|
ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 24006 80
|
| Hospital Charge Code |
24006
|
| Min. Negotiated Rate |
$591.28 |
| Max. Negotiated Rate |
$2,483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,433.34
|
| Rate for Payer: Aetna of WY Medicare |
$695.62
|
| Rate for Payer: Beech Street Commercial |
$2,358.85
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,408.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,433.34
|
| Rate for Payer: First Choice Health Commercial |
$2,234.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,358.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.62
|
| Rate for Payer: HealthUtah PPO |
$2,483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,408.51
|
| Rate for Payer: Multiplan Medicare/VA |
$591.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,433.34
|
| Rate for Payer: PacificSource Commercial |
$2,234.70
|
| Rate for Payer: PHCS PPO |
$2,358.85
|
| Rate for Payer: Three Rivers PPO |
$1,862.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.62
|
| Rate for Payer: United Healthcare Commercial |
$2,160.21
|
| Rate for Payer: United Healthcare Medicare |
$695.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,110.55
|
|
|
ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
24006
|
| Min. Negotiated Rate |
$591.28 |
| Max. Negotiated Rate |
$2,483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,433.34
|
| Rate for Payer: Aetna of WY Medicare |
$695.62
|
| Rate for Payer: Beech Street Commercial |
$2,358.85
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,408.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,433.34
|
| Rate for Payer: First Choice Health Commercial |
$2,234.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,358.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.62
|
| Rate for Payer: HealthUtah PPO |
$2,483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,408.51
|
| Rate for Payer: Multiplan Medicare/VA |
$591.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,433.34
|
| Rate for Payer: PacificSource Commercial |
$2,234.70
|
| Rate for Payer: PHCS PPO |
$2,358.85
|
| Rate for Payer: Three Rivers PPO |
$1,862.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.62
|
| Rate for Payer: United Healthcare Commercial |
$2,160.21
|
| Rate for Payer: United Healthcare Medicare |
$695.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,110.55
|
|
|
ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 24006 AS
|
| Hospital Charge Code |
24006
|
| Min. Negotiated Rate |
$591.28 |
| Max. Negotiated Rate |
$2,483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,433.34
|
| Rate for Payer: Aetna of WY Medicare |
$695.62
|
| Rate for Payer: Beech Street Commercial |
$2,358.85
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: Cash Price |
$1,738.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,408.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,433.34
|
| Rate for Payer: First Choice Health Commercial |
$2,234.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,358.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.62
|
| Rate for Payer: HealthUtah PPO |
$2,483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,408.51
|
| Rate for Payer: Multiplan Medicare/VA |
$591.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,433.34
|
| Rate for Payer: PacificSource Commercial |
$2,234.70
|
| Rate for Payer: PHCS PPO |
$2,358.85
|
| Rate for Payer: Three Rivers PPO |
$1,862.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.62
|
| Rate for Payer: United Healthcare Commercial |
$2,160.21
|
| Rate for Payer: United Healthcare Medicare |
$695.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,110.55
|
|
|
ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
24000
|
| Min. Negotiated Rate |
$399.44 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,346.12
|
| Rate for Payer: Aetna of WY Medicare |
$469.93
|
| Rate for Payer: Beech Street Commercial |
$2,274.30
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,322.18
|
| Rate for Payer: Cigna of WY Commercial |
$2,346.12
|
| Rate for Payer: First Choice Health Commercial |
$2,154.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,274.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.93
|
| Rate for Payer: HealthUtah PPO |
$2,394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,322.18
|
| Rate for Payer: Multiplan Medicare/VA |
$399.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,346.12
|
| Rate for Payer: PacificSource Commercial |
$2,154.60
|
| Rate for Payer: PHCS PPO |
$2,274.30
|
| Rate for Payer: Three Rivers PPO |
$1,795.50
|
| Rate for Payer: TriWest Veterans Administration |
$469.93
|
| Rate for Payer: United Healthcare Commercial |
$2,082.78
|
| Rate for Payer: United Healthcare Medicare |
$469.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,034.90
|
|
|
ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
HCPCS 24000 AS
|
| Hospital Charge Code |
24000
|
| Min. Negotiated Rate |
$399.44 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,346.12
|
| Rate for Payer: Aetna of WY Medicare |
$469.93
|
| Rate for Payer: Beech Street Commercial |
$2,274.30
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,322.18
|
| Rate for Payer: Cigna of WY Commercial |
$2,346.12
|
| Rate for Payer: First Choice Health Commercial |
$2,154.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,274.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.93
|
| Rate for Payer: HealthUtah PPO |
$2,394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,322.18
|
| Rate for Payer: Multiplan Medicare/VA |
$399.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,346.12
|
| Rate for Payer: PacificSource Commercial |
$2,154.60
|
| Rate for Payer: PHCS PPO |
$2,274.30
|
| Rate for Payer: Three Rivers PPO |
$1,795.50
|
| Rate for Payer: TriWest Veterans Administration |
$469.93
|
| Rate for Payer: United Healthcare Commercial |
$2,082.78
|
| Rate for Payer: United Healthcare Medicare |
$469.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,034.90
|
|
|
ARTHRT ELBOW W/JT EXPL W/WOBX W/O RMVL LOOSE/FB
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
24101
|
| Min. Negotiated Rate |
$420.24 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,728.72
|
| Rate for Payer: Aetna of WY Medicare |
$494.40
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,711.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,728.72
|
| Rate for Payer: First Choice Health Commercial |
$1,587.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$494.40
|
| Rate for Payer: HealthUtah PPO |
$1,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,711.08
|
| Rate for Payer: Multiplan Medicare/VA |
$420.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,728.72
|
| Rate for Payer: PacificSource Commercial |
$1,587.60
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,323.00
|
| Rate for Payer: TriWest Veterans Administration |
$494.40
|
| Rate for Payer: United Healthcare Commercial |
$1,534.68
|
| Rate for Payer: United Healthcare Medicare |
$494.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,499.40
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26080 80
|
| Hospital Charge Code |
26080
|
| Min. Negotiated Rate |
$335.89 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,176.00
|
| Rate for Payer: Aetna of WY Medicare |
$395.16
|
| Rate for Payer: Beech Street Commercial |
$1,140.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,164.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,176.00
|
| Rate for Payer: First Choice Health Commercial |
$1,080.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.16
|
| Rate for Payer: HealthUtah PPO |
$1,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,164.00
|
| Rate for Payer: Multiplan Medicare/VA |
$335.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,176.00
|
| Rate for Payer: PacificSource Commercial |
$1,080.00
|
| Rate for Payer: PHCS PPO |
$1,140.00
|
| Rate for Payer: Three Rivers PPO |
$900.00
|
| Rate for Payer: TriWest Veterans Administration |
$395.16
|
| Rate for Payer: United Healthcare Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare Medicare |
$395.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,020.00
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
26080
|
| Min. Negotiated Rate |
$335.89 |
| Max. Negotiated Rate |
$1,411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,382.78
|
| Rate for Payer: Aetna of WY Medicare |
$395.16
|
| Rate for Payer: Beech Street Commercial |
$1,340.45
|
| Rate for Payer: Cash Price |
$987.70
|
| Rate for Payer: Cash Price |
$987.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,368.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,382.78
|
| Rate for Payer: First Choice Health Commercial |
$1,269.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,340.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.16
|
| Rate for Payer: HealthUtah PPO |
$1,411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,368.67
|
| Rate for Payer: Multiplan Medicare/VA |
$335.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,382.78
|
| Rate for Payer: PacificSource Commercial |
$1,269.90
|
| Rate for Payer: PHCS PPO |
$1,340.45
|
| Rate for Payer: Three Rivers PPO |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration |
$395.16
|
| Rate for Payer: United Healthcare Commercial |
$1,227.57
|
| Rate for Payer: United Healthcare Medicare |
$395.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,199.35
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA
|
Professional
|
Both
|
$1,197.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
26075
|
| Min. Negotiated Rate |
$284.92 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,173.06
|
| Rate for Payer: Aetna of WY Medicare |
$335.20
|
| Rate for Payer: Beech Street Commercial |
$1,137.15
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,161.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,173.06
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,137.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.20
|
| Rate for Payer: HealthUtah PPO |
$1,197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,161.09
|
| Rate for Payer: Multiplan Medicare/VA |
$284.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,173.06
|
| Rate for Payer: PacificSource Commercial |
$1,077.30
|
| Rate for Payer: PHCS PPO |
$1,137.15
|
| Rate for Payer: Three Rivers PPO |
$897.75
|
| Rate for Payer: TriWest Veterans Administration |
$335.20
|
| Rate for Payer: United Healthcare Commercial |
$1,041.39
|
| Rate for Payer: United Healthcare Medicare |
$335.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,017.45
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA
|
Professional
|
Both
|
$1,197.00
|
|
|
Service Code
|
HCPCS 26075 80
|
| Hospital Charge Code |
26075
|
| Min. Negotiated Rate |
$284.92 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,173.06
|
| Rate for Payer: Aetna of WY Medicare |
$335.20
|
| Rate for Payer: Beech Street Commercial |
$1,137.15
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,161.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,173.06
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,137.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.20
|
| Rate for Payer: HealthUtah PPO |
$1,197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,161.09
|
| Rate for Payer: Multiplan Medicare/VA |
$284.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,173.06
|
| Rate for Payer: PacificSource Commercial |
$1,077.30
|
| Rate for Payer: PHCS PPO |
$1,137.15
|
| Rate for Payer: Three Rivers PPO |
$897.75
|
| Rate for Payer: TriWest Veterans Administration |
$335.20
|
| Rate for Payer: United Healthcare Commercial |
$1,041.39
|
| Rate for Payer: United Healthcare Medicare |
$335.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,017.45
|
|
|
ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
23107
|
| Min. Negotiated Rate |
$551.09 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,312.40
|
| Rate for Payer: Aetna of WY Medicare |
$648.34
|
| Rate for Payer: Beech Street Commercial |
$3,211.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,278.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,312.40
|
| Rate for Payer: First Choice Health Commercial |
$3,042.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$648.34
|
| Rate for Payer: HealthUtah PPO |
$3,380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,278.60
|
| Rate for Payer: Multiplan Medicare/VA |
$551.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3,312.40
|
| Rate for Payer: PacificSource Commercial |
$3,042.00
|
| Rate for Payer: PHCS PPO |
$3,211.00
|
| Rate for Payer: Three Rivers PPO |
$2,535.00
|
| Rate for Payer: TriWest Veterans Administration |
$648.34
|
| Rate for Payer: United Healthcare Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare Medicare |
$648.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,873.00
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$6,316.00
|
|
|
Service Code
|
HCPCS 27310 80
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$6,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,189.68
|
| Rate for Payer: Aetna of WY Medicare |
$712.43
|
| Rate for Payer: Beech Street Commercial |
$6,000.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,126.52
|
| Rate for Payer: Cigna of WY Commercial |
$6,189.68
|
| Rate for Payer: First Choice Health Commercial |
$5,684.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,000.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.43
|
| Rate for Payer: HealthUtah PPO |
$6,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,126.52
|
| Rate for Payer: Multiplan Medicare/VA |
$605.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,189.68
|
| Rate for Payer: PacificSource Commercial |
$5,684.40
|
| Rate for Payer: PHCS PPO |
$6,000.20
|
| Rate for Payer: Three Rivers PPO |
$4,737.00
|
| Rate for Payer: TriWest Veterans Administration |
$712.43
|
| Rate for Payer: United Healthcare Commercial |
$5,494.92
|
| Rate for Payer: United Healthcare Medicare |
$712.43
|
| Rate for Payer: WINHealth Partners Commercial |
$5,368.60
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$6,316.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$6,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,189.68
|
| Rate for Payer: Aetna of WY Medicare |
$712.43
|
| Rate for Payer: Beech Street Commercial |
$6,000.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,126.52
|
| Rate for Payer: Cigna of WY Commercial |
$6,189.68
|
| Rate for Payer: First Choice Health Commercial |
$5,684.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,000.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.43
|
| Rate for Payer: HealthUtah PPO |
$6,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,126.52
|
| Rate for Payer: Multiplan Medicare/VA |
$605.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,189.68
|
| Rate for Payer: PacificSource Commercial |
$5,684.40
|
| Rate for Payer: PHCS PPO |
$6,000.20
|
| Rate for Payer: Three Rivers PPO |
$4,737.00
|
| Rate for Payer: TriWest Veterans Administration |
$712.43
|
| Rate for Payer: United Healthcare Commercial |
$5,494.92
|
| Rate for Payer: United Healthcare Medicare |
$712.43
|
| Rate for Payer: WINHealth Partners Commercial |
$5,368.60
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$6,316.00
|
|
|
Service Code
|
HCPCS 27310 AS
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$6,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,189.68
|
| Rate for Payer: Aetna of WY Medicare |
$712.43
|
| Rate for Payer: Beech Street Commercial |
$6,000.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,126.52
|
| Rate for Payer: Cigna of WY Commercial |
$6,189.68
|
| Rate for Payer: First Choice Health Commercial |
$5,684.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,000.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.43
|
| Rate for Payer: HealthUtah PPO |
$6,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,126.52
|
| Rate for Payer: Multiplan Medicare/VA |
$605.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,189.68
|
| Rate for Payer: PacificSource Commercial |
$5,684.40
|
| Rate for Payer: PHCS PPO |
$6,000.20
|
| Rate for Payer: Three Rivers PPO |
$4,737.00
|
| Rate for Payer: TriWest Veterans Administration |
$712.43
|
| Rate for Payer: United Healthcare Commercial |
$5,494.92
|
| Rate for Payer: United Healthcare Medicare |
$712.43
|
| Rate for Payer: WINHealth Partners Commercial |
$5,368.60
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$6,632.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
27331
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$6,632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,499.36
|
| Rate for Payer: Aetna of WY Medicare |
$467.88
|
| Rate for Payer: Beech Street Commercial |
$6,300.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,433.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,499.36
|
| Rate for Payer: First Choice Health Commercial |
$5,968.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,300.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.88
|
| Rate for Payer: HealthUtah PPO |
$6,632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,433.04
|
| Rate for Payer: Multiplan Medicare/VA |
$397.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,499.36
|
| Rate for Payer: PacificSource Commercial |
$5,968.80
|
| Rate for Payer: PHCS PPO |
$6,300.40
|
| Rate for Payer: Three Rivers PPO |
$4,974.00
|
| Rate for Payer: TriWest Veterans Administration |
$467.88
|
| Rate for Payer: United Healthcare Commercial |
$5,769.84
|
| Rate for Payer: United Healthcare Medicare |
$467.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,637.20
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$6,632.00
|
|
|
Service Code
|
HCPCS 27331 AS
|
| Hospital Charge Code |
27331
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$6,632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,499.36
|
| Rate for Payer: Aetna of WY Medicare |
$467.88
|
| Rate for Payer: Beech Street Commercial |
$6,300.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,433.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,499.36
|
| Rate for Payer: First Choice Health Commercial |
$5,968.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,300.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.88
|
| Rate for Payer: HealthUtah PPO |
$6,632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,433.04
|
| Rate for Payer: Multiplan Medicare/VA |
$397.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,499.36
|
| Rate for Payer: PacificSource Commercial |
$5,968.80
|
| Rate for Payer: PHCS PPO |
$6,300.40
|
| Rate for Payer: Three Rivers PPO |
$4,974.00
|
| Rate for Payer: TriWest Veterans Administration |
$467.88
|
| Rate for Payer: United Healthcare Commercial |
$5,769.84
|
| Rate for Payer: United Healthcare Medicare |
$467.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,637.20
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$6,632.00
|
|
|
Service Code
|
HCPCS 27331 80
|
| Hospital Charge Code |
27331
|
| Min. Negotiated Rate |
$397.70 |
| Max. Negotiated Rate |
$6,632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,499.36
|
| Rate for Payer: Aetna of WY Medicare |
$467.88
|
| Rate for Payer: Beech Street Commercial |
$6,300.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: Cash Price |
$4,642.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,433.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,499.36
|
| Rate for Payer: First Choice Health Commercial |
$5,968.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,300.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.88
|
| Rate for Payer: HealthUtah PPO |
$6,632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,433.04
|
| Rate for Payer: Multiplan Medicare/VA |
$397.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,499.36
|
| Rate for Payer: PacificSource Commercial |
$5,968.80
|
| Rate for Payer: PHCS PPO |
$6,300.40
|
| Rate for Payer: Three Rivers PPO |
$4,974.00
|
| Rate for Payer: TriWest Veterans Administration |
$467.88
|
| Rate for Payer: United Healthcare Commercial |
$5,769.84
|
| Rate for Payer: United Healthcare Medicare |
$467.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,637.20
|
|
|
ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 28052
|
| Hospital Charge Code |
28052
|
| Min. Negotiated Rate |
$213.38 |
| Max. Negotiated Rate |
$1,355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,327.90
|
| Rate for Payer: Aetna of WY Medicare |
$251.03
|
| Rate for Payer: Beech Street Commercial |
$1,287.25
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,314.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,327.90
|
| Rate for Payer: First Choice Health Commercial |
$1,219.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,287.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$251.03
|
| Rate for Payer: HealthUtah PPO |
$1,355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,314.35
|
| Rate for Payer: Multiplan Medicare/VA |
$213.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,327.90
|
| Rate for Payer: PacificSource Commercial |
$1,219.50
|
| Rate for Payer: PHCS PPO |
$1,287.25
|
| Rate for Payer: Three Rivers PPO |
$1,016.25
|
| Rate for Payer: TriWest Veterans Administration |
$251.03
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
| Rate for Payer: United Healthcare Medicare |
$251.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,151.75
|
|
|
ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 28052 80
|
| Hospital Charge Code |
28052
|
| Min. Negotiated Rate |
$213.38 |
| Max. Negotiated Rate |
$1,355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,327.90
|
| Rate for Payer: Aetna of WY Medicare |
$251.03
|
| Rate for Payer: Beech Street Commercial |
$1,287.25
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: Cash Price |
$948.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,314.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,327.90
|
| Rate for Payer: First Choice Health Commercial |
$1,219.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,287.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$251.03
|
| Rate for Payer: HealthUtah PPO |
$1,355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,314.35
|
| Rate for Payer: Multiplan Medicare/VA |
$213.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,327.90
|
| Rate for Payer: PacificSource Commercial |
$1,219.50
|
| Rate for Payer: PHCS PPO |
$1,287.25
|
| Rate for Payer: Three Rivers PPO |
$1,016.25
|
| Rate for Payer: TriWest Veterans Administration |
$251.03
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
| Rate for Payer: United Healthcare Medicare |
$251.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,151.75
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,897.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
25040
|
| Min. Negotiated Rate |
$464.22 |
| Max. Negotiated Rate |
$2,897.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,839.06
|
| Rate for Payer: Aetna of WY Medicare |
$546.14
|
| Rate for Payer: Beech Street Commercial |
$2,752.15
|
| Rate for Payer: Cash Price |
$2,027.90
|
| Rate for Payer: Cash Price |
$2,027.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,810.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,839.06
|
| Rate for Payer: First Choice Health Commercial |
$2,607.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,752.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$546.14
|
| Rate for Payer: HealthUtah PPO |
$2,897.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,810.09
|
| Rate for Payer: Multiplan Medicare/VA |
$464.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,839.06
|
| Rate for Payer: PacificSource Commercial |
$2,607.30
|
| Rate for Payer: PHCS PPO |
$2,752.15
|
| Rate for Payer: Three Rivers PPO |
$2,172.75
|
| Rate for Payer: TriWest Veterans Administration |
$546.14
|
| Rate for Payer: United Healthcare Commercial |
$2,520.39
|
| Rate for Payer: United Healthcare Medicare |
$546.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,462.45
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
28022
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,658.16
|
| Rate for Payer: Aetna of WY Medicare |
$320.53
|
| Rate for Payer: Beech Street Commercial |
$1,607.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,641.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,658.16
|
| Rate for Payer: First Choice Health Commercial |
$1,522.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,607.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.53
|
| Rate for Payer: HealthUtah PPO |
$1,692.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,641.24
|
| Rate for Payer: Multiplan Medicare/VA |
$272.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,658.16
|
| Rate for Payer: PacificSource Commercial |
$1,522.80
|
| Rate for Payer: PHCS PPO |
$1,607.40
|
| Rate for Payer: Three Rivers PPO |
$1,269.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.53
|
| Rate for Payer: United Healthcare Commercial |
$1,472.04
|
| Rate for Payer: United Healthcare Medicare |
$320.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,438.20
|
|
|
ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
25101
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$2,083.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,041.34
|
| Rate for Payer: Aetna of WY Medicare |
$401.18
|
| Rate for Payer: Beech Street Commercial |
$1,978.85
|
| Rate for Payer: Cash Price |
$1,458.10
|
| Rate for Payer: Cash Price |
$1,458.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,020.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,041.34
|
| Rate for Payer: First Choice Health Commercial |
$1,874.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,978.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.18
|
| Rate for Payer: HealthUtah PPO |
$2,083.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,020.51
|
| Rate for Payer: Multiplan Medicare/VA |
$341.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,041.34
|
| Rate for Payer: PacificSource Commercial |
$1,874.70
|
| Rate for Payer: PHCS PPO |
$1,978.85
|
| Rate for Payer: Three Rivers PPO |
$1,562.25
|
| Rate for Payer: TriWest Veterans Administration |
$401.18
|
| Rate for Payer: United Healthcare Commercial |
$1,812.21
|
| Rate for Payer: United Healthcare Medicare |
$401.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,770.55
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$9,613.00
|
|
|
Service Code
|
HCPCS 27335 80
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$9,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,420.74
|
| Rate for Payer: Aetna of WY Medicare |
$744.39
|
| Rate for Payer: Beech Street Commercial |
$9,132.35
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,324.61
|
| Rate for Payer: Cigna of WY Commercial |
$9,420.74
|
| Rate for Payer: First Choice Health Commercial |
$8,651.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,132.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$744.39
|
| Rate for Payer: HealthUtah PPO |
$9,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,324.61
|
| Rate for Payer: Multiplan Medicare/VA |
$632.73
|
| Rate for Payer: One Health Plan of WY PPO |
$9,420.74
|
| Rate for Payer: PacificSource Commercial |
$8,651.70
|
| Rate for Payer: PHCS PPO |
$9,132.35
|
| Rate for Payer: Three Rivers PPO |
$7,209.75
|
| Rate for Payer: TriWest Veterans Administration |
$744.39
|
| Rate for Payer: United Healthcare Commercial |
$8,363.31
|
| Rate for Payer: United Healthcare Medicare |
$744.39
|
| Rate for Payer: WINHealth Partners Commercial |
$8,171.05
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$9,613.00
|
|
|
Service Code
|
HCPCS 27335 AS
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$9,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,420.74
|
| Rate for Payer: Aetna of WY Medicare |
$744.39
|
| Rate for Payer: Beech Street Commercial |
$9,132.35
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,324.61
|
| Rate for Payer: Cigna of WY Commercial |
$9,420.74
|
| Rate for Payer: First Choice Health Commercial |
$8,651.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,132.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$744.39
|
| Rate for Payer: HealthUtah PPO |
$9,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,324.61
|
| Rate for Payer: Multiplan Medicare/VA |
$632.73
|
| Rate for Payer: One Health Plan of WY PPO |
$9,420.74
|
| Rate for Payer: PacificSource Commercial |
$8,651.70
|
| Rate for Payer: PHCS PPO |
$9,132.35
|
| Rate for Payer: Three Rivers PPO |
$7,209.75
|
| Rate for Payer: TriWest Veterans Administration |
$744.39
|
| Rate for Payer: United Healthcare Commercial |
$8,363.31
|
| Rate for Payer: United Healthcare Medicare |
$744.39
|
| Rate for Payer: WINHealth Partners Commercial |
$8,171.05
|
|
|
ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$9,613.00
|
|
|
Service Code
|
HCPCS 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$632.73 |
| Max. Negotiated Rate |
$9,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,420.74
|
| Rate for Payer: Aetna of WY Medicare |
$744.39
|
| Rate for Payer: Beech Street Commercial |
$9,132.35
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: Cash Price |
$6,729.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,324.61
|
| Rate for Payer: Cigna of WY Commercial |
$9,420.74
|
| Rate for Payer: First Choice Health Commercial |
$8,651.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,132.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$744.39
|
| Rate for Payer: HealthUtah PPO |
$9,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,324.61
|
| Rate for Payer: Multiplan Medicare/VA |
$632.73
|
| Rate for Payer: One Health Plan of WY PPO |
$9,420.74
|
| Rate for Payer: PacificSource Commercial |
$8,651.70
|
| Rate for Payer: PHCS PPO |
$9,132.35
|
| Rate for Payer: Three Rivers PPO |
$7,209.75
|
| Rate for Payer: TriWest Veterans Administration |
$744.39
|
| Rate for Payer: United Healthcare Commercial |
$8,363.31
|
| Rate for Payer: United Healthcare Medicare |
$744.39
|
| Rate for Payer: WINHealth Partners Commercial |
$8,171.05
|
|
