|
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 GREATER HUMERAL TUBEROSITY FX W/O MNPJ
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 23620
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,098.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,076.04
|
| Rate for Payer: Aetna of WY Medicare |
$262.59
|
| Rate for Payer: Beech Street Commercial |
$1,043.10
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,065.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,076.04
|
| Rate for Payer: First Choice Health Commercial |
$988.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,043.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.59
|
| Rate for Payer: HealthUtah PPO |
$1,098.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,065.06
|
| Rate for Payer: Multiplan Medicare/VA |
$223.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,076.04
|
| Rate for Payer: PacificSource Commercial |
$988.20
|
| Rate for Payer: PHCS PPO |
$1,043.10
|
| Rate for Payer: Three Rivers PPO |
$823.50
|
| Rate for Payer: TriWest Veterans Administration |
$262.59
|
| Rate for Payer: United Healthcare Commercial |
$1,043.10
|
| Rate for Payer: WINHealth Partners Commercial |
$933.30
|
|
|
CLTX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 27246
|
| Min. Negotiated Rate |
$324.57 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$966.28
|
| Rate for Payer: Aetna of WY Medicare |
$381.85
|
| Rate for Payer: Beech Street Commercial |
$936.70
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$956.42
|
| Rate for Payer: Cigna of WY Commercial |
$966.28
|
| Rate for Payer: First Choice Health Commercial |
$887.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$936.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.85
|
| Rate for Payer: HealthUtah PPO |
$986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$956.42
|
| Rate for Payer: Multiplan Medicare/VA |
$324.57
|
| Rate for Payer: One Health Plan of WY PPO |
$966.28
|
| Rate for Payer: PacificSource Commercial |
$887.40
|
| Rate for Payer: PHCS PPO |
$936.70
|
| Rate for Payer: Three Rivers PPO |
$739.50
|
| Rate for Payer: TriWest Veterans Administration |
$381.85
|
| Rate for Payer: United Healthcare Commercial |
$936.70
|
| Rate for Payer: WINHealth Partners Commercial |
$838.10
|
|
|
CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Professional
|
Both
|
$5,389.00
|
|
|
Service Code
|
HCPCS 27252
|
| Min. Negotiated Rate |
$615.38 |
| Max. Negotiated Rate |
$5,389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,281.22
|
| Rate for Payer: Aetna of WY Medicare |
$723.98
|
| Rate for Payer: Beech Street Commercial |
$5,119.55
|
| Rate for Payer: Cash Price |
$3,772.30
|
| Rate for Payer: Cash Price |
$3,772.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,227.33
|
| Rate for Payer: Cigna of WY Commercial |
$5,281.22
|
| Rate for Payer: First Choice Health Commercial |
$4,850.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,119.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.98
|
| Rate for Payer: HealthUtah PPO |
$5,389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,227.33
|
| Rate for Payer: Multiplan Medicare/VA |
$615.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,281.22
|
| Rate for Payer: PacificSource Commercial |
$4,850.10
|
| Rate for Payer: PHCS PPO |
$5,119.55
|
| Rate for Payer: Three Rivers PPO |
$4,041.75
|
| Rate for Payer: TriWest Veterans Administration |
$723.98
|
| Rate for Payer: United Healthcare Commercial |
$5,119.55
|
| Rate for Payer: WINHealth Partners Commercial |
$4,580.65
|
|
|
CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 24576
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$838.88
|
| Rate for Payer: Aetna of WY Medicare |
$317.32
|
| Rate for Payer: Beech Street Commercial |
$813.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$830.32
|
| Rate for Payer: Cigna of WY Commercial |
$838.88
|
| Rate for Payer: First Choice Health Commercial |
$770.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$813.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.32
|
| Rate for Payer: HealthUtah PPO |
$856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$830.32
|
| Rate for Payer: Multiplan Medicare/VA |
$269.72
|
| Rate for Payer: One Health Plan of WY PPO |
$838.88
|
| Rate for Payer: PacificSource Commercial |
$770.40
|
| Rate for Payer: PHCS PPO |
$813.20
|
| Rate for Payer: Three Rivers PPO |
$642.00
|
| Rate for Payer: TriWest Veterans Administration |
$317.32
|
| Rate for Payer: United Healthcare Commercial |
$813.20
|
| Rate for Payer: WINHealth Partners Commercial |
$727.60
|
|
|
CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 24560
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$482.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$472.36
|
| Rate for Payer: Aetna of WY Medicare |
$297.51
|
| Rate for Payer: Beech Street Commercial |
$457.90
|
| Rate for Payer: Cash Price |
$337.40
|
| Rate for Payer: Cash Price |
$337.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$467.54
|
| Rate for Payer: Cigna of WY Commercial |
$472.36
|
| Rate for Payer: First Choice Health Commercial |
$433.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$457.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.51
|
| Rate for Payer: HealthUtah PPO |
$482.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$467.54
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: One Health Plan of WY PPO |
$472.36
|
| Rate for Payer: PacificSource Commercial |
$433.80
|
| Rate for Payer: PHCS PPO |
$457.90
|
| Rate for Payer: Three Rivers PPO |
$361.50
|
| Rate for Payer: TriWest Veterans Administration |
$297.51
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
| Rate for Payer: WINHealth Partners Commercial |
$409.70
|
|
|
CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$1,981.00
|
|
|
Service Code
|
HCPCS 24505
|
| Min. Negotiated Rate |
$382.28 |
| Max. Negotiated Rate |
$1,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,941.38
|
| Rate for Payer: Aetna of WY Medicare |
$449.74
|
| Rate for Payer: Beech Street Commercial |
$1,881.95
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,921.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,941.38
|
| Rate for Payer: First Choice Health Commercial |
$1,782.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,881.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.74
|
| Rate for Payer: HealthUtah PPO |
$1,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,921.57
|
| Rate for Payer: Multiplan Medicare/VA |
$382.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,941.38
|
| Rate for Payer: PacificSource Commercial |
$1,782.90
|
| Rate for Payer: PHCS PPO |
$1,881.95
|
| Rate for Payer: Three Rivers PPO |
$1,485.75
|
| Rate for Payer: TriWest Veterans Administration |
$449.74
|
| Rate for Payer: United Healthcare Commercial |
$1,881.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,683.85
|
|
|
CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 28660
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$92.25
|
| Rate for Payer: Beech Street Commercial |
$380.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: First Choice Health Commercial |
$360.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.25
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$78.41
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$380.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$380.00
|
| Rate for Payer: WINHealth Partners Commercial |
$340.00
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 26775
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,455.30
|
| Rate for Payer: Aetna of WY Medicare |
$356.81
|
| Rate for Payer: Beech Street Commercial |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,440.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,455.30
|
| Rate for Payer: First Choice Health Commercial |
$1,336.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,410.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.81
|
| Rate for Payer: HealthUtah PPO |
$1,485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,440.45
|
| Rate for Payer: Multiplan Medicare/VA |
$303.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,455.30
|
| Rate for Payer: PacificSource Commercial |
$1,336.50
|
| Rate for Payer: PHCS PPO |
$1,410.75
|
| Rate for Payer: Three Rivers PPO |
$1,113.75
|
| Rate for Payer: TriWest Veterans Administration |
$356.81
|
| Rate for Payer: United Healthcare Commercial |
$1,410.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,262.25
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 26770
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$661.50
|
| Rate for Payer: Aetna of WY Medicare |
$264.84
|
| Rate for Payer: Beech Street Commercial |
$641.25
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$654.75
|
| Rate for Payer: Cigna of WY Commercial |
$661.50
|
| Rate for Payer: First Choice Health Commercial |
$607.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.84
|
| Rate for Payer: HealthUtah PPO |
$675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$654.75
|
| Rate for Payer: Multiplan Medicare/VA |
$225.11
|
| Rate for Payer: One Health Plan of WY PPO |
$661.50
|
| Rate for Payer: PacificSource Commercial |
$607.50
|
| Rate for Payer: PHCS PPO |
$641.25
|
| Rate for Payer: Three Rivers PPO |
$506.25
|
| Rate for Payer: TriWest Veterans Administration |
$264.84
|
| Rate for Payer: United Healthcare Commercial |
$641.25
|
| Rate for Payer: WINHealth Partners Commercial |
$573.75
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 27760
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$1,351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,323.98
|
| Rate for Payer: Aetna of WY Medicare |
$310.13
|
| Rate for Payer: Beech Street Commercial |
$1,283.45
|
| Rate for Payer: Cash Price |
$945.70
|
| Rate for Payer: Cash Price |
$945.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,310.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,323.98
|
| Rate for Payer: First Choice Health Commercial |
$1,215.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,283.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.13
|
| Rate for Payer: HealthUtah PPO |
$1,351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,310.47
|
| Rate for Payer: Multiplan Medicare/VA |
$263.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,323.98
|
| Rate for Payer: PacificSource Commercial |
$1,215.90
|
| Rate for Payer: PHCS PPO |
$1,283.45
|
| Rate for Payer: Three Rivers PPO |
$1,013.25
|
| Rate for Payer: TriWest Veterans Administration |
$310.13
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,148.35
|
|
|
CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 27762
|
| Min. Negotiated Rate |
$371.99 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,872.78
|
| Rate for Payer: Aetna of WY Medicare |
$437.63
|
| Rate for Payer: Beech Street Commercial |
$1,815.45
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,853.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,872.78
|
| Rate for Payer: First Choice Health Commercial |
$1,719.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,815.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.63
|
| Rate for Payer: HealthUtah PPO |
$1,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,853.67
|
| Rate for Payer: Multiplan Medicare/VA |
$371.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,872.78
|
| Rate for Payer: PacificSource Commercial |
$1,719.90
|
| Rate for Payer: PHCS PPO |
$1,815.45
|
| Rate for Payer: Three Rivers PPO |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration |
$437.63
|
| Rate for Payer: United Healthcare Commercial |
$1,815.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.35
|
|
|
CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 26605
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,271.06
|
| Rate for Payer: Aetna of WY Medicare |
$299.81
|
| Rate for Payer: Beech Street Commercial |
$1,232.15
|
| Rate for Payer: Cash Price |
$907.90
|
| Rate for Payer: Cash Price |
$907.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,258.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,271.06
|
| Rate for Payer: First Choice Health Commercial |
$1,167.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,232.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.81
|
| Rate for Payer: HealthUtah PPO |
$1,297.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,258.09
|
| Rate for Payer: Multiplan Medicare/VA |
$254.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,271.06
|
| Rate for Payer: PacificSource Commercial |
$1,167.30
|
| Rate for Payer: PHCS PPO |
$1,232.15
|
| Rate for Payer: Three Rivers PPO |
$972.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.81
|
| Rate for Payer: United Healthcare Commercial |
$1,232.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,102.45
|
|
|
CLTX METACARPAL FX W/O MANIPULATION EACH BONE
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 26600
|
| Min. Negotiated Rate |
$247.42 |
| Max. Negotiated Rate |
$583.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$571.34
|
| Rate for Payer: Aetna of WY Medicare |
$291.08
|
| Rate for Payer: Beech Street Commercial |
$553.85
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$565.51
|
| Rate for Payer: Cigna of WY Commercial |
$571.34
|
| Rate for Payer: First Choice Health Commercial |
$524.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$553.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.08
|
| Rate for Payer: HealthUtah PPO |
$583.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$565.51
|
| Rate for Payer: Multiplan Medicare/VA |
$247.42
|
| Rate for Payer: One Health Plan of WY PPO |
$571.34
|
| Rate for Payer: PacificSource Commercial |
$524.70
|
| Rate for Payer: PHCS PPO |
$553.85
|
| Rate for Payer: Three Rivers PPO |
$437.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.08
|
| Rate for Payer: United Healthcare Commercial |
$553.85
|
| Rate for Payer: WINHealth Partners Commercial |
$495.55
|
|
|
CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 26700
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$887.88
|
| Rate for Payer: Aetna of WY Medicare |
$314.40
|
| Rate for Payer: Beech Street Commercial |
$860.70
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$878.82
|
| Rate for Payer: Cigna of WY Commercial |
$887.88
|
| Rate for Payer: First Choice Health Commercial |
$815.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$860.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.40
|
| Rate for Payer: HealthUtah PPO |
$906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$878.82
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$887.88
|
| Rate for Payer: PacificSource Commercial |
$815.40
|
| Rate for Payer: PHCS PPO |
$860.70
|
| Rate for Payer: Three Rivers PPO |
$679.50
|
| Rate for Payer: TriWest Veterans Administration |
$314.40
|
| Rate for Payer: United Healthcare Commercial |
$860.70
|
| Rate for Payer: WINHealth Partners Commercial |
$770.10
|
|
|
CLTX METAR FX W/MANJ
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 28475
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$981.96
|
| Rate for Payer: Aetna of WY Medicare |
$228.67
|
| Rate for Payer: Beech Street Commercial |
$951.90
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$971.94
|
| Rate for Payer: Cigna of WY Commercial |
$981.96
|
| Rate for Payer: First Choice Health Commercial |
$901.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.67
|
| Rate for Payer: HealthUtah PPO |
$1,002.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$971.94
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$981.96
|
| Rate for Payer: PacificSource Commercial |
$901.80
|
| Rate for Payer: PHCS PPO |
$951.90
|
| Rate for Payer: Three Rivers PPO |
$751.50
|
| Rate for Payer: TriWest Veterans Administration |
$228.67
|
| Rate for Payer: United Healthcare Commercial |
$951.90
|
| Rate for Payer: WINHealth Partners Commercial |
$851.70
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 28630
|
| Min. Negotiated Rate |
$91.83 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$108.04
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: First Choice Health Commercial |
$441.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.04
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$91.83
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$108.04
|
| Rate for Payer: United Healthcare Commercial |
$465.50
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
|
|
CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 26725
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$636.02
|
| Rate for Payer: Aetna of WY Medicare |
$306.16
|
| Rate for Payer: Beech Street Commercial |
$616.55
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$629.53
|
| Rate for Payer: Cigna of WY Commercial |
$636.02
|
| Rate for Payer: First Choice Health Commercial |
$584.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$616.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.16
|
| Rate for Payer: HealthUtah PPO |
$649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$629.53
|
| Rate for Payer: Multiplan Medicare/VA |
$260.24
|
| Rate for Payer: One Health Plan of WY PPO |
$636.02
|
| Rate for Payer: PacificSource Commercial |
$584.10
|
| Rate for Payer: PHCS PPO |
$616.55
|
| Rate for Payer: Three Rivers PPO |
$486.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.16
|
| Rate for Payer: United Healthcare Commercial |
$616.55
|
| Rate for Payer: WINHealth Partners Commercial |
$551.65
|
|
|
CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 26720
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$800.66
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$776.15
|
| Rate for Payer: Cash Price |
$571.90
|
| Rate for Payer: Cash Price |
$571.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$792.49
|
| Rate for Payer: Cigna of WY Commercial |
$800.66
|
| Rate for Payer: First Choice Health Commercial |
$735.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$776.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$817.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$792.49
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$800.66
|
| Rate for Payer: PacificSource Commercial |
$735.30
|
| Rate for Payer: PHCS PPO |
$776.15
|
| Rate for Payer: Three Rivers PPO |
$612.75
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$776.15
|
| Rate for Payer: WINHealth Partners Commercial |
$694.45
|
|
|
CLTX POST HIP ARTHRP DISLC REQ ANES
|
Professional
|
Both
|
$2,568.00
|
|
|
Service Code
|
HCPCS 27266
|
| Min. Negotiated Rate |
$483.59 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,516.64
|
| Rate for Payer: Aetna of WY Medicare |
$568.93
|
| Rate for Payer: Beech Street Commercial |
$2,439.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,490.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,516.64
|
| Rate for Payer: First Choice Health Commercial |
$2,311.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,439.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.93
|
| Rate for Payer: HealthUtah PPO |
$2,568.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,490.96
|
| Rate for Payer: Multiplan Medicare/VA |
$483.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,516.64
|
| Rate for Payer: PacificSource Commercial |
$2,311.20
|
| Rate for Payer: PHCS PPO |
$2,439.60
|
| Rate for Payer: Three Rivers PPO |
$1,926.00
|
| Rate for Payer: TriWest Veterans Administration |
$568.93
|
| Rate for Payer: United Healthcare Commercial |
$2,439.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,182.80
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 27265
|
| Min. Negotiated Rate |
$350.97 |
| Max. Negotiated Rate |
$1,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,747.34
|
| Rate for Payer: Aetna of WY Medicare |
$412.91
|
| Rate for Payer: Beech Street Commercial |
$1,693.85
|
| Rate for Payer: Cash Price |
$1,248.10
|
| Rate for Payer: Cash Price |
$1,248.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,729.51
|
| Rate for Payer: Cigna of WY Commercial |
$1,747.34
|
| Rate for Payer: First Choice Health Commercial |
$1,604.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,693.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.91
|
| Rate for Payer: HealthUtah PPO |
$1,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,729.51
|
| Rate for Payer: Multiplan Medicare/VA |
$350.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,747.34
|
| Rate for Payer: PacificSource Commercial |
$1,604.70
|
| Rate for Payer: PHCS PPO |
$1,693.85
|
| Rate for Payer: Three Rivers PPO |
$1,337.25
|
| Rate for Payer: TriWest Veterans Administration |
$412.91
|
| Rate for Payer: United Healthcare Commercial |
$1,693.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,515.55
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27780
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,215.20
|
| Rate for Payer: Aetna of WY Medicare |
$287.46
|
| Rate for Payer: Beech Street Commercial |
$1,178.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,202.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,215.20
|
| Rate for Payer: First Choice Health Commercial |
$1,116.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,178.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.46
|
| Rate for Payer: HealthUtah PPO |
$1,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,202.80
|
| Rate for Payer: Multiplan Medicare/VA |
$244.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,215.20
|
| Rate for Payer: PacificSource Commercial |
$1,116.00
|
| Rate for Payer: PHCS PPO |
$1,178.00
|
| Rate for Payer: Three Rivers PPO |
$930.00
|
| Rate for Payer: TriWest Veterans Administration |
$287.46
|
| Rate for Payer: United Healthcare Commercial |
$1,178.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.00
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 27780 50
|
| Min. Negotiated Rate |
$1,858.50 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,428.44
|
| Rate for Payer: Beech Street Commercial |
$2,354.10
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,403.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,428.44
|
| Rate for Payer: First Choice Health Commercial |
$2,230.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,354.10
|
| Rate for Payer: HealthUtah PPO |
$2,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,403.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,428.44
|
| Rate for Payer: PacificSource Commercial |
$2,230.20
|
| Rate for Payer: PHCS PPO |
$2,354.10
|
| Rate for Payer: Three Rivers PPO |
$1,858.50
|
| Rate for Payer: United Healthcare Commercial |
$2,354.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,106.30
|
|
|
CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 23605
|
| Min. Negotiated Rate |
$361.43 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$425.21
|
| Rate for Payer: Beech Street Commercial |
$1,771.75
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: First Choice Health Commercial |
$1,678.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.21
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$361.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,771.75
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$425.21
|
| Rate for Payer: United Healthcare Commercial |
$1,771.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,585.25
|
|
|
CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 23600
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,296.54
|
| Rate for Payer: Aetna of WY Medicare |
$319.45
|
| Rate for Payer: Beech Street Commercial |
$1,256.85
|
| Rate for Payer: Cash Price |
$926.10
|
| Rate for Payer: Cash Price |
$926.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,283.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,296.54
|
| Rate for Payer: First Choice Health Commercial |
$1,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,256.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.45
|
| Rate for Payer: HealthUtah PPO |
$1,323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,283.31
|
| Rate for Payer: Multiplan Medicare/VA |
$271.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,296.54
|
| Rate for Payer: PacificSource Commercial |
$1,190.70
|
| Rate for Payer: PHCS PPO |
$1,256.85
|
| Rate for Payer: Three Rivers PPO |
$992.25
|
| Rate for Payer: TriWest Veterans Administration |
$319.45
|
| Rate for Payer: United Healthcare Commercial |
$1,256.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,124.55
|
|
