|
COPE MANDRIL WIRE GUIDE G05822
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
6550172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.79 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Aetna of WY Medicare |
$62.72
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.06
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.78
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$56.79
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.78
|
| Rate for Payer: United Healthcare Commercial |
$93.59
|
| Rate for Payer: United Healthcare Medicare |
$59.78
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE [129166]
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
NDC 5936551281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$602.68 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Aetna of WY Medicare |
$665.60
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,008.80
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$634.40
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$602.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$634.40
|
| Rate for Payer: United Healthcare Commercial |
$993.20
|
| Rate for Payer: United Healthcare Medicare |
$634.40
|
| Rate for Payer: WINHealth Partners Commercial |
$988.00
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE [129166]
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
NDC 5936551281
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$563.16 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Aetna of WY Medicare |
$686.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,008.80
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$592.80
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$563.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$592.80
|
| Rate for Payer: United Healthcare Commercial |
$993.20
|
| Rate for Payer: United Healthcare Medicare |
$592.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,019.20
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$3,053.00
|
|
|
Service Code
|
HCPCS 23415 AS
|
| Min. Negotiated Rate |
$578.14 |
| Max. Negotiated Rate |
$3,053.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,991.94
|
| Rate for Payer: Beech Street Commercial |
$2,900.35
|
| Rate for Payer: Cash Price |
$2,137.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,961.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,991.94
|
| Rate for Payer: First Choice Health Commercial |
$2,747.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,900.35
|
| Rate for Payer: HealthUtah PPO |
$3,053.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,961.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,991.94
|
| Rate for Payer: PacificSource Commercial |
$2,747.70
|
| Rate for Payer: PHCS PPO |
$2,900.35
|
| Rate for Payer: Three Rivers PPO |
$2,289.75
|
| Rate for Payer: United Healthcare Commercial |
$2,900.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.05
|
|
|
CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$3,053.00
|
|
|
Service Code
|
HCPCS 23415 80
|
| Min. Negotiated Rate |
$578.14 |
| Max. Negotiated Rate |
$3,053.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,991.94
|
| Rate for Payer: Beech Street Commercial |
$2,900.35
|
| Rate for Payer: Cash Price |
$2,137.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,961.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,991.94
|
| Rate for Payer: First Choice Health Commercial |
$2,747.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,900.35
|
| Rate for Payer: HealthUtah PPO |
$3,053.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,961.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,991.94
|
| Rate for Payer: PacificSource Commercial |
$2,747.70
|
| Rate for Payer: PHCS PPO |
$2,900.35
|
| Rate for Payer: Three Rivers PPO |
$2,289.75
|
| Rate for Payer: United Healthcare Commercial |
$2,900.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.05
|
|
|
CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$3,053.00
|
|
|
Service Code
|
HCPCS 23415
|
| Min. Negotiated Rate |
$578.14 |
| Max. Negotiated Rate |
$3,053.00 |
| Rate for Payer: PacificSource Commercial |
$2,747.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,991.94
|
| Rate for Payer: Aetna of WY Medicare |
$680.16
|
| Rate for Payer: Beech Street Commercial |
$2,900.35
|
| Rate for Payer: Cash Price |
$2,137.10
|
| Rate for Payer: Cash Price |
$2,137.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,961.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,991.94
|
| Rate for Payer: First Choice Health Commercial |
$2,747.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,900.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$680.16
|
| Rate for Payer: HealthUtah PPO |
$3,053.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,961.41
|
| Rate for Payer: Multiplan Medicare/VA |
$578.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,991.94
|
| Rate for Payer: PHCS PPO |
$2,900.35
|
| Rate for Payer: Three Rivers PPO |
$2,289.75
|
| Rate for Payer: TriWest Veterans Administration |
$680.16
|
| Rate for Payer: United Healthcare Commercial |
$2,900.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.05
|
|
|
CORING 08MM TREPHINE
|
Facility
|
IP
|
$1,547.00
|
|
| Hospital Charge Code |
3004127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$896.49 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$990.08
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.67
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$896.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$943.67
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$943.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,469.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING 08MM TREPHINE
|
Facility
|
OP
|
$1,547.00
|
|
| Hospital Charge Code |
3004127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.70 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,021.02
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$881.79
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$837.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$881.79
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$881.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING 09MM TREPHINE
|
Facility
|
OP
|
$1,547.00
|
|
| Hospital Charge Code |
3003368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.70 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,021.02
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$881.79
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$837.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$881.79
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$881.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING 09MM TREPHINE
|
Facility
|
IP
|
$1,547.00
|
|
| Hospital Charge Code |
3003368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$896.49 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$990.08
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.67
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$896.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$943.67
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$943.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,469.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING 11MM TREPHINE
|
Facility
|
OP
|
$1,547.00
|
|
| Hospital Charge Code |
3003016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.70 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,021.02
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$881.79
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$837.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$881.79
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$881.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING 11MM TREPHINE
|
Facility
|
IP
|
$1,547.00
|
|
| Hospital Charge Code |
3003016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$896.49 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,516.06
|
| Rate for Payer: Aetna of WY Medicare |
$990.08
|
| Rate for Payer: Altius Commercial |
$1,485.12
|
| Rate for Payer: Beech Street Commercial |
$1,516.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,500.59
|
| Rate for Payer: Cash Price |
$1,082.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,500.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,516.06
|
| Rate for Payer: Entrust Commercial |
$1,469.65
|
| Rate for Payer: First Choice Health Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,469.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.67
|
| Rate for Payer: HealthUtah PPO |
$1,547.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,500.59
|
| Rate for Payer: Multiplan Medicare/VA |
$896.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,516.06
|
| Rate for Payer: PacificSource Commercial |
$1,392.30
|
| Rate for Payer: PHCS PPO |
$1,516.06
|
| Rate for Payer: Three Rivers PPO |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration |
$943.67
|
| Rate for Payer: United Healthcare Commercial |
$1,477.38
|
| Rate for Payer: United Healthcare Medicare |
$943.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,469.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,469.65
|
|
|
CORING REAMER 10MM W/PIN 1224S
|
Facility
|
IP
|
$838.04
|
|
| Hospital Charge Code |
3001985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.64 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$536.35
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.20
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$485.64
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$511.20
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$511.20
|
| Rate for Payer: WINHealth Partners Commercial |
$796.14
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORING REAMER 10MM W/PIN 1224S
|
Facility
|
OP
|
$838.04
|
|
| Hospital Charge Code |
3001985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.80 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$553.11
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.68
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$453.80
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$477.68
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$477.68
|
| Rate for Payer: WINHealth Partners Commercial |
$821.28
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORING REAMER 11MM AR-1226S
|
Facility
|
OP
|
$717.50
|
|
| Hospital Charge Code |
3002095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.53 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$473.55
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.98
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$388.53
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$408.98
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$408.98
|
| Rate for Payer: WINHealth Partners Commercial |
$703.15
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 11MM AR-1226S
|
Facility
|
IP
|
$717.50
|
|
| Hospital Charge Code |
3002095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.79 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$459.20
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.68
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$415.79
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$437.68
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$437.68
|
| Rate for Payer: WINHealth Partners Commercial |
$681.62
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 12MM AR-1227S
|
Facility
|
OP
|
$717.50
|
|
| Hospital Charge Code |
3002096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.53 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$473.55
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.98
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$388.53
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$408.98
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$408.98
|
| Rate for Payer: WINHealth Partners Commercial |
$703.15
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 12MM AR-1227S
|
Facility
|
IP
|
$717.50
|
|
| Hospital Charge Code |
3002096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.79 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$459.20
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.68
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$415.79
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$437.68
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$437.68
|
| Rate for Payer: WINHealth Partners Commercial |
$681.62
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 7MM PIN AR-1220S
|
Facility
|
OP
|
$717.50
|
|
| Hospital Charge Code |
3002093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.53 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$473.55
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.98
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$388.53
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$408.98
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$408.98
|
| Rate for Payer: WINHealth Partners Commercial |
$703.15
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 7MM PIN AR-1220S
|
Facility
|
IP
|
$717.50
|
|
| Hospital Charge Code |
3002093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.79 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$459.20
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.68
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$415.79
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$437.68
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$437.68
|
| Rate for Payer: WINHealth Partners Commercial |
$681.62
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CORING REAMER 8MM PIN AR-1222S
|
Facility
|
OP
|
$838.04
|
|
| Hospital Charge Code |
3002094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.80 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$553.11
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.68
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$453.80
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$477.68
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$477.68
|
| Rate for Payer: WINHealth Partners Commercial |
$821.28
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORING REAMER 8MM PIN AR-1222S
|
Facility
|
IP
|
$838.04
|
|
| Hospital Charge Code |
3002094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.64 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$536.35
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.20
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$485.64
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$511.20
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$511.20
|
| Rate for Payer: WINHealth Partners Commercial |
$796.14
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORING REAMER 9MM PIN AR-1223S
|
Facility
|
IP
|
$838.04
|
|
| Hospital Charge Code |
3002059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.64 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$536.35
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.20
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$485.64
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$511.20
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$511.20
|
| Rate for Payer: WINHealth Partners Commercial |
$796.14
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORING REAMER 9MM PIN AR-1223S
|
Facility
|
OP
|
$838.04
|
|
| Hospital Charge Code |
3002059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.80 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.28
|
| Rate for Payer: Aetna of WY Medicare |
$553.11
|
| Rate for Payer: Altius Commercial |
$804.52
|
| Rate for Payer: Beech Street Commercial |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.90
|
| Rate for Payer: Cash Price |
$586.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.90
|
| Rate for Payer: Cigna of WY Commercial |
$821.28
|
| Rate for Payer: Entrust Commercial |
$796.14
|
| Rate for Payer: First Choice Health Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.68
|
| Rate for Payer: HealthUtah PPO |
$838.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.90
|
| Rate for Payer: Multiplan Medicare/VA |
$453.80
|
| Rate for Payer: One Health Plan of WY PPO |
$821.28
|
| Rate for Payer: PacificSource Commercial |
$754.24
|
| Rate for Payer: PHCS PPO |
$821.28
|
| Rate for Payer: Three Rivers PPO |
$628.53
|
| Rate for Payer: TriWest Veterans Administration |
$477.68
|
| Rate for Payer: United Healthcare Commercial |
$800.33
|
| Rate for Payer: United Healthcare Medicare |
$477.68
|
| Rate for Payer: WINHealth Partners Commercial |
$821.28
|
| Rate for Payer: Wise Provider Network Commercial |
$796.14
|
|
|
CORRECT BUNION, SIMPLE
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 28290 80
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$462.56
|
| Rate for Payer: Beech Street Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$457.84
|
| Rate for Payer: Cigna of WY Commercial |
$462.56
|
| Rate for Payer: First Choice Health Commercial |
$424.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$448.40
|
| Rate for Payer: HealthUtah PPO |
$472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$457.84
|
| Rate for Payer: One Health Plan of WY PPO |
$462.56
|
| Rate for Payer: PacificSource Commercial |
$424.80
|
| Rate for Payer: PHCS PPO |
$448.40
|
| Rate for Payer: Three Rivers PPO |
$354.00
|
| Rate for Payer: United Healthcare Commercial |
$448.40
|
| Rate for Payer: WINHealth Partners Commercial |
$401.20
|
|
