|
ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 36821 AS
|
| Hospital Charge Code |
36821
|
| Min. Negotiated Rate |
$518.39 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,132.48
|
| Rate for Payer: Aetna of WY Medicare |
$609.87
|
| Rate for Payer: Beech Street Commercial |
$2,067.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,110.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,132.48
|
| Rate for Payer: First Choice Health Commercial |
$1,958.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,067.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.87
|
| Rate for Payer: HealthUtah PPO |
$2,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,110.72
|
| Rate for Payer: Multiplan Medicare/VA |
$518.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,132.48
|
| Rate for Payer: PacificSource Commercial |
$1,958.40
|
| Rate for Payer: PHCS PPO |
$2,067.20
|
| Rate for Payer: Three Rivers PPO |
$1,632.00
|
| Rate for Payer: TriWest Veterans Administration |
$609.87
|
| Rate for Payer: United Healthcare Commercial |
$1,893.12
|
| Rate for Payer: United Healthcare Medicare |
$609.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,849.60
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$5,763.00
|
|
|
Service Code
|
HCPCS 22551
|
| Hospital Charge Code |
22551
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$5,763.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,647.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,615.14
|
| Rate for Payer: Beech Street Commercial |
$5,474.85
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,590.11
|
| Rate for Payer: Cigna of WY Commercial |
$5,647.74
|
| Rate for Payer: First Choice Health Commercial |
$5,186.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,474.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,615.14
|
| Rate for Payer: HealthUtah PPO |
$5,763.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,590.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,372.87
|
| Rate for Payer: One Health Plan of WY PPO |
$5,647.74
|
| Rate for Payer: PacificSource Commercial |
$5,186.70
|
| Rate for Payer: PHCS PPO |
$5,474.85
|
| Rate for Payer: Three Rivers PPO |
$4,322.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,615.14
|
| Rate for Payer: United Healthcare Commercial |
$5,013.81
|
| Rate for Payer: United Healthcare Medicare |
$1,615.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,898.55
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$5,763.00
|
|
|
Service Code
|
HCPCS 22551 80
|
| Hospital Charge Code |
22551
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$5,763.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,647.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,615.14
|
| Rate for Payer: Beech Street Commercial |
$5,474.85
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,590.11
|
| Rate for Payer: Cigna of WY Commercial |
$5,647.74
|
| Rate for Payer: First Choice Health Commercial |
$5,186.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,474.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,615.14
|
| Rate for Payer: HealthUtah PPO |
$5,763.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,590.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,372.87
|
| Rate for Payer: One Health Plan of WY PPO |
$5,647.74
|
| Rate for Payer: PacificSource Commercial |
$5,186.70
|
| Rate for Payer: PHCS PPO |
$5,474.85
|
| Rate for Payer: Three Rivers PPO |
$4,322.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,615.14
|
| Rate for Payer: United Healthcare Commercial |
$5,013.81
|
| Rate for Payer: United Healthcare Medicare |
$1,615.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,898.55
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$5,763.00
|
|
|
Service Code
|
HCPCS 22551 AS
|
| Hospital Charge Code |
22551
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$5,763.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,647.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,615.14
|
| Rate for Payer: Beech Street Commercial |
$5,474.85
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: Cash Price |
$4,034.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,590.11
|
| Rate for Payer: Cigna of WY Commercial |
$5,647.74
|
| Rate for Payer: First Choice Health Commercial |
$5,186.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,474.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,615.14
|
| Rate for Payer: HealthUtah PPO |
$5,763.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,590.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,372.87
|
| Rate for Payer: One Health Plan of WY PPO |
$5,647.74
|
| Rate for Payer: PacificSource Commercial |
$5,186.70
|
| Rate for Payer: PHCS PPO |
$5,474.85
|
| Rate for Payer: Three Rivers PPO |
$4,322.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,615.14
|
| Rate for Payer: United Healthcare Commercial |
$5,013.81
|
| Rate for Payer: United Healthcare Medicare |
$1,615.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,898.55
|
|
|
ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,301.00
|
|
|
Service Code
|
HCPCS 22554 80
|
| Hospital Charge Code |
22554
|
| Min. Negotiated Rate |
$1,024.46 |
| Max. Negotiated Rate |
$4,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,214.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,205.25
|
| Rate for Payer: Beech Street Commercial |
$4,085.95
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,171.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,214.98
|
| Rate for Payer: First Choice Health Commercial |
$3,870.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,085.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,205.25
|
| Rate for Payer: HealthUtah PPO |
$4,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,171.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,214.98
|
| Rate for Payer: PacificSource Commercial |
$3,870.90
|
| Rate for Payer: PHCS PPO |
$4,085.95
|
| Rate for Payer: Three Rivers PPO |
$3,225.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,205.25
|
| Rate for Payer: United Healthcare Commercial |
$3,741.87
|
| Rate for Payer: United Healthcare Medicare |
$1,205.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,655.85
|
|
|
ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,301.00
|
|
|
Service Code
|
HCPCS 22554 AS
|
| Hospital Charge Code |
22554
|
| Min. Negotiated Rate |
$1,024.46 |
| Max. Negotiated Rate |
$4,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,214.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,205.25
|
| Rate for Payer: Beech Street Commercial |
$4,085.95
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,171.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,214.98
|
| Rate for Payer: First Choice Health Commercial |
$3,870.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,085.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,205.25
|
| Rate for Payer: HealthUtah PPO |
$4,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,171.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,214.98
|
| Rate for Payer: PacificSource Commercial |
$3,870.90
|
| Rate for Payer: PHCS PPO |
$4,085.95
|
| Rate for Payer: Three Rivers PPO |
$3,225.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,205.25
|
| Rate for Payer: United Healthcare Commercial |
$3,741.87
|
| Rate for Payer: United Healthcare Medicare |
$1,205.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,655.85
|
|
|
ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,301.00
|
|
|
Service Code
|
HCPCS 22554
|
| Hospital Charge Code |
22554
|
| Min. Negotiated Rate |
$1,024.46 |
| Max. Negotiated Rate |
$4,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,214.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,205.25
|
| Rate for Payer: Beech Street Commercial |
$4,085.95
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: Cash Price |
$3,010.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,171.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,214.98
|
| Rate for Payer: First Choice Health Commercial |
$3,870.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,085.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,205.25
|
| Rate for Payer: HealthUtah PPO |
$4,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,171.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,214.98
|
| Rate for Payer: PacificSource Commercial |
$3,870.90
|
| Rate for Payer: PHCS PPO |
$4,085.95
|
| Rate for Payer: Three Rivers PPO |
$3,225.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,205.25
|
| Rate for Payer: United Healthcare Commercial |
$3,741.87
|
| Rate for Payer: United Healthcare Medicare |
$1,205.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,655.85
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 22552 AS
|
| Hospital Charge Code |
22552
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,293.60
|
| Rate for Payer: Aetna of WY Medicare |
$369.82
|
| Rate for Payer: Beech Street Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,280.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,293.60
|
| Rate for Payer: First Choice Health Commercial |
$1,188.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,254.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.82
|
| Rate for Payer: HealthUtah PPO |
$1,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,280.40
|
| Rate for Payer: Multiplan Medicare/VA |
$314.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,293.60
|
| Rate for Payer: PacificSource Commercial |
$1,188.00
|
| Rate for Payer: PHCS PPO |
$1,254.00
|
| Rate for Payer: Three Rivers PPO |
$990.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.82
|
| Rate for Payer: United Healthcare Commercial |
$1,148.40
|
| Rate for Payer: United Healthcare Medicare |
$369.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,122.00
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 22552
|
| Hospital Charge Code |
22552
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,293.60
|
| Rate for Payer: Aetna of WY Medicare |
$369.82
|
| Rate for Payer: Beech Street Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,280.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,293.60
|
| Rate for Payer: First Choice Health Commercial |
$1,188.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,254.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.82
|
| Rate for Payer: HealthUtah PPO |
$1,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,280.40
|
| Rate for Payer: Multiplan Medicare/VA |
$314.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,293.60
|
| Rate for Payer: PacificSource Commercial |
$1,188.00
|
| Rate for Payer: PHCS PPO |
$1,254.00
|
| Rate for Payer: Three Rivers PPO |
$990.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.82
|
| Rate for Payer: United Healthcare Commercial |
$1,148.40
|
| Rate for Payer: United Healthcare Medicare |
$369.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,122.00
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 22552 80
|
| Hospital Charge Code |
22552
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,293.60
|
| Rate for Payer: Aetna of WY Medicare |
$369.82
|
| Rate for Payer: Beech Street Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,280.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,293.60
|
| Rate for Payer: First Choice Health Commercial |
$1,188.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,254.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.82
|
| Rate for Payer: HealthUtah PPO |
$1,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,280.40
|
| Rate for Payer: Multiplan Medicare/VA |
$314.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,293.60
|
| Rate for Payer: PacificSource Commercial |
$1,188.00
|
| Rate for Payer: PHCS PPO |
$1,254.00
|
| Rate for Payer: Three Rivers PPO |
$990.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.82
|
| Rate for Payer: United Healthcare Commercial |
$1,148.40
|
| Rate for Payer: United Healthcare Medicare |
$369.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,122.00
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 22585
|
| Hospital Charge Code |
22585
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,060.36
|
| Rate for Payer: Aetna of WY Medicare |
$303.45
|
| Rate for Payer: Beech Street Commercial |
$1,027.90
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,049.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,060.36
|
| Rate for Payer: First Choice Health Commercial |
$973.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,027.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.45
|
| Rate for Payer: HealthUtah PPO |
$1,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,049.54
|
| Rate for Payer: Multiplan Medicare/VA |
$257.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,060.36
|
| Rate for Payer: PacificSource Commercial |
$973.80
|
| Rate for Payer: PHCS PPO |
$1,027.90
|
| Rate for Payer: Three Rivers PPO |
$811.50
|
| Rate for Payer: TriWest Veterans Administration |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$941.34
|
| Rate for Payer: United Healthcare Medicare |
$303.45
|
| Rate for Payer: WINHealth Partners Commercial |
$919.70
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 22585 AS
|
| Hospital Charge Code |
22585
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,060.36
|
| Rate for Payer: Aetna of WY Medicare |
$303.45
|
| Rate for Payer: Beech Street Commercial |
$1,027.90
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,049.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,060.36
|
| Rate for Payer: First Choice Health Commercial |
$973.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,027.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.45
|
| Rate for Payer: HealthUtah PPO |
$1,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,049.54
|
| Rate for Payer: Multiplan Medicare/VA |
$257.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,060.36
|
| Rate for Payer: PacificSource Commercial |
$973.80
|
| Rate for Payer: PHCS PPO |
$1,027.90
|
| Rate for Payer: Three Rivers PPO |
$811.50
|
| Rate for Payer: TriWest Veterans Administration |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$941.34
|
| Rate for Payer: United Healthcare Medicare |
$303.45
|
| Rate for Payer: WINHealth Partners Commercial |
$919.70
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 22585 80
|
| Hospital Charge Code |
22585
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,060.36
|
| Rate for Payer: Aetna of WY Medicare |
$303.45
|
| Rate for Payer: Beech Street Commercial |
$1,027.90
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: Cash Price |
$757.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,049.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,060.36
|
| Rate for Payer: First Choice Health Commercial |
$973.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,027.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.45
|
| Rate for Payer: HealthUtah PPO |
$1,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,049.54
|
| Rate for Payer: Multiplan Medicare/VA |
$257.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,060.36
|
| Rate for Payer: PacificSource Commercial |
$973.80
|
| Rate for Payer: PHCS PPO |
$1,027.90
|
| Rate for Payer: Three Rivers PPO |
$811.50
|
| Rate for Payer: TriWest Veterans Administration |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$941.34
|
| Rate for Payer: United Healthcare Medicare |
$303.45
|
| Rate for Payer: WINHealth Partners Commercial |
$919.70
|
|
|
ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 26841 80
|
| Hospital Charge Code |
26841
|
| Min. Negotiated Rate |
$646.11 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,657.76
|
| Rate for Payer: Aetna of WY Medicare |
$760.13
|
| Rate for Payer: Beech Street Commercial |
$2,576.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,630.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,657.76
|
| Rate for Payer: First Choice Health Commercial |
$2,440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,576.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$760.13
|
| Rate for Payer: HealthUtah PPO |
$2,712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,630.64
|
| Rate for Payer: Multiplan Medicare/VA |
$646.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,657.76
|
| Rate for Payer: PacificSource Commercial |
$2,440.80
|
| Rate for Payer: PHCS PPO |
$2,576.40
|
| Rate for Payer: Three Rivers PPO |
$2,034.00
|
| Rate for Payer: TriWest Veterans Administration |
$760.13
|
| Rate for Payer: United Healthcare Commercial |
$2,359.44
|
| Rate for Payer: United Healthcare Medicare |
$760.13
|
| Rate for Payer: WINHealth Partners Commercial |
$2,305.20
|
|
|
ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
26841
|
| Min. Negotiated Rate |
$646.11 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,657.76
|
| Rate for Payer: Aetna of WY Medicare |
$760.13
|
| Rate for Payer: Beech Street Commercial |
$2,576.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,630.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,657.76
|
| Rate for Payer: First Choice Health Commercial |
$2,440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,576.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$760.13
|
| Rate for Payer: HealthUtah PPO |
$2,712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,630.64
|
| Rate for Payer: Multiplan Medicare/VA |
$646.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,657.76
|
| Rate for Payer: PacificSource Commercial |
$2,440.80
|
| Rate for Payer: PHCS PPO |
$2,576.40
|
| Rate for Payer: Three Rivers PPO |
$2,034.00
|
| Rate for Payer: TriWest Veterans Administration |
$760.13
|
| Rate for Payer: United Healthcare Commercial |
$2,359.44
|
| Rate for Payer: United Healthcare Medicare |
$760.13
|
| Rate for Payer: WINHealth Partners Commercial |
$2,305.20
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 28730
|
| Hospital Charge Code |
28730
|
| Min. Negotiated Rate |
$598.75 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,462.74
|
| Rate for Payer: Aetna of WY Medicare |
$704.41
|
| Rate for Payer: Beech Street Commercial |
$2,387.35
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,437.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,462.74
|
| Rate for Payer: First Choice Health Commercial |
$2,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,387.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.41
|
| Rate for Payer: HealthUtah PPO |
$2,513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,437.61
|
| Rate for Payer: Multiplan Medicare/VA |
$598.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,462.74
|
| Rate for Payer: PacificSource Commercial |
$2,261.70
|
| Rate for Payer: PHCS PPO |
$2,387.35
|
| Rate for Payer: Three Rivers PPO |
$1,884.75
|
| Rate for Payer: TriWest Veterans Administration |
$704.41
|
| Rate for Payer: United Healthcare Commercial |
$2,186.31
|
| Rate for Payer: United Healthcare Medicare |
$704.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,136.05
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 28730 AS
|
| Hospital Charge Code |
28730
|
| Min. Negotiated Rate |
$598.75 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,462.74
|
| Rate for Payer: Aetna of WY Medicare |
$704.41
|
| Rate for Payer: Beech Street Commercial |
$2,387.35
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,437.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,462.74
|
| Rate for Payer: First Choice Health Commercial |
$2,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,387.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.41
|
| Rate for Payer: HealthUtah PPO |
$2,513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,437.61
|
| Rate for Payer: Multiplan Medicare/VA |
$598.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,462.74
|
| Rate for Payer: PacificSource Commercial |
$2,261.70
|
| Rate for Payer: PHCS PPO |
$2,387.35
|
| Rate for Payer: Three Rivers PPO |
$1,884.75
|
| Rate for Payer: TriWest Veterans Administration |
$704.41
|
| Rate for Payer: United Healthcare Commercial |
$2,186.31
|
| Rate for Payer: United Healthcare Medicare |
$704.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,136.05
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 28730 80
|
| Hospital Charge Code |
28730
|
| Min. Negotiated Rate |
$598.75 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,462.74
|
| Rate for Payer: Aetna of WY Medicare |
$704.41
|
| Rate for Payer: Beech Street Commercial |
$2,387.35
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,437.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,462.74
|
| Rate for Payer: First Choice Health Commercial |
$2,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,387.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.41
|
| Rate for Payer: HealthUtah PPO |
$2,513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,437.61
|
| Rate for Payer: Multiplan Medicare/VA |
$598.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,462.74
|
| Rate for Payer: PacificSource Commercial |
$2,261.70
|
| Rate for Payer: PHCS PPO |
$2,387.35
|
| Rate for Payer: Three Rivers PPO |
$1,884.75
|
| Rate for Payer: TriWest Veterans Administration |
$704.41
|
| Rate for Payer: United Healthcare Commercial |
$2,186.31
|
| Rate for Payer: United Healthcare Medicare |
$704.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,136.05
|
|
|
ARTHREX FLEXTIP PROBE 35CM
|
Facility
|
OP
|
$3,500.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,928.50 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,430.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,310.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,360.00
|
| Rate for Payer: Altius Commercial |
$3,360.00
|
| Rate for Payer: Beech Street Commercial |
$3,430.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,873.50
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,395.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,430.00
|
| Rate for Payer: Entrust Commercial |
$3,325.00
|
| Rate for Payer: First Choice Health Commercial |
$3,325.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,325.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,030.00
|
| Rate for Payer: HealthUtah PPO |
$3,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,395.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,928.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,430.00
|
| Rate for Payer: PacificSource Commercial |
$3,150.00
|
| Rate for Payer: PHCS PPO |
$3,430.00
|
| Rate for Payer: Three Rivers PPO |
$2,625.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,030.00
|
| Rate for Payer: United Healthcare Commercial |
$3,045.00
|
| Rate for Payer: United Healthcare Medicare |
$2,030.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,430.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,325.00
|
|
|
ARTHREX FLEXTIP PROBE 35CM
|
Facility
|
IP
|
$3,500.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,194.50 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,430.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,360.00
|
| Rate for Payer: Altius Commercial |
$3,360.00
|
| Rate for Payer: Beech Street Commercial |
$3,430.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,873.50
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,395.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,430.00
|
| Rate for Payer: Entrust Commercial |
$3,325.00
|
| Rate for Payer: First Choice Health Commercial |
$3,325.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,325.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,310.00
|
| Rate for Payer: HealthUtah PPO |
$3,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,395.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,194.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,430.00
|
| Rate for Payer: PacificSource Commercial |
$3,150.00
|
| Rate for Payer: PHCS PPO |
$3,430.00
|
| Rate for Payer: Three Rivers PPO |
$2,625.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,310.00
|
| Rate for Payer: United Healthcare Commercial |
$3,045.00
|
| Rate for Payer: United Healthcare Medicare |
$2,310.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,325.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,325.00
|
|
|
ARTHREX MAIN PUMP TUB AR-6410
|
Facility
|
IP
|
$249.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.36 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$239.40
|
| Rate for Payer: Altius Commercial |
$239.40
|
| Rate for Payer: Beech Street Commercial |
$244.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.74
|
| Rate for Payer: Cash Price |
$174.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.90
|
| Rate for Payer: Cigna of WY Commercial |
$244.39
|
| Rate for Payer: Entrust Commercial |
$236.91
|
| Rate for Payer: First Choice Health Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.59
|
| Rate for Payer: HealthUtah PPO |
$249.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.90
|
| Rate for Payer: Multiplan Medicare/VA |
$156.36
|
| Rate for Payer: One Health Plan of WY PPO |
$244.39
|
| Rate for Payer: PacificSource Commercial |
$224.44
|
| Rate for Payer: PHCS PPO |
$244.39
|
| Rate for Payer: Three Rivers PPO |
$187.04
|
| Rate for Payer: TriWest Veterans Administration |
$164.59
|
| Rate for Payer: United Healthcare Commercial |
$216.96
|
| Rate for Payer: United Healthcare Medicare |
$164.59
|
| Rate for Payer: WINHealth Partners Commercial |
$236.91
|
| Rate for Payer: Wise Provider Network Commercial |
$236.91
|
|
|
ARTHREX MAIN PUMP TUB AR-6410
|
Facility
|
OP
|
$249.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.41 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.39
|
| Rate for Payer: Aetna of WY Medicare |
$164.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$239.40
|
| Rate for Payer: Altius Commercial |
$239.40
|
| Rate for Payer: Beech Street Commercial |
$244.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.74
|
| Rate for Payer: Cash Price |
$174.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.90
|
| Rate for Payer: Cigna of WY Commercial |
$244.39
|
| Rate for Payer: Entrust Commercial |
$236.91
|
| Rate for Payer: First Choice Health Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.64
|
| Rate for Payer: HealthUtah PPO |
$249.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.90
|
| Rate for Payer: Multiplan Medicare/VA |
$137.41
|
| Rate for Payer: One Health Plan of WY PPO |
$244.39
|
| Rate for Payer: PacificSource Commercial |
$224.44
|
| Rate for Payer: PHCS PPO |
$244.39
|
| Rate for Payer: Three Rivers PPO |
$187.04
|
| Rate for Payer: TriWest Veterans Administration |
$144.64
|
| Rate for Payer: United Healthcare Commercial |
$216.96
|
| Rate for Payer: United Healthcare Medicare |
$144.64
|
| Rate for Payer: WINHealth Partners Commercial |
$244.39
|
| Rate for Payer: Wise Provider Network Commercial |
$236.91
|
|
|
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Hospital Charge Code |
20605
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.98
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$333.45
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$340.47
|
| Rate for Payer: Cigna of WY Commercial |
$343.98
|
| Rate for Payer: First Choice Health Commercial |
$315.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$333.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$340.47
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$343.98
|
| Rate for Payer: PacificSource Commercial |
$315.90
|
| Rate for Payer: PHCS PPO |
$333.45
|
| Rate for Payer: Three Rivers PPO |
$263.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$305.37
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$298.35
|
|
|
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
20605
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
| Rate for Payer: WINHealth Partners Commercial |
$149.60
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
20610
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.46
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$215.65
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.19
|
| Rate for Payer: Cigna of WY Commercial |
$222.46
|
| Rate for Payer: First Choice Health Commercial |
$204.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.19
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$222.46
|
| Rate for Payer: PacificSource Commercial |
$204.30
|
| Rate for Payer: PHCS PPO |
$215.65
|
| Rate for Payer: Three Rivers PPO |
$170.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$197.49
|
| Rate for Payer: United Healthcare Medicare |
$43.42
|
| Rate for Payer: WINHealth Partners Commercial |
$192.95
|
|
