|
DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$5,589.00
|
|
|
Service Code
|
HCPCS 27602 AS
|
| Min. Negotiated Rate |
$383.94 |
| Max. Negotiated Rate |
$5,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,477.22
|
| Rate for Payer: Beech Street Commercial |
$5,309.55
|
| Rate for Payer: Cash Price |
$3,912.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,421.33
|
| Rate for Payer: Cigna of WY Commercial |
$5,477.22
|
| Rate for Payer: First Choice Health Commercial |
$5,030.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,309.55
|
| Rate for Payer: HealthUtah PPO |
$5,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,421.33
|
| Rate for Payer: One Health Plan of WY PPO |
$5,477.22
|
| Rate for Payer: PacificSource Commercial |
$5,030.10
|
| Rate for Payer: PHCS PPO |
$5,309.55
|
| Rate for Payer: Three Rivers PPO |
$4,191.75
|
| Rate for Payer: United Healthcare Commercial |
$5,309.55
|
| Rate for Payer: WINHealth Partners Commercial |
$4,750.65
|
|
|
DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 62287 AS
|
| Min. Negotiated Rate |
$1,550.25 |
| Max. Negotiated Rate |
$2,067.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,025.66
|
| Rate for Payer: Beech Street Commercial |
$1,963.65
|
| Rate for Payer: Cash Price |
$1,446.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,004.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,025.66
|
| Rate for Payer: First Choice Health Commercial |
$1,860.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,963.65
|
| Rate for Payer: HealthUtah PPO |
$2,067.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,004.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,025.66
|
| Rate for Payer: PacificSource Commercial |
$1,860.30
|
| Rate for Payer: PHCS PPO |
$1,963.65
|
| Rate for Payer: Three Rivers PPO |
$1,550.25
|
| Rate for Payer: United Healthcare Commercial |
$1,963.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,756.95
|
|
|
DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 62287 80
|
| Min. Negotiated Rate |
$1,550.25 |
| Max. Negotiated Rate |
$2,067.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,025.66
|
| Rate for Payer: Beech Street Commercial |
$1,963.65
|
| Rate for Payer: Cash Price |
$1,446.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,004.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,025.66
|
| Rate for Payer: First Choice Health Commercial |
$1,860.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,963.65
|
| Rate for Payer: HealthUtah PPO |
$2,067.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,004.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,025.66
|
| Rate for Payer: PacificSource Commercial |
$1,860.30
|
| Rate for Payer: PHCS PPO |
$1,963.65
|
| Rate for Payer: Three Rivers PPO |
$1,550.25
|
| Rate for Payer: United Healthcare Commercial |
$1,963.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,756.95
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 11044 AS
|
| Min. Negotiated Rate |
$419.25 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Beech Street Commercial |
$531.05
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: First Choice Health Commercial |
$503.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$531.05
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: United Healthcare Commercial |
$531.05
|
| Rate for Payer: WINHealth Partners Commercial |
$475.15
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$973.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$973.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$953.54
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$924.35
|
| Rate for Payer: Cash Price |
$681.10
|
| Rate for Payer: Cash Price |
$681.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$943.81
|
| Rate for Payer: Cigna of WY Commercial |
$953.54
|
| Rate for Payer: First Choice Health Commercial |
$875.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$924.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$973.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$943.81
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$953.54
|
| Rate for Payer: PacificSource Commercial |
$875.70
|
| Rate for Payer: PHCS PPO |
$924.35
|
| Rate for Payer: Three Rivers PPO |
$729.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$924.35
|
| Rate for Payer: WINHealth Partners Commercial |
$827.05
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 11044 80
|
| Min. Negotiated Rate |
$419.25 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Beech Street Commercial |
$531.05
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: First Choice Health Commercial |
$503.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$531.05
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: United Healthcare Commercial |
$531.05
|
| Rate for Payer: WINHealth Partners Commercial |
$475.15
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$113.70 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$572.32
|
| Rate for Payer: Aetna of WY Medicare |
$133.77
|
| Rate for Payer: Beech Street Commercial |
$554.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$566.48
|
| Rate for Payer: Cigna of WY Commercial |
$572.32
|
| Rate for Payer: First Choice Health Commercial |
$525.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$554.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.77
|
| Rate for Payer: HealthUtah PPO |
$584.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$566.48
|
| Rate for Payer: Multiplan Medicare/VA |
$113.70
|
| Rate for Payer: One Health Plan of WY PPO |
$572.32
|
| Rate for Payer: PacificSource Commercial |
$525.60
|
| Rate for Payer: PHCS PPO |
$554.80
|
| Rate for Payer: Three Rivers PPO |
$438.00
|
| Rate for Payer: TriWest Veterans Administration |
$133.77
|
| Rate for Payer: United Healthcare Commercial |
$554.80
|
| Rate for Payer: WINHealth Partners Commercial |
$496.40
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$49.40
|
| Rate for Payer: Beech Street Commercial |
$211.85
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: First Choice Health Commercial |
$200.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.40
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$41.99
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$211.85
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.40
|
| Rate for Payer: United Healthcare Commercial |
$211.85
|
| Rate for Payer: WINHealth Partners Commercial |
$189.55
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 11043 80
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Beech Street Commercial |
$143.45
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: First Choice Health Commercial |
$135.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$143.45
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$143.45
|
| Rate for Payer: WINHealth Partners Commercial |
$128.35
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Beech Street Commercial |
$631.75
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: First Choice Health Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$631.75
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: WINHealth Partners Commercial |
$565.25
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$51.75
|
| Rate for Payer: Beech Street Commercial |
$227.05
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: First Choice Health Commercial |
$215.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.75
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$43.99
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$227.05
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
| Rate for Payer: WINHealth Partners Commercial |
$203.15
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$11.48
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
| Rate for Payer: WINHealth Partners Commercial |
$52.70
|
|
|
DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$267.90
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: First Choice Health Commercial |
$253.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$267.90
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$267.90
|
| Rate for Payer: WINHealth Partners Commercial |
$267.90
|
|
|
DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$23.39
|
| Rate for Payer: Beech Street Commercial |
$152.95
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: First Choice Health Commercial |
$144.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.39
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$19.88
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$152.95
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.39
|
| Rate for Payer: United Healthcare Commercial |
$152.95
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Beech Street Commercial |
$248.90
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: First Choice Health Commercial |
$235.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: HealthUtah PPO |
$262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$248.90
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
| Rate for Payer: WINHealth Partners Commercial |
$222.70
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 11042 80
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Beech Street Commercial |
$107.35
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: First Choice Health Commercial |
$101.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$107.35
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
| Rate for Payer: WINHealth Partners Commercial |
$96.05
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$23.87
|
| Rate for Payer: Beech Street Commercial |
$109.25
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: First Choice Health Commercial |
$103.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.87
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$20.29
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$109.25
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.87
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: WINHealth Partners Commercial |
$97.75
|
|
|
DECELLULARIZED DERMIS 20X25X1
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
3004117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
DECELLULARIZED DERMIS 20X25X1
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
3004117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
DECELLULARIZED DERMIS 25X30X1
|
Facility
|
OP
|
$4,200.00
|
|
| Hospital Charge Code |
3004279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.30 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,772.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,394.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,274.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,394.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,394.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,116.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
DECELLULARIZED DERMIS 25X30X1
|
Facility
|
IP
|
$4,200.00
|
|
| Hospital Charge Code |
3004279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.90 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,562.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,433.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,562.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,990.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
DECELLULARIZED DERMIS 4X7X.2CM
|
Facility
|
OP
|
$9,922.50
|
|
| Hospital Charge Code |
3003291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,373.03 |
| Max. Negotiated Rate |
$9,922.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,724.05
|
| Rate for Payer: Aetna of WY Medicare |
$6,548.85
|
| Rate for Payer: Altius Commercial |
$9,525.60
|
| Rate for Payer: Beech Street Commercial |
$9,724.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,624.82
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,624.82
|
| Rate for Payer: Cigna of WY Commercial |
$9,724.05
|
| Rate for Payer: Entrust Commercial |
$9,426.38
|
| Rate for Payer: First Choice Health Commercial |
$9,426.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,426.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,655.82
|
| Rate for Payer: HealthUtah PPO |
$9,922.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,624.82
|
| Rate for Payer: Multiplan Medicare/VA |
$5,373.03
|
| Rate for Payer: One Health Plan of WY PPO |
$9,724.05
|
| Rate for Payer: PacificSource Commercial |
$8,930.25
|
| Rate for Payer: PHCS PPO |
$9,724.05
|
| Rate for Payer: Three Rivers PPO |
$7,441.88
|
| Rate for Payer: TriWest Veterans Administration |
$5,655.82
|
| Rate for Payer: United Healthcare Commercial |
$9,475.99
|
| Rate for Payer: United Healthcare Medicare |
$5,655.82
|
| Rate for Payer: WINHealth Partners Commercial |
$9,724.05
|
| Rate for Payer: Wise Provider Network Commercial |
$9,426.38
|
|
|
DECELLULARIZED DERMIS 4X7X.2CM
|
Facility
|
IP
|
$9,922.50
|
|
| Hospital Charge Code |
3003291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,750.09 |
| Max. Negotiated Rate |
$9,922.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,724.05
|
| Rate for Payer: Aetna of WY Medicare |
$6,350.40
|
| Rate for Payer: Altius Commercial |
$9,525.60
|
| Rate for Payer: Beech Street Commercial |
$9,724.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,624.82
|
| Rate for Payer: Cash Price |
$6,945.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,624.82
|
| Rate for Payer: Cigna of WY Commercial |
$9,724.05
|
| Rate for Payer: Entrust Commercial |
$9,426.38
|
| Rate for Payer: First Choice Health Commercial |
$9,426.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,426.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,052.72
|
| Rate for Payer: HealthUtah PPO |
$9,922.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,624.82
|
| Rate for Payer: Multiplan Medicare/VA |
$5,750.09
|
| Rate for Payer: One Health Plan of WY PPO |
$9,724.05
|
| Rate for Payer: PacificSource Commercial |
$8,930.25
|
| Rate for Payer: PHCS PPO |
$9,724.05
|
| Rate for Payer: Three Rivers PPO |
$7,441.88
|
| Rate for Payer: TriWest Veterans Administration |
$6,052.72
|
| Rate for Payer: United Healthcare Commercial |
$9,475.99
|
| Rate for Payer: United Healthcare Medicare |
$6,052.72
|
| Rate for Payer: WINHealth Partners Commercial |
$9,426.38
|
| Rate for Payer: Wise Provider Network Commercial |
$9,426.38
|
|
|
DECELLULARIZED DERMIS AFLEX301
|
Facility
|
OP
|
$13,879.25
|
|
| Hospital Charge Code |
3002378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,515.61 |
| Max. Negotiated Rate |
$13,879.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,601.66
|
| Rate for Payer: Aetna of WY Medicare |
$9,160.30
|
| Rate for Payer: Altius Commercial |
$13,324.08
|
| Rate for Payer: Beech Street Commercial |
$13,601.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,462.87
|
| Rate for Payer: Cash Price |
$9,715.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,462.87
|
| Rate for Payer: Cigna of WY Commercial |
$13,601.66
|
| Rate for Payer: Entrust Commercial |
$13,185.29
|
| Rate for Payer: First Choice Health Commercial |
$13,185.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,185.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,911.17
|
| Rate for Payer: HealthUtah PPO |
$13,879.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,462.87
|
| Rate for Payer: Multiplan Medicare/VA |
$7,515.61
|
| Rate for Payer: One Health Plan of WY PPO |
$13,601.66
|
| Rate for Payer: PacificSource Commercial |
$12,491.32
|
| Rate for Payer: PHCS PPO |
$13,601.66
|
| Rate for Payer: Three Rivers PPO |
$10,409.44
|
| Rate for Payer: TriWest Veterans Administration |
$7,911.17
|
| Rate for Payer: United Healthcare Commercial |
$13,254.68
|
| Rate for Payer: United Healthcare Medicare |
$7,911.17
|
| Rate for Payer: WINHealth Partners Commercial |
$13,601.66
|
| Rate for Payer: Wise Provider Network Commercial |
$13,185.29
|
|
|
DECELLULARIZED DERMIS AFLEX301
|
Facility
|
IP
|
$13,879.25
|
|
| Hospital Charge Code |
3002378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,043.03 |
| Max. Negotiated Rate |
$13,879.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,601.66
|
| Rate for Payer: Aetna of WY Medicare |
$8,882.72
|
| Rate for Payer: Altius Commercial |
$13,324.08
|
| Rate for Payer: Beech Street Commercial |
$13,601.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,462.87
|
| Rate for Payer: Cash Price |
$9,715.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,462.87
|
| Rate for Payer: Cigna of WY Commercial |
$13,601.66
|
| Rate for Payer: Entrust Commercial |
$13,185.29
|
| Rate for Payer: First Choice Health Commercial |
$13,185.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,185.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,466.34
|
| Rate for Payer: HealthUtah PPO |
$13,879.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,462.87
|
| Rate for Payer: Multiplan Medicare/VA |
$8,043.03
|
| Rate for Payer: One Health Plan of WY PPO |
$13,601.66
|
| Rate for Payer: PacificSource Commercial |
$12,491.32
|
| Rate for Payer: PHCS PPO |
$13,601.66
|
| Rate for Payer: Three Rivers PPO |
$10,409.44
|
| Rate for Payer: TriWest Veterans Administration |
$8,466.34
|
| Rate for Payer: United Healthcare Commercial |
$13,254.68
|
| Rate for Payer: United Healthcare Medicare |
$8,466.34
|
| Rate for Payer: WINHealth Partners Commercial |
$13,185.29
|
| Rate for Payer: Wise Provider Network Commercial |
$13,185.29
|
|
