
$1,222.20
|
| Rate for Payer: PHCS PPO |
$1,290.10
|
| Rate for Payer: Three Rivers PPO |
$1,018.50
|
| Rate for Payer: TriWest Veterans Administration |
$314.31
|
| Rate for Payer: United Healthcare Commercial |
$1,290.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,154.30
|
|
|
CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$358.10 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$483.14
|
| Rate for Payer: Aetna of WY Medicare |
$421.30
|
| Rate for Payer: Beech Street Commercial |
$468.35
|
| Rate for Payer: Cash Price |
$345.10
|
| Rate for Payer: Cash Price |
$345.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$478.21
|
| Rate for Payer: Cigna of WY Commercial |
$483.14
|
| Rate for Payer: First Choice Health Commercial |
$443.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$468.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$421.30
|
| Rate for Payer: HealthUtah PPO |
$493.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$478.21
|
| Rate for Payer: Multiplan Medicare/VA |
$358.10
|
| Rate for Payer: One Health Plan of WY PPO |
$483.14
|
| Rate for Payer: PacificSource Commercial |
$443.70
|
| Rate for Payer: PHCS PPO |
$468.35
|
| Rate for Payer: Three Rivers PPO |
$369.75
|
| Rate for Payer: TriWest Veterans Administration |
$421.30
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
| Rate for Payer: WINHealth Partners Commercial |
$419.05
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$325.99 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.00
|
| Rate for Payer: Aetna of WY Medicare |
$383.52
|
| Rate for Payer: Beech Street Commercial |
$1,615.00
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.00
|
| Rate for Payer: First Choice Health Commercial |
$1,530.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.52
|
| Rate for Payer: HealthUtah PPO |
$1,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.00
|
| Rate for Payer: Multiplan Medicare/VA |
$325.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.00
|
| Rate for Payer: PacificSource Commercial |
$1,530.00
|
| Rate for Payer: PHCS PPO |
$1,615.00
|
| Rate for Payer: Three Rivers PPO |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$383.52
|
| Rate for Payer: United Healthcare Commercial |
$1,615.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,445.00
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 27786 80
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Beech Street Commercial |
$183.35
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: First Choice Health Commercial |
$173.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$183.35
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: WINHealth Partners Commercial |
$164.05
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$245.74 |
| Max. Negotiated Rate |
$1,266.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,240.68
|
| Rate for Payer: Aetna of WY Medicare |
$289.10
|
| Rate for Payer: Beech Street Commercial |
$1,202.70
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,228.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,240.68
|
| Rate for Payer: First Choice Health Commercial |
$1,139.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,202.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.10
|
| Rate for Payer: HealthUtah PPO |
$1,266.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,228.02
|
| Rate for Payer: Multiplan Medicare/VA |
$245.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,240.68
|
| Rate for Payer: PacificSource Commercial |
$1,139.40
|
| Rate for Payer: PHCS PPO |
$1,202.70
|
| Rate for Payer: Three Rivers PPO |
$949.50
|
| Rate for Payer: TriWest Veterans Administration |
$289.10
|
| Rate for Payer: United Healthcare Commercial |
$1,202.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,076.10
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$751.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.98
|
| Rate for Payer: Aetna of WY Medicare |
$275.15
|
| Rate for Payer: Beech Street Commercial |
$713.45
|
| Rate for Payer: Cash Price |
$525.70
|
| Rate for Payer: Cash Price |
$525.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$728.47
|
| Rate for Payer: Cigna of WY Commercial |
$735.98
|
| Rate for Payer: First Choice Health Commercial |
$675.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$713.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.15
|
| Rate for Payer: HealthUtah PPO |
$751.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$728.47
|
| Rate for Payer: Multiplan Medicare/VA |
$233.88
|
| Rate for Payer: One Health Plan of WY PPO |
$735.98
|
| Rate for Payer: PacificSource Commercial |
$675.90
|
| Rate for Payer: PHCS PPO |
$713.45
|
| Rate for Payer: Three Rivers PPO |
$563.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.15
|
| Rate for Payer: United Healthcare Commercial |
$713.45
|
| Rate for Payer: WINHealth Partners Commercial |
$638.35
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$797.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.06
|
| Rate for Payer: Aetna of WY Medicare |
$193.47
|
| Rate for Payer: Beech Street Commercial |
$757.15
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.09
|
| Rate for Payer: Cigna of WY Commercial |
$781.06
|
| Rate for Payer: First Choice Health Commercial |
$717.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.47
|
| Rate for Payer: HealthUtah PPO |
$797.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.09
|
| Rate for Payer: Multiplan Medicare/VA |
$164.45
|
| Rate for Payer: One Health Plan of WY PPO |
$781.06
|
| Rate for Payer: PacificSource Commercial |
$717.30
|
| Rate for Payer: PHCS PPO |
$757.15
|
| Rate for Payer: Three Rivers PPO |
$597.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.47
|
| Rate for Payer: United Healthcare Commercial |
$757.15
|
| Rate for Payer: WINHealth Partners Commercial |
$677.45
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$842.65
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 25600 50
|
| Min. Negotiated Rate |
$1,329.75 |
| Max. Negotiated Rate |
$1,773.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,737.54
|
| Rate for Payer: Beech Street Commercial |
$1,684.35
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,719.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,737.54
|
| Rate for Payer: First Choice Health Commercial |
$1,595.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,684.35
|
| Rate for Payer: HealthUtah PPO |
$1,773.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,719.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,737.54
|
| Rate for Payer: PacificSource Commercial |
$1,595.70
|
| Rate for Payer: PHCS PPO |
$1,684.35
|
| Rate for Payer: Three Rivers PPO |
$1,329.75
|
| Rate for Payer: United Healthcare Commercial |
$1,684.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,507.05
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,363.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,335.74
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$1,294.85
|
| Rate for Payer: Cash Price |
$954.10
|
| Rate for Payer: Cash Price |
$954.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,322.11
|
| Rate for Payer: Cigna of WY Commercial |
$1,335.74
|
| Rate for Payer: First Choice Health Commercial |
$1,226.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,294.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$1,363.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,322.11
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,335.74
|
| Rate for Payer: PacificSource Commercial |
$1,226.70
|
| Rate for Payer: PHCS PPO |
$1,294.85
|
| Rate for Payer: Three Rivers PPO |
$1,022.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$1,294.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,158.55
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF
|
Professional
|
Both
|
$2,723.00
|
|
|
Service Code
|
HCPCS 25605 50
|
| Min. Negotiated Rate |
$2,042.25 |
| Max. Negotiated Rate |
$2,723.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,668.54
|
| Rate for Payer: Beech Street Commercial |
$2,586.85
|
| Rate for Payer: Cash Price |
$1,906.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,641.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,668.54
|
| Rate for Payer: First Choice Health Commercial |
$2,450.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,586.85
|
| Rate for Payer: HealthUtah PPO |
$2,723.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,641.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2,668.54
|
| Rate for Payer: PacificSource Commercial |
$2,450.70
|
| Rate for Payer: PHCS PPO |
$2,586.85
|
| Rate for Payer: Three Rivers PPO |
$2,042.25
|
| Rate for Payer: United Healthcare Commercial |
$2,586.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,314.55
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 25605 80
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Beech Street Commercial |
$359.10
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: First Choice Health Commercial |
$340.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$359.10
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: WINHealth Partners Commercial |
$321.30
|
|
|
CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$2,260.00
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$1,695.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Beech Street Commercial |
$2,147.00
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: First Choice Health Commercial |
$2,034.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,147.00
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: United Healthcare Commercial |
$2,147.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,921.00
|
|
|
CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$2,998.00
|
|
|
Service Code
|
HCPCS 27510
|
| Min. Negotiated Rate |
$563.13 |
| Max. Negotiated Rate |
$2,998.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,938.04
|
| Rate for Payer: Aetna of WY Medicare |
$662.51
|
| Rate for Payer: Beech Street Commercial |
$2,848.10
|
| Rate for Payer: Cash Price |
$2,098.60
|
| Rate for Payer: Cash Price |
$2,098.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,908.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,938.04
|
| Rate for Payer: First Choice Health Commercial |
$2,698.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,848.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.51
|
| Rate for Payer: HealthUtah PPO |
$2,998.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,908.06
|
| Rate for Payer: Multiplan Medicare/VA |
$563.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,938.04
|
| Rate for Payer: PacificSource Commercial |
$2,698.20
|
| Rate for Payer: PHCS PPO |
$2,848.10
|
| Rate for Payer: Three Rivers PPO |
$2,248.50
|
| Rate for Payer: TriWest Veterans Administration |
$662.51
|
| Rate for Payer: United Healthcare Commercial |
$2,848.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,548.30
|
|
|
CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 27508
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,144.24
|
| Rate for Payer: Aetna of WY Medicare |
$491.29
|
| Rate for Payer: Beech Street Commercial |
$2,078.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,122.36
|
| Rate for Payer: Cigna of WY Commercial |
$2,144.24
|
| Rate for Payer: First Choice Health Commercial |
$1,969.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.29
|
| Rate for Payer: HealthUtah PPO |
$2,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,122.36
|
| Rate for Payer: Multiplan Medicare/VA |
$417.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,144.24
|
| Rate for Payer: PacificSource Commercial |
$1,969.20
|
| Rate for Payer: PHCS PPO |
$2,078.60
|
| Rate for Payer: Three Rivers PPO |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration |
$491.29
|
| Rate for Payer: United Healthcare Commercial |
$2,078.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,859.80
|
|
|
CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 27230
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,051.14
|
| Rate for Payer: Aetna of WY Medicare |
$471.98
|
| Rate for Payer: Beech Street Commercial |
$1,988.35
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,030.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,051.14
|
| Rate for Payer: First Choice Health Commercial |
$1,883.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.98
|
| Rate for Payer: HealthUtah PPO |
$2,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,030.21
|
| Rate for Payer: Multiplan Medicare/VA |
$401.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,051.14
|
| Rate for Payer: PacificSource Commercial |
$1,883.70
|
| Rate for Payer: PHCS PPO |
$1,988.35
|
| Rate for Payer: Three Rivers PPO |
$1,569.75
|
| Rate for Payer: TriWest Veterans Administration |
$471.98
|
| Rate for Payer: United Healthcare Commercial |
$1,988.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,779.05
|
|
|
CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$3,349.00
|
|
|
Service Code
|
HCPCS 27502
|
| Min. Negotiated Rate |
$618.98 |
| Max. Negotiated Rate |
$3,349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,282.02
|
| Rate for Payer: Aetna of WY Medicare |
$728.21
|
| Rate for Payer: Beech Street Commercial |
$3,181.55
|
| Rate for Payer: Cash Price |
$2,344.30
|
| Rate for Payer: Cash Price |
$2,344.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,248.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,282.02
|
| Rate for Payer: First Choice Health Commercial |
$3,014.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,181.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.21
|
| Rate for Payer: HealthUtah PPO |
$3,349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,248.53
|
| Rate for Payer: Multiplan Medicare/VA |
$618.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,282.02
|
| Rate for Payer: PacificSource Commercial |
$3,014.10
|
| Rate for Payer: PHCS PPO |
$3,181.55
|
| Rate for Payer: Three Rivers PPO |
$2,511.75
|
| Rate for Payer: TriWest Veterans Administration |
$728.21
|
| Rate for Payer: United Healthcare Commercial |
$3,181.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,846.65
|
|
|
CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 28495
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$149.65
|
| Rate for Payer: Beech Street Commercial |
$620.35
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: First Choice Health Commercial |
$587.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.65
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$127.20
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$620.35
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$149.65
|
| Rate for Payer: United Healthcare Commercial |
$620.35
|
| Rate for Payer: WINHealth Partners Commercial |
$555.05
|
|
|
CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 28490
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$125.35
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.35
|
| Rate for Payer: HealthUtah PPO |
$546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Multiplan Medicare/VA |
$106.55
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.35
|
| Rate for Payer: United Healthcare Commercial |
$518.70
|
| Rate for Payer: WINHealth Partners Commercial |
$464.10
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 28515
|
| Min. Negotiated Rate |
$122.62 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$615.44
|
| Rate for Payer: Aetna of WY Medicare |
$144.26
|
| Rate for Payer: Beech Street Commercial |
$596.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.16
|
| Rate for Payer: Cigna of WY Commercial |
$615.44
|
| Rate for Payer: First Choice Health Commercial |
$565.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$596.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.26
|
| Rate for Payer: HealthUtah PPO |
$628.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.16
|
| Rate for Payer: Multiplan Medicare/VA |
$122.62
|
| Rate for Payer: One Health Plan of WY PPO |
$615.44
|
| Rate for Payer: PacificSource Commercial |
$565.20
|
| Rate for Payer: PHCS PPO |
$596.60
|
| Rate for Payer: Three Rivers PPO |
$471.00
|
| Rate for Payer: TriWest Veterans Administration |
$144.26
|
| Rate for Payer: United Healthcare Commercial |
$596.60
|
| Rate for Payer: WINHealth Partners Commercial |
$533.80
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 28510
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$516.46
|
| Rate for Payer: Aetna of WY Medicare |
$121.59
|
| Rate for Payer: Beech Street Commercial |
$500.65
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$511.19
|
| Rate for Payer: Cigna of WY Commercial |
$516.46
|
| Rate for Payer: First Choice Health Commercial |
$474.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.59
|
| Rate for Payer: HealthUtah PPO |
$527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$511.19
|
| Rate for Payer: Multiplan Medicare/VA |
$103.35
|
| Rate for Payer: One Health Plan of WY PPO |
$516.46
|
| Rate for Payer: PacificSource Commercial |
$474.30
|
| Rate for Payer: PHCS PPO |
$500.65
|
| Rate for Payer: Three Rivers PPO |
$395.25
|
| Rate for Payer: TriWest Veterans Administration |
$121.59
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
| Rate for Payer: WINHealth Partners Commercial |
$447.95
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
HCPCS 27824
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$1,341.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,314.18
|
| Rate for Payer: Aetna of WY Medicare |
$306.18
|
| Rate for Payer: Beech Street Commercial |
$1,273.95
|
| Rate for Payer: Cash Price |
$938.70
|
| Rate for Payer: Cash Price |
$938.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,300.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,314.18
|
| Rate for Payer: First Choice Health Commercial |
$1,206.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.18
|
| Rate for Payer: HealthUtah PPO |
$1,341.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,300.77
|
| Rate for Payer: Multiplan Medicare/VA |
$260.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,314.18
|
| Rate for Payer: PacificSource Commercial |
$1,206.90
|
| Rate for Payer: PHCS PPO |
$1,273.95
|
| Rate for Payer: Three Rivers PPO |
$1,005.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.18
|
| Rate for Payer: United Healthcare Commercial |
$1,273.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,139.85
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$4,356.00
|
|
|
Service Code
|
HCPCS 27825 50
|
| Min. Negotiated Rate |
$3,267.00 |
| Max. Negotiated Rate |
$4,356.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,268.88
|
| Rate for Payer: Beech Street Commercial |
$4,138.20
|
| Rate for Payer: Cash Price |
$3,049.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,225.32
|
| Rate for Payer: Cigna of WY Commercial |
$4,268.88
|
| Rate for Payer: First Choice Health Commercial |
$3,920.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,138.20
|
| Rate for Payer: HealthUtah PPO |
$4,356.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,225.32
|
| Rate for Payer: One Health Plan of WY PPO |
$4,268.88
|
| Rate for Payer: PacificSource Commercial |
$3,920.40
|
| Rate for Payer: PHCS PPO |
$4,138.20
|
| Rate for Payer: Three Rivers PPO |
$3,267.00
|
| Rate for Payer: United Healthcare Commercial |
$4,138.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,702.60
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,178.00
|
|
|
Service Code
|
HCPCS 27825 AS
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,134.44
|
| Rate for Payer: Beech Street Commercial |
$2,069.10
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,112.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,134.44
|
| Rate for Payer: First Choice Health Commercial |
$1,960.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,069.10
|
| Rate for Payer: HealthUtah PPO |
$2,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,112.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,134.44
|
| Rate for Payer: PacificSource Commercial |
$1,960.20
|
| Rate for Payer: PHCS PPO |
$2,069.10
|
| Rate for Payer: Three Rivers PPO |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$2,069.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,851.30
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,178.00
|
|
|
Service Code
|
HCPCS 27825
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,134.44
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$2,069.10
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,112.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,134.44
|
| Rate for Payer: First Choice Health Commercial |
$1,960.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,069.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,112.66
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,134.44
|
| Rate for Payer: PacificSource Commercial |
$1,960.20
|
| Rate for Payer: PHCS PPO |
$2,069.10
|
| Rate for Payer: Three Rivers PPO |
$1,633.50
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$2,069.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,851.30
|
|
