|
ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 28755
|
| Min. Negotiated Rate |
$278.36 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Aetna of WY Medicare |
$327.48
|
| Rate for Payer: Beech Street Commercial |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: First Choice Health Commercial |
$1,324.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.48
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Medicare/VA |
$278.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,398.40
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration |
$327.48
|
| Rate for Payer: United Healthcare Commercial |
$1,398.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.20
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 28750 AS
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,525.46
|
| Rate for Payer: Beech Street Commercial |
$2,448.15
|
| Rate for Payer: Cash Price |
$1,803.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,499.69
|
| Rate for Payer: Cigna of WY Commercial |
$2,525.46
|
| Rate for Payer: First Choice Health Commercial |
$2,319.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,448.15
|
| Rate for Payer: HealthUtah PPO |
$2,577.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,499.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,525.46
|
| Rate for Payer: PacificSource Commercial |
$2,319.30
|
| Rate for Payer: PHCS PPO |
$2,448.15
|
| Rate for Payer: Three Rivers PPO |
$1,932.75
|
| Rate for Payer: United Healthcare Commercial |
$2,448.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,190.45
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 28750
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,525.46
|
| Rate for Payer: Aetna of WY Medicare |
$560.82
|
| Rate for Payer: Beech Street Commercial |
$2,448.15
|
| Rate for Payer: Cash Price |
$1,803.90
|
| Rate for Payer: Cash Price |
$1,803.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,499.69
|
| Rate for Payer: Cigna of WY Commercial |
$2,525.46
|
| Rate for Payer: First Choice Health Commercial |
$2,319.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,448.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$560.82
|
| Rate for Payer: HealthUtah PPO |
$2,577.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,499.69
|
| Rate for Payer: Multiplan Medicare/VA |
$476.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,525.46
|
| Rate for Payer: PacificSource Commercial |
$2,319.30
|
| Rate for Payer: PHCS PPO |
$2,448.15
|
| Rate for Payer: Three Rivers PPO |
$1,932.75
|
| Rate for Payer: TriWest Veterans Administration |
$560.82
|
| Rate for Payer: United Healthcare Commercial |
$2,448.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,190.45
|
|
|
ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 28750 80
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,525.46
|
| Rate for Payer: Beech Street Commercial |
$2,448.15
|
| Rate for Payer: Cash Price |
$1,803.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,499.69
|
| Rate for Payer: Cigna of WY Commercial |
$2,525.46
|
| Rate for Payer: First Choice Health Commercial |
$2,319.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,448.15
|
| Rate for Payer: HealthUtah PPO |
$2,577.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,499.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,525.46
|
| Rate for Payer: PacificSource Commercial |
$2,319.30
|
| Rate for Payer: PHCS PPO |
$2,448.15
|
| Rate for Payer: Three Rivers PPO |
$1,932.75
|
| Rate for Payer: United Healthcare Commercial |
$2,448.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,190.45
|
|
|
ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$6,495.00
|
|
|
Service Code
|
HCPCS 26860 AS
|
| Min. Negotiated Rate |
$4,871.25 |
| Max. Negotiated Rate |
$6,495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,365.10
|
| Rate for Payer: Beech Street Commercial |
$6,170.25
|
| Rate for Payer: Cash Price |
$4,546.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,300.15
|
| Rate for Payer: Cigna of WY Commercial |
$6,365.10
|
| Rate for Payer: First Choice Health Commercial |
$5,845.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,170.25
|
| Rate for Payer: HealthUtah PPO |
$6,495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,300.15
|
| Rate for Payer: One Health Plan of WY PPO |
$6,365.10
|
| Rate for Payer: PacificSource Commercial |
$5,845.50
|
| Rate for Payer: PHCS PPO |
$6,170.25
|
| Rate for Payer: Three Rivers PPO |
$4,871.25
|
| Rate for Payer: United Healthcare Commercial |
$6,170.25
|
| Rate for Payer: WINHealth Partners Commercial |
$5,520.75
|
|
|
ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$3,382.00
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$3,382.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,314.36
|
| Rate for Payer: Aetna of WY Medicare |
$603.39
|
| Rate for Payer: Beech Street Commercial |
$3,212.90
|
| Rate for Payer: Cash Price |
$2,367.40
|
| Rate for Payer: Cash Price |
$2,367.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,280.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,314.36
|
| Rate for Payer: First Choice Health Commercial |
$3,043.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,212.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.39
|
| Rate for Payer: HealthUtah PPO |
$3,382.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,280.54
|
| Rate for Payer: Multiplan Medicare/VA |
$512.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,314.36
|
| Rate for Payer: PacificSource Commercial |
$3,043.80
|
| Rate for Payer: PHCS PPO |
$3,212.90
|
| Rate for Payer: Three Rivers PPO |
$2,536.50
|
| Rate for Payer: TriWest Veterans Administration |
$603.39
|
| Rate for Payer: United Healthcare Commercial |
$3,212.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,874.70
|
|
|
ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$3,564.00
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$3,564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,492.72
|
| Rate for Payer: Aetna of WY Medicare |
$96.39
|
| Rate for Payer: Beech Street Commercial |
$3,385.80
|
| Rate for Payer: Cash Price |
$2,494.80
|
| Rate for Payer: Cash Price |
$2,494.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,457.08
|
| Rate for Payer: Cigna of WY Commercial |
$3,492.72
|
| Rate for Payer: First Choice Health Commercial |
$3,207.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,385.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.39
|
| Rate for Payer: HealthUtah PPO |
$3,564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,457.08
|
| Rate for Payer: Multiplan Medicare/VA |
$81.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,492.72
|
| Rate for Payer: PacificSource Commercial |
$3,207.60
|
| Rate for Payer: PHCS PPO |
$3,385.80
|
| Rate for Payer: Three Rivers PPO |
$2,673.00
|
| Rate for Payer: TriWest Veterans Administration |
$96.39
|
| Rate for Payer: United Healthcare Commercial |
$3,385.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,029.40
|
|
|
ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$8,163.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$612.04 |
| Max. Negotiated Rate |
$8,163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,999.74
|
| Rate for Payer: Aetna of WY Medicare |
$720.05
|
| Rate for Payer: Beech Street Commercial |
$7,754.85
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,918.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,999.74
|
| Rate for Payer: First Choice Health Commercial |
$7,346.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,754.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$720.05
|
| Rate for Payer: HealthUtah PPO |
$8,163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,918.11
|
| Rate for Payer: Multiplan Medicare/VA |
$612.04
|
| Rate for Payer: One Health Plan of WY PPO |
$7,999.74
|
| Rate for Payer: PacificSource Commercial |
$7,346.70
|
| Rate for Payer: PHCS PPO |
$7,754.85
|
| Rate for Payer: Three Rivers PPO |
$6,122.25
|
| Rate for Payer: TriWest Veterans Administration |
$720.05
|
| Rate for Payer: United Healthcare Commercial |
$7,754.85
|
| Rate for Payer: WINHealth Partners Commercial |
$6,938.55
|
|
|
ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$8,163.00
|
|
|
Service Code
|
HCPCS 26850 AS
|
| Min. Negotiated Rate |
$612.04 |
| Max. Negotiated Rate |
$8,163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,999.74
|
| Rate for Payer: Beech Street Commercial |
$7,754.85
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,918.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,999.74
|
| Rate for Payer: First Choice Health Commercial |
$7,346.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,754.85
|
| Rate for Payer: HealthUtah PPO |
$8,163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,918.11
|
| Rate for Payer: One Health Plan of WY PPO |
$7,999.74
|
| Rate for Payer: PacificSource Commercial |
$7,346.70
|
| Rate for Payer: PHCS PPO |
$7,754.85
|
| Rate for Payer: Three Rivers PPO |
$6,122.25
|
| Rate for Payer: United Healthcare Commercial |
$7,754.85
|
| Rate for Payer: WINHealth Partners Commercial |
$6,938.55
|
|
|
ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 28740 80
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$752.64
|
| Rate for Payer: Beech Street Commercial |
$729.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$744.96
|
| Rate for Payer: Cigna of WY Commercial |
$752.64
|
| Rate for Payer: First Choice Health Commercial |
$691.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$729.60
|
| Rate for Payer: HealthUtah PPO |
$768.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$744.96
|
| Rate for Payer: One Health Plan of WY PPO |
$752.64
|
| Rate for Payer: PacificSource Commercial |
$691.20
|
| Rate for Payer: PHCS PPO |
$729.60
|
| Rate for Payer: Three Rivers PPO |
$576.00
|
| Rate for Payer: United Healthcare Commercial |
$729.60
|
| Rate for Payer: WINHealth Partners Commercial |
$652.80
|
|
|
ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$4,303.00
|
|
|
Service Code
|
HCPCS 28740
|
| Min. Negotiated Rate |
$509.86 |
| Max. Negotiated Rate |
$4,303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,216.94
|
| Rate for Payer: Aetna of WY Medicare |
$599.83
|
| Rate for Payer: Beech Street Commercial |
$4,087.85
|
| Rate for Payer: Cash Price |
$3,012.10
|
| Rate for Payer: Cash Price |
$3,012.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,173.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,216.94
|
| Rate for Payer: First Choice Health Commercial |
$3,872.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,087.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.83
|
| Rate for Payer: HealthUtah PPO |
$4,303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,173.91
|
| Rate for Payer: Multiplan Medicare/VA |
$509.86
|
| Rate for Payer: One Health Plan of WY PPO |
$4,216.94
|
| Rate for Payer: PacificSource Commercial |
$3,872.70
|
| Rate for Payer: PHCS PPO |
$4,087.85
|
| Rate for Payer: Three Rivers PPO |
$3,227.25
|
| Rate for Payer: TriWest Veterans Administration |
$599.83
|
| Rate for Payer: United Healthcare Commercial |
$4,087.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.55
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 22632 AS
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.82
|
| Rate for Payer: Beech Street Commercial |
$436.05
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$445.23
|
| Rate for Payer: Cigna of WY Commercial |
$449.82
|
| Rate for Payer: First Choice Health Commercial |
$413.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$436.05
|
| Rate for Payer: HealthUtah PPO |
$459.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$445.23
|
| Rate for Payer: One Health Plan of WY PPO |
$449.82
|
| Rate for Payer: PacificSource Commercial |
$413.10
|
| Rate for Payer: PHCS PPO |
$436.05
|
| Rate for Payer: Three Rivers PPO |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$436.05
|
| Rate for Payer: WINHealth Partners Commercial |
$390.15
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 22632
|
| Min. Negotiated Rate |
$254.38 |
| Max. Negotiated Rate |
$1,262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,236.76
|
| Rate for Payer: Aetna of WY Medicare |
$299.27
|
| Rate for Payer: Beech Street Commercial |
$1,198.90
|
| Rate for Payer: Cash Price |
$883.40
|
| Rate for Payer: Cash Price |
$883.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,224.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,236.76
|
| Rate for Payer: First Choice Health Commercial |
$1,135.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,198.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.27
|
| Rate for Payer: HealthUtah PPO |
$1,262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,224.14
|
| Rate for Payer: Multiplan Medicare/VA |
$254.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,236.76
|
| Rate for Payer: PacificSource Commercial |
$1,135.80
|
| Rate for Payer: PHCS PPO |
$1,198.90
|
| Rate for Payer: Three Rivers PPO |
$946.50
|
| Rate for Payer: TriWest Veterans Administration |
$299.27
|
| Rate for Payer: United Healthcare Commercial |
$1,198.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,072.70
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 22632 80
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.82
|
| Rate for Payer: Beech Street Commercial |
$436.05
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$445.23
|
| Rate for Payer: Cigna of WY Commercial |
$449.82
|
| Rate for Payer: First Choice Health Commercial |
$413.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$436.05
|
| Rate for Payer: HealthUtah PPO |
$459.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$445.23
|
| Rate for Payer: One Health Plan of WY PPO |
$449.82
|
| Rate for Payer: PacificSource Commercial |
$413.10
|
| Rate for Payer: PHCS PPO |
$436.05
|
| Rate for Payer: Three Rivers PPO |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$436.05
|
| Rate for Payer: WINHealth Partners Commercial |
$390.15
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,905.00
|
|
|
Service Code
|
HCPCS 22630
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$6,905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,766.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,484.15
|
| Rate for Payer: Beech Street Commercial |
$6,559.75
|
| Rate for Payer: Cash Price |
$4,833.50
|
| Rate for Payer: Cash Price |
$4,833.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,697.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,766.90
|
| Rate for Payer: First Choice Health Commercial |
$6,214.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,559.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,484.15
|
| Rate for Payer: HealthUtah PPO |
$6,905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,697.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1,261.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6,766.90
|
| Rate for Payer: PacificSource Commercial |
$6,214.50
|
| Rate for Payer: PHCS PPO |
$6,559.75
|
| Rate for Payer: Three Rivers PPO |
$5,178.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,484.15
|
| Rate for Payer: United Healthcare Commercial |
$6,559.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,869.25
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,905.00
|
|
|
Service Code
|
HCPCS 22630 80
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$6,905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,766.90
|
| Rate for Payer: Beech Street Commercial |
$6,559.75
|
| Rate for Payer: Cash Price |
$4,833.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,697.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,766.90
|
| Rate for Payer: First Choice Health Commercial |
$6,214.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,559.75
|
| Rate for Payer: HealthUtah PPO |
$6,905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,697.85
|
| Rate for Payer: One Health Plan of WY PPO |
$6,766.90
|
| Rate for Payer: PacificSource Commercial |
$6,214.50
|
| Rate for Payer: PHCS PPO |
$6,559.75
|
| Rate for Payer: Three Rivers PPO |
$5,178.75
|
| Rate for Payer: United Healthcare Commercial |
$6,559.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,869.25
|
|
|
ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,905.00
|
|
|
Service Code
|
HCPCS 22630 AS
|
| Min. Negotiated Rate |
$1,261.53 |
| Max. Negotiated Rate |
$6,905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,766.90
|
| Rate for Payer: Beech Street Commercial |
$6,559.75
|
| Rate for Payer: Cash Price |
$4,833.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,697.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,766.90
|
| Rate for Payer: First Choice Health Commercial |
$6,214.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,559.75
|
| Rate for Payer: HealthUtah PPO |
$6,905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,697.85
|
| Rate for Payer: One Health Plan of WY PPO |
$6,766.90
|
| Rate for Payer: PacificSource Commercial |
$6,214.50
|
| Rate for Payer: PHCS PPO |
$6,559.75
|
| Rate for Payer: Three Rivers PPO |
$5,178.75
|
| Rate for Payer: United Healthcare Commercial |
$6,559.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,869.25
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$6,319.00
|
|
|
Service Code
|
HCPCS 22612
|
| Min. Negotiated Rate |
$1,281.15 |
| Max. Negotiated Rate |
$6,319.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,192.62
|
| Rate for Payer: Aetna of WY Medicare |
$1,507.24
|
| Rate for Payer: Beech Street Commercial |
$6,003.05
|
| Rate for Payer: Cash Price |
$4,423.30
|
| Rate for Payer: Cash Price |
$4,423.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,129.43
|
| Rate for Payer: Cigna of WY Commercial |
$6,192.62
|
| Rate for Payer: First Choice Health Commercial |
$5,687.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,003.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,507.24
|
| Rate for Payer: HealthUtah PPO |
$6,319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,129.43
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.15
|
| Rate for Payer: One Health Plan of WY PPO |
$6,192.62
|
| Rate for Payer: PacificSource Commercial |
$5,687.10
|
| Rate for Payer: PHCS PPO |
$6,003.05
|
| Rate for Payer: Three Rivers PPO |
$4,739.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,507.24
|
| Rate for Payer: United Healthcare Commercial |
$6,003.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,371.15
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 22612 AS
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$802.62
|
| Rate for Payer: Beech Street Commercial |
$778.05
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$794.43
|
| Rate for Payer: Cigna of WY Commercial |
$802.62
|
| Rate for Payer: First Choice Health Commercial |
$737.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$778.05
|
| Rate for Payer: HealthUtah PPO |
$819.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$794.43
|
| Rate for Payer: One Health Plan of WY PPO |
$802.62
|
| Rate for Payer: PacificSource Commercial |
$737.10
|
| Rate for Payer: PHCS PPO |
$778.05
|
| Rate for Payer: Three Rivers PPO |
$614.25
|
| Rate for Payer: United Healthcare Commercial |
$778.05
|
| Rate for Payer: WINHealth Partners Commercial |
$696.15
|
|
|
ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 22612 80
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$802.62
|
| Rate for Payer: Beech Street Commercial |
$778.05
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$794.43
|
| Rate for Payer: Cigna of WY Commercial |
$802.62
|
| Rate for Payer: First Choice Health Commercial |
$737.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$778.05
|
| Rate for Payer: HealthUtah PPO |
$819.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$794.43
|
| Rate for Payer: One Health Plan of WY PPO |
$802.62
|
| Rate for Payer: PacificSource Commercial |
$737.10
|
| Rate for Payer: PHCS PPO |
$778.05
|
| Rate for Payer: Three Rivers PPO |
$614.25
|
| Rate for Payer: United Healthcare Commercial |
$778.05
|
| Rate for Payer: WINHealth Partners Commercial |
$696.15
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 22614 AS
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,510.18
|
| Rate for Payer: Beech Street Commercial |
$1,463.95
|
| Rate for Payer: Cash Price |
$1,078.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,494.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,510.18
|
| Rate for Payer: First Choice Health Commercial |
$1,386.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,463.95
|
| Rate for Payer: HealthUtah PPO |
$1,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,494.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,510.18
|
| Rate for Payer: PacificSource Commercial |
$1,386.90
|
| Rate for Payer: PHCS PPO |
$1,463.95
|
| Rate for Payer: Three Rivers PPO |
$1,155.75
|
| Rate for Payer: United Healthcare Commercial |
$1,463.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,309.85
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 22614
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,510.18
|
| Rate for Payer: Aetna of WY Medicare |
$365.33
|
| Rate for Payer: Beech Street Commercial |
$1,463.95
|
| Rate for Payer: Cash Price |
$1,078.70
|
| Rate for Payer: Cash Price |
$1,078.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,494.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,510.18
|
| Rate for Payer: First Choice Health Commercial |
$1,386.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,463.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.33
|
| Rate for Payer: HealthUtah PPO |
$1,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,494.77
|
| Rate for Payer: Multiplan Medicare/VA |
$310.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,510.18
|
| Rate for Payer: PacificSource Commercial |
$1,386.90
|
| Rate for Payer: PHCS PPO |
$1,463.95
|
| Rate for Payer: Three Rivers PPO |
$1,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$365.33
|
| Rate for Payer: United Healthcare Commercial |
$1,463.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,309.85
|
|
|
ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 22614 80
|
| Min. Negotiated Rate |
$310.53 |
| Max. Negotiated Rate |
$1,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,510.18
|
| Rate for Payer: Beech Street Commercial |
$1,463.95
|
| Rate for Payer: Cash Price |
$1,078.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,494.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,510.18
|
| Rate for Payer: First Choice Health Commercial |
$1,386.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,463.95
|
| Rate for Payer: HealthUtah PPO |
$1,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,494.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,510.18
|
| Rate for Payer: PacificSource Commercial |
$1,386.90
|
| Rate for Payer: PHCS PPO |
$1,463.95
|
| Rate for Payer: Three Rivers PPO |
$1,155.75
|
| Rate for Payer: United Healthcare Commercial |
$1,463.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,309.85
|
|
|
ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$5,843.00
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$642.37 |
| Max. Negotiated Rate |
$5,843.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,726.14
|
| Rate for Payer: Aetna of WY Medicare |
$755.73
|
| Rate for Payer: Beech Street Commercial |
$5,550.85
|
| Rate for Payer: Cash Price |
$4,090.10
|
| Rate for Payer: Cash Price |
$4,090.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,667.71
|
| Rate for Payer: Cigna of WY Commercial |
$5,726.14
|
| Rate for Payer: First Choice Health Commercial |
$5,258.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,550.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$755.73
|
| Rate for Payer: HealthUtah PPO |
$5,843.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,667.71
|
| Rate for Payer: Multiplan Medicare/VA |
$642.37
|
| Rate for Payer: One Health Plan of WY PPO |
$5,726.14
|
| Rate for Payer: PacificSource Commercial |
$5,258.70
|
| Rate for Payer: PHCS PPO |
$5,550.85
|
| Rate for Payer: Three Rivers PPO |
$4,382.25
|
| Rate for Payer: TriWest Veterans Administration |
$755.73
|
| Rate for Payer: United Healthcare Commercial |
$5,550.85
|
| Rate for Payer: WINHealth Partners Commercial |
$4,966.55
|
|
|
ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 28725 80
|
| Min. Negotiated Rate |
$877.50 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,146.60
|
| Rate for Payer: Beech Street Commercial |
$1,111.50
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,134.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,146.60
|
| Rate for Payer: First Choice Health Commercial |
$1,053.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,111.50
|
| Rate for Payer: HealthUtah PPO |
$1,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,134.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,146.60
|
| Rate for Payer: PacificSource Commercial |
$1,053.00
|
| Rate for Payer: PHCS PPO |
$1,111.50
|
| Rate for Payer: Three Rivers PPO |
$877.50
|
| Rate for Payer: United Healthcare Commercial |
$1,111.50
|
| Rate for Payer: WINHealth Partners Commercial |
$994.50
|
|
