|
ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 25825
|
| 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
|
|
|
ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 25825 AS
|
| 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
|
|
|
ARTHROGRAM TRAY
|
Facility
|
IP
|
$55.41
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$55.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.19
|
| Rate for Payer: Altius Commercial |
$53.19
|
| Rate for Payer: Beech Street Commercial |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.49
|
| Rate for Payer: Cash Price |
$38.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.75
|
| Rate for Payer: Cigna of WY Commercial |
$54.30
|
| Rate for Payer: Entrust Commercial |
$52.64
|
| Rate for Payer: First Choice Health Commercial |
$52.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.57
|
| Rate for Payer: HealthUtah PPO |
$55.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.75
|
| Rate for Payer: Multiplan Medicare/VA |
$34.74
|
| Rate for Payer: One Health Plan of WY PPO |
$54.30
|
| Rate for Payer: PacificSource Commercial |
$49.87
|
| Rate for Payer: PHCS PPO |
$54.30
|
| Rate for Payer: Three Rivers PPO |
$41.56
|
| Rate for Payer: TriWest Veterans Administration |
$36.57
|
| Rate for Payer: United Healthcare Commercial |
$48.21
|
| Rate for Payer: United Healthcare Medicare |
$36.57
|
| Rate for Payer: WINHealth Partners Commercial |
$52.64
|
| Rate for Payer: Wise Provider Network Commercial |
$52.64
|
|
|
ARTHROGRAM TRAY
|
Facility
|
OP
|
$55.41
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$55.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.30
|
| Rate for Payer: Aetna of WY Medicare |
$36.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.19
|
| Rate for Payer: Altius Commercial |
$53.19
|
| Rate for Payer: Beech Street Commercial |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.49
|
| Rate for Payer: Cash Price |
$38.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.75
|
| Rate for Payer: Cigna of WY Commercial |
$54.30
|
| Rate for Payer: Entrust Commercial |
$52.64
|
| Rate for Payer: First Choice Health Commercial |
$52.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.14
|
| Rate for Payer: HealthUtah PPO |
$55.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.75
|
| Rate for Payer: Multiplan Medicare/VA |
$30.53
|
| Rate for Payer: One Health Plan of WY PPO |
$54.30
|
| Rate for Payer: PacificSource Commercial |
$49.87
|
| Rate for Payer: PHCS PPO |
$54.30
|
| Rate for Payer: Three Rivers PPO |
$41.56
|
| Rate for Payer: TriWest Veterans Administration |
$32.14
|
| Rate for Payer: United Healthcare Commercial |
$48.21
|
| Rate for Payer: United Healthcare Medicare |
$32.14
|
| Rate for Payer: WINHealth Partners Commercial |
$54.30
|
| Rate for Payer: Wise Provider Network Commercial |
$52.64
|
|
|
ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,156.00
|
| Rate for Payer: Aetna of WY Medicare |
$80.61
|
| Rate for Payer: Beech Street Commercial |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,134.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,156.00
|
| Rate for Payer: First Choice Health Commercial |
$1,980.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,090.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.61
|
| Rate for Payer: HealthUtah PPO |
$2,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,134.00
|
| Rate for Payer: Multiplan Medicare/VA |
$68.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,156.00
|
| Rate for Payer: PacificSource Commercial |
$1,980.00
|
| Rate for Payer: PHCS PPO |
$2,090.00
|
| Rate for Payer: Three Rivers PPO |
$1,650.00
|
| Rate for Payer: TriWest Veterans Administration |
$80.61
|
| Rate for Payer: United Healthcare Commercial |
$1,914.00
|
| Rate for Payer: United Healthcare Medicare |
$80.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,090.00
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$9,968.00
|
|
|
Service Code
|
HCPCS 27702 80
|
| Hospital Charge Code |
27702
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$9,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,768.64
|
| Rate for Payer: Aetna of WY Medicare |
$928.33
|
| Rate for Payer: Beech Street Commercial |
$9,469.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,668.96
|
| Rate for Payer: Cigna of WY Commercial |
$9,768.64
|
| Rate for Payer: First Choice Health Commercial |
$8,971.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,469.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.33
|
| Rate for Payer: HealthUtah PPO |
$9,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,668.96
|
| Rate for Payer: Multiplan Medicare/VA |
$789.08
|
| Rate for Payer: One Health Plan of WY PPO |
$9,768.64
|
| Rate for Payer: PacificSource Commercial |
$8,971.20
|
| Rate for Payer: PHCS PPO |
$9,469.60
|
| Rate for Payer: Three Rivers PPO |
$7,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$928.33
|
| Rate for Payer: United Healthcare Commercial |
$8,672.16
|
| Rate for Payer: United Healthcare Medicare |
$928.33
|
| Rate for Payer: WINHealth Partners Commercial |
$8,472.80
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$9,968.00
|
|
|
Service Code
|
HCPCS 27702 AS
|
| Hospital Charge Code |
27702
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$9,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,768.64
|
| Rate for Payer: Aetna of WY Medicare |
$928.33
|
| Rate for Payer: Beech Street Commercial |
$9,469.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,668.96
|
| Rate for Payer: Cigna of WY Commercial |
$9,768.64
|
| Rate for Payer: First Choice Health Commercial |
$8,971.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,469.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.33
|
| Rate for Payer: HealthUtah PPO |
$9,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,668.96
|
| Rate for Payer: Multiplan Medicare/VA |
$789.08
|
| Rate for Payer: One Health Plan of WY PPO |
$9,768.64
|
| Rate for Payer: PacificSource Commercial |
$8,971.20
|
| Rate for Payer: PHCS PPO |
$9,469.60
|
| Rate for Payer: Three Rivers PPO |
$7,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$928.33
|
| Rate for Payer: United Healthcare Commercial |
$8,672.16
|
| Rate for Payer: United Healthcare Medicare |
$928.33
|
| Rate for Payer: WINHealth Partners Commercial |
$8,472.80
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$9,968.00
|
|
|
Service Code
|
HCPCS 27702
|
| Hospital Charge Code |
27702
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$9,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,768.64
|
| Rate for Payer: Aetna of WY Medicare |
$928.33
|
| Rate for Payer: Beech Street Commercial |
$9,469.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: Cash Price |
$6,977.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,668.96
|
| Rate for Payer: Cigna of WY Commercial |
$9,768.64
|
| Rate for Payer: First Choice Health Commercial |
$8,971.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,469.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.33
|
| Rate for Payer: HealthUtah PPO |
$9,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,668.96
|
| Rate for Payer: Multiplan Medicare/VA |
$789.08
|
| Rate for Payer: One Health Plan of WY PPO |
$9,768.64
|
| Rate for Payer: PacificSource Commercial |
$8,971.20
|
| Rate for Payer: PHCS PPO |
$9,469.60
|
| Rate for Payer: Three Rivers PPO |
$7,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$928.33
|
| Rate for Payer: United Healthcare Commercial |
$8,672.16
|
| Rate for Payer: United Healthcare Medicare |
$928.33
|
| Rate for Payer: WINHealth Partners Commercial |
$8,472.80
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$4,503.00
|
|
|
Service Code
|
HCPCS 27442 80
|
| Hospital Charge Code |
27442
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$4,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,412.94
|
| Rate for Payer: Aetna of WY Medicare |
$840.46
|
| Rate for Payer: Beech Street Commercial |
$4,277.85
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,367.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,412.94
|
| Rate for Payer: First Choice Health Commercial |
$4,052.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,277.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$840.46
|
| Rate for Payer: HealthUtah PPO |
$4,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,367.91
|
| Rate for Payer: Multiplan Medicare/VA |
$714.39
|
| Rate for Payer: One Health Plan of WY PPO |
$4,412.94
|
| Rate for Payer: PacificSource Commercial |
$4,052.70
|
| Rate for Payer: PHCS PPO |
$4,277.85
|
| Rate for Payer: Three Rivers PPO |
$3,377.25
|
| Rate for Payer: TriWest Veterans Administration |
$840.46
|
| Rate for Payer: United Healthcare Commercial |
$3,917.61
|
| Rate for Payer: United Healthcare Medicare |
$840.46
|
| Rate for Payer: WINHealth Partners Commercial |
$3,827.55
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$4,503.00
|
|
|
Service Code
|
HCPCS 27442 AS
|
| Hospital Charge Code |
27442
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$4,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,412.94
|
| Rate for Payer: Aetna of WY Medicare |
$840.46
|
| Rate for Payer: Beech Street Commercial |
$4,277.85
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,367.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,412.94
|
| Rate for Payer: First Choice Health Commercial |
$4,052.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,277.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$840.46
|
| Rate for Payer: HealthUtah PPO |
$4,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,367.91
|
| Rate for Payer: Multiplan Medicare/VA |
$714.39
|
| Rate for Payer: One Health Plan of WY PPO |
$4,412.94
|
| Rate for Payer: PacificSource Commercial |
$4,052.70
|
| Rate for Payer: PHCS PPO |
$4,277.85
|
| Rate for Payer: Three Rivers PPO |
$3,377.25
|
| Rate for Payer: TriWest Veterans Administration |
$840.46
|
| Rate for Payer: United Healthcare Commercial |
$3,917.61
|
| Rate for Payer: United Healthcare Medicare |
$840.46
|
| Rate for Payer: WINHealth Partners Commercial |
$3,827.55
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$4,503.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
27442
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$4,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,412.94
|
| Rate for Payer: Aetna of WY Medicare |
$840.46
|
| Rate for Payer: Beech Street Commercial |
$4,277.85
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: Cash Price |
$3,152.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,367.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,412.94
|
| Rate for Payer: First Choice Health Commercial |
$4,052.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,277.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$840.46
|
| Rate for Payer: HealthUtah PPO |
$4,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,367.91
|
| Rate for Payer: Multiplan Medicare/VA |
$714.39
|
| Rate for Payer: One Health Plan of WY PPO |
$4,412.94
|
| Rate for Payer: PacificSource Commercial |
$4,052.70
|
| Rate for Payer: PHCS PPO |
$4,277.85
|
| Rate for Payer: Three Rivers PPO |
$3,377.25
|
| Rate for Payer: TriWest Veterans Administration |
$840.46
|
| Rate for Payer: United Healthcare Commercial |
$3,917.61
|
| Rate for Payer: United Healthcare Medicare |
$840.46
|
| Rate for Payer: WINHealth Partners Commercial |
$3,827.55
|
|
|
ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$4,941.00
|
|
|
Service Code
|
HCPCS 23472 AS
|
| Hospital Charge Code |
23472
|
| Min. Negotiated Rate |
$1,176.95 |
| Max. Negotiated Rate |
$4,941.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,842.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,384.65
|
| Rate for Payer: Beech Street Commercial |
$4,693.95
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,792.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,842.18
|
| Rate for Payer: First Choice Health Commercial |
$4,446.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,693.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,384.65
|
| Rate for Payer: HealthUtah PPO |
$4,941.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,792.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1,176.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,842.18
|
| Rate for Payer: PacificSource Commercial |
$4,446.90
|
| Rate for Payer: PHCS PPO |
$4,693.95
|
| Rate for Payer: Three Rivers PPO |
$3,705.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,384.65
|
| Rate for Payer: United Healthcare Commercial |
$4,298.67
|
| Rate for Payer: United Healthcare Medicare |
$1,384.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,199.85
|
|
|
ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$4,941.00
|
|
|
Service Code
|
HCPCS 23472 80
|
| Hospital Charge Code |
23472
|
| Min. Negotiated Rate |
$1,176.95 |
| Max. Negotiated Rate |
$4,941.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,842.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,384.65
|
| Rate for Payer: Beech Street Commercial |
$4,693.95
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,792.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,842.18
|
| Rate for Payer: First Choice Health Commercial |
$4,446.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,693.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,384.65
|
| Rate for Payer: HealthUtah PPO |
$4,941.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,792.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1,176.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,842.18
|
| Rate for Payer: PacificSource Commercial |
$4,446.90
|
| Rate for Payer: PHCS PPO |
$4,693.95
|
| Rate for Payer: Three Rivers PPO |
$3,705.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,384.65
|
| Rate for Payer: United Healthcare Commercial |
$4,298.67
|
| Rate for Payer: United Healthcare Medicare |
$1,384.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,199.85
|
|
|
ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$4,941.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
23472
|
| Min. Negotiated Rate |
$1,176.95 |
| Max. Negotiated Rate |
$4,941.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,842.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,384.65
|
| Rate for Payer: Beech Street Commercial |
$4,693.95
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: Cash Price |
$3,458.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,792.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,842.18
|
| Rate for Payer: First Choice Health Commercial |
$4,446.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,693.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,384.65
|
| Rate for Payer: HealthUtah PPO |
$4,941.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,792.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1,176.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,842.18
|
| Rate for Payer: PacificSource Commercial |
$4,446.90
|
| Rate for Payer: PHCS PPO |
$4,693.95
|
| Rate for Payer: Three Rivers PPO |
$3,705.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,384.65
|
| Rate for Payer: United Healthcare Commercial |
$4,298.67
|
| Rate for Payer: United Healthcare Medicare |
$1,384.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,199.85
|
|
|
ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY
|
Professional
|
Both
|
$6,154.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
23470
|
| Min. Negotiated Rate |
$978.97 |
| Max. Negotiated Rate |
$6,154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,030.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,151.73
|
| Rate for Payer: Beech Street Commercial |
$5,846.30
|
| Rate for Payer: Cash Price |
$4,307.80
|
| Rate for Payer: Cash Price |
$4,307.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,969.38
|
| Rate for Payer: Cigna of WY Commercial |
$6,030.92
|
| Rate for Payer: First Choice Health Commercial |
$5,538.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,846.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,151.73
|
| Rate for Payer: HealthUtah PPO |
$6,154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,969.38
|
| Rate for Payer: Multiplan Medicare/VA |
$978.97
|
| Rate for Payer: One Health Plan of WY PPO |
$6,030.92
|
| Rate for Payer: PacificSource Commercial |
$5,538.60
|
| Rate for Payer: PHCS PPO |
$5,846.30
|
| Rate for Payer: Three Rivers PPO |
$4,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,151.73
|
| Rate for Payer: United Healthcare Commercial |
$5,353.98
|
| Rate for Payer: United Healthcare Medicare |
$1,151.73
|
| Rate for Payer: WINHealth Partners Commercial |
$5,230.90
|
|
|
ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY
|
Professional
|
Both
|
$6,154.00
|
|
|
Service Code
|
HCPCS 23470 80
|
| Hospital Charge Code |
23470
|
| Min. Negotiated Rate |
$978.97 |
| Max. Negotiated Rate |
$6,154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,030.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,151.73
|
| Rate for Payer: Beech Street Commercial |
$5,846.30
|
| Rate for Payer: Cash Price |
$4,307.80
|
| Rate for Payer: Cash Price |
$4,307.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,969.38
|
| Rate for Payer: Cigna of WY Commercial |
$6,030.92
|
| Rate for Payer: First Choice Health Commercial |
$5,538.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,846.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,151.73
|
| Rate for Payer: HealthUtah PPO |
$6,154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,969.38
|
| Rate for Payer: Multiplan Medicare/VA |
$978.97
|
| Rate for Payer: One Health Plan of WY PPO |
$6,030.92
|
| Rate for Payer: PacificSource Commercial |
$5,538.60
|
| Rate for Payer: PHCS PPO |
$5,846.30
|
| Rate for Payer: Three Rivers PPO |
$4,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,151.73
|
| Rate for Payer: United Healthcare Commercial |
$5,353.98
|
| Rate for Payer: United Healthcare Medicare |
$1,151.73
|
| Rate for Payer: WINHealth Partners Commercial |
$5,230.90
|
|
|
ARTHROPLASTY INTERPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,543.00
|
|
|
Service Code
|
HCPCS 26535
|
| Hospital Charge Code |
26535
|
| Min. Negotiated Rate |
$367.51 |
| Max. Negotiated Rate |
$1,543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,512.14
|
| Rate for Payer: Aetna of WY Medicare |
$432.36
|
| Rate for Payer: Beech Street Commercial |
$1,465.85
|
| Rate for Payer: Cash Price |
$1,080.10
|
| Rate for Payer: Cash Price |
$1,080.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,496.71
|
| Rate for Payer: Cigna of WY Commercial |
$1,512.14
|
| Rate for Payer: First Choice Health Commercial |
$1,388.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,465.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.36
|
| Rate for Payer: HealthUtah PPO |
$1,543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,496.71
|
| Rate for Payer: Multiplan Medicare/VA |
$367.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,512.14
|
| Rate for Payer: PacificSource Commercial |
$1,388.70
|
| Rate for Payer: PHCS PPO |
$1,465.85
|
| Rate for Payer: Three Rivers PPO |
$1,157.25
|
| Rate for Payer: TriWest Veterans Administration |
$432.36
|
| Rate for Payer: United Healthcare Commercial |
$1,342.41
|
| Rate for Payer: United Healthcare Medicare |
$432.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,311.55
|
|
|
ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 26536 AS
|
| Hospital Charge Code |
26536
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$735.73
|
| Rate for Payer: Beech Street Commercial |
$2,493.75
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: First Choice Health Commercial |
$2,362.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$735.73
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$625.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,493.75
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$735.73
|
| Rate for Payer: United Healthcare Commercial |
$2,283.75
|
| Rate for Payer: United Healthcare Medicare |
$735.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,231.25
|
|
|
ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
26536
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$735.73
|
| Rate for Payer: Beech Street Commercial |
$2,493.75
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: First Choice Health Commercial |
$2,362.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$735.73
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$625.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,493.75
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$735.73
|
| Rate for Payer: United Healthcare Commercial |
$2,283.75
|
| Rate for Payer: United Healthcare Medicare |
$735.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,231.25
|
|
|
ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 26530 AS
|
| Hospital Charge Code |
26530
|
| Min. Negotiated Rate |
$452.93 |
| Max. Negotiated Rate |
$2,725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,670.50
|
| Rate for Payer: Aetna of WY Medicare |
$532.86
|
| Rate for Payer: Beech Street Commercial |
$2,588.75
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,643.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,670.50
|
| Rate for Payer: First Choice Health Commercial |
$2,452.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,588.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$532.86
|
| Rate for Payer: HealthUtah PPO |
$2,725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,643.25
|
| Rate for Payer: Multiplan Medicare/VA |
$452.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,670.50
|
| Rate for Payer: PacificSource Commercial |
$2,452.50
|
| Rate for Payer: PHCS PPO |
$2,588.75
|
| Rate for Payer: Three Rivers PPO |
$2,043.75
|
| Rate for Payer: TriWest Veterans Administration |
$532.86
|
| Rate for Payer: United Healthcare Commercial |
$2,370.75
|
| Rate for Payer: United Healthcare Medicare |
$532.86
|
| Rate for Payer: WINHealth Partners Commercial |
$2,316.25
|
|
|
ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 26530
|
| Hospital Charge Code |
26530
|
| Min. Negotiated Rate |
$452.93 |
| Max. Negotiated Rate |
$2,725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,670.50
|
| Rate for Payer: Aetna of WY Medicare |
$532.86
|
| Rate for Payer: Beech Street Commercial |
$2,588.75
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,643.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,670.50
|
| Rate for Payer: First Choice Health Commercial |
$2,452.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,588.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$532.86
|
| Rate for Payer: HealthUtah PPO |
$2,725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,643.25
|
| Rate for Payer: Multiplan Medicare/VA |
$452.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,670.50
|
| Rate for Payer: PacificSource Commercial |
$2,452.50
|
| Rate for Payer: PHCS PPO |
$2,588.75
|
| Rate for Payer: Three Rivers PPO |
$2,043.75
|
| Rate for Payer: TriWest Veterans Administration |
$532.86
|
| Rate for Payer: United Healthcare Commercial |
$2,370.75
|
| Rate for Payer: United Healthcare Medicare |
$532.86
|
| Rate for Payer: WINHealth Partners Commercial |
$2,316.25
|
|
|
ARTHROPLASTY PATELLA W/O PROSTHESIS
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 27437 80
|
| Hospital Charge Code |
27437
|
| Min. Negotiated Rate |
$547.88 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,734.20
|
| Rate for Payer: Aetna of WY Medicare |
$644.57
|
| Rate for Payer: Beech Street Commercial |
$2,650.50
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,706.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,734.20
|
| Rate for Payer: First Choice Health Commercial |
$2,511.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,650.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$644.57
|
| Rate for Payer: HealthUtah PPO |
$2,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,706.30
|
| Rate for Payer: Multiplan Medicare/VA |
$547.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,734.20
|
| Rate for Payer: PacificSource Commercial |
$2,511.00
|
| Rate for Payer: PHCS PPO |
$2,650.50
|
| Rate for Payer: Three Rivers PPO |
$2,092.50
|
| Rate for Payer: TriWest Veterans Administration |
$644.57
|
| Rate for Payer: United Healthcare Commercial |
$2,427.30
|
| Rate for Payer: United Healthcare Medicare |
$644.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,371.50
|
|
|
ARTHROPLASTY PATELLA W/O PROSTHESIS
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 27437
|
| Hospital Charge Code |
27437
|
| Min. Negotiated Rate |
$547.88 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,734.20
|
| Rate for Payer: Aetna of WY Medicare |
$644.57
|
| Rate for Payer: Beech Street Commercial |
$2,650.50
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: Cash Price |
$1,953.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,706.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,734.20
|
| Rate for Payer: First Choice Health Commercial |
$2,511.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,650.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$644.57
|
| Rate for Payer: HealthUtah PPO |
$2,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,706.30
|
| Rate for Payer: Multiplan Medicare/VA |
$547.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2,734.20
|
| Rate for Payer: PacificSource Commercial |
$2,511.00
|
| Rate for Payer: PHCS PPO |
$2,650.50
|
| Rate for Payer: Three Rivers PPO |
$2,092.50
|
| Rate for Payer: TriWest Veterans Administration |
$644.57
|
| Rate for Payer: United Healthcare Commercial |
$2,427.30
|
| Rate for Payer: United Healthcare Medicare |
$644.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,371.50
|
|
|
ARTHROPLASTY PATELLA W/PROSTHESIS
|
Professional
|
Both
|
$4,344.00
|
|
|
Service Code
|
HCPCS 27438 80
|
| Hospital Charge Code |
27438
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,257.12
|
| Rate for Payer: Aetna of WY Medicare |
$814.38
|
| Rate for Payer: Beech Street Commercial |
$4,126.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,213.68
|
| Rate for Payer: Cigna of WY Commercial |
$4,257.12
|
| Rate for Payer: First Choice Health Commercial |
$3,909.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,126.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$814.38
|
| Rate for Payer: HealthUtah PPO |
$4,344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,213.68
|
| Rate for Payer: Multiplan Medicare/VA |
$692.22
|
| Rate for Payer: One Health Plan of WY PPO |
$4,257.12
|
| Rate for Payer: PacificSource Commercial |
$3,909.60
|
| Rate for Payer: PHCS PPO |
$4,126.80
|
| Rate for Payer: Three Rivers PPO |
$3,258.00
|
| Rate for Payer: TriWest Veterans Administration |
$814.38
|
| Rate for Payer: United Healthcare Commercial |
$3,779.28
|
| Rate for Payer: United Healthcare Medicare |
$814.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,692.40
|
|
|
ARTHROPLASTY PATELLA W/PROSTHESIS
|
Professional
|
Both
|
$4,344.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
27438
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,257.12
|
| Rate for Payer: Aetna of WY Medicare |
$814.38
|
| Rate for Payer: Beech Street Commercial |
$4,126.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,213.68
|
| Rate for Payer: Cigna of WY Commercial |
$4,257.12
|
| Rate for Payer: First Choice Health Commercial |
$3,909.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,126.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$814.38
|
| Rate for Payer: HealthUtah PPO |
$4,344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,213.68
|
| Rate for Payer: Multiplan Medicare/VA |
$692.22
|
| Rate for Payer: One Health Plan of WY PPO |
$4,257.12
|
| Rate for Payer: PacificSource Commercial |
$3,909.60
|
| Rate for Payer: PHCS PPO |
$4,126.80
|
| Rate for Payer: Three Rivers PPO |
$3,258.00
|
| Rate for Payer: TriWest Veterans Administration |
$814.38
|
| Rate for Payer: United Healthcare Commercial |
$3,779.28
|
| Rate for Payer: United Healthcare Medicare |
$814.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,692.40
|
|
