|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,068.00
|
|
|
Service Code
|
HCPCS 22632 AS
|
| Hospital Charge Code |
22632
|
| Min. Negotiated Rate |
$254.38 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,046.64
|
| Rate for Payer: Aetna of WY Medicare |
$299.27
|
| Rate for Payer: Beech Street Commercial |
$1,014.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,035.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,046.64
|
| Rate for Payer: First Choice Health Commercial |
$961.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,014.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.27
|
| Rate for Payer: HealthUtah PPO |
$1,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,035.96
|
| Rate for Payer: Multiplan Medicare/VA |
$254.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,046.64
|
| Rate for Payer: PacificSource Commercial |
$961.20
|
| Rate for Payer: PHCS PPO |
$1,014.60
|
| Rate for Payer: Three Rivers PPO |
$801.00
|
| Rate for Payer: TriWest Veterans Administration |
$299.27
|
| Rate for Payer: United Healthcare Commercial |
$929.16
|
| Rate for Payer: United Healthcare Medicare |
$299.27
|
| Rate for Payer: WINHealth Partners Commercial |
$907.80
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,068.00
|
|
|
Service Code
|
HCPCS 22632
|
| Hospital Charge Code |
22632
|
| Min. Negotiated Rate |
$254.38 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,046.64
|
| Rate for Payer: Aetna of WY Medicare |
$299.27
|
| Rate for Payer: Beech Street Commercial |
$1,014.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,035.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,046.64
|
| Rate for Payer: First Choice Health Commercial |
$961.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,014.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.27
|
| Rate for Payer: HealthUtah PPO |
$1,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,035.96
|
| Rate for Payer: Multiplan Medicare/VA |
$254.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,046.64
|
| Rate for Payer: PacificSource Commercial |
$961.20
|
| Rate for Payer: PHCS PPO |
$1,014.60
|
| Rate for Payer: Three Rivers PPO |
$801.00
|
| Rate for Payer: TriWest Veterans Administration |
$299.27
|
| Rate for Payer: United Healthcare Commercial |
$929.16
|
| Rate for Payer: United Healthcare Medicare |
$299.27
|
| Rate for Payer: WINHealth Partners Commercial |
$907.80
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$5,295.00
|
|
|
Service Code
|
HCPCS 22630 AS
|
| Hospital Charge Code |
22630
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$5,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,189.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,484.15
|
| Rate for Payer: Beech Street Commercial |
$5,030.25
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,136.15
|
| Rate for Payer: Cigna of WY Commercial |
$5,189.10
|
| Rate for Payer: First Choice Health Commercial |
$4,765.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,030.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,484.15
|
| Rate for Payer: HealthUtah PPO |
$5,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,136.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,261.53
|
| Rate for Payer: One Health Plan of WY PPO |
$5,189.10
|
| Rate for Payer: PacificSource Commercial |
$4,765.50
|
| Rate for Payer: PHCS PPO |
$5,030.25
|
| Rate for Payer: Three Rivers PPO |
$3,971.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,484.15
|
| Rate for Payer: United Healthcare Commercial |
$4,606.65
|
| Rate for Payer: United Healthcare Medicare |
$1,484.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4,500.75
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$5,295.00
|
|
|
Service Code
|
HCPCS 22630
|
| Hospital Charge Code |
22630
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$5,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,189.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,484.15
|
| Rate for Payer: Beech Street Commercial |
$5,030.25
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,136.15
|
| Rate for Payer: Cigna of WY Commercial |
$5,189.10
|
| Rate for Payer: First Choice Health Commercial |
$4,765.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,030.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,484.15
|
| Rate for Payer: HealthUtah PPO |
$5,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,136.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,261.53
|
| Rate for Payer: One Health Plan of WY PPO |
$5,189.10
|
| Rate for Payer: PacificSource Commercial |
$4,765.50
|
| Rate for Payer: PHCS PPO |
$5,030.25
|
| Rate for Payer: Three Rivers PPO |
$3,971.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,484.15
|
| Rate for Payer: United Healthcare Commercial |
$4,606.65
|
| Rate for Payer: United Healthcare Medicare |
$1,484.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4,500.75
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$5,295.00
|
|
|
Service Code
|
HCPCS 22630 80
|
| Hospital Charge Code |
22630
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$5,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,189.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,484.15
|
| Rate for Payer: Beech Street Commercial |
$5,030.25
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,136.15
|
| Rate for Payer: Cigna of WY Commercial |
$5,189.10
|
| Rate for Payer: First Choice Health Commercial |
$4,765.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,030.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,484.15
|
| Rate for Payer: HealthUtah PPO |
$5,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,136.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,261.53
|
| Rate for Payer: One Health Plan of WY PPO |
$5,189.10
|
| Rate for Payer: PacificSource Commercial |
$4,765.50
|
| Rate for Payer: PHCS PPO |
$5,030.25
|
| Rate for Payer: Three Rivers PPO |
$3,971.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,484.15
|
| Rate for Payer: United Healthcare Commercial |
$4,606.65
|
| Rate for Payer: United Healthcare Medicare |
$1,484.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4,500.75
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$5,378.00
|
|
|
Service Code
|
HCPCS 22612
|
| Hospital Charge Code |
22612
|
| Min. Negotiated Rate |
$1,281.15 |
| Max. Negotiated Rate |
$5,378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,270.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,507.24
|
| Rate for Payer: Beech Street Commercial |
$5,109.10
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,216.66
|
| Rate for Payer: Cigna of WY Commercial |
$5,270.44
|
| Rate for Payer: First Choice Health Commercial |
$4,840.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,109.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,507.24
|
| Rate for Payer: HealthUtah PPO |
$5,378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,216.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,270.44
|
| Rate for Payer: PacificSource Commercial |
$4,840.20
|
| Rate for Payer: PHCS PPO |
$5,109.10
|
| Rate for Payer: Three Rivers PPO |
$4,033.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,507.24
|
| Rate for Payer: United Healthcare Commercial |
$4,678.86
|
| Rate for Payer: United Healthcare Medicare |
$1,507.24
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.30
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$5,378.00
|
|
|
Service Code
|
HCPCS 22612 AS
|
| Hospital Charge Code |
22612
|
| Min. Negotiated Rate |
$1,281.15 |
| Max. Negotiated Rate |
$5,378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,270.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,507.24
|
| Rate for Payer: Beech Street Commercial |
$5,109.10
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,216.66
|
| Rate for Payer: Cigna of WY Commercial |
$5,270.44
|
| Rate for Payer: First Choice Health Commercial |
$4,840.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,109.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,507.24
|
| Rate for Payer: HealthUtah PPO |
$5,378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,216.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,270.44
|
| Rate for Payer: PacificSource Commercial |
$4,840.20
|
| Rate for Payer: PHCS PPO |
$5,109.10
|
| Rate for Payer: Three Rivers PPO |
$4,033.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,507.24
|
| Rate for Payer: United Healthcare Commercial |
$4,678.86
|
| Rate for Payer: United Healthcare Medicare |
$1,507.24
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.30
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$5,378.00
|
|
|
Service Code
|
HCPCS 22612 80
|
| Hospital Charge Code |
22612
|
| Min. Negotiated Rate |
$1,281.15 |
| Max. Negotiated Rate |
$5,378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,270.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,507.24
|
| Rate for Payer: Beech Street Commercial |
$5,109.10
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: Cash Price |
$3,764.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,216.66
|
| Rate for Payer: Cigna of WY Commercial |
$5,270.44
|
| Rate for Payer: First Choice Health Commercial |
$4,840.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,109.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,507.24
|
| Rate for Payer: HealthUtah PPO |
$5,378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,216.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,270.44
|
| Rate for Payer: PacificSource Commercial |
$4,840.20
|
| Rate for Payer: PHCS PPO |
$5,109.10
|
| Rate for Payer: Three Rivers PPO |
$4,033.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,507.24
|
| Rate for Payer: United Healthcare Commercial |
$4,678.86
|
| Rate for Payer: United Healthcare Medicare |
$1,507.24
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.30
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 22614 80
|
| Hospital Charge Code |
22614
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,803.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,766.94
|
| Rate for Payer: Aetna of WY Medicare |
$365.33
|
| Rate for Payer: Beech Street Commercial |
$1,712.85
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,748.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,766.94
|
| Rate for Payer: First Choice Health Commercial |
$1,622.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,712.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.33
|
| Rate for Payer: HealthUtah PPO |
$1,803.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,748.91
|
| Rate for Payer: Multiplan Medicare/VA |
$310.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,766.94
|
| Rate for Payer: PacificSource Commercial |
$1,622.70
|
| Rate for Payer: PHCS PPO |
$1,712.85
|
| Rate for Payer: Three Rivers PPO |
$1,352.25
|
| Rate for Payer: TriWest Veterans Administration |
$365.33
|
| Rate for Payer: United Healthcare Commercial |
$1,568.61
|
| Rate for Payer: United Healthcare Medicare |
$365.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,532.55
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 22614 AS
|
| Hospital Charge Code |
22614
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,803.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,766.94
|
| Rate for Payer: Aetna of WY Medicare |
$365.33
|
| Rate for Payer: Beech Street Commercial |
$1,712.85
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,748.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,766.94
|
| Rate for Payer: First Choice Health Commercial |
$1,622.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,712.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.33
|
| Rate for Payer: HealthUtah PPO |
$1,803.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,748.91
|
| Rate for Payer: Multiplan Medicare/VA |
$310.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,766.94
|
| Rate for Payer: PacificSource Commercial |
$1,622.70
|
| Rate for Payer: PHCS PPO |
$1,712.85
|
| Rate for Payer: Three Rivers PPO |
$1,352.25
|
| Rate for Payer: TriWest Veterans Administration |
$365.33
|
| Rate for Payer: United Healthcare Commercial |
$1,568.61
|
| Rate for Payer: United Healthcare Medicare |
$365.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,532.55
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 22614
|
| Hospital Charge Code |
22614
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,803.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,766.94
|
| Rate for Payer: Aetna of WY Medicare |
$365.33
|
| Rate for Payer: Beech Street Commercial |
$1,712.85
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: Cash Price |
$1,262.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,748.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,766.94
|
| Rate for Payer: First Choice Health Commercial |
$1,622.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,712.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.33
|
| Rate for Payer: HealthUtah PPO |
$1,803.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,748.91
|
| Rate for Payer: Multiplan Medicare/VA |
$310.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,766.94
|
| Rate for Payer: PacificSource Commercial |
$1,622.70
|
| Rate for Payer: PHCS PPO |
$1,712.85
|
| Rate for Payer: Three Rivers PPO |
$1,352.25
|
| Rate for Payer: TriWest Veterans Administration |
$365.33
|
| Rate for Payer: United Healthcare Commercial |
$1,568.61
|
| Rate for Payer: United Healthcare Medicare |
$365.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,532.55
|
|
|
ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
HCPCS 28725 80
|
| Hospital Charge Code |
28725
|
| Min. Negotiated Rate |
$642.37 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,642.08
|
| Rate for Payer: Aetna of WY Medicare |
$755.73
|
| Rate for Payer: Beech Street Commercial |
$2,561.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,615.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,642.08
|
| Rate for Payer: First Choice Health Commercial |
$2,426.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,561.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$755.73
|
| Rate for Payer: HealthUtah PPO |
$2,696.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,615.12
|
| Rate for Payer: Multiplan Medicare/VA |
$642.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,642.08
|
| Rate for Payer: PacificSource Commercial |
$2,426.40
|
| Rate for Payer: PHCS PPO |
$2,561.20
|
| Rate for Payer: Three Rivers PPO |
$2,022.00
|
| Rate for Payer: TriWest Veterans Administration |
$755.73
|
| Rate for Payer: United Healthcare Commercial |
$2,345.52
|
| Rate for Payer: United Healthcare Medicare |
$755.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,291.60
|
|
|
ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
HCPCS 28725
|
| Hospital Charge Code |
28725
|
| Min. Negotiated Rate |
$642.37 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,642.08
|
| Rate for Payer: Aetna of WY Medicare |
$755.73
|
| Rate for Payer: Beech Street Commercial |
$2,561.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,615.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,642.08
|
| Rate for Payer: First Choice Health Commercial |
$2,426.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,561.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$755.73
|
| Rate for Payer: HealthUtah PPO |
$2,696.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,615.12
|
| Rate for Payer: Multiplan Medicare/VA |
$642.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,642.08
|
| Rate for Payer: PacificSource Commercial |
$2,426.40
|
| Rate for Payer: PHCS PPO |
$2,561.20
|
| Rate for Payer: Three Rivers PPO |
$2,022.00
|
| Rate for Payer: TriWest Veterans Administration |
$755.73
|
| Rate for Payer: United Healthcare Commercial |
$2,345.52
|
| Rate for Payer: United Healthcare Medicare |
$755.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,291.60
|
|
|
ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 27871
|
| Hospital Charge Code |
27871
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,349.06
|
| Rate for Payer: Aetna of WY Medicare |
$671.33
|
| Rate for Payer: Beech Street Commercial |
$2,277.15
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,325.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,349.06
|
| Rate for Payer: First Choice Health Commercial |
$2,157.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,277.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.33
|
| Rate for Payer: HealthUtah PPO |
$2,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,325.09
|
| Rate for Payer: Multiplan Medicare/VA |
$570.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,349.06
|
| Rate for Payer: PacificSource Commercial |
$2,157.30
|
| Rate for Payer: PHCS PPO |
$2,277.15
|
| Rate for Payer: Three Rivers PPO |
$1,797.75
|
| Rate for Payer: TriWest Veterans Administration |
$671.33
|
| Rate for Payer: United Healthcare Commercial |
$2,085.39
|
| Rate for Payer: United Healthcare Medicare |
$671.33
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.45
|
|
|
ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 27871 80
|
| Hospital Charge Code |
27871
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,349.06
|
| Rate for Payer: Aetna of WY Medicare |
$671.33
|
| Rate for Payer: Beech Street Commercial |
$2,277.15
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,325.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,349.06
|
| Rate for Payer: First Choice Health Commercial |
$2,157.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,277.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.33
|
| Rate for Payer: HealthUtah PPO |
$2,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,325.09
|
| Rate for Payer: Multiplan Medicare/VA |
$570.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,349.06
|
| Rate for Payer: PacificSource Commercial |
$2,157.30
|
| Rate for Payer: PHCS PPO |
$2,277.15
|
| Rate for Payer: Three Rivers PPO |
$1,797.75
|
| Rate for Payer: TriWest Veterans Administration |
$671.33
|
| Rate for Payer: United Healthcare Commercial |
$2,085.39
|
| Rate for Payer: United Healthcare Medicare |
$671.33
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.45
|
|
|
ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 28715 80
|
| Hospital Charge Code |
28715
|
| Min. Negotiated Rate |
$773.46 |
| Max. Negotiated Rate |
$1,698.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,664.04
|
| Rate for Payer: Aetna of WY Medicare |
$909.95
|
| Rate for Payer: Beech Street Commercial |
$1,613.10
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,647.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,664.04
|
| Rate for Payer: First Choice Health Commercial |
$1,528.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,613.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$909.95
|
| Rate for Payer: HealthUtah PPO |
$1,698.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,647.06
|
| Rate for Payer: Multiplan Medicare/VA |
$773.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,664.04
|
| Rate for Payer: PacificSource Commercial |
$1,528.20
|
| Rate for Payer: PHCS PPO |
$1,613.10
|
| Rate for Payer: Three Rivers PPO |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration |
$909.95
|
| Rate for Payer: United Healthcare Commercial |
$1,477.26
|
| Rate for Payer: United Healthcare Medicare |
$909.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,443.30
|
|
|
ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$5,446.00
|
|
|
Service Code
|
HCPCS 25800 AS
|
| Hospital Charge Code |
25800
|
| Min. Negotiated Rate |
$604.92 |
| Max. Negotiated Rate |
$5,446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,337.08
|
| Rate for Payer: Aetna of WY Medicare |
$711.67
|
| Rate for Payer: Beech Street Commercial |
$5,173.70
|
| Rate for Payer: Cash Price |
$3,812.20
|
| Rate for Payer: Cash Price |
$3,812.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,282.62
|
| Rate for Payer: Cigna of WY Commercial |
$5,337.08
|
| Rate for Payer: First Choice Health Commercial |
$4,901.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,173.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$711.67
|
| Rate for Payer: HealthUtah PPO |
$5,446.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,282.62
|
| Rate for Payer: Multiplan Medicare/VA |
$604.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,337.08
|
| Rate for Payer: PacificSource Commercial |
$4,901.40
|
| Rate for Payer: PHCS PPO |
$5,173.70
|
| Rate for Payer: Three Rivers PPO |
$4,084.50
|
| Rate for Payer: TriWest Veterans Administration |
$711.67
|
| Rate for Payer: United Healthcare Commercial |
$4,738.02
|
| Rate for Payer: United Healthcare Medicare |
$711.67
|
| Rate for Payer: WINHealth Partners Commercial |
$4,629.10
|
|
|
ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$5,446.00
|
|
|
Service Code
|
HCPCS 25800
|
| Hospital Charge Code |
25800
|
| Min. Negotiated Rate |
$604.92 |
| Max. Negotiated Rate |
$5,446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,337.08
|
| Rate for Payer: Aetna of WY Medicare |
$711.67
|
| Rate for Payer: Beech Street Commercial |
$5,173.70
|
| Rate for Payer: Cash Price |
$3,812.20
|
| Rate for Payer: Cash Price |
$3,812.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,282.62
|
| Rate for Payer: Cigna of WY Commercial |
$5,337.08
|
| Rate for Payer: First Choice Health Commercial |
$4,901.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,173.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$711.67
|
| Rate for Payer: HealthUtah PPO |
$5,446.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,282.62
|
| Rate for Payer: Multiplan Medicare/VA |
$604.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,337.08
|
| Rate for Payer: PacificSource Commercial |
$4,901.40
|
| Rate for Payer: PHCS PPO |
$5,173.70
|
| Rate for Payer: Three Rivers PPO |
$4,084.50
|
| Rate for Payer: TriWest Veterans Administration |
$711.67
|
| Rate for Payer: United Healthcare Commercial |
$4,738.02
|
| Rate for Payer: United Healthcare Medicare |
$711.67
|
| Rate for Payer: WINHealth Partners Commercial |
$4,629.10
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 25820 80
|
| Hospital Charge Code |
25820
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$635.36
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.36
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$540.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$635.36
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$635.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 25820 AS
|
| Hospital Charge Code |
25820
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$635.36
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.36
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$540.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$635.36
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$635.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 25820
|
| Hospital Charge Code |
25820
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$2,267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,221.66
|
| Rate for Payer: Aetna of WY Medicare |
$635.36
|
| Rate for Payer: Beech Street Commercial |
$2,153.65
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: Cash Price |
$1,586.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,198.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,221.66
|
| Rate for Payer: First Choice Health Commercial |
$2,040.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.36
|
| Rate for Payer: HealthUtah PPO |
$2,267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,198.99
|
| Rate for Payer: Multiplan Medicare/VA |
$540.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,221.66
|
| Rate for Payer: PacificSource Commercial |
$2,040.30
|
| Rate for Payer: PHCS PPO |
$2,153.65
|
| Rate for Payer: Three Rivers PPO |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration |
$635.36
|
| Rate for Payer: United Healthcare Commercial |
$1,972.29
|
| Rate for Payer: United Healthcare Medicare |
$635.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,926.95
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$11,219.00
|
|
|
Service Code
|
HCPCS 25810 LT
|
| Hospital Charge Code |
25810
|
| Min. Negotiated Rate |
$716.69 |
| Max. Negotiated Rate |
$11,219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,994.62
|
| Rate for Payer: Aetna of WY Medicare |
$843.17
|
| Rate for Payer: Beech Street Commercial |
$10,658.05
|
| Rate for Payer: Cash Price |
$7,853.30
|
| Rate for Payer: Cash Price |
$7,853.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,882.43
|
| Rate for Payer: Cigna of WY Commercial |
$10,994.62
|
| Rate for Payer: First Choice Health Commercial |
$10,097.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,658.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.17
|
| Rate for Payer: HealthUtah PPO |
$11,219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,882.43
|
| Rate for Payer: Multiplan Medicare/VA |
$716.69
|
| Rate for Payer: One Health Plan of WY PPO |
$10,994.62
|
| Rate for Payer: PacificSource Commercial |
$10,097.10
|
| Rate for Payer: PHCS PPO |
$10,658.05
|
| Rate for Payer: Three Rivers PPO |
$8,414.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.17
|
| Rate for Payer: United Healthcare Commercial |
$9,760.53
|
| Rate for Payer: United Healthcare Medicare |
$843.17
|
| Rate for Payer: WINHealth Partners Commercial |
$9,536.15
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$4,066.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
25810
|
| Min. Negotiated Rate |
$716.69 |
| Max. Negotiated Rate |
$4,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,984.68
|
| Rate for Payer: Aetna of WY Medicare |
$843.17
|
| Rate for Payer: Beech Street Commercial |
$3,862.70
|
| Rate for Payer: Cash Price |
$2,846.20
|
| Rate for Payer: Cash Price |
$2,846.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,944.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,984.68
|
| Rate for Payer: First Choice Health Commercial |
$3,659.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,862.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.17
|
| Rate for Payer: HealthUtah PPO |
$4,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,944.02
|
| Rate for Payer: Multiplan Medicare/VA |
$716.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,984.68
|
| Rate for Payer: PacificSource Commercial |
$3,659.40
|
| Rate for Payer: PHCS PPO |
$3,862.70
|
| Rate for Payer: Three Rivers PPO |
$3,049.50
|
| Rate for Payer: TriWest Veterans Administration |
$843.17
|
| Rate for Payer: United Healthcare Commercial |
$3,537.42
|
| Rate for Payer: United Healthcare Medicare |
$843.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3,456.10
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$4,066.00
|
|
|
Service Code
|
HCPCS 25810 AS
|
| Hospital Charge Code |
25810
|
| Min. Negotiated Rate |
$716.69 |
| Max. Negotiated Rate |
$4,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,984.68
|
| Rate for Payer: Aetna of WY Medicare |
$843.17
|
| Rate for Payer: Beech Street Commercial |
$3,862.70
|
| Rate for Payer: Cash Price |
$2,846.20
|
| Rate for Payer: Cash Price |
$2,846.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,944.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,984.68
|
| Rate for Payer: First Choice Health Commercial |
$3,659.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,862.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.17
|
| Rate for Payer: HealthUtah PPO |
$4,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,944.02
|
| Rate for Payer: Multiplan Medicare/VA |
$716.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,984.68
|
| Rate for Payer: PacificSource Commercial |
$3,659.40
|
| Rate for Payer: PHCS PPO |
$3,862.70
|
| Rate for Payer: Three Rivers PPO |
$3,049.50
|
| Rate for Payer: TriWest Veterans Administration |
$843.17
|
| Rate for Payer: United Healthcare Commercial |
$3,537.42
|
| Rate for Payer: United Healthcare Medicare |
$843.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3,456.10
|
|
|
ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 25825 80
|
| Hospital Charge Code |
25825
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,920.00
|
| Rate for Payer: Aetna of WY Medicare |
$774.89
|
| Rate for Payer: Beech Street Commercial |
$3,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,880.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,920.00
|
| Rate for Payer: First Choice Health Commercial |
$3,600.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$774.89
|
| Rate for Payer: HealthUtah PPO |
$4,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,880.00
|
| Rate for Payer: Multiplan Medicare/VA |
$658.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,920.00
|
| Rate for Payer: PacificSource Commercial |
$3,600.00
|
| Rate for Payer: PHCS PPO |
$3,800.00
|
| Rate for Payer: Three Rivers PPO |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration |
$774.89
|
| Rate for Payer: United Healthcare Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare Medicare |
$774.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3,400.00
|
|
