|
ARTHREX FLEXTIP PROBE 28CM
|
Facility
|
OP
|
$980.00
|
|
| Hospital Charge Code |
3004669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.67 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$646.80
|
| 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 |
$558.60
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$530.67
|
| 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 |
$558.60
|
| Rate for Payer: United Healthcare Commercial |
$935.90
|
| Rate for Payer: United Healthcare Medicare |
$558.60
|
| Rate for Payer: WINHealth Partners Commercial |
$960.40
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
ARTHREX FLEXTIP PROBE 35CM
|
Facility
|
IP
|
$980.00
|
|
| Hospital Charge Code |
3004670
|
|
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
|
|
|
ARTHREX FLEXTIP PROBE 35CM
|
Facility
|
OP
|
$980.00
|
|
| Hospital Charge Code |
3004670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.67 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$646.80
|
| 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 |
$558.60
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$530.67
|
| 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 |
$558.60
|
| Rate for Payer: United Healthcare Commercial |
$935.90
|
| Rate for Payer: United Healthcare Medicare |
$558.60
|
| Rate for Payer: WINHealth Partners Commercial |
$960.40
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
ARTHREX MAIN PUMP TUB AR-6410
|
Facility
|
IP
|
$249.38
|
|
| Hospital Charge Code |
2650699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.52 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.39
|
| Rate for Payer: Aetna of WY Medicare |
$159.60
|
| Rate for Payer: Altius Commercial |
$239.40
|
| Rate for Payer: Beech Street Commercial |
$244.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$241.90
|
| Rate for Payer: Cash Price |
$174.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.90
|
| Rate for Payer: Cigna of WY Commercial |
$244.39
|
| Rate for Payer: Entrust Commercial |
$236.91
|
| Rate for Payer: First Choice Health Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.12
|
| Rate for Payer: HealthUtah PPO |
$249.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.90
|
| Rate for Payer: Multiplan Medicare/VA |
$144.52
|
| Rate for Payer: One Health Plan of WY PPO |
$244.39
|
| Rate for Payer: PacificSource Commercial |
$224.44
|
| Rate for Payer: PHCS PPO |
$244.39
|
| Rate for Payer: Three Rivers PPO |
$187.04
|
| Rate for Payer: TriWest Veterans Administration |
$152.12
|
| Rate for Payer: United Healthcare Commercial |
$238.16
|
| Rate for Payer: United Healthcare Medicare |
$152.12
|
| Rate for Payer: WINHealth Partners Commercial |
$236.91
|
| Rate for Payer: Wise Provider Network Commercial |
$236.91
|
|
|
ARTHREX MAIN PUMP TUB AR-6410
|
Facility
|
OP
|
$249.38
|
|
| Hospital Charge Code |
2650699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.39
|
| Rate for Payer: Aetna of WY Medicare |
$164.59
|
| Rate for Payer: Altius Commercial |
$239.40
|
| Rate for Payer: Beech Street Commercial |
$244.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$241.90
|
| Rate for Payer: Cash Price |
$174.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.90
|
| Rate for Payer: Cigna of WY Commercial |
$244.39
|
| Rate for Payer: Entrust Commercial |
$236.91
|
| Rate for Payer: First Choice Health Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.15
|
| Rate for Payer: HealthUtah PPO |
$249.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.90
|
| Rate for Payer: Multiplan Medicare/VA |
$135.04
|
| Rate for Payer: One Health Plan of WY PPO |
$244.39
|
| Rate for Payer: PacificSource Commercial |
$224.44
|
| Rate for Payer: PHCS PPO |
$244.39
|
| Rate for Payer: Three Rivers PPO |
$187.04
|
| Rate for Payer: TriWest Veterans Administration |
$142.15
|
| Rate for Payer: United Healthcare Commercial |
$238.16
|
| Rate for Payer: United Healthcare Medicare |
$142.15
|
| Rate for Payer: WINHealth Partners Commercial |
$244.39
|
| Rate for Payer: Wise Provider Network Commercial |
$236.91
|
|
|
ARTHRO BIOINDUCTIVE 1 LARGE
|
Facility
|
IP
|
$11,375.00
|
|
| Hospital Charge Code |
3003431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,591.81 |
| Max. Negotiated Rate |
$11,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,147.50
|
| Rate for Payer: Aetna of WY Medicare |
$7,280.00
|
| Rate for Payer: Altius Commercial |
$10,920.00
|
| Rate for Payer: Beech Street Commercial |
$11,147.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,033.75
|
| Rate for Payer: Cash Price |
$7,962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,033.75
|
| Rate for Payer: Cigna of WY Commercial |
$11,147.50
|
| Rate for Payer: Entrust Commercial |
$10,806.25
|
| Rate for Payer: First Choice Health Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,938.75
|
| Rate for Payer: HealthUtah PPO |
$11,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,033.75
|
| Rate for Payer: Multiplan Medicare/VA |
$6,591.81
|
| Rate for Payer: One Health Plan of WY PPO |
$11,147.50
|
| Rate for Payer: PacificSource Commercial |
$10,237.50
|
| Rate for Payer: PHCS PPO |
$11,147.50
|
| Rate for Payer: Three Rivers PPO |
$8,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,938.75
|
| Rate for Payer: United Healthcare Commercial |
$10,863.12
|
| Rate for Payer: United Healthcare Medicare |
$6,938.75
|
| Rate for Payer: WINHealth Partners Commercial |
$10,806.25
|
| Rate for Payer: Wise Provider Network Commercial |
$10,806.25
|
|
|
ARTHRO BIOINDUCTIVE 1 LARGE
|
Facility
|
OP
|
$11,375.00
|
|
| Hospital Charge Code |
3003431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.56 |
| Max. Negotiated Rate |
$11,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,147.50
|
| Rate for Payer: Aetna of WY Medicare |
$7,507.50
|
| Rate for Payer: Altius Commercial |
$10,920.00
|
| Rate for Payer: Beech Street Commercial |
$11,147.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,033.75
|
| Rate for Payer: Cash Price |
$7,962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,033.75
|
| Rate for Payer: Cigna of WY Commercial |
$11,147.50
|
| Rate for Payer: Entrust Commercial |
$10,806.25
|
| Rate for Payer: First Choice Health Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,483.75
|
| Rate for Payer: HealthUtah PPO |
$11,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,033.75
|
| Rate for Payer: Multiplan Medicare/VA |
$6,159.56
|
| Rate for Payer: One Health Plan of WY PPO |
$11,147.50
|
| Rate for Payer: PacificSource Commercial |
$10,237.50
|
| Rate for Payer: PHCS PPO |
$11,147.50
|
| Rate for Payer: Three Rivers PPO |
$8,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,483.75
|
| Rate for Payer: United Healthcare Commercial |
$10,863.12
|
| Rate for Payer: United Healthcare Medicare |
$6,483.75
|
| Rate for Payer: WINHealth Partners Commercial |
$11,147.50
|
| Rate for Payer: Wise Provider Network Commercial |
$10,806.25
|
|
|
ARTHRO BIOINDUCTIVE 1 MED
|
Facility
|
IP
|
$11,375.00
|
|
| Hospital Charge Code |
3003001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,591.81 |
| Max. Negotiated Rate |
$11,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,147.50
|
| Rate for Payer: Aetna of WY Medicare |
$7,280.00
|
| Rate for Payer: Altius Commercial |
$10,920.00
|
| Rate for Payer: Beech Street Commercial |
$11,147.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,033.75
|
| Rate for Payer: Cash Price |
$7,962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,033.75
|
| Rate for Payer: Cigna of WY Commercial |
$11,147.50
|
| Rate for Payer: Entrust Commercial |
$10,806.25
|
| Rate for Payer: First Choice Health Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,938.75
|
| Rate for Payer: HealthUtah PPO |
$11,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,033.75
|
| Rate for Payer: Multiplan Medicare/VA |
$6,591.81
|
| Rate for Payer: One Health Plan of WY PPO |
$11,147.50
|
| Rate for Payer: PacificSource Commercial |
$10,237.50
|
| Rate for Payer: PHCS PPO |
$11,147.50
|
| Rate for Payer: Three Rivers PPO |
$8,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,938.75
|
| Rate for Payer: United Healthcare Commercial |
$10,863.12
|
| Rate for Payer: United Healthcare Medicare |
$6,938.75
|
| Rate for Payer: WINHealth Partners Commercial |
$10,806.25
|
| Rate for Payer: Wise Provider Network Commercial |
$10,806.25
|
|
|
ARTHRO BIOINDUCTIVE 1 MED
|
Facility
|
OP
|
$11,375.00
|
|
| Hospital Charge Code |
3003001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.56 |
| Max. Negotiated Rate |
$11,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,147.50
|
| Rate for Payer: Aetna of WY Medicare |
$7,507.50
|
| Rate for Payer: Altius Commercial |
$10,920.00
|
| Rate for Payer: Beech Street Commercial |
$11,147.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,033.75
|
| Rate for Payer: Cash Price |
$7,962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,033.75
|
| Rate for Payer: Cigna of WY Commercial |
$11,147.50
|
| Rate for Payer: Entrust Commercial |
$10,806.25
|
| Rate for Payer: First Choice Health Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,806.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,483.75
|
| Rate for Payer: HealthUtah PPO |
$11,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,033.75
|
| Rate for Payer: Multiplan Medicare/VA |
$6,159.56
|
| Rate for Payer: One Health Plan of WY PPO |
$11,147.50
|
| Rate for Payer: PacificSource Commercial |
$10,237.50
|
| Rate for Payer: PHCS PPO |
$11,147.50
|
| Rate for Payer: Three Rivers PPO |
$8,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,483.75
|
| Rate for Payer: United Healthcare Commercial |
$10,863.12
|
| Rate for Payer: United Healthcare Medicare |
$6,483.75
|
| Rate for Payer: WINHealth Partners Commercial |
$11,147.50
|
| Rate for Payer: Wise Provider Network Commercial |
$10,806.25
|
|
|
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 20605
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$142.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: First Choice Health Commercial |
$135.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.25
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$142.50
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
| Rate for Payer: WINHealth Partners Commercial |
$127.50
|
|
|
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$293.02
|
| Rate for Payer: Beech Street Commercial |
$284.05
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$290.03
|
| Rate for Payer: Cigna of WY Commercial |
$293.02
|
| Rate for Payer: First Choice Health Commercial |
$269.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$284.05
|
| Rate for Payer: HealthUtah PPO |
$299.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$290.03
|
| Rate for Payer: One Health Plan of WY PPO |
$293.02
|
| Rate for Payer: PacificSource Commercial |
$269.10
|
| Rate for Payer: PHCS PPO |
$284.05
|
| Rate for Payer: Three Rivers PPO |
$224.25
|
| Rate for Payer: United Healthcare Commercial |
$284.05
|
| Rate for Payer: WINHealth Partners Commercial |
$254.15
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
HCPCS 20610 50
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$381.22
|
| Rate for Payer: Beech Street Commercial |
$369.55
|
| Rate for Payer: Cash Price |
$272.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$377.33
|
| Rate for Payer: Cigna of WY Commercial |
$381.22
|
| Rate for Payer: First Choice Health Commercial |
$350.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$369.55
|
| Rate for Payer: HealthUtah PPO |
$389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$377.33
|
| Rate for Payer: One Health Plan of WY PPO |
$381.22
|
| Rate for Payer: PacificSource Commercial |
$350.10
|
| Rate for Payer: PHCS PPO |
$369.55
|
| Rate for Payer: Three Rivers PPO |
$291.75
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
| Rate for Payer: WINHealth Partners Commercial |
$330.65
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 20610
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$43.42
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.42
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.42
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: WINHealth Partners Commercial |
$164.90
|
|
|
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 20611
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$56.35
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.35
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$47.90
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.35
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
|
|
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Beech Street Commercial |
$288.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PHCS PPO |
$288.80
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: United Healthcare Commercial |
$288.80
|
| Rate for Payer: WINHealth Partners Commercial |
$258.40
|
|
|
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 20600
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$34.27
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.27
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$29.13
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.27
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 20604
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$43.68
|
| Rate for Payer: Beech Street Commercial |
$308.75
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: First Choice Health Commercial |
$292.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.68
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$37.13
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$308.75
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: WINHealth Partners Commercial |
$276.25
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 27870 AS
|
| Min. Negotiated Rate |
$1,105.50 |
| Max. Negotiated Rate |
$1,474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,444.52
|
| Rate for Payer: Beech Street Commercial |
$1,400.30
|
| Rate for Payer: Cash Price |
$1,031.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,429.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,444.52
|
| Rate for Payer: First Choice Health Commercial |
$1,326.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,400.30
|
| Rate for Payer: HealthUtah PPO |
$1,474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,429.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,444.52
|
| Rate for Payer: PacificSource Commercial |
$1,326.60
|
| Rate for Payer: PHCS PPO |
$1,400.30
|
| Rate for Payer: Three Rivers PPO |
$1,105.50
|
| Rate for Payer: United Healthcare Commercial |
$1,400.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,252.90
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$7,376.00
|
|
|
Service Code
|
HCPCS 27870 80
|
| Min. Negotiated Rate |
$827.48 |
| Max. Negotiated Rate |
$7,376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,228.48
|
| Rate for Payer: Beech Street Commercial |
$7,007.20
|
| Rate for Payer: Cash Price |
$5,163.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,154.72
|
| Rate for Payer: Cigna of WY Commercial |
$7,228.48
|
| Rate for Payer: First Choice Health Commercial |
$6,638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,007.20
|
| Rate for Payer: HealthUtah PPO |
$7,376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,154.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7,228.48
|
| Rate for Payer: PacificSource Commercial |
$6,638.40
|
| Rate for Payer: PHCS PPO |
$7,007.20
|
| Rate for Payer: Three Rivers PPO |
$5,532.00
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,269.60
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$7,376.00
|
|
|
Service Code
|
HCPCS 27870
|
| Min. Negotiated Rate |
$827.48 |
| Max. Negotiated Rate |
$7,376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,228.48
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Beech Street Commercial |
$7,007.20
|
| Rate for Payer: Cash Price |
$5,163.20
|
| Rate for Payer: Cash Price |
$5,163.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,154.72
|
| Rate for Payer: Cigna of WY Commercial |
$7,228.48
|
| Rate for Payer: First Choice Health Commercial |
$6,638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,007.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$7,376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,154.72
|
| Rate for Payer: Multiplan Medicare/VA |
$827.48
|
| Rate for Payer: One Health Plan of WY PPO |
$7,228.48
|
| Rate for Payer: PacificSource Commercial |
$6,638.40
|
| Rate for Payer: PHCS PPO |
$7,007.20
|
| Rate for Payer: Three Rivers PPO |
$5,532.00
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,269.60
|
|
|
ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 22634 AS
|
| Min. Negotiated Rate |
$384.55 |
| Max. Negotiated Rate |
$4,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,640.30
|
| Rate for Payer: Beech Street Commercial |
$4,498.25
|
| Rate for Payer: Cash Price |
$3,314.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,592.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,640.30
|
| Rate for Payer: First Choice Health Commercial |
$4,261.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,498.25
|
| Rate for Payer: HealthUtah PPO |
$4,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,592.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,640.30
|
| Rate for Payer: PacificSource Commercial |
$4,261.50
|
| Rate for Payer: PHCS PPO |
$4,498.25
|
| Rate for Payer: Three Rivers PPO |
$3,551.25
|
| Rate for Payer: United Healthcare Commercial |
$4,498.25
|
| Rate for Payer: WINHealth Partners Commercial |
$4,024.75
|
|
|
ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 22634
|
| Min. Negotiated Rate |
$384.55 |
| Max. Negotiated Rate |
$4,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,640.30
|
| Rate for Payer: Aetna of WY Medicare |
$452.41
|
| Rate for Payer: Beech Street Commercial |
$4,498.25
|
| Rate for Payer: Cash Price |
$3,314.50
|
| Rate for Payer: Cash Price |
$3,314.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,592.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,640.30
|
| Rate for Payer: First Choice Health Commercial |
$4,261.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,498.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.41
|
| Rate for Payer: HealthUtah PPO |
$4,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,592.95
|
| Rate for Payer: Multiplan Medicare/VA |
$384.55
|
| Rate for Payer: One Health Plan of WY PPO |
$4,640.30
|
| Rate for Payer: PacificSource Commercial |
$4,261.50
|
| Rate for Payer: PHCS PPO |
$4,498.25
|
| Rate for Payer: Three Rivers PPO |
$3,551.25
|
| Rate for Payer: TriWest Veterans Administration |
$452.41
|
| Rate for Payer: United Healthcare Commercial |
$4,498.25
|
| Rate for Payer: WINHealth Partners Commercial |
$4,024.75
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$8,074.00
|
|
|
Service Code
|
HCPCS 22633
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,912.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,718.56
|
| Rate for Payer: Beech Street Commercial |
$7,670.30
|
| Rate for Payer: Cash Price |
$5,651.80
|
| Rate for Payer: Cash Price |
$5,651.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,831.78
|
| Rate for Payer: Cigna of WY Commercial |
$7,912.52
|
| Rate for Payer: First Choice Health Commercial |
$7,266.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,670.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,718.56
|
| Rate for Payer: HealthUtah PPO |
$8,074.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,831.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1,460.78
|
| Rate for Payer: One Health Plan of WY PPO |
$7,912.52
|
| Rate for Payer: PacificSource Commercial |
$7,266.60
|
| Rate for Payer: PHCS PPO |
$7,670.30
|
| Rate for Payer: Three Rivers PPO |
$6,055.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,718.56
|
| Rate for Payer: United Healthcare Commercial |
$7,670.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,862.90
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$8,074.00
|
|
|
Service Code
|
HCPCS 22633 80
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,912.52
|
| Rate for Payer: Beech Street Commercial |
$7,670.30
|
| Rate for Payer: Cash Price |
$5,651.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,831.78
|
| Rate for Payer: Cigna of WY Commercial |
$7,912.52
|
| Rate for Payer: First Choice Health Commercial |
$7,266.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,670.30
|
| Rate for Payer: HealthUtah PPO |
$8,074.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,831.78
|
| Rate for Payer: One Health Plan of WY PPO |
$7,912.52
|
| Rate for Payer: PacificSource Commercial |
$7,266.60
|
| Rate for Payer: PHCS PPO |
$7,670.30
|
| Rate for Payer: Three Rivers PPO |
$6,055.50
|
| Rate for Payer: United Healthcare Commercial |
$7,670.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,862.90
|
|
|
ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$8,074.00
|
|
|
Service Code
|
HCPCS 22633 AS
|
| Min. Negotiated Rate |
$1,460.78 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,912.52
|
| Rate for Payer: Beech Street Commercial |
$7,670.30
|
| Rate for Payer: Cash Price |
$5,651.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,831.78
|
| Rate for Payer: Cigna of WY Commercial |
$7,912.52
|
| Rate for Payer: First Choice Health Commercial |
$7,266.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,670.30
|
| Rate for Payer: HealthUtah PPO |
$8,074.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,831.78
|
| Rate for Payer: One Health Plan of WY PPO |
$7,912.52
|
| Rate for Payer: PacificSource Commercial |
$7,266.60
|
| Rate for Payer: PHCS PPO |
$7,670.30
|
| Rate for Payer: Three Rivers PPO |
$6,055.50
|
| Rate for Payer: United Healthcare Commercial |
$7,670.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,862.90
|
|
