|
AR-SCOPE PROBE 220MM60 AR-4070
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
3002392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$448.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$679.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$405.65
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$427.00
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare |
$427.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
ARTERIAL FEMORAL CATH KIT 18G
|
Facility
|
OP
|
$378.70
|
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.07 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.13
|
| Rate for Payer: Aetna of WY Medicare |
$249.94
|
| Rate for Payer: Altius Commercial |
$363.55
|
| Rate for Payer: Beech Street Commercial |
$371.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$367.34
|
| Rate for Payer: Cash Price |
$265.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.34
|
| Rate for Payer: Cigna of WY Commercial |
$371.13
|
| Rate for Payer: Entrust Commercial |
$359.76
|
| Rate for Payer: First Choice Health Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$215.86
|
| Rate for Payer: HealthUtah PPO |
$378.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.34
|
| Rate for Payer: Multiplan Medicare/VA |
$205.07
|
| Rate for Payer: One Health Plan of WY PPO |
$371.13
|
| Rate for Payer: PacificSource Commercial |
$340.83
|
| Rate for Payer: PHCS PPO |
$371.13
|
| Rate for Payer: Three Rivers PPO |
$284.02
|
| Rate for Payer: TriWest Veterans Administration |
$215.86
|
| Rate for Payer: United Healthcare Commercial |
$361.66
|
| Rate for Payer: United Healthcare Medicare |
$215.86
|
| Rate for Payer: WINHealth Partners Commercial |
$371.13
|
| Rate for Payer: Wise Provider Network Commercial |
$359.76
|
|
|
ARTERIAL FEMORAL CATH KIT 18G
|
Facility
|
IP
|
$378.70
|
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.46 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.13
|
| Rate for Payer: Aetna of WY Medicare |
$242.37
|
| Rate for Payer: Altius Commercial |
$363.55
|
| Rate for Payer: Beech Street Commercial |
$371.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$367.34
|
| Rate for Payer: Cash Price |
$265.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.34
|
| Rate for Payer: Cigna of WY Commercial |
$371.13
|
| Rate for Payer: Entrust Commercial |
$359.76
|
| Rate for Payer: First Choice Health Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.01
|
| Rate for Payer: HealthUtah PPO |
$378.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.34
|
| Rate for Payer: Multiplan Medicare/VA |
$219.46
|
| Rate for Payer: One Health Plan of WY PPO |
$371.13
|
| Rate for Payer: PacificSource Commercial |
$340.83
|
| Rate for Payer: PHCS PPO |
$371.13
|
| Rate for Payer: Three Rivers PPO |
$284.02
|
| Rate for Payer: TriWest Veterans Administration |
$231.01
|
| Rate for Payer: United Healthcare Commercial |
$361.66
|
| Rate for Payer: United Healthcare Medicare |
$231.01
|
| Rate for Payer: WINHealth Partners Commercial |
$359.76
|
| Rate for Payer: Wise Provider Network Commercial |
$359.76
|
|
|
ARTERIAL WRIST SUPPORT ANES
|
Facility
|
IP
|
$13.11
|
|
| Hospital Charge Code |
2500202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.85
|
| Rate for Payer: Aetna of WY Medicare |
$8.39
|
| Rate for Payer: Altius Commercial |
$12.59
|
| Rate for Payer: Beech Street Commercial |
$12.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.72
|
| Rate for Payer: Cigna of WY Commercial |
$12.85
|
| Rate for Payer: Entrust Commercial |
$12.45
|
| Rate for Payer: First Choice Health Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.00
|
| Rate for Payer: HealthUtah PPO |
$13.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.72
|
| Rate for Payer: Multiplan Medicare/VA |
$7.60
|
| Rate for Payer: One Health Plan of WY PPO |
$12.85
|
| Rate for Payer: PacificSource Commercial |
$11.80
|
| Rate for Payer: PHCS PPO |
$12.85
|
| Rate for Payer: Three Rivers PPO |
$9.83
|
| Rate for Payer: TriWest Veterans Administration |
$8.00
|
| Rate for Payer: United Healthcare Commercial |
$12.52
|
| Rate for Payer: United Healthcare Medicare |
$8.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12.45
|
| Rate for Payer: Wise Provider Network Commercial |
$12.45
|
|
|
ARTERIAL WRIST SUPPORT ANES
|
Facility
|
OP
|
$13.11
|
|
| Hospital Charge Code |
2500202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.85
|
| Rate for Payer: Aetna of WY Medicare |
$8.65
|
| Rate for Payer: Altius Commercial |
$12.59
|
| Rate for Payer: Beech Street Commercial |
$12.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.72
|
| Rate for Payer: Cigna of WY Commercial |
$12.85
|
| Rate for Payer: Entrust Commercial |
$12.45
|
| Rate for Payer: First Choice Health Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.47
|
| Rate for Payer: HealthUtah PPO |
$13.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.72
|
| Rate for Payer: Multiplan Medicare/VA |
$7.10
|
| Rate for Payer: One Health Plan of WY PPO |
$12.85
|
| Rate for Payer: PacificSource Commercial |
$11.80
|
| Rate for Payer: PHCS PPO |
$12.85
|
| Rate for Payer: Three Rivers PPO |
$9.83
|
| Rate for Payer: TriWest Veterans Administration |
$7.47
|
| Rate for Payer: United Healthcare Commercial |
$12.52
|
| Rate for Payer: United Healthcare Medicare |
$7.47
|
| Rate for Payer: WINHealth Partners Commercial |
$12.85
|
| Rate for Payer: Wise Provider Network Commercial |
$12.45
|
|
|
ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,493.00
|
|
|
Service Code
|
HCPCS 36821 80
|
| Min. Negotiated Rate |
$1,869.75 |
| Max. Negotiated Rate |
$2,493.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,443.14
|
| Rate for Payer: Beech Street Commercial |
$2,368.35
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,418.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,443.14
|
| Rate for Payer: First Choice Health Commercial |
$2,243.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,368.35
|
| Rate for Payer: HealthUtah PPO |
$2,493.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,418.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,443.14
|
| Rate for Payer: PacificSource Commercial |
$2,243.70
|
| Rate for Payer: PHCS PPO |
$2,368.35
|
| Rate for Payer: Three Rivers PPO |
$1,869.75
|
| Rate for Payer: United Healthcare Commercial |
$2,368.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,119.05
|
|
|
ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$12,469.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$518.39 |
| Max. Negotiated Rate |
$12,469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,219.62
|
| Rate for Payer: Aetna of WY Medicare |
$609.87
|
| Rate for Payer: Beech Street Commercial |
$11,845.55
|
| Rate for Payer: Cash Price |
$8,728.30
|
| Rate for Payer: Cash Price |
$8,728.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,094.93
|
| Rate for Payer: Cigna of WY Commercial |
$12,219.62
|
| Rate for Payer: First Choice Health Commercial |
$11,222.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,845.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.87
|
| Rate for Payer: HealthUtah PPO |
$12,469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,094.93
|
| Rate for Payer: Multiplan Medicare/VA |
$518.39
|
| Rate for Payer: One Health Plan of WY PPO |
$12,219.62
|
| Rate for Payer: PacificSource Commercial |
$11,222.10
|
| Rate for Payer: PHCS PPO |
$11,845.55
|
| Rate for Payer: Three Rivers PPO |
$9,351.75
|
| Rate for Payer: TriWest Veterans Administration |
$609.87
|
| Rate for Payer: United Healthcare Commercial |
$11,845.55
|
| Rate for Payer: WINHealth Partners Commercial |
$10,598.65
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$7,478.00
|
|
|
Service Code
|
HCPCS 22551 AS
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$7,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,328.44
|
| Rate for Payer: Beech Street Commercial |
$7,104.10
|
| Rate for Payer: Cash Price |
$5,234.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,253.66
|
| Rate for Payer: Cigna of WY Commercial |
$7,328.44
|
| Rate for Payer: First Choice Health Commercial |
$6,730.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,104.10
|
| Rate for Payer: HealthUtah PPO |
$7,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,253.66
|
| Rate for Payer: One Health Plan of WY PPO |
$7,328.44
|
| Rate for Payer: PacificSource Commercial |
$6,730.20
|
| Rate for Payer: PHCS PPO |
$7,104.10
|
| Rate for Payer: Three Rivers PPO |
$5,608.50
|
| Rate for Payer: United Healthcare Commercial |
$7,104.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,356.30
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$7,478.00
|
|
|
Service Code
|
HCPCS 22551
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$7,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,328.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,615.14
|
| Rate for Payer: Beech Street Commercial |
$7,104.10
|
| Rate for Payer: Cash Price |
$5,234.60
|
| Rate for Payer: Cash Price |
$5,234.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,253.66
|
| Rate for Payer: Cigna of WY Commercial |
$7,328.44
|
| Rate for Payer: First Choice Health Commercial |
$6,730.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,104.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,615.14
|
| Rate for Payer: HealthUtah PPO |
$7,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,253.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,372.87
|
| Rate for Payer: One Health Plan of WY PPO |
$7,328.44
|
| Rate for Payer: PacificSource Commercial |
$6,730.20
|
| Rate for Payer: PHCS PPO |
$7,104.10
|
| Rate for Payer: Three Rivers PPO |
$5,608.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,615.14
|
| Rate for Payer: United Healthcare Commercial |
$7,104.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,356.30
|
|
|
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$7,478.00
|
|
|
Service Code
|
HCPCS 22551 80
|
| Min. Negotiated Rate |
$1,372.87 |
| Max. Negotiated Rate |
$7,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,328.44
|
| Rate for Payer: Beech Street Commercial |
$7,104.10
|
| Rate for Payer: Cash Price |
$5,234.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,253.66
|
| Rate for Payer: Cigna of WY Commercial |
$7,328.44
|
| Rate for Payer: First Choice Health Commercial |
$6,730.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,104.10
|
| Rate for Payer: HealthUtah PPO |
$7,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,253.66
|
| Rate for Payer: One Health Plan of WY PPO |
$7,328.44
|
| Rate for Payer: PacificSource Commercial |
$6,730.20
|
| Rate for Payer: PHCS PPO |
$7,104.10
|
| Rate for Payer: Three Rivers PPO |
$5,608.50
|
| Rate for Payer: United Healthcare Commercial |
$7,104.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,356.30
|
|
|
ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$5,014.00
|
|
|
Service Code
|
HCPCS 22554
|
| Min. Negotiated Rate |
$1,024.46 |
| Max. Negotiated Rate |
$5,014.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,913.72
|
| Rate for Payer: Aetna of WY Medicare |
$1,205.25
|
| Rate for Payer: Beech Street Commercial |
$4,763.30
|
| Rate for Payer: Cash Price |
$3,509.80
|
| Rate for Payer: Cash Price |
$3,509.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,863.58
|
| Rate for Payer: Cigna of WY Commercial |
$4,913.72
|
| Rate for Payer: First Choice Health Commercial |
$4,512.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,763.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,205.25
|
| Rate for Payer: HealthUtah PPO |
$5,014.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,863.58
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,913.72
|
| Rate for Payer: PacificSource Commercial |
$4,512.60
|
| Rate for Payer: PHCS PPO |
$4,763.30
|
| Rate for Payer: Three Rivers PPO |
$3,760.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,205.25
|
| Rate for Payer: United Healthcare Commercial |
$4,763.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,261.90
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 22552 80
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: United Healthcare Commercial |
$647.90
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 22552
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$369.82
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.82
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$314.35
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$369.82
|
| Rate for Payer: United Healthcare Commercial |
$647.90
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 22552 AS
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: United Healthcare Commercial |
$647.90
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 22585
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,259.30
|
| Rate for Payer: Aetna of WY Medicare |
$303.45
|
| Rate for Payer: Beech Street Commercial |
$1,220.75
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,246.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,259.30
|
| Rate for Payer: First Choice Health Commercial |
$1,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,220.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.45
|
| Rate for Payer: HealthUtah PPO |
$1,285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,246.45
|
| Rate for Payer: Multiplan Medicare/VA |
$257.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,259.30
|
| Rate for Payer: PacificSource Commercial |
$1,156.50
|
| Rate for Payer: PHCS PPO |
$1,220.75
|
| Rate for Payer: Three Rivers PPO |
$963.75
|
| Rate for Payer: TriWest Veterans Administration |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$1,220.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,092.25
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 22585 80
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$556.64
|
| Rate for Payer: Beech Street Commercial |
$539.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$550.96
|
| Rate for Payer: Cigna of WY Commercial |
$556.64
|
| Rate for Payer: First Choice Health Commercial |
$511.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$539.60
|
| Rate for Payer: HealthUtah PPO |
$568.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$550.96
|
| Rate for Payer: One Health Plan of WY PPO |
$556.64
|
| Rate for Payer: PacificSource Commercial |
$511.20
|
| Rate for Payer: PHCS PPO |
$539.60
|
| Rate for Payer: Three Rivers PPO |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$539.60
|
| Rate for Payer: WINHealth Partners Commercial |
$482.80
|
|
|
ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 22585 AS
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$556.64
|
| Rate for Payer: Beech Street Commercial |
$539.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$550.96
|
| Rate for Payer: Cigna of WY Commercial |
$556.64
|
| Rate for Payer: First Choice Health Commercial |
$511.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$539.60
|
| Rate for Payer: HealthUtah PPO |
$568.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$550.96
|
| Rate for Payer: One Health Plan of WY PPO |
$556.64
|
| Rate for Payer: PacificSource Commercial |
$511.20
|
| Rate for Payer: PHCS PPO |
$539.60
|
| Rate for Payer: Three Rivers PPO |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$539.60
|
| Rate for Payer: WINHealth Partners Commercial |
$482.80
|
|
|
ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$4,511.00
|
|
|
Service Code
|
HCPCS 26841
|
| Min. Negotiated Rate |
$646.11 |
| Max. Negotiated Rate |
$4,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,420.78
|
| Rate for Payer: Aetna of WY Medicare |
$760.13
|
| Rate for Payer: Beech Street Commercial |
$4,285.45
|
| Rate for Payer: Cash Price |
$3,157.70
|
| Rate for Payer: Cash Price |
$3,157.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,375.67
|
| Rate for Payer: Cigna of WY Commercial |
$4,420.78
|
| Rate for Payer: First Choice Health Commercial |
$4,059.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,285.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$760.13
|
| Rate for Payer: HealthUtah PPO |
$4,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,375.67
|
| Rate for Payer: Multiplan Medicare/VA |
$646.11
|
| Rate for Payer: One Health Plan of WY PPO |
$4,420.78
|
| Rate for Payer: PacificSource Commercial |
$4,059.90
|
| Rate for Payer: PHCS PPO |
$4,285.45
|
| Rate for Payer: Three Rivers PPO |
$3,383.25
|
| Rate for Payer: TriWest Veterans Administration |
$760.13
|
| Rate for Payer: United Healthcare Commercial |
$4,285.45
|
| Rate for Payer: WINHealth Partners Commercial |
$3,834.35
|
|
|
ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 26841 80
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$595.84
|
| Rate for Payer: Beech Street Commercial |
$577.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$589.76
|
| Rate for Payer: Cigna of WY Commercial |
$595.84
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$577.60
|
| Rate for Payer: HealthUtah PPO |
$608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$589.76
|
| Rate for Payer: One Health Plan of WY PPO |
$595.84
|
| Rate for Payer: PacificSource Commercial |
$547.20
|
| Rate for Payer: PHCS PPO |
$577.60
|
| Rate for Payer: Three Rivers PPO |
$456.00
|
| Rate for Payer: United Healthcare Commercial |
$577.60
|
| Rate for Payer: WINHealth Partners Commercial |
$516.80
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 28730 80
|
| Min. Negotiated Rate |
$741.75 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$969.22
|
| Rate for Payer: Beech Street Commercial |
$939.55
|
| Rate for Payer: Cash Price |
$692.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$959.33
|
| Rate for Payer: Cigna of WY Commercial |
$969.22
|
| Rate for Payer: First Choice Health Commercial |
$890.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$939.55
|
| Rate for Payer: HealthUtah PPO |
$989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$959.33
|
| Rate for Payer: One Health Plan of WY PPO |
$969.22
|
| Rate for Payer: PacificSource Commercial |
$890.10
|
| Rate for Payer: PHCS PPO |
$939.55
|
| Rate for Payer: Three Rivers PPO |
$741.75
|
| Rate for Payer: United Healthcare Commercial |
$939.55
|
| Rate for Payer: WINHealth Partners Commercial |
$840.65
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 28730 AS
|
| Min. Negotiated Rate |
$741.75 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$969.22
|
| Rate for Payer: Beech Street Commercial |
$939.55
|
| Rate for Payer: Cash Price |
$692.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$959.33
|
| Rate for Payer: Cigna of WY Commercial |
$969.22
|
| Rate for Payer: First Choice Health Commercial |
$890.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$939.55
|
| Rate for Payer: HealthUtah PPO |
$989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$959.33
|
| Rate for Payer: One Health Plan of WY PPO |
$969.22
|
| Rate for Payer: PacificSource Commercial |
$890.10
|
| Rate for Payer: PHCS PPO |
$939.55
|
| Rate for Payer: Three Rivers PPO |
$741.75
|
| Rate for Payer: United Healthcare Commercial |
$939.55
|
| Rate for Payer: WINHealth Partners Commercial |
$840.65
|
|
|
ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$4,961.00
|
|
|
Service Code
|
HCPCS 28730
|
| Min. Negotiated Rate |
$598.75 |
| Max. Negotiated Rate |
$4,961.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,861.78
|
| Rate for Payer: Aetna of WY Medicare |
$704.41
|
| Rate for Payer: Beech Street Commercial |
$4,712.95
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,812.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,861.78
|
| Rate for Payer: First Choice Health Commercial |
$4,464.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,712.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.41
|
| Rate for Payer: HealthUtah PPO |
$4,961.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,812.17
|
| Rate for Payer: Multiplan Medicare/VA |
$598.75
|
| Rate for Payer: One Health Plan of WY PPO |
$4,861.78
|
| Rate for Payer: PacificSource Commercial |
$4,464.90
|
| Rate for Payer: PHCS PPO |
$4,712.95
|
| Rate for Payer: Three Rivers PPO |
$3,720.75
|
| Rate for Payer: TriWest Veterans Administration |
$704.41
|
| Rate for Payer: United Healthcare Commercial |
$4,712.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,216.85
|
|
|
ARTHREX ANGEL PRP KIT
|
Facility
|
OP
|
$1,328.60
|
|
| Hospital Charge Code |
3003576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.44 |
| Max. Negotiated Rate |
$1,328.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,302.03
|
| Rate for Payer: Aetna of WY Medicare |
$876.88
|
| Rate for Payer: Altius Commercial |
$1,275.46
|
| Rate for Payer: Beech Street Commercial |
$1,302.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,288.74
|
| Rate for Payer: Cash Price |
$930.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,302.03
|
| Rate for Payer: Entrust Commercial |
$1,262.17
|
| Rate for Payer: First Choice Health Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$757.30
|
| Rate for Payer: HealthUtah PPO |
$1,328.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.74
|
| Rate for Payer: Multiplan Medicare/VA |
$719.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,302.03
|
| Rate for Payer: PacificSource Commercial |
$1,195.74
|
| Rate for Payer: PHCS PPO |
$1,302.03
|
| Rate for Payer: Three Rivers PPO |
$996.45
|
| Rate for Payer: TriWest Veterans Administration |
$757.30
|
| Rate for Payer: United Healthcare Commercial |
$1,268.81
|
| Rate for Payer: United Healthcare Medicare |
$757.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,302.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1,262.17
|
|
|
ARTHREX ANGEL PRP KIT
|
Facility
|
IP
|
$1,328.60
|
|
| Hospital Charge Code |
3003576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.92 |
| Max. Negotiated Rate |
$1,328.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,302.03
|
| Rate for Payer: Aetna of WY Medicare |
$850.30
|
| Rate for Payer: Altius Commercial |
$1,275.46
|
| Rate for Payer: Beech Street Commercial |
$1,302.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,288.74
|
| Rate for Payer: Cash Price |
$930.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,302.03
|
| Rate for Payer: Entrust Commercial |
$1,262.17
|
| Rate for Payer: First Choice Health Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$810.45
|
| Rate for Payer: HealthUtah PPO |
$1,328.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.74
|
| Rate for Payer: Multiplan Medicare/VA |
$769.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,302.03
|
| Rate for Payer: PacificSource Commercial |
$1,195.74
|
| Rate for Payer: PHCS PPO |
$1,302.03
|
| Rate for Payer: Three Rivers PPO |
$996.45
|
| Rate for Payer: TriWest Veterans Administration |
$810.45
|
| Rate for Payer: United Healthcare Commercial |
$1,268.81
|
| Rate for Payer: United Healthcare Medicare |
$810.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,262.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1,262.17
|
|
|
ARTHREX FLEXTIP PROBE 28CM
|
Facility
|
IP
|
$980.00
|
|
| Hospital Charge Code |
3004669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.91 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$627.20
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$950.60
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$597.80
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$567.91
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$597.80
|
| Rate for Payer: United Healthcare Commercial |
$935.90
|
| Rate for Payer: United Healthcare Medicare |
$597.80
|
| Rate for Payer: WINHealth Partners Commercial |
$931.00
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
