|
CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 24640
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Medicare |
$78.47
|
| Rate for Payer: Beech Street Commercial |
$329.65
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: First Choice Health Commercial |
$312.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.47
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$66.70
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$329.65
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.47
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
| Rate for Payer: WINHealth Partners Commercial |
$294.95
|
|
|
CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Professional
|
Both
|
$2,485.00
|
|
|
Service Code
|
HCPCS 25520
|
| Min. Negotiated Rate |
$458.97 |
| Max. Negotiated Rate |
$2,485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,435.30
|
| Rate for Payer: Aetna of WY Medicare |
$539.96
|
| Rate for Payer: Beech Street Commercial |
$2,360.75
|
| Rate for Payer: Cash Price |
$1,739.50
|
| Rate for Payer: Cash Price |
$1,739.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,410.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,435.30
|
| Rate for Payer: First Choice Health Commercial |
$2,236.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,360.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.96
|
| Rate for Payer: HealthUtah PPO |
$2,485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,410.45
|
| Rate for Payer: Multiplan Medicare/VA |
$458.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,435.30
|
| Rate for Payer: PacificSource Commercial |
$2,236.50
|
| Rate for Payer: PHCS PPO |
$2,360.75
|
| Rate for Payer: Three Rivers PPO |
$1,863.75
|
| Rate for Payer: TriWest Veterans Administration |
$539.96
|
| Rate for Payer: United Healthcare Commercial |
$2,360.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,112.25
|
|
|
CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 23575
|
| Min. Negotiated Rate |
$322.59 |
| Max. Negotiated Rate |
$1,678.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,644.44
|
| Rate for Payer: Aetna of WY Medicare |
$379.52
|
| Rate for Payer: Beech Street Commercial |
$1,594.10
|
| Rate for Payer: Cash Price |
$1,174.60
|
| Rate for Payer: Cash Price |
$1,174.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,627.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,644.44
|
| Rate for Payer: First Choice Health Commercial |
$1,510.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,594.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.52
|
| Rate for Payer: HealthUtah PPO |
$1,678.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,627.66
|
| Rate for Payer: Multiplan Medicare/VA |
$322.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,644.44
|
| Rate for Payer: PacificSource Commercial |
$1,510.20
|
| Rate for Payer: PHCS PPO |
$1,594.10
|
| Rate for Payer: Three Rivers PPO |
$1,258.50
|
| Rate for Payer: TriWest Veterans Administration |
$379.52
|
| Rate for Payer: United Healthcare Commercial |
$1,594.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,426.30
|
|
|
CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 23665
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$1,686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,652.28
|
| Rate for Payer: Aetna of WY Medicare |
$399.70
|
| Rate for Payer: Beech Street Commercial |
$1,601.70
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,635.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,652.28
|
| Rate for Payer: First Choice Health Commercial |
$1,517.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,601.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.70
|
| Rate for Payer: HealthUtah PPO |
$1,686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,635.42
|
| Rate for Payer: Multiplan Medicare/VA |
$339.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,652.28
|
| Rate for Payer: PacificSource Commercial |
$1,517.40
|
| Rate for Payer: PHCS PPO |
$1,601.70
|
| Rate for Payer: Three Rivers PPO |
$1,264.50
|
| Rate for Payer: TriWest Veterans Administration |
$399.70
|
| Rate for Payer: United Healthcare Commercial |
$1,601.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,433.10
|
|
|
CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MNPJ
|
Professional
|
Both
|
$2,136.00
|
|
|
Service Code
|
HCPCS 23675
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,093.28
|
| Rate for Payer: Aetna of WY Medicare |
$497.25
|
| Rate for Payer: Beech Street Commercial |
$2,029.20
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,071.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,093.28
|
| Rate for Payer: First Choice Health Commercial |
$1,922.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,029.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.25
|
| Rate for Payer: HealthUtah PPO |
$2,136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,071.92
|
| Rate for Payer: Multiplan Medicare/VA |
$422.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,093.28
|
| Rate for Payer: PacificSource Commercial |
$1,922.40
|
| Rate for Payer: PHCS PPO |
$2,029.20
|
| Rate for Payer: Three Rivers PPO |
$1,602.00
|
| Rate for Payer: TriWest Veterans Administration |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$2,029.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,815.60
|
|
|
CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 24535
|
| Min. Negotiated Rate |
$481.47 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$566.44
|
| Rate for Payer: Beech Street Commercial |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: First Choice Health Commercial |
$2,250.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.44
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$481.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,375.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$566.44
|
| Rate for Payer: United Healthcare Commercial |
$2,375.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,125.00
|
|
|
CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 24530
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$1,526.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,495.48
|
| Rate for Payer: Aetna of WY Medicare |
$353.53
|
| Rate for Payer: Beech Street Commercial |
$1,449.70
|
| Rate for Payer: Cash Price |
$1,068.20
|
| Rate for Payer: Cash Price |
$1,068.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,480.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,495.48
|
| Rate for Payer: First Choice Health Commercial |
$1,373.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,449.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.53
|
| Rate for Payer: HealthUtah PPO |
$1,526.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,480.22
|
| Rate for Payer: Multiplan Medicare/VA |
$300.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,495.48
|
| Rate for Payer: PacificSource Commercial |
$1,373.40
|
| Rate for Payer: PHCS PPO |
$1,449.70
|
| Rate for Payer: Three Rivers PPO |
$1,144.50
|
| Rate for Payer: TriWest Veterans Administration |
$353.53
|
| Rate for Payer: United Healthcare Commercial |
$1,449.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,297.10
|
|
|
CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 27501
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$2,194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,150.12
|
| Rate for Payer: Aetna of WY Medicare |
$488.15
|
| Rate for Payer: Beech Street Commercial |
$2,084.30
|
| Rate for Payer: Cash Price |
$1,535.80
|
| Rate for Payer: Cash Price |
$1,535.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,128.18
|
| Rate for Payer: Cigna of WY Commercial |
$2,150.12
|
| Rate for Payer: First Choice Health Commercial |
$1,974.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,084.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$488.15
|
| Rate for Payer: HealthUtah PPO |
$2,194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,128.18
|
| Rate for Payer: Multiplan Medicare/VA |
$414.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,150.12
|
| Rate for Payer: PacificSource Commercial |
$1,974.60
|
| Rate for Payer: PHCS PPO |
$2,084.30
|
| Rate for Payer: Three Rivers PPO |
$1,645.50
|
| Rate for Payer: TriWest Veterans Administration |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$2,084.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,864.90
|
|
|
CLTX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
HCPCS 27530
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$1,251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,225.98
|
| Rate for Payer: Aetna of WY Medicare |
$292.22
|
| Rate for Payer: Beech Street Commercial |
$1,188.45
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,213.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,225.98
|
| Rate for Payer: First Choice Health Commercial |
$1,125.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,188.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.22
|
| Rate for Payer: HealthUtah PPO |
$1,251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,213.47
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,225.98
|
| Rate for Payer: PacificSource Commercial |
$1,125.90
|
| Rate for Payer: PHCS PPO |
$1,188.45
|
| Rate for Payer: Three Rivers PPO |
$938.25
|
| Rate for Payer: TriWest Veterans Administration |
$292.22
|
| Rate for Payer: United Healthcare Commercial |
$1,188.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.35
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 27752
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,126.60
|
| Rate for Payer: Aetna of WY Medicare |
$483.41
|
| Rate for Payer: Beech Street Commercial |
$2,061.50
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,104.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,126.60
|
| Rate for Payer: First Choice Health Commercial |
$1,953.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,061.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.41
|
| Rate for Payer: HealthUtah PPO |
$2,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,104.90
|
| Rate for Payer: Multiplan Medicare/VA |
$410.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,126.60
|
| Rate for Payer: PacificSource Commercial |
$1,953.00
|
| Rate for Payer: PHCS PPO |
$2,061.50
|
| Rate for Payer: Three Rivers PPO |
$1,627.50
|
| Rate for Payer: TriWest Veterans Administration |
$483.41
|
| Rate for Payer: United Healthcare Commercial |
$2,061.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,844.50
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$2,814.00
|
|
|
Service Code
|
HCPCS 27750 50
|
| Min. Negotiated Rate |
$2,110.50 |
| Max. Negotiated Rate |
$2,814.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,757.72
|
| Rate for Payer: Beech Street Commercial |
$2,673.30
|
| Rate for Payer: Cash Price |
$1,969.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,729.58
|
| Rate for Payer: Cigna of WY Commercial |
$2,757.72
|
| Rate for Payer: First Choice Health Commercial |
$2,532.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,673.30
|
| Rate for Payer: HealthUtah PPO |
$2,814.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,729.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,757.72
|
| Rate for Payer: PacificSource Commercial |
$2,532.60
|
| Rate for Payer: PHCS PPO |
$2,673.30
|
| Rate for Payer: Three Rivers PPO |
$2,110.50
|
| Rate for Payer: United Healthcare Commercial |
$2,673.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,391.90
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS 27750
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$1,408.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,379.84
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$1,337.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,365.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,379.84
|
| Rate for Payer: First Choice Health Commercial |
$1,267.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,337.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$1,408.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,365.76
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,379.84
|
| Rate for Payer: PacificSource Commercial |
$1,267.20
|
| Rate for Payer: PHCS PPO |
$1,337.60
|
| Rate for Payer: Three Rivers PPO |
$1,056.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$1,337.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,196.80
|
|
|
CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ
|
Professional
|
Both
|
$2,312.00
|
|
|
Service Code
|
HCPCS 25680
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$2,312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,265.76
|
| Rate for Payer: Aetna of WY Medicare |
$525.08
|
| Rate for Payer: Beech Street Commercial |
$2,196.40
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,242.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,265.76
|
| Rate for Payer: First Choice Health Commercial |
$2,080.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,196.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$525.08
|
| Rate for Payer: HealthUtah PPO |
$2,312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,242.64
|
| Rate for Payer: Multiplan Medicare/VA |
$446.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,265.76
|
| Rate for Payer: PacificSource Commercial |
$2,080.80
|
| Rate for Payer: PHCS PPO |
$2,196.40
|
| Rate for Payer: Three Rivers PPO |
$1,734.00
|
| Rate for Payer: TriWest Veterans Administration |
$525.08
|
| Rate for Payer: United Healthcare Commercial |
$2,196.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,965.20
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$2,470.00
|
|
|
Service Code
|
HCPCS 27818 AS
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,420.60
|
| Rate for Payer: Beech Street Commercial |
$2,346.50
|
| Rate for Payer: Cash Price |
$1,729.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,395.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,420.60
|
| Rate for Payer: First Choice Health Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,346.50
|
| Rate for Payer: HealthUtah PPO |
$2,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,395.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,420.60
|
| Rate for Payer: PacificSource Commercial |
$2,223.00
|
| Rate for Payer: PHCS PPO |
$2,346.50
|
| Rate for Payer: Three Rivers PPO |
$1,852.50
|
| Rate for Payer: United Healthcare Commercial |
$2,346.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,099.50
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,919.00
|
|
|
Service Code
|
HCPCS 27818
|
| Min. Negotiated Rate |
$370.86 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,880.62
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Beech Street Commercial |
$1,823.05
|
| Rate for Payer: Cash Price |
$1,343.30
|
| Rate for Payer: Cash Price |
$1,343.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,861.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,880.62
|
| Rate for Payer: First Choice Health Commercial |
$1,727.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,823.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: HealthUtah PPO |
$1,919.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,861.43
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,880.62
|
| Rate for Payer: PacificSource Commercial |
$1,727.10
|
| Rate for Payer: PHCS PPO |
$1,823.05
|
| Rate for Payer: Three Rivers PPO |
$1,439.25
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: United Healthcare Commercial |
$1,823.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,631.15
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 22310 80
|
| Min. Negotiated Rate |
$1,173.75 |
| Max. Negotiated Rate |
$1,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,533.70
|
| Rate for Payer: Beech Street Commercial |
$1,486.75
|
| Rate for Payer: Cash Price |
$1,095.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,518.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,533.70
|
| Rate for Payer: First Choice Health Commercial |
$1,408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,486.75
|
| Rate for Payer: HealthUtah PPO |
$1,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,518.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,533.70
|
| Rate for Payer: PacificSource Commercial |
$1,408.50
|
| Rate for Payer: PHCS PPO |
$1,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,173.75
|
| Rate for Payer: United Healthcare Commercial |
$1,486.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,330.25
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 22310 AS
|
| Min. Negotiated Rate |
$1,173.75 |
| Max. Negotiated Rate |
$1,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,533.70
|
| Rate for Payer: Beech Street Commercial |
$1,486.75
|
| Rate for Payer: Cash Price |
$1,095.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,518.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,533.70
|
| Rate for Payer: First Choice Health Commercial |
$1,408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,486.75
|
| Rate for Payer: HealthUtah PPO |
$1,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,518.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,533.70
|
| Rate for Payer: PacificSource Commercial |
$1,408.50
|
| Rate for Payer: PHCS PPO |
$1,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,173.75
|
| Rate for Payer: United Healthcare Commercial |
$1,486.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,330.25
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,281.00
|
|
|
Service Code
|
HCPCS 22310
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,255.38
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,216.95
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,242.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,255.38
|
| Rate for Payer: First Choice Health Commercial |
$1,152.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,216.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,281.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,242.57
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,255.38
|
| Rate for Payer: PacificSource Commercial |
$1,152.90
|
| Rate for Payer: PHCS PPO |
$1,216.95
|
| Rate for Payer: Three Rivers PPO |
$960.75
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,216.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,088.85
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 57260 80
|
| Min. Negotiated Rate |
$475.50 |
| Max. Negotiated Rate |
$634.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$621.32
|
| Rate for Payer: Beech Street Commercial |
$602.30
|
| Rate for Payer: Cash Price |
$443.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$614.98
|
| Rate for Payer: Cigna of WY Commercial |
$621.32
|
| Rate for Payer: First Choice Health Commercial |
$570.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$602.30
|
| Rate for Payer: HealthUtah PPO |
$634.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$614.98
|
| Rate for Payer: One Health Plan of WY PPO |
$621.32
|
| Rate for Payer: PacificSource Commercial |
$570.60
|
| Rate for Payer: PHCS PPO |
$602.30
|
| Rate for Payer: Three Rivers PPO |
$475.50
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
| Rate for Payer: WINHealth Partners Commercial |
$538.90
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$3,322.00
|
|
|
Service Code
|
HCPCS 57260
|
| Min. Negotiated Rate |
$637.61 |
| Max. Negotiated Rate |
$3,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,255.56
|
| Rate for Payer: Aetna of WY Medicare |
$750.13
|
| Rate for Payer: Beech Street Commercial |
$3,155.90
|
| Rate for Payer: Cash Price |
$2,325.40
|
| Rate for Payer: Cash Price |
$2,325.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,222.34
|
| Rate for Payer: Cigna of WY Commercial |
$3,255.56
|
| Rate for Payer: First Choice Health Commercial |
$2,989.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,155.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$750.13
|
| Rate for Payer: HealthUtah PPO |
$3,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,222.34
|
| Rate for Payer: Multiplan Medicare/VA |
$637.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,255.56
|
| Rate for Payer: PacificSource Commercial |
$2,989.80
|
| Rate for Payer: PHCS PPO |
$3,155.90
|
| Rate for Payer: Three Rivers PPO |
$2,491.50
|
| Rate for Payer: TriWest Veterans Administration |
$750.13
|
| Rate for Payer: United Healthcare Commercial |
$3,155.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,823.70
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$4,503.00
|
|
|
Service Code
|
HCPCS 57265
|
| Min. Negotiated Rate |
$712.53 |
| Max. Negotiated Rate |
$4,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,412.94
|
| Rate for Payer: Aetna of WY Medicare |
$838.27
|
| Rate for Payer: Beech Street Commercial |
$4,277.85
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,367.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,412.94
|
| Rate for Payer: First Choice Health Commercial |
$4,052.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,277.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$838.27
|
| Rate for Payer: HealthUtah PPO |
$4,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,367.91
|
| Rate for Payer: Multiplan Medicare/VA |
$712.53
|
| Rate for Payer: One Health Plan of WY PPO |
$4,412.94
|
| Rate for Payer: PacificSource Commercial |
$4,052.70
|
| Rate for Payer: PHCS PPO |
$4,277.85
|
| Rate for Payer: Three Rivers PPO |
$3,377.25
|
| Rate for Payer: TriWest Veterans Administration |
$838.27
|
| Rate for Payer: United Healthcare Commercial |
$4,277.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,827.55
|
|
|
CNTRL 3 LUM CVC 7F 30CM ADAPT
|
Facility
|
IP
|
$127.18
|
|
| Hospital Charge Code |
2400259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.64
|
| Rate for Payer: Aetna of WY Medicare |
$81.40
|
| Rate for Payer: Altius Commercial |
$122.09
|
| Rate for Payer: Beech Street Commercial |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.36
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.36
|
| Rate for Payer: Cigna of WY Commercial |
$124.64
|
| Rate for Payer: Entrust Commercial |
$120.82
|
| Rate for Payer: First Choice Health Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.58
|
| Rate for Payer: HealthUtah PPO |
$127.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.36
|
| Rate for Payer: Multiplan Medicare/VA |
$73.70
|
| Rate for Payer: One Health Plan of WY PPO |
$124.64
|
| Rate for Payer: PacificSource Commercial |
$114.46
|
| Rate for Payer: PHCS PPO |
$124.64
|
| Rate for Payer: Three Rivers PPO |
$95.38
|
| Rate for Payer: TriWest Veterans Administration |
$77.58
|
| Rate for Payer: United Healthcare Commercial |
$121.46
|
| Rate for Payer: United Healthcare Medicare |
$77.58
|
| Rate for Payer: WINHealth Partners Commercial |
$120.82
|
| Rate for Payer: Wise Provider Network Commercial |
$120.82
|
|
|
CNTRL 3 LUM CVC 7F 30CM ADAPT
|
Facility
|
OP
|
$127.18
|
|
| Hospital Charge Code |
2400259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.64
|
| Rate for Payer: Aetna of WY Medicare |
$83.94
|
| Rate for Payer: Altius Commercial |
$122.09
|
| Rate for Payer: Beech Street Commercial |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.36
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.36
|
| Rate for Payer: Cigna of WY Commercial |
$124.64
|
| Rate for Payer: Entrust Commercial |
$120.82
|
| Rate for Payer: First Choice Health Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.49
|
| Rate for Payer: HealthUtah PPO |
$127.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.36
|
| Rate for Payer: Multiplan Medicare/VA |
$68.87
|
| Rate for Payer: One Health Plan of WY PPO |
$124.64
|
| Rate for Payer: PacificSource Commercial |
$114.46
|
| Rate for Payer: PHCS PPO |
$124.64
|
| Rate for Payer: Three Rivers PPO |
$95.38
|
| Rate for Payer: TriWest Veterans Administration |
$72.49
|
| Rate for Payer: United Healthcare Commercial |
$121.46
|
| Rate for Payer: United Healthcare Medicare |
$72.49
|
| Rate for Payer: WINHealth Partners Commercial |
$124.64
|
| Rate for Payer: Wise Provider Network Commercial |
$120.82
|
|
|
CNTRL VENOUS 3 LUMEN PRESSURE
|
Facility
|
OP
|
$446.60
|
|
| Hospital Charge Code |
2400238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.83 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.67
|
| Rate for Payer: Aetna of WY Medicare |
$294.76
|
| Rate for Payer: Altius Commercial |
$428.74
|
| Rate for Payer: Beech Street Commercial |
$437.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$433.20
|
| Rate for Payer: Cash Price |
$312.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.20
|
| Rate for Payer: Cigna of WY Commercial |
$437.67
|
| Rate for Payer: Entrust Commercial |
$424.27
|
| Rate for Payer: First Choice Health Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.56
|
| Rate for Payer: HealthUtah PPO |
$446.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.20
|
| Rate for Payer: Multiplan Medicare/VA |
$241.83
|
| Rate for Payer: One Health Plan of WY PPO |
$437.67
|
| Rate for Payer: PacificSource Commercial |
$401.94
|
| Rate for Payer: PHCS PPO |
$437.67
|
| Rate for Payer: Three Rivers PPO |
$334.95
|
| Rate for Payer: TriWest Veterans Administration |
$254.56
|
| Rate for Payer: United Healthcare Commercial |
$426.50
|
| Rate for Payer: United Healthcare Medicare |
$254.56
|
| Rate for Payer: WINHealth Partners Commercial |
$437.67
|
| Rate for Payer: Wise Provider Network Commercial |
$424.27
|
|
|
CNTRL VENOUS 3 LUMEN PRESSURE
|
Facility
|
IP
|
$446.60
|
|
| Hospital Charge Code |
2400238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: United Healthcare Commercial |
$426.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.67
|
| Rate for Payer: Aetna of WY Medicare |
$285.82
|
| Rate for Payer: Altius Commercial |
$428.74
|
| Rate for Payer: Beech Street Commercial |
$437.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$433.20
|
| Rate for Payer: Cash Price |
$312.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.20
|
| Rate for Payer: Cigna of WY Commercial |
$437.67
|
| Rate for Payer: Entrust Commercial |
$424.27
|
| Rate for Payer: First Choice Health Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.43
|
| Rate for Payer: HealthUtah PPO |
$446.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.20
|
| Rate for Payer: Multiplan Medicare/VA |
$258.80
|
| Rate for Payer: One Health Plan of WY PPO |
$437.67
|
| Rate for Payer: PacificSource Commercial |
$401.94
|
| Rate for Payer: PHCS PPO |
$437.67
|
| Rate for Payer: Three Rivers PPO |
$334.95
|
| Rate for Payer: TriWest Veterans Administration |
$272.43
|
| Rate for Payer: United Healthcare Medicare |
$272.43
|
| Rate for Payer: WINHealth Partners Commercial |
$424.27
|
| Rate for Payer: Wise Provider Network Commercial |
$424.27
|
|
