|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
NDC 0003089431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.68
|
| Rate for Payer: Aetna of WY Medicare |
$32.11
|
| Rate for Payer: Altius Commercial |
$46.70
|
| Rate for Payer: Beech Street Commercial |
$47.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.19
|
| Rate for Payer: Cash Price |
$34.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.19
|
| Rate for Payer: Cigna of WY Commercial |
$47.68
|
| Rate for Payer: Entrust Commercial |
$46.22
|
| Rate for Payer: First Choice Health Commercial |
$46.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.73
|
| Rate for Payer: HealthUtah PPO |
$48.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.19
|
| Rate for Payer: Multiplan Medicare/VA |
$26.34
|
| Rate for Payer: One Health Plan of WY PPO |
$47.68
|
| Rate for Payer: PacificSource Commercial |
$43.78
|
| Rate for Payer: PHCS PPO |
$47.68
|
| Rate for Payer: Three Rivers PPO |
$36.49
|
| Rate for Payer: TriWest Veterans Administration |
$27.73
|
| Rate for Payer: United Healthcare Commercial |
$46.46
|
| Rate for Payer: United Healthcare Medicare |
$27.73
|
| Rate for Payer: WINHealth Partners Commercial |
$47.68
|
| Rate for Payer: Wise Provider Network Commercial |
$46.22
|
|
|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
NDC 0003089431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.68
|
| Rate for Payer: Aetna of WY Medicare |
$31.14
|
| Rate for Payer: Altius Commercial |
$46.70
|
| Rate for Payer: Beech Street Commercial |
$47.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.19
|
| Rate for Payer: Cash Price |
$34.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.19
|
| Rate for Payer: Cigna of WY Commercial |
$47.68
|
| Rate for Payer: Entrust Commercial |
$46.22
|
| Rate for Payer: First Choice Health Commercial |
$46.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.68
|
| Rate for Payer: HealthUtah PPO |
$48.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.19
|
| Rate for Payer: Multiplan Medicare/VA |
$28.19
|
| Rate for Payer: One Health Plan of WY PPO |
$47.68
|
| Rate for Payer: PacificSource Commercial |
$43.78
|
| Rate for Payer: PHCS PPO |
$47.68
|
| Rate for Payer: Three Rivers PPO |
$36.49
|
| Rate for Payer: TriWest Veterans Administration |
$29.68
|
| Rate for Payer: United Healthcare Commercial |
$46.46
|
| Rate for Payer: United Healthcare Medicare |
$29.68
|
| Rate for Payer: WINHealth Partners Commercial |
$46.22
|
| Rate for Payer: Wise Provider Network Commercial |
$46.22
|
|
|
APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$1,971.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,931.58
|
| Rate for Payer: Aetna of WY Medicare |
$78.30
|
| Rate for Payer: Beech Street Commercial |
$1,872.45
|
| Rate for Payer: Cash Price |
$1,379.70
|
| Rate for Payer: Cash Price |
$1,379.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,911.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,931.58
|
| Rate for Payer: First Choice Health Commercial |
$1,773.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,872.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$1,971.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,911.87
|
| Rate for Payer: Multiplan Medicare/VA |
$66.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,931.58
|
| Rate for Payer: PacificSource Commercial |
$1,773.90
|
| Rate for Payer: PHCS PPO |
$1,872.45
|
| Rate for Payer: Three Rivers PPO |
$1,478.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$1,872.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.35
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$3,881.00
|
|
|
Service Code
|
HCPCS 44960 80
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$3,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,803.38
|
| Rate for Payer: Beech Street Commercial |
$3,686.95
|
| Rate for Payer: Cash Price |
$2,716.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,764.57
|
| Rate for Payer: Cigna of WY Commercial |
$3,803.38
|
| Rate for Payer: First Choice Health Commercial |
$3,492.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,686.95
|
| Rate for Payer: HealthUtah PPO |
$3,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,764.57
|
| Rate for Payer: One Health Plan of WY PPO |
$3,803.38
|
| Rate for Payer: PacificSource Commercial |
$3,492.90
|
| Rate for Payer: PHCS PPO |
$3,686.95
|
| Rate for Payer: Three Rivers PPO |
$2,910.75
|
| Rate for Payer: United Healthcare Commercial |
$3,686.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,298.85
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$3,881.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$3,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,803.38
|
| Rate for Payer: Aetna of WY Medicare |
$831.79
|
| Rate for Payer: Beech Street Commercial |
$3,686.95
|
| Rate for Payer: Cash Price |
$2,716.70
|
| Rate for Payer: Cash Price |
$2,716.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,764.57
|
| Rate for Payer: Cigna of WY Commercial |
$3,803.38
|
| Rate for Payer: First Choice Health Commercial |
$3,492.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,686.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.79
|
| Rate for Payer: HealthUtah PPO |
$3,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,764.57
|
| Rate for Payer: Multiplan Medicare/VA |
$707.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,803.38
|
| Rate for Payer: PacificSource Commercial |
$3,492.90
|
| Rate for Payer: PHCS PPO |
$3,686.95
|
| Rate for Payer: Three Rivers PPO |
$2,910.75
|
| Rate for Payer: TriWest Veterans Administration |
$831.79
|
| Rate for Payer: United Healthcare Commercial |
$3,686.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,298.85
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$3,881.00
|
|
|
Service Code
|
HCPCS 44960 AS
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$3,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,803.38
|
| Rate for Payer: Beech Street Commercial |
$3,686.95
|
| Rate for Payer: Cash Price |
$2,716.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,764.57
|
| Rate for Payer: Cigna of WY Commercial |
$3,803.38
|
| Rate for Payer: First Choice Health Commercial |
$3,492.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,686.95
|
| Rate for Payer: HealthUtah PPO |
$3,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,764.57
|
| Rate for Payer: One Health Plan of WY PPO |
$3,803.38
|
| Rate for Payer: PacificSource Commercial |
$3,492.90
|
| Rate for Payer: PHCS PPO |
$3,686.95
|
| Rate for Payer: Three Rivers PPO |
$2,910.75
|
| Rate for Payer: United Healthcare Commercial |
$3,686.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,298.85
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$2,846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,789.08
|
| Rate for Payer: Aetna of WY Medicare |
$610.31
|
| Rate for Payer: Beech Street Commercial |
$2,703.70
|
| Rate for Payer: Cash Price |
$1,992.20
|
| Rate for Payer: Cash Price |
$1,992.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,760.62
|
| Rate for Payer: Cigna of WY Commercial |
$2,789.08
|
| Rate for Payer: First Choice Health Commercial |
$2,561.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,703.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.31
|
| Rate for Payer: HealthUtah PPO |
$2,846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,760.62
|
| Rate for Payer: Multiplan Medicare/VA |
$518.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,789.08
|
| Rate for Payer: PacificSource Commercial |
$2,561.40
|
| Rate for Payer: PHCS PPO |
$2,703.70
|
| Rate for Payer: Three Rivers PPO |
$2,134.50
|
| Rate for Payer: TriWest Veterans Administration |
$610.31
|
| Rate for Payer: United Healthcare Commercial |
$2,703.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,419.10
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 44950 80
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$2,846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,789.08
|
| Rate for Payer: Beech Street Commercial |
$2,703.70
|
| Rate for Payer: Cash Price |
$1,992.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,760.62
|
| Rate for Payer: Cigna of WY Commercial |
$2,789.08
|
| Rate for Payer: First Choice Health Commercial |
$2,561.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,703.70
|
| Rate for Payer: HealthUtah PPO |
$2,846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,760.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,789.08
|
| Rate for Payer: PacificSource Commercial |
$2,561.40
|
| Rate for Payer: PHCS PPO |
$2,703.70
|
| Rate for Payer: Three Rivers PPO |
$2,134.50
|
| Rate for Payer: United Healthcare Commercial |
$2,703.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,419.10
|
|
|
APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$257.74
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$249.85
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$255.11
|
| Rate for Payer: Cigna of WY Commercial |
$257.74
|
| Rate for Payer: First Choice Health Commercial |
$236.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$255.11
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$257.74
|
| Rate for Payer: PacificSource Commercial |
$236.70
|
| Rate for Payer: PHCS PPO |
$249.85
|
| Rate for Payer: Three Rivers PPO |
$197.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: WINHealth Partners Commercial |
$223.55
|
|
|
APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 29075 50
|
| Min. Negotiated Rate |
$395.25 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$516.46
|
| Rate for Payer: Beech Street Commercial |
$500.65
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$511.19
|
| Rate for Payer: Cigna of WY Commercial |
$516.46
|
| Rate for Payer: First Choice Health Commercial |
$474.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.65
|
| Rate for Payer: HealthUtah PPO |
$527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$511.19
|
| Rate for Payer: One Health Plan of WY PPO |
$516.46
|
| Rate for Payer: PacificSource Commercial |
$474.30
|
| Rate for Payer: PHCS PPO |
$500.65
|
| Rate for Payer: Three Rivers PPO |
$395.25
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
| Rate for Payer: WINHealth Partners Commercial |
$447.95
|
|
|
APPLICATION CAST FINGER
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$299.88
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$290.70
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$296.82
|
| Rate for Payer: Cigna of WY Commercial |
$299.88
|
| Rate for Payer: First Choice Health Commercial |
$275.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$296.82
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$299.88
|
| Rate for Payer: PacificSource Commercial |
$275.40
|
| Rate for Payer: PHCS PPO |
$290.70
|
| Rate for Payer: Three Rivers PPO |
$229.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$290.70
|
| Rate for Payer: WINHealth Partners Commercial |
$260.10
|
|
|
APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$65.43
|
| Rate for Payer: Beech Street Commercial |
$270.75
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.43
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$55.62
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$270.75
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$65.43
|
| Rate for Payer: United Healthcare Commercial |
$270.75
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
|
|
APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Beech Street Commercial |
$275.50
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: First Choice Health Commercial |
$261.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.10
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$275.50
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$275.50
|
| Rate for Payer: WINHealth Partners Commercial |
$246.50
|
|
|
APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$118.75
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: First Choice Health Commercial |
$112.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$118.75
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
| Rate for Payer: WINHealth Partners Commercial |
$106.25
|
|
|
APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 22851 80
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$731.08
|
| Rate for Payer: Beech Street Commercial |
$708.70
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$723.62
|
| Rate for Payer: Cigna of WY Commercial |
$731.08
|
| Rate for Payer: First Choice Health Commercial |
$671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$708.70
|
| Rate for Payer: HealthUtah PPO |
$746.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$723.62
|
| Rate for Payer: One Health Plan of WY PPO |
$731.08
|
| Rate for Payer: PacificSource Commercial |
$671.40
|
| Rate for Payer: PHCS PPO |
$708.70
|
| Rate for Payer: Three Rivers PPO |
$559.50
|
| Rate for Payer: United Healthcare Commercial |
$708.70
|
| Rate for Payer: WINHealth Partners Commercial |
$634.10
|
|
|
APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 22851 AS
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$731.08
|
| Rate for Payer: Beech Street Commercial |
$708.70
|
| Rate for Payer: Cash Price |
$522.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$723.62
|
| Rate for Payer: Cigna of WY Commercial |
$731.08
|
| Rate for Payer: First Choice Health Commercial |
$671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$708.70
|
| Rate for Payer: HealthUtah PPO |
$746.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$723.62
|
| Rate for Payer: One Health Plan of WY PPO |
$731.08
|
| Rate for Payer: PacificSource Commercial |
$671.40
|
| Rate for Payer: PHCS PPO |
$708.70
|
| Rate for Payer: Three Rivers PPO |
$559.50
|
| Rate for Payer: United Healthcare Commercial |
$708.70
|
| Rate for Payer: WINHealth Partners Commercial |
$634.10
|
|
|
APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.42
|
| Rate for Payer: Aetna of WY Medicare |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$170.05
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.63
|
| Rate for Payer: Cigna of WY Commercial |
$175.42
|
| Rate for Payer: First Choice Health Commercial |
$161.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.56
|
| Rate for Payer: HealthUtah PPO |
$179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.63
|
| Rate for Payer: Multiplan Medicare/VA |
$33.63
|
| Rate for Payer: One Health Plan of WY PPO |
$175.42
|
| Rate for Payer: PacificSource Commercial |
$161.10
|
| Rate for Payer: PHCS PPO |
$170.05
|
| Rate for Payer: Three Rivers PPO |
$134.25
|
| Rate for Payer: TriWest Veterans Administration |
$39.56
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: WINHealth Partners Commercial |
$152.15
|
|
|
APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 29105 50
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: First Choice Health Commercial |
$324.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$342.00
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: WINHealth Partners Commercial |
$306.00
|
|
|
APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$81.06 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$417.48
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Beech Street Commercial |
$404.70
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$413.22
|
| Rate for Payer: Cigna of WY Commercial |
$417.48
|
| Rate for Payer: First Choice Health Commercial |
$383.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$404.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.36
|
| Rate for Payer: HealthUtah PPO |
$426.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$413.22
|
| Rate for Payer: Multiplan Medicare/VA |
$81.06
|
| Rate for Payer: One Health Plan of WY PPO |
$417.48
|
| Rate for Payer: PacificSource Commercial |
$383.40
|
| Rate for Payer: PHCS PPO |
$404.70
|
| Rate for Payer: Three Rivers PPO |
$319.50
|
| Rate for Payer: TriWest Veterans Administration |
$95.36
|
| Rate for Payer: United Healthcare Commercial |
$404.70
|
| Rate for Payer: WINHealth Partners Commercial |
$362.10
|
|
|
APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$86.89 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.86
|
| Rate for Payer: Aetna of WY Medicare |
$102.22
|
| Rate for Payer: Beech Street Commercial |
$434.15
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$443.29
|
| Rate for Payer: Cigna of WY Commercial |
$447.86
|
| Rate for Payer: First Choice Health Commercial |
$411.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$434.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.22
|
| Rate for Payer: HealthUtah PPO |
$457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$443.29
|
| Rate for Payer: Multiplan Medicare/VA |
$86.89
|
| Rate for Payer: One Health Plan of WY PPO |
$447.86
|
| Rate for Payer: PacificSource Commercial |
$411.30
|
| Rate for Payer: PHCS PPO |
$434.15
|
| Rate for Payer: Three Rivers PPO |
$342.75
|
| Rate for Payer: TriWest Veterans Administration |
$102.22
|
| Rate for Payer: United Healthcare Commercial |
$434.15
|
| Rate for Payer: WINHealth Partners Commercial |
$388.45
|
|
|
APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$50.71
|
| Rate for Payer: Beech Street Commercial |
$204.25
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: First Choice Health Commercial |
$193.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.71
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$43.10
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$204.25
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.71
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
| Rate for Payer: WINHealth Partners Commercial |
$182.75
|
|
|
APPLICATION MODALITY 1/> AREAS INFRARED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 97026
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$6.46
|
| Rate for Payer: Beech Street Commercial |
$14.25
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: First Choice Health Commercial |
$13.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.46
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$5.49
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.25
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$6.46
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
|
|
APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$16.61
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.61
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$14.12
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$16.61
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 20692 AS
|
| Min. Negotiated Rate |
$927.89 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,802.00
|
| Rate for Payer: Beech Street Commercial |
$4,655.00
|
| Rate for Payer: Cash Price |
$3,430.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,753.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,802.00
|
| Rate for Payer: First Choice Health Commercial |
$4,410.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,655.00
|
| Rate for Payer: HealthUtah PPO |
$4,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,753.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4,802.00
|
| Rate for Payer: PacificSource Commercial |
$4,410.00
|
| Rate for Payer: PHCS PPO |
$4,655.00
|
| Rate for Payer: Three Rivers PPO |
$3,675.00
|
| Rate for Payer: United Healthcare Commercial |
$4,655.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,165.00
|
|
|
APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$927.89 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,802.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,091.64
|
| Rate for Payer: Beech Street Commercial |
$4,655.00
|
| Rate for Payer: Cash Price |
$3,430.00
|
| Rate for Payer: Cash Price |
$3,430.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,753.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,802.00
|
| Rate for Payer: First Choice Health Commercial |
$4,410.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,655.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,091.64
|
| Rate for Payer: HealthUtah PPO |
$4,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,753.00
|
| Rate for Payer: Multiplan Medicare/VA |
$927.89
|
| Rate for Payer: One Health Plan of WY PPO |
$4,802.00
|
| Rate for Payer: PacificSource Commercial |
$4,410.00
|
| Rate for Payer: PHCS PPO |
$4,655.00
|
| Rate for Payer: Three Rivers PPO |
$3,675.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,091.64
|
| Rate for Payer: United Healthcare Commercial |
$4,655.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,165.00
|
|
