|
ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$6,998.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
27130
|
| Min. Negotiated Rate |
$1,045.90 |
| Max. Negotiated Rate |
$6,998.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,858.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.47
|
| Rate for Payer: Beech Street Commercial |
$6,648.10
|
| Rate for Payer: Cash Price |
$4,898.60
|
| Rate for Payer: Cash Price |
$4,898.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,788.06
|
| Rate for Payer: Cigna of WY Commercial |
$6,858.04
|
| Rate for Payer: First Choice Health Commercial |
$6,298.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,648.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.47
|
| Rate for Payer: HealthUtah PPO |
$6,998.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,788.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,045.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,858.04
|
| Rate for Payer: PacificSource Commercial |
$6,298.20
|
| Rate for Payer: PHCS PPO |
$6,648.10
|
| Rate for Payer: Three Rivers PPO |
$5,248.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.47
|
| Rate for Payer: United Healthcare Commercial |
$6,088.26
|
| Rate for Payer: United Healthcare Medicare |
$1,230.47
|
| Rate for Payer: WINHealth Partners Commercial |
$5,948.30
|
|
|
ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM
|
Professional
|
Both
|
$4,963.00
|
|
|
Service Code
|
HCPCS 24363 80
|
| Hospital Charge Code |
24363
|
| Min. Negotiated Rate |
$1,182.18 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,390.80
|
| Rate for Payer: Beech Street Commercial |
$4,714.85
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: First Choice Health Commercial |
$4,466.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,390.80
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,182.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PHCS PPO |
$4,714.85
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,390.80
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$1,390.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,218.55
|
|
|
ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM
|
Professional
|
Both
|
$4,963.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
24363
|
| Min. Negotiated Rate |
$1,182.18 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,390.80
|
| Rate for Payer: Beech Street Commercial |
$4,714.85
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: First Choice Health Commercial |
$4,466.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,390.80
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,182.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PHCS PPO |
$4,714.85
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,390.80
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$1,390.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,218.55
|
|
|
ARTHRP INTERCARPAL/CARP/MTCRPL JT INTERPOSITION
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 25447 AS
|
| Hospital Charge Code |
25447
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$6,653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,519.94
|
| Rate for Payer: Aetna of WY Medicare |
$811.05
|
| Rate for Payer: Beech Street Commercial |
$6,320.35
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,453.41
|
| Rate for Payer: Cigna of WY Commercial |
$6,519.94
|
| Rate for Payer: First Choice Health Commercial |
$5,987.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,320.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.05
|
| Rate for Payer: HealthUtah PPO |
$6,653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,453.41
|
| Rate for Payer: Multiplan Medicare/VA |
$689.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,519.94
|
| Rate for Payer: PacificSource Commercial |
$5,987.70
|
| Rate for Payer: PHCS PPO |
$6,320.35
|
| Rate for Payer: Three Rivers PPO |
$4,989.75
|
| Rate for Payer: TriWest Veterans Administration |
$811.05
|
| Rate for Payer: United Healthcare Commercial |
$5,788.11
|
| Rate for Payer: United Healthcare Medicare |
$811.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,655.05
|
|
|
ARTHRP INTERCARPAL/CARP/MTCRPL JT INTERPOSITION
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
25447
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$6,653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,519.94
|
| Rate for Payer: Aetna of WY Medicare |
$811.05
|
| Rate for Payer: Beech Street Commercial |
$6,320.35
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,453.41
|
| Rate for Payer: Cigna of WY Commercial |
$6,519.94
|
| Rate for Payer: First Choice Health Commercial |
$5,987.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,320.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.05
|
| Rate for Payer: HealthUtah PPO |
$6,653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,453.41
|
| Rate for Payer: Multiplan Medicare/VA |
$689.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,519.94
|
| Rate for Payer: PacificSource Commercial |
$5,987.70
|
| Rate for Payer: PHCS PPO |
$6,320.35
|
| Rate for Payer: Three Rivers PPO |
$4,989.75
|
| Rate for Payer: TriWest Veterans Administration |
$811.05
|
| Rate for Payer: United Healthcare Commercial |
$5,788.11
|
| Rate for Payer: United Healthcare Medicare |
$811.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,655.05
|
|
|
ARTHRP INTERCARPAL/CARP/MTCRPL JT INTERPOSITION
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 25447 80
|
| Hospital Charge Code |
25447
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$6,653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,519.94
|
| Rate for Payer: Aetna of WY Medicare |
$811.05
|
| Rate for Payer: Beech Street Commercial |
$6,320.35
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,453.41
|
| Rate for Payer: Cigna of WY Commercial |
$6,519.94
|
| Rate for Payer: First Choice Health Commercial |
$5,987.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,320.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.05
|
| Rate for Payer: HealthUtah PPO |
$6,653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,453.41
|
| Rate for Payer: Multiplan Medicare/VA |
$689.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,519.94
|
| Rate for Payer: PacificSource Commercial |
$5,987.70
|
| Rate for Payer: PHCS PPO |
$6,320.35
|
| Rate for Payer: Three Rivers PPO |
$4,989.75
|
| Rate for Payer: TriWest Veterans Administration |
$811.05
|
| Rate for Payer: United Healthcare Commercial |
$5,788.11
|
| Rate for Payer: United Healthcare Medicare |
$811.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,655.05
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$6,991.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
27447
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$6,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,851.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$6,641.45
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,781.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,851.18
|
| Rate for Payer: First Choice Health Commercial |
$6,291.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,641.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$6,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,781.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$6,851.18
|
| Rate for Payer: PacificSource Commercial |
$6,291.90
|
| Rate for Payer: PHCS PPO |
$6,641.45
|
| Rate for Payer: Three Rivers PPO |
$5,243.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$6,082.17
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$5,942.35
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$6,991.00
|
|
|
Service Code
|
HCPCS 27447 80
|
| Hospital Charge Code |
27447
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$6,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,851.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$6,641.45
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,781.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,851.18
|
| Rate for Payer: First Choice Health Commercial |
$6,291.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,641.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$6,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,781.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$6,851.18
|
| Rate for Payer: PacificSource Commercial |
$6,291.90
|
| Rate for Payer: PHCS PPO |
$6,641.45
|
| Rate for Payer: Three Rivers PPO |
$5,243.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$6,082.17
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$5,942.35
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$13,982.00
|
|
|
Service Code
|
HCPCS 27447 50
|
| Hospital Charge Code |
27447
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$13,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,702.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$13,282.90
|
| Rate for Payer: Cash Price |
$9,787.40
|
| Rate for Payer: Cash Price |
$9,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,562.54
|
| Rate for Payer: Cigna of WY Commercial |
$13,702.36
|
| Rate for Payer: First Choice Health Commercial |
$12,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,282.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$13,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,562.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$13,702.36
|
| Rate for Payer: PacificSource Commercial |
$12,583.80
|
| Rate for Payer: PHCS PPO |
$13,282.90
|
| Rate for Payer: Three Rivers PPO |
$10,486.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$12,164.34
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$11,884.70
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$6,991.00
|
|
|
Service Code
|
HCPCS 27447 AS
|
| Hospital Charge Code |
27447
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$6,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,851.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$6,641.45
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: Cash Price |
$4,893.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,781.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,851.18
|
| Rate for Payer: First Choice Health Commercial |
$6,291.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,641.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$6,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,781.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$6,851.18
|
| Rate for Payer: PacificSource Commercial |
$6,291.90
|
| Rate for Payer: PHCS PPO |
$6,641.45
|
| Rate for Payer: Three Rivers PPO |
$5,243.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$6,082.17
|
| Rate for Payer: United Healthcare Medicare |
$1,228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$5,942.35
|
|
|
ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$5,980.00
|
|
|
Service Code
|
HCPCS 27446 AS
|
| Hospital Charge Code |
27446
|
| Min. Negotiated Rate |
$937.23 |
| Max. Negotiated Rate |
$5,980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,860.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,102.62
|
| Rate for Payer: Beech Street Commercial |
$5,681.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,800.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,860.40
|
| Rate for Payer: First Choice Health Commercial |
$5,382.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.62
|
| Rate for Payer: HealthUtah PPO |
$5,980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,800.60
|
| Rate for Payer: Multiplan Medicare/VA |
$937.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5,860.40
|
| Rate for Payer: PacificSource Commercial |
$5,382.00
|
| Rate for Payer: PHCS PPO |
$5,681.00
|
| Rate for Payer: Three Rivers PPO |
$4,485.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.62
|
| Rate for Payer: United Healthcare Commercial |
$5,202.60
|
| Rate for Payer: United Healthcare Medicare |
$1,102.62
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.00
|
|
|
ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$5,980.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
27446
|
| Min. Negotiated Rate |
$937.23 |
| Max. Negotiated Rate |
$5,980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,860.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,102.62
|
| Rate for Payer: Beech Street Commercial |
$5,681.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,800.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,860.40
|
| Rate for Payer: First Choice Health Commercial |
$5,382.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.62
|
| Rate for Payer: HealthUtah PPO |
$5,980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,800.60
|
| Rate for Payer: Multiplan Medicare/VA |
$937.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5,860.40
|
| Rate for Payer: PacificSource Commercial |
$5,382.00
|
| Rate for Payer: PHCS PPO |
$5,681.00
|
| Rate for Payer: Three Rivers PPO |
$4,485.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.62
|
| Rate for Payer: United Healthcare Commercial |
$5,202.60
|
| Rate for Payer: United Healthcare Medicare |
$1,102.62
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.00
|
|
|
ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$5,980.00
|
|
|
Service Code
|
HCPCS 27446 80
|
| Hospital Charge Code |
27446
|
| Min. Negotiated Rate |
$937.23 |
| Max. Negotiated Rate |
$5,980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,860.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,102.62
|
| Rate for Payer: Beech Street Commercial |
$5,681.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: Cash Price |
$4,186.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,800.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,860.40
|
| Rate for Payer: First Choice Health Commercial |
$5,382.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.62
|
| Rate for Payer: HealthUtah PPO |
$5,980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,800.60
|
| Rate for Payer: Multiplan Medicare/VA |
$937.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5,860.40
|
| Rate for Payer: PacificSource Commercial |
$5,382.00
|
| Rate for Payer: PHCS PPO |
$5,681.00
|
| Rate for Payer: Three Rivers PPO |
$4,485.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.62
|
| Rate for Payer: United Healthcare Commercial |
$5,202.60
|
| Rate for Payer: United Healthcare Medicare |
$1,102.62
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.00
|
|
|
ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT
|
Professional
|
Both
|
$2,209.00
|
|
|
Service Code
|
HCPCS 26531 AS
|
| Hospital Charge Code |
26531
|
| Min. Negotiated Rate |
$526.06 |
| Max. Negotiated Rate |
$2,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,164.82
|
| Rate for Payer: Aetna of WY Medicare |
$618.89
|
| Rate for Payer: Beech Street Commercial |
$2,098.55
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,142.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,164.82
|
| Rate for Payer: First Choice Health Commercial |
$1,988.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,098.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$618.89
|
| Rate for Payer: HealthUtah PPO |
$2,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,142.73
|
| Rate for Payer: Multiplan Medicare/VA |
$526.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,164.82
|
| Rate for Payer: PacificSource Commercial |
$1,988.10
|
| Rate for Payer: PHCS PPO |
$2,098.55
|
| Rate for Payer: Three Rivers PPO |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration |
$618.89
|
| Rate for Payer: United Healthcare Commercial |
$1,921.83
|
| Rate for Payer: United Healthcare Medicare |
$618.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,877.65
|
|
|
ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT
|
Professional
|
Both
|
$2,209.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
26531
|
| Min. Negotiated Rate |
$526.06 |
| Max. Negotiated Rate |
$2,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,164.82
|
| Rate for Payer: Aetna of WY Medicare |
$618.89
|
| Rate for Payer: Beech Street Commercial |
$2,098.55
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,142.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,164.82
|
| Rate for Payer: First Choice Health Commercial |
$1,988.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,098.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$618.89
|
| Rate for Payer: HealthUtah PPO |
$2,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,142.73
|
| Rate for Payer: Multiplan Medicare/VA |
$526.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,164.82
|
| Rate for Payer: PacificSource Commercial |
$1,988.10
|
| Rate for Payer: PHCS PPO |
$2,098.55
|
| Rate for Payer: Three Rivers PPO |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration |
$618.89
|
| Rate for Payer: United Healthcare Commercial |
$1,921.83
|
| Rate for Payer: United Healthcare Medicare |
$618.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,877.65
|
|
|
ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/ENTIR CARPS
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 25446
|
| Hospital Charge Code |
25446
|
| Min. Negotiated Rate |
$961.17 |
| Max. Negotiated Rate |
$3,732.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,657.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,130.79
|
| Rate for Payer: Beech Street Commercial |
$3,545.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,620.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,657.36
|
| Rate for Payer: First Choice Health Commercial |
$3,358.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,130.79
|
| Rate for Payer: HealthUtah PPO |
$3,732.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,620.04
|
| Rate for Payer: Multiplan Medicare/VA |
$961.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,657.36
|
| Rate for Payer: PacificSource Commercial |
$3,358.80
|
| Rate for Payer: PHCS PPO |
$3,545.40
|
| Rate for Payer: Three Rivers PPO |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,130.79
|
| Rate for Payer: United Healthcare Commercial |
$3,246.84
|
| Rate for Payer: United Healthcare Medicare |
$1,130.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,172.20
|
|
|
ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/ENTIR CARPS
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 25446 AS
|
| Hospital Charge Code |
25446
|
| Min. Negotiated Rate |
$961.17 |
| Max. Negotiated Rate |
$3,732.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,657.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,130.79
|
| Rate for Payer: Beech Street Commercial |
$3,545.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,620.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,657.36
|
| Rate for Payer: First Choice Health Commercial |
$3,358.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,130.79
|
| Rate for Payer: HealthUtah PPO |
$3,732.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,620.04
|
| Rate for Payer: Multiplan Medicare/VA |
$961.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,657.36
|
| Rate for Payer: PacificSource Commercial |
$3,358.80
|
| Rate for Payer: PHCS PPO |
$3,545.40
|
| Rate for Payer: Three Rivers PPO |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,130.79
|
| Rate for Payer: United Healthcare Commercial |
$3,246.84
|
| Rate for Payer: United Healthcare Medicare |
$1,130.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,172.20
|
|
|
ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$5,061.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
29888
|
| Min. Negotiated Rate |
$798.71 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,959.78
|
| Rate for Payer: Aetna of WY Medicare |
$939.66
|
| Rate for Payer: Beech Street Commercial |
$4,807.95
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,909.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,959.78
|
| Rate for Payer: First Choice Health Commercial |
$4,554.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,807.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.66
|
| Rate for Payer: HealthUtah PPO |
$5,061.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,909.17
|
| Rate for Payer: Multiplan Medicare/VA |
$798.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4,959.78
|
| Rate for Payer: PacificSource Commercial |
$4,554.90
|
| Rate for Payer: PHCS PPO |
$4,807.95
|
| Rate for Payer: Three Rivers PPO |
$3,795.75
|
| Rate for Payer: TriWest Veterans Administration |
$939.66
|
| Rate for Payer: United Healthcare Commercial |
$4,403.07
|
| Rate for Payer: United Healthcare Medicare |
$939.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4,301.85
|
|
|
ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$5,061.00
|
|
|
Service Code
|
HCPCS 29888 AS
|
| Hospital Charge Code |
29888
|
| Min. Negotiated Rate |
$798.71 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,959.78
|
| Rate for Payer: Aetna of WY Medicare |
$939.66
|
| Rate for Payer: Beech Street Commercial |
$4,807.95
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,909.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,959.78
|
| Rate for Payer: First Choice Health Commercial |
$4,554.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,807.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.66
|
| Rate for Payer: HealthUtah PPO |
$5,061.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,909.17
|
| Rate for Payer: Multiplan Medicare/VA |
$798.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4,959.78
|
| Rate for Payer: PacificSource Commercial |
$4,554.90
|
| Rate for Payer: PHCS PPO |
$4,807.95
|
| Rate for Payer: Three Rivers PPO |
$3,795.75
|
| Rate for Payer: TriWest Veterans Administration |
$939.66
|
| Rate for Payer: United Healthcare Commercial |
$4,403.07
|
| Rate for Payer: United Healthcare Medicare |
$939.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4,301.85
|
|
|
ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$5,061.00
|
|
|
Service Code
|
HCPCS 29888 80
|
| Hospital Charge Code |
29888
|
| Min. Negotiated Rate |
$798.71 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,959.78
|
| Rate for Payer: Aetna of WY Medicare |
$939.66
|
| Rate for Payer: Beech Street Commercial |
$4,807.95
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: Cash Price |
$3,542.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,909.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,959.78
|
| Rate for Payer: First Choice Health Commercial |
$4,554.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,807.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.66
|
| Rate for Payer: HealthUtah PPO |
$5,061.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,909.17
|
| Rate for Payer: Multiplan Medicare/VA |
$798.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4,959.78
|
| Rate for Payer: PacificSource Commercial |
$4,554.90
|
| Rate for Payer: PHCS PPO |
$4,807.95
|
| Rate for Payer: Three Rivers PPO |
$3,795.75
|
| Rate for Payer: TriWest Veterans Administration |
$939.66
|
| Rate for Payer: United Healthcare Commercial |
$4,403.07
|
| Rate for Payer: United Healthcare Medicare |
$939.66
|
| Rate for Payer: WINHealth Partners Commercial |
$4,301.85
|
|
|
ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$6,311.00
|
|
|
Service Code
|
HCPCS 29889
|
| Hospital Charge Code |
29889
|
| Min. Negotiated Rate |
$1,004.77 |
| Max. Negotiated Rate |
$6,311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,184.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,182.08
|
| Rate for Payer: Beech Street Commercial |
$5,995.45
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,121.67
|
| Rate for Payer: Cigna of WY Commercial |
$6,184.78
|
| Rate for Payer: First Choice Health Commercial |
$5,679.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,995.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,182.08
|
| Rate for Payer: HealthUtah PPO |
$6,311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,121.67
|
| Rate for Payer: Multiplan Medicare/VA |
$1,004.77
|
| Rate for Payer: One Health Plan of WY PPO |
$6,184.78
|
| Rate for Payer: PacificSource Commercial |
$5,679.90
|
| Rate for Payer: PHCS PPO |
$5,995.45
|
| Rate for Payer: Three Rivers PPO |
$4,733.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,182.08
|
| Rate for Payer: United Healthcare Commercial |
$5,490.57
|
| Rate for Payer: United Healthcare Medicare |
$1,182.08
|
| Rate for Payer: WINHealth Partners Commercial |
$5,364.35
|
|
|
ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$6,311.00
|
|
|
Service Code
|
HCPCS 29889 80
|
| Hospital Charge Code |
29889
|
| Min. Negotiated Rate |
$1,004.77 |
| Max. Negotiated Rate |
$6,311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,184.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,182.08
|
| Rate for Payer: Beech Street Commercial |
$5,995.45
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,121.67
|
| Rate for Payer: Cigna of WY Commercial |
$6,184.78
|
| Rate for Payer: First Choice Health Commercial |
$5,679.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,995.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,182.08
|
| Rate for Payer: HealthUtah PPO |
$6,311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,121.67
|
| Rate for Payer: Multiplan Medicare/VA |
$1,004.77
|
| Rate for Payer: One Health Plan of WY PPO |
$6,184.78
|
| Rate for Payer: PacificSource Commercial |
$5,679.90
|
| Rate for Payer: PHCS PPO |
$5,995.45
|
| Rate for Payer: Three Rivers PPO |
$4,733.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,182.08
|
| Rate for Payer: United Healthcare Commercial |
$5,490.57
|
| Rate for Payer: United Healthcare Medicare |
$1,182.08
|
| Rate for Payer: WINHealth Partners Commercial |
$5,364.35
|
|
|
ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT
|
Professional
|
Both
|
$7,869.00
|
|
|
Service Code
|
HCPCS 29891
|
| Hospital Charge Code |
29891
|
| Min. Negotiated Rate |
$557.42 |
| Max. Negotiated Rate |
$7,869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,711.62
|
| Rate for Payer: Aetna of WY Medicare |
$655.79
|
| Rate for Payer: Beech Street Commercial |
$7,475.55
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,632.93
|
| Rate for Payer: Cigna of WY Commercial |
$7,711.62
|
| Rate for Payer: First Choice Health Commercial |
$7,082.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,475.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.79
|
| Rate for Payer: HealthUtah PPO |
$7,869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,632.93
|
| Rate for Payer: Multiplan Medicare/VA |
$557.42
|
| Rate for Payer: One Health Plan of WY PPO |
$7,711.62
|
| Rate for Payer: PacificSource Commercial |
$7,082.10
|
| Rate for Payer: PHCS PPO |
$7,475.55
|
| Rate for Payer: Three Rivers PPO |
$5,901.75
|
| Rate for Payer: TriWest Veterans Administration |
$655.79
|
| Rate for Payer: United Healthcare Commercial |
$6,846.03
|
| Rate for Payer: United Healthcare Medicare |
$655.79
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.65
|
|
|
ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT
|
Professional
|
Both
|
$7,869.00
|
|
|
Service Code
|
HCPCS 29891 AS
|
| Hospital Charge Code |
29891
|
| Min. Negotiated Rate |
$557.42 |
| Max. Negotiated Rate |
$7,869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,711.62
|
| Rate for Payer: Aetna of WY Medicare |
$655.79
|
| Rate for Payer: Beech Street Commercial |
$7,475.55
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,632.93
|
| Rate for Payer: Cigna of WY Commercial |
$7,711.62
|
| Rate for Payer: First Choice Health Commercial |
$7,082.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,475.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.79
|
| Rate for Payer: HealthUtah PPO |
$7,869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,632.93
|
| Rate for Payer: Multiplan Medicare/VA |
$557.42
|
| Rate for Payer: One Health Plan of WY PPO |
$7,711.62
|
| Rate for Payer: PacificSource Commercial |
$7,082.10
|
| Rate for Payer: PHCS PPO |
$7,475.55
|
| Rate for Payer: Three Rivers PPO |
$5,901.75
|
| Rate for Payer: TriWest Veterans Administration |
$655.79
|
| Rate for Payer: United Healthcare Commercial |
$6,846.03
|
| Rate for Payer: United Healthcare Medicare |
$655.79
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.65
|
|
|
ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT
|
Professional
|
Both
|
$7,869.00
|
|
|
Service Code
|
HCPCS 29891 80
|
| Hospital Charge Code |
29891
|
| Min. Negotiated Rate |
$557.42 |
| Max. Negotiated Rate |
$7,869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,711.62
|
| Rate for Payer: Aetna of WY Medicare |
$655.79
|
| Rate for Payer: Beech Street Commercial |
$7,475.55
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: Cash Price |
$5,508.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,632.93
|
| Rate for Payer: Cigna of WY Commercial |
$7,711.62
|
| Rate for Payer: First Choice Health Commercial |
$7,082.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,475.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.79
|
| Rate for Payer: HealthUtah PPO |
$7,869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,632.93
|
| Rate for Payer: Multiplan Medicare/VA |
$557.42
|
| Rate for Payer: One Health Plan of WY PPO |
$7,711.62
|
| Rate for Payer: PacificSource Commercial |
$7,082.10
|
| Rate for Payer: PHCS PPO |
$7,475.55
|
| Rate for Payer: Three Rivers PPO |
$5,901.75
|
| Rate for Payer: TriWest Veterans Administration |
$655.79
|
| Rate for Payer: United Healthcare Commercial |
$6,846.03
|
| Rate for Payer: United Healthcare Medicare |
$655.79
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.65
|
|
