|
ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$11,738.00
|
|
|
Service Code
|
HCPCS 27871
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$11,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,503.24
|
| Rate for Payer: Aetna of WY Medicare |
$671.33
|
| Rate for Payer: Beech Street Commercial |
$11,151.10
|
| Rate for Payer: Cash Price |
$8,216.60
|
| Rate for Payer: Cash Price |
$8,216.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,385.86
|
| Rate for Payer: Cigna of WY Commercial |
$11,503.24
|
| Rate for Payer: First Choice Health Commercial |
$10,564.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,151.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.33
|
| Rate for Payer: HealthUtah PPO |
$11,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,385.86
|
| Rate for Payer: Multiplan Medicare/VA |
$570.63
|
| Rate for Payer: One Health Plan of WY PPO |
$11,503.24
|
| Rate for Payer: PacificSource Commercial |
$10,564.20
|
| Rate for Payer: PHCS PPO |
$11,151.10
|
| Rate for Payer: Three Rivers PPO |
$8,803.50
|
| Rate for Payer: TriWest Veterans Administration |
$671.33
|
| Rate for Payer: United Healthcare Commercial |
$11,151.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,977.30
|
|
|
ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$11,738.00
|
|
|
Service Code
|
HCPCS 27871 80
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$11,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,503.24
|
| Rate for Payer: Beech Street Commercial |
$11,151.10
|
| Rate for Payer: Cash Price |
$8,216.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,385.86
|
| Rate for Payer: Cigna of WY Commercial |
$11,503.24
|
| Rate for Payer: First Choice Health Commercial |
$10,564.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,151.10
|
| Rate for Payer: HealthUtah PPO |
$11,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,385.86
|
| Rate for Payer: One Health Plan of WY PPO |
$11,503.24
|
| Rate for Payer: PacificSource Commercial |
$10,564.20
|
| Rate for Payer: PHCS PPO |
$11,151.10
|
| Rate for Payer: Three Rivers PPO |
$8,803.50
|
| Rate for Payer: United Healthcare Commercial |
$11,151.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,977.30
|
|
|
ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$14,581.00
|
|
|
Service Code
|
HCPCS 28715 80
|
| Min. Negotiated Rate |
$10,935.75 |
| Max. Negotiated Rate |
$14,581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,289.38
|
| Rate for Payer: Beech Street Commercial |
$13,851.95
|
| Rate for Payer: Cash Price |
$10,206.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,143.57
|
| Rate for Payer: Cigna of WY Commercial |
$14,289.38
|
| Rate for Payer: First Choice Health Commercial |
$13,122.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,851.95
|
| Rate for Payer: HealthUtah PPO |
$14,581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,143.57
|
| Rate for Payer: One Health Plan of WY PPO |
$14,289.38
|
| Rate for Payer: PacificSource Commercial |
$13,122.90
|
| Rate for Payer: PHCS PPO |
$13,851.95
|
| Rate for Payer: Three Rivers PPO |
$10,935.75
|
| Rate for Payer: United Healthcare Commercial |
$13,851.95
|
| Rate for Payer: WINHealth Partners Commercial |
$12,393.85
|
|
|
ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 25800 AS
|
| Min. Negotiated Rate |
$604.92 |
| Max. Negotiated Rate |
$4,655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,561.90
|
| Rate for Payer: Beech Street Commercial |
$4,422.25
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,515.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,561.90
|
| Rate for Payer: First Choice Health Commercial |
$4,189.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,422.25
|
| Rate for Payer: HealthUtah PPO |
$4,655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,515.35
|
| Rate for Payer: One Health Plan of WY PPO |
$4,561.90
|
| Rate for Payer: PacificSource Commercial |
$4,189.50
|
| Rate for Payer: PHCS PPO |
$4,422.25
|
| Rate for Payer: Three Rivers PPO |
$3,491.25
|
| Rate for Payer: United Healthcare Commercial |
$4,422.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
|
|
ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$604.92 |
| Max. Negotiated Rate |
$4,655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,561.90
|
| Rate for Payer: Aetna of WY Medicare |
$711.67
|
| Rate for Payer: Beech Street Commercial |
$4,422.25
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,515.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,561.90
|
| Rate for Payer: First Choice Health Commercial |
$4,189.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,422.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$711.67
|
| Rate for Payer: HealthUtah PPO |
$4,655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,515.35
|
| Rate for Payer: Multiplan Medicare/VA |
$604.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4,561.90
|
| Rate for Payer: PacificSource Commercial |
$4,189.50
|
| Rate for Payer: PHCS PPO |
$4,422.25
|
| Rate for Payer: Three Rivers PPO |
$3,491.25
|
| Rate for Payer: TriWest Veterans Administration |
$711.67
|
| Rate for Payer: United Healthcare Commercial |
$4,422.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
|
|
ARTHRODESIS WRIST LIMITED W/AUTOGRAFT
|
Professional
|
Both
|
$3,419.00
|
|
|
Service Code
|
HCPCS 25825 80
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$3,419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,350.62
|
| Rate for Payer: Beech Street Commercial |
$3,248.05
|
| Rate for Payer: Cash Price |
$2,393.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,316.43
|
| Rate for Payer: Cigna of WY Commercial |
$3,350.62
|
| Rate for Payer: First Choice Health Commercial |
$3,077.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,248.05
|
| Rate for Payer: HealthUtah PPO |
$3,419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,316.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,350.62
|
| Rate for Payer: PacificSource Commercial |
$3,077.10
|
| Rate for Payer: PHCS PPO |
$3,248.05
|
| Rate for Payer: Three Rivers PPO |
$2,564.25
|
| Rate for Payer: United Healthcare Commercial |
$3,248.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,906.15
|
|
|
ARTHRODESIS WRIST LIMITED W/AUTOGRAFT
|
Professional
|
Both
|
$3,419.00
|
|
|
Service Code
|
HCPCS 25825 AS
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$3,419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,350.62
|
| Rate for Payer: Beech Street Commercial |
$3,248.05
|
| Rate for Payer: Cash Price |
$2,393.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,316.43
|
| Rate for Payer: Cigna of WY Commercial |
$3,350.62
|
| Rate for Payer: First Choice Health Commercial |
$3,077.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,248.05
|
| Rate for Payer: HealthUtah PPO |
$3,419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,316.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,350.62
|
| Rate for Payer: PacificSource Commercial |
$3,077.10
|
| Rate for Payer: PHCS PPO |
$3,248.05
|
| Rate for Payer: Three Rivers PPO |
$2,564.25
|
| Rate for Payer: United Healthcare Commercial |
$3,248.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,906.15
|
|
|
ARTHRODESIS WRIST LIMITED W/AUTOGRAFT
|
Professional
|
Both
|
$3,419.00
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$3,419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,350.62
|
| Rate for Payer: Aetna of WY Medicare |
$774.89
|
| Rate for Payer: Beech Street Commercial |
$3,248.05
|
| Rate for Payer: Cash Price |
$2,393.30
|
| Rate for Payer: Cash Price |
$2,393.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,316.43
|
| Rate for Payer: Cigna of WY Commercial |
$3,350.62
|
| Rate for Payer: First Choice Health Commercial |
$3,077.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,248.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$774.89
|
| Rate for Payer: HealthUtah PPO |
$3,419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,316.43
|
| Rate for Payer: Multiplan Medicare/VA |
$658.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,350.62
|
| Rate for Payer: PacificSource Commercial |
$3,077.10
|
| Rate for Payer: PHCS PPO |
$3,248.05
|
| Rate for Payer: Three Rivers PPO |
$2,564.25
|
| Rate for Payer: TriWest Veterans Administration |
$774.89
|
| Rate for Payer: United Healthcare Commercial |
$3,248.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,906.15
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$11,638.00
|
|
|
Service Code
|
HCPCS 25820 80
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$11,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,405.24
|
| Rate for Payer: Beech Street Commercial |
$11,056.10
|
| Rate for Payer: Cash Price |
$8,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,288.86
|
| Rate for Payer: Cigna of WY Commercial |
$11,405.24
|
| Rate for Payer: First Choice Health Commercial |
$10,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,056.10
|
| Rate for Payer: HealthUtah PPO |
$11,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,288.86
|
| Rate for Payer: One Health Plan of WY PPO |
$11,405.24
|
| Rate for Payer: PacificSource Commercial |
$10,474.20
|
| Rate for Payer: PHCS PPO |
$11,056.10
|
| Rate for Payer: Three Rivers PPO |
$8,728.50
|
| Rate for Payer: United Healthcare Commercial |
$11,056.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,892.30
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$11,638.00
|
|
|
Service Code
|
HCPCS 25820 AS
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$11,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,405.24
|
| Rate for Payer: Beech Street Commercial |
$11,056.10
|
| Rate for Payer: Cash Price |
$8,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,288.86
|
| Rate for Payer: Cigna of WY Commercial |
$11,405.24
|
| Rate for Payer: First Choice Health Commercial |
$10,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,056.10
|
| Rate for Payer: HealthUtah PPO |
$11,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,288.86
|
| Rate for Payer: One Health Plan of WY PPO |
$11,405.24
|
| Rate for Payer: PacificSource Commercial |
$10,474.20
|
| Rate for Payer: PHCS PPO |
$11,056.10
|
| Rate for Payer: Three Rivers PPO |
$8,728.50
|
| Rate for Payer: United Healthcare Commercial |
$11,056.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,892.30
|
|
|
ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$11,638.00
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$11,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,405.24
|
| Rate for Payer: Aetna of WY Medicare |
$635.36
|
| Rate for Payer: Beech Street Commercial |
$11,056.10
|
| Rate for Payer: Cash Price |
$8,146.60
|
| Rate for Payer: Cash Price |
$8,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,288.86
|
| Rate for Payer: Cigna of WY Commercial |
$11,405.24
|
| Rate for Payer: First Choice Health Commercial |
$10,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,056.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.36
|
| Rate for Payer: HealthUtah PPO |
$11,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,288.86
|
| Rate for Payer: Multiplan Medicare/VA |
$540.06
|
| Rate for Payer: One Health Plan of WY PPO |
$11,405.24
|
| Rate for Payer: PacificSource Commercial |
$10,474.20
|
| Rate for Payer: PHCS PPO |
$11,056.10
|
| Rate for Payer: Three Rivers PPO |
$8,728.50
|
| Rate for Payer: TriWest Veterans Administration |
$635.36
|
| Rate for Payer: United Healthcare Commercial |
$11,056.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,892.30
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 25810
|
| Min. Negotiated Rate |
$716.69 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$843.17
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.17
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$716.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.17
|
| Rate for Payer: United Healthcare Commercial |
$3,301.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$9,589.00
|
|
|
Service Code
|
HCPCS 25810 LT
|
| Min. Negotiated Rate |
$7,191.75 |
| Max. Negotiated Rate |
$9,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,397.22
|
| Rate for Payer: Beech Street Commercial |
$9,109.55
|
| Rate for Payer: Cash Price |
$6,712.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,301.33
|
| Rate for Payer: Cigna of WY Commercial |
$9,397.22
|
| Rate for Payer: First Choice Health Commercial |
$8,630.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,109.55
|
| Rate for Payer: HealthUtah PPO |
$9,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,301.33
|
| Rate for Payer: One Health Plan of WY PPO |
$9,397.22
|
| Rate for Payer: PacificSource Commercial |
$8,630.10
|
| Rate for Payer: PHCS PPO |
$9,109.55
|
| Rate for Payer: Three Rivers PPO |
$7,191.75
|
| Rate for Payer: United Healthcare Commercial |
$9,109.55
|
| Rate for Payer: WINHealth Partners Commercial |
$8,150.65
|
|
|
ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 25810 AS
|
| Min. Negotiated Rate |
$716.69 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: United Healthcare Commercial |
$3,301.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
ARTHROGRAM TRAY
|
Facility
|
OP
|
$18.83
|
|
| Hospital Charge Code |
6550014A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$18.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.45
|
| Rate for Payer: Aetna of WY Medicare |
$12.43
|
| Rate for Payer: Altius Commercial |
$18.08
|
| Rate for Payer: Beech Street Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.27
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.27
|
| Rate for Payer: Cigna of WY Commercial |
$18.45
|
| Rate for Payer: Entrust Commercial |
$17.89
|
| Rate for Payer: First Choice Health Commercial |
$17.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.73
|
| Rate for Payer: HealthUtah PPO |
$18.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.27
|
| Rate for Payer: Multiplan Medicare/VA |
$10.20
|
| Rate for Payer: One Health Plan of WY PPO |
$18.45
|
| Rate for Payer: PacificSource Commercial |
$16.95
|
| Rate for Payer: PHCS PPO |
$18.45
|
| Rate for Payer: Three Rivers PPO |
$14.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.73
|
| Rate for Payer: United Healthcare Commercial |
$17.98
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WINHealth Partners Commercial |
$18.45
|
| Rate for Payer: Wise Provider Network Commercial |
$17.89
|
|
|
ARTHROGRAM TRAY
|
Facility
|
OP
|
$946.05
|
|
| Hospital Charge Code |
6550014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$512.29 |
| Max. Negotiated Rate |
$946.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$927.13
|
| Rate for Payer: Aetna of WY Medicare |
$624.39
|
| Rate for Payer: Altius Commercial |
$908.21
|
| Rate for Payer: Beech Street Commercial |
$927.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$917.67
|
| Rate for Payer: Cash Price |
$662.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$917.67
|
| Rate for Payer: Cigna of WY Commercial |
$927.13
|
| Rate for Payer: Entrust Commercial |
$898.75
|
| Rate for Payer: First Choice Health Commercial |
$898.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$898.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.25
|
| Rate for Payer: HealthUtah PPO |
$946.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$917.67
|
| Rate for Payer: Multiplan Medicare/VA |
$512.29
|
| Rate for Payer: One Health Plan of WY PPO |
$927.13
|
| Rate for Payer: PacificSource Commercial |
$851.44
|
| Rate for Payer: PHCS PPO |
$927.13
|
| Rate for Payer: Three Rivers PPO |
$709.54
|
| Rate for Payer: TriWest Veterans Administration |
$539.25
|
| Rate for Payer: United Healthcare Commercial |
$903.48
|
| Rate for Payer: United Healthcare Medicare |
$539.25
|
| Rate for Payer: WINHealth Partners Commercial |
$927.13
|
| Rate for Payer: Wise Provider Network Commercial |
$898.75
|
|
|
ARTHROGRAM TRAY
|
Facility
|
IP
|
$946.05
|
|
| Hospital Charge Code |
6550014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.24 |
| Max. Negotiated Rate |
$946.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$927.13
|
| Rate for Payer: Aetna of WY Medicare |
$605.47
|
| Rate for Payer: Altius Commercial |
$908.21
|
| Rate for Payer: Beech Street Commercial |
$927.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$917.67
|
| Rate for Payer: Cash Price |
$662.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$917.67
|
| Rate for Payer: Cigna of WY Commercial |
$927.13
|
| Rate for Payer: Entrust Commercial |
$898.75
|
| Rate for Payer: First Choice Health Commercial |
$898.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$898.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.09
|
| Rate for Payer: HealthUtah PPO |
$946.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$917.67
|
| Rate for Payer: Multiplan Medicare/VA |
$548.24
|
| Rate for Payer: One Health Plan of WY PPO |
$927.13
|
| Rate for Payer: PacificSource Commercial |
$851.44
|
| Rate for Payer: PHCS PPO |
$927.13
|
| Rate for Payer: Three Rivers PPO |
$709.54
|
| Rate for Payer: TriWest Veterans Administration |
$577.09
|
| Rate for Payer: United Healthcare Commercial |
$903.48
|
| Rate for Payer: United Healthcare Medicare |
$577.09
|
| Rate for Payer: WINHealth Partners Commercial |
$898.75
|
| Rate for Payer: Wise Provider Network Commercial |
$898.75
|
|
|
ARTHROGRAM TRAY
|
Facility
|
IP
|
$18.83
|
|
| Hospital Charge Code |
6550014A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$18.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.45
|
| Rate for Payer: Aetna of WY Medicare |
$12.05
|
| Rate for Payer: Altius Commercial |
$18.08
|
| Rate for Payer: Beech Street Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.27
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.27
|
| Rate for Payer: Cigna of WY Commercial |
$18.45
|
| Rate for Payer: Entrust Commercial |
$17.89
|
| Rate for Payer: First Choice Health Commercial |
$17.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.49
|
| Rate for Payer: HealthUtah PPO |
$18.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.27
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: One Health Plan of WY PPO |
$18.45
|
| Rate for Payer: PacificSource Commercial |
$16.95
|
| Rate for Payer: PHCS PPO |
$18.45
|
| Rate for Payer: Three Rivers PPO |
$14.12
|
| Rate for Payer: TriWest Veterans Administration |
$11.49
|
| Rate for Payer: United Healthcare Commercial |
$17.98
|
| Rate for Payer: United Healthcare Medicare |
$11.49
|
| Rate for Payer: WINHealth Partners Commercial |
$17.89
|
| Rate for Payer: Wise Provider Network Commercial |
$17.89
|
|
|
ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS G0289
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$1,880.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,842.40
|
| Rate for Payer: Aetna of WY Medicare |
$80.61
|
| Rate for Payer: Beech Street Commercial |
$1,786.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,823.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,842.40
|
| Rate for Payer: First Choice Health Commercial |
$1,692.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,786.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.61
|
| Rate for Payer: HealthUtah PPO |
$1,880.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,823.60
|
| Rate for Payer: Multiplan Medicare/VA |
$68.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,842.40
|
| Rate for Payer: PacificSource Commercial |
$1,692.00
|
| Rate for Payer: PHCS PPO |
$1,786.00
|
| Rate for Payer: Three Rivers PPO |
$1,410.00
|
| Rate for Payer: TriWest Veterans Administration |
$80.61
|
| Rate for Payer: United Healthcare Commercial |
$1,786.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,786.00
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 27702 AS
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,349.60
|
| Rate for Payer: Beech Street Commercial |
$8,094.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,264.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,349.60
|
| Rate for Payer: First Choice Health Commercial |
$7,668.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,094.00
|
| Rate for Payer: HealthUtah PPO |
$8,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,264.40
|
| Rate for Payer: One Health Plan of WY PPO |
$8,349.60
|
| Rate for Payer: PacificSource Commercial |
$7,668.00
|
| Rate for Payer: PHCS PPO |
$8,094.00
|
| Rate for Payer: Three Rivers PPO |
$6,390.00
|
| Rate for Payer: United Healthcare Commercial |
$8,094.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,242.00
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 27702 80
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,349.60
|
| Rate for Payer: Beech Street Commercial |
$8,094.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,264.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,349.60
|
| Rate for Payer: First Choice Health Commercial |
$7,668.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,094.00
|
| Rate for Payer: HealthUtah PPO |
$8,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,264.40
|
| Rate for Payer: One Health Plan of WY PPO |
$8,349.60
|
| Rate for Payer: PacificSource Commercial |
$7,668.00
|
| Rate for Payer: PHCS PPO |
$8,094.00
|
| Rate for Payer: Three Rivers PPO |
$6,390.00
|
| Rate for Payer: United Healthcare Commercial |
$8,094.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,242.00
|
|
|
ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 27702
|
| Min. Negotiated Rate |
$789.08 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,349.60
|
| Rate for Payer: Aetna of WY Medicare |
$928.33
|
| Rate for Payer: Beech Street Commercial |
$8,094.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,264.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,349.60
|
| Rate for Payer: First Choice Health Commercial |
$7,668.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.33
|
| Rate for Payer: HealthUtah PPO |
$8,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,264.40
|
| Rate for Payer: Multiplan Medicare/VA |
$789.08
|
| Rate for Payer: One Health Plan of WY PPO |
$8,349.60
|
| Rate for Payer: PacificSource Commercial |
$7,668.00
|
| Rate for Payer: PHCS PPO |
$8,094.00
|
| Rate for Payer: Three Rivers PPO |
$6,390.00
|
| Rate for Payer: TriWest Veterans Administration |
$928.33
|
| Rate for Payer: United Healthcare Commercial |
$8,094.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,242.00
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$3,849.00
|
|
|
Service Code
|
HCPCS 27442 AS
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$3,849.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,772.02
|
| Rate for Payer: Beech Street Commercial |
$3,656.55
|
| Rate for Payer: Cash Price |
$2,694.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,733.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,772.02
|
| Rate for Payer: First Choice Health Commercial |
$3,464.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,656.55
|
| Rate for Payer: HealthUtah PPO |
$3,849.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,733.53
|
| Rate for Payer: One Health Plan of WY PPO |
$3,772.02
|
| Rate for Payer: PacificSource Commercial |
$3,464.10
|
| Rate for Payer: PHCS PPO |
$3,656.55
|
| Rate for Payer: Three Rivers PPO |
$2,886.75
|
| Rate for Payer: United Healthcare Commercial |
$3,656.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,271.65
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$3,849.00
|
|
|
Service Code
|
HCPCS 27442
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$3,849.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,772.02
|
| Rate for Payer: Aetna of WY Medicare |
$840.46
|
| Rate for Payer: Beech Street Commercial |
$3,656.55
|
| Rate for Payer: Cash Price |
$2,694.30
|
| Rate for Payer: Cash Price |
$2,694.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,733.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,772.02
|
| Rate for Payer: First Choice Health Commercial |
$3,464.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,656.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$840.46
|
| Rate for Payer: HealthUtah PPO |
$3,849.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,733.53
|
| Rate for Payer: Multiplan Medicare/VA |
$714.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,772.02
|
| Rate for Payer: PacificSource Commercial |
$3,464.10
|
| Rate for Payer: PHCS PPO |
$3,656.55
|
| Rate for Payer: Three Rivers PPO |
$2,886.75
|
| Rate for Payer: TriWest Veterans Administration |
$840.46
|
| Rate for Payer: United Healthcare Commercial |
$3,656.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,271.65
|
|
|
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$3,849.00
|
|
|
Service Code
|
HCPCS 27442 80
|
| Min. Negotiated Rate |
$714.39 |
| Max. Negotiated Rate |
$3,849.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,772.02
|
| Rate for Payer: Beech Street Commercial |
$3,656.55
|
| Rate for Payer: Cash Price |
$2,694.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,733.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,772.02
|
| Rate for Payer: First Choice Health Commercial |
$3,464.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,656.55
|
| Rate for Payer: HealthUtah PPO |
$3,849.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,733.53
|
| Rate for Payer: One Health Plan of WY PPO |
$3,772.02
|
| Rate for Payer: PacificSource Commercial |
$3,464.10
|
| Rate for Payer: PHCS PPO |
$3,656.55
|
| Rate for Payer: Three Rivers PPO |
$2,886.75
|
| Rate for Payer: United Healthcare Commercial |
$3,656.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,271.65
|
|
