|
HC PRO ARTHROSCOPY KNEE DEB/SHAV AC
|
Professional
|
Both
|
$6,407.00
|
|
|
Service Code
|
HCPCS 29877 50
|
| Hospital Charge Code |
9832987701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$513.70 |
| Max. Negotiated Rate |
$6,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,278.86
|
| Rate for Payer: Aetna of WY Medicare |
$604.35
|
| Rate for Payer: Beech Street Commercial |
$6,086.65
|
| Rate for Payer: Cash Price |
$4,484.90
|
| Rate for Payer: Cash Price |
$4,484.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,214.79
|
| Rate for Payer: Cigna of WY Commercial |
$6,278.86
|
| Rate for Payer: First Choice Health Commercial |
$5,766.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,086.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.35
|
| Rate for Payer: HealthUtah PPO |
$6,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,214.79
|
| Rate for Payer: Multiplan Medicare/VA |
$513.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,278.86
|
| Rate for Payer: PacificSource Commercial |
$5,766.30
|
| Rate for Payer: PHCS PPO |
$6,086.65
|
| Rate for Payer: Three Rivers PPO |
$4,805.25
|
| Rate for Payer: TriWest Veterans Administration |
$604.35
|
| Rate for Payer: United Healthcare Commercial |
$5,574.09
|
| Rate for Payer: United Healthcare Medicare |
$604.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,445.95
|
|
|
HC PRO ARTHROSCOPY KNEE DEB/SHAV AC
|
Professional
|
Both
|
$3,203.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
9832987701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$513.70 |
| Max. Negotiated Rate |
$3,203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,138.94
|
| Rate for Payer: Aetna of WY Medicare |
$604.35
|
| Rate for Payer: Beech Street Commercial |
$3,042.85
|
| Rate for Payer: Cash Price |
$2,242.10
|
| Rate for Payer: Cash Price |
$2,242.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,106.91
|
| Rate for Payer: Cigna of WY Commercial |
$3,138.94
|
| Rate for Payer: First Choice Health Commercial |
$2,882.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,042.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.35
|
| Rate for Payer: HealthUtah PPO |
$3,203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,106.91
|
| Rate for Payer: Multiplan Medicare/VA |
$513.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,138.94
|
| Rate for Payer: PacificSource Commercial |
$2,882.70
|
| Rate for Payer: PHCS PPO |
$3,042.85
|
| Rate for Payer: Three Rivers PPO |
$2,402.25
|
| Rate for Payer: TriWest Veterans Administration |
$604.35
|
| Rate for Payer: United Healthcare Commercial |
$2,786.61
|
| Rate for Payer: United Healthcare Medicare |
$604.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,722.55
|
|
|
HC PRO ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX
|
Professional
|
Both
|
$4,228.00
|
|
|
Service Code
|
HCPCS 29870 50
|
| Hospital Charge Code |
9832987001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$341.54 |
| Max. Negotiated Rate |
$4,228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,143.44
|
| Rate for Payer: Aetna of WY Medicare |
$401.81
|
| Rate for Payer: Beech Street Commercial |
$4,016.60
|
| Rate for Payer: Cash Price |
$2,959.60
|
| Rate for Payer: Cash Price |
$2,959.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,101.16
|
| Rate for Payer: Cigna of WY Commercial |
$4,143.44
|
| Rate for Payer: First Choice Health Commercial |
$3,805.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,016.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.81
|
| Rate for Payer: HealthUtah PPO |
$4,228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,101.16
|
| Rate for Payer: Multiplan Medicare/VA |
$341.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,143.44
|
| Rate for Payer: PacificSource Commercial |
$3,805.20
|
| Rate for Payer: PHCS PPO |
$4,016.60
|
| Rate for Payer: Three Rivers PPO |
$3,171.00
|
| Rate for Payer: TriWest Veterans Administration |
$401.81
|
| Rate for Payer: United Healthcare Commercial |
$3,678.36
|
| Rate for Payer: United Healthcare Medicare |
$401.81
|
| Rate for Payer: WINHealth Partners Commercial |
$3,593.80
|
|
|
HC PRO ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
9832987001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$341.54 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,071.72
|
| Rate for Payer: Aetna of WY Medicare |
$401.81
|
| Rate for Payer: Beech Street Commercial |
$2,008.30
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,050.58
|
| Rate for Payer: Cigna of WY Commercial |
$2,071.72
|
| Rate for Payer: First Choice Health Commercial |
$1,902.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,008.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.81
|
| Rate for Payer: HealthUtah PPO |
$2,114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,050.58
|
| Rate for Payer: Multiplan Medicare/VA |
$341.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,071.72
|
| Rate for Payer: PacificSource Commercial |
$1,902.60
|
| Rate for Payer: PHCS PPO |
$2,008.30
|
| Rate for Payer: Three Rivers PPO |
$1,585.50
|
| Rate for Payer: TriWest Veterans Administration |
$401.81
|
| Rate for Payer: United Healthcare Commercial |
$1,839.18
|
| Rate for Payer: United Healthcare Medicare |
$401.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,796.90
|
|
|
HC PRO ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE
|
Professional
|
Both
|
$2,649.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
9832987101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$427.72 |
| Max. Negotiated Rate |
$2,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,596.02
|
| Rate for Payer: Aetna of WY Medicare |
$503.20
|
| Rate for Payer: Beech Street Commercial |
$2,516.55
|
| Rate for Payer: Cash Price |
$1,854.30
|
| Rate for Payer: Cash Price |
$1,854.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,569.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,596.02
|
| Rate for Payer: First Choice Health Commercial |
$2,384.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,516.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$503.20
|
| Rate for Payer: HealthUtah PPO |
$2,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,569.53
|
| Rate for Payer: Multiplan Medicare/VA |
$427.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,596.02
|
| Rate for Payer: PacificSource Commercial |
$2,384.10
|
| Rate for Payer: PHCS PPO |
$2,516.55
|
| Rate for Payer: Three Rivers PPO |
$1,986.75
|
| Rate for Payer: TriWest Veterans Administration |
$503.20
|
| Rate for Payer: United Healthcare Commercial |
$2,304.63
|
| Rate for Payer: United Healthcare Medicare |
$503.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,251.65
|
|
|
HC PRO ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST
|
Professional
|
Both
|
$5,418.00
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
9832986601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$865.09 |
| Max. Negotiated Rate |
$5,418.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,309.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,017.75
|
| Rate for Payer: Beech Street Commercial |
$5,147.10
|
| Rate for Payer: Cash Price |
$3,792.60
|
| Rate for Payer: Cash Price |
$3,792.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,255.46
|
| Rate for Payer: Cigna of WY Commercial |
$5,309.64
|
| Rate for Payer: First Choice Health Commercial |
$4,876.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,147.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,017.75
|
| Rate for Payer: HealthUtah PPO |
$5,418.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,255.46
|
| Rate for Payer: Multiplan Medicare/VA |
$865.09
|
| Rate for Payer: One Health Plan of WY PPO |
$5,309.64
|
| Rate for Payer: PacificSource Commercial |
$4,876.20
|
| Rate for Payer: PHCS PPO |
$5,147.10
|
| Rate for Payer: Three Rivers PPO |
$4,063.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,017.75
|
| Rate for Payer: United Healthcare Commercial |
$4,713.66
|
| Rate for Payer: United Healthcare Medicare |
$1,017.75
|
| Rate for Payer: WINHealth Partners Commercial |
$4,605.30
|
|
|
HC PRO ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS
|
Professional
|
Both
|
$6,742.00
|
|
|
Service Code
|
HCPCS 29876 50
|
| Hospital Charge Code |
9832987601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$539.62 |
| Max. Negotiated Rate |
$6,742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,607.16
|
| Rate for Payer: Aetna of WY Medicare |
$634.85
|
| Rate for Payer: Beech Street Commercial |
$6,404.90
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: Cash Price |
$4,719.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,539.74
|
| Rate for Payer: Cigna of WY Commercial |
$6,607.16
|
| Rate for Payer: First Choice Health Commercial |
$6,067.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$634.85
|
| Rate for Payer: HealthUtah PPO |
$6,742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,539.74
|
| Rate for Payer: Multiplan Medicare/VA |
$539.62
|
| Rate for Payer: One Health Plan of WY PPO |
$6,607.16
|
| Rate for Payer: PacificSource Commercial |
$6,067.80
|
| Rate for Payer: PHCS PPO |
$6,404.90
|
| Rate for Payer: Three Rivers PPO |
$5,056.50
|
| Rate for Payer: TriWest Veterans Administration |
$634.85
|
| Rate for Payer: United Healthcare Commercial |
$5,865.54
|
| Rate for Payer: United Healthcare Medicare |
$634.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,730.70
|
|
|
HC PRO ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
9832987601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$539.62 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$634.85
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$634.85
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$539.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$634.85
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$634.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
HC PRO ARTHROSCOPY KNEE W/ REMOVAL FB
|
Professional
|
Both
|
$2,773.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
9832987401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$445.92 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,717.54
|
| Rate for Payer: Aetna of WY Medicare |
$524.61
|
| Rate for Payer: Beech Street Commercial |
$2,634.35
|
| Rate for Payer: Cash Price |
$1,941.10
|
| Rate for Payer: Cash Price |
$1,941.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,689.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,717.54
|
| Rate for Payer: First Choice Health Commercial |
$2,495.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,634.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.61
|
| Rate for Payer: HealthUtah PPO |
$2,773.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,689.81
|
| Rate for Payer: Multiplan Medicare/VA |
$445.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,717.54
|
| Rate for Payer: PacificSource Commercial |
$2,495.70
|
| Rate for Payer: PHCS PPO |
$2,634.35
|
| Rate for Payer: Three Rivers PPO |
$2,079.75
|
| Rate for Payer: TriWest Veterans Administration |
$524.61
|
| Rate for Payer: United Healthcare Commercial |
$2,412.51
|
| Rate for Payer: United Healthcare Medicare |
$524.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,357.05
|
|
|
HC PRO ARTHROSCOPY, SHOULDER DEBRIDEM
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
9832982201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,915.50
|
| Rate for Payer: Aetna of WY Medicare |
$528.31
|
| Rate for Payer: Beech Street Commercial |
$2,826.25
|
| Rate for Payer: Cash Price |
$2,082.50
|
| Rate for Payer: Cash Price |
$2,082.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,885.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,915.50
|
| Rate for Payer: First Choice Health Commercial |
$2,677.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,826.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.31
|
| Rate for Payer: HealthUtah PPO |
$2,975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,885.75
|
| Rate for Payer: Multiplan Medicare/VA |
$449.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,915.50
|
| Rate for Payer: PacificSource Commercial |
$2,677.50
|
| Rate for Payer: PHCS PPO |
$2,826.25
|
| Rate for Payer: Three Rivers PPO |
$2,231.25
|
| Rate for Payer: TriWest Veterans Administration |
$528.31
|
| Rate for Payer: United Healthcare Commercial |
$2,588.25
|
| Rate for Payer: United Healthcare Medicare |
$528.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.75
|
|
|
HC PRO ARTHROSCOPY, SHOULDER DEBRIDEM
|
Professional
|
Both
|
$3,237.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
9832982301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,172.26
|
| Rate for Payer: Aetna of WY Medicare |
$577.29
|
| Rate for Payer: Beech Street Commercial |
$3,075.15
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,139.89
|
| Rate for Payer: Cigna of WY Commercial |
$3,172.26
|
| Rate for Payer: First Choice Health Commercial |
$2,913.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,075.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.29
|
| Rate for Payer: HealthUtah PPO |
$3,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,139.89
|
| Rate for Payer: Multiplan Medicare/VA |
$490.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,172.26
|
| Rate for Payer: PacificSource Commercial |
$2,913.30
|
| Rate for Payer: PHCS PPO |
$3,075.15
|
| Rate for Payer: Three Rivers PPO |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration |
$577.29
|
| Rate for Payer: United Healthcare Commercial |
$2,816.19
|
| Rate for Payer: United Healthcare Medicare |
$577.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,751.45
|
|
|
HC PRO ARTHROSCOPY, SHOULDER, DECOMPR
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
9832982601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$162.04
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.04
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$137.73
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.04
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$162.04
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
HC PRO ARTHROSCOPY, SHOULDER DISTAL C
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
9832982401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$560.22 |
| Max. Negotiated Rate |
$3,482.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,412.36
|
| Rate for Payer: Aetna of WY Medicare |
$659.08
|
| Rate for Payer: Beech Street Commercial |
$3,307.90
|
| Rate for Payer: Cash Price |
$2,437.40
|
| Rate for Payer: Cash Price |
$2,437.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,377.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,412.36
|
| Rate for Payer: First Choice Health Commercial |
$3,133.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,307.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$659.08
|
| Rate for Payer: HealthUtah PPO |
$3,482.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,377.54
|
| Rate for Payer: Multiplan Medicare/VA |
$560.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,412.36
|
| Rate for Payer: PacificSource Commercial |
$3,133.80
|
| Rate for Payer: PHCS PPO |
$3,307.90
|
| Rate for Payer: Three Rivers PPO |
$2,611.50
|
| Rate for Payer: TriWest Veterans Administration |
$659.08
|
| Rate for Payer: United Healthcare Commercial |
$3,029.34
|
| Rate for Payer: United Healthcare Medicare |
$659.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,959.70
|
|
|
HC PRO ARTHROSCOPY, SHOULDER W/ BICEP
|
Professional
|
Both
|
$4,739.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
9832982801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$752.43 |
| Max. Negotiated Rate |
$4,739.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,644.22
|
| Rate for Payer: Aetna of WY Medicare |
$885.21
|
| Rate for Payer: Beech Street Commercial |
$4,502.05
|
| Rate for Payer: Cash Price |
$3,317.30
|
| Rate for Payer: Cash Price |
$3,317.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,596.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,644.22
|
| Rate for Payer: First Choice Health Commercial |
$4,265.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,502.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$885.21
|
| Rate for Payer: HealthUtah PPO |
$4,739.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,596.83
|
| Rate for Payer: Multiplan Medicare/VA |
$752.43
|
| Rate for Payer: One Health Plan of WY PPO |
$4,644.22
|
| Rate for Payer: PacificSource Commercial |
$4,265.10
|
| Rate for Payer: PHCS PPO |
$4,502.05
|
| Rate for Payer: Three Rivers PPO |
$3,554.25
|
| Rate for Payer: TriWest Veterans Administration |
$885.21
|
| Rate for Payer: United Healthcare Commercial |
$4,122.93
|
| Rate for Payer: United Healthcare Medicare |
$885.21
|
| Rate for Payer: WINHealth Partners Commercial |
$4,028.15
|
|
|
HC PRO ARTHROSCOPY, SHOULDER W/ ROTAT
|
Professional
|
Both
|
$5,522.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
9832982701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$875.58 |
| Max. Negotiated Rate |
$5,522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,411.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,030.09
|
| Rate for Payer: Beech Street Commercial |
$5,245.90
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,356.34
|
| Rate for Payer: Cigna of WY Commercial |
$5,411.56
|
| Rate for Payer: First Choice Health Commercial |
$4,969.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,245.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.09
|
| Rate for Payer: HealthUtah PPO |
$5,522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,356.34
|
| Rate for Payer: Multiplan Medicare/VA |
$875.58
|
| Rate for Payer: One Health Plan of WY PPO |
$5,411.56
|
| Rate for Payer: PacificSource Commercial |
$4,969.80
|
| Rate for Payer: PHCS PPO |
$5,245.90
|
| Rate for Payer: Three Rivers PPO |
$4,141.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.09
|
| Rate for Payer: United Healthcare Commercial |
$4,804.14
|
| Rate for Payer: United Healthcare Medicare |
$1,030.09
|
| Rate for Payer: WINHealth Partners Commercial |
$4,693.70
|
|
|
HC PRO ARTHROSCOPY WITH MENISCUS REPAIR
|
Professional
|
Both
|
$3,576.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
9832988201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$568.19 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,504.48
|
| Rate for Payer: Aetna of WY Medicare |
$668.46
|
| Rate for Payer: Beech Street Commercial |
$3,397.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,468.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,504.48
|
| Rate for Payer: First Choice Health Commercial |
$3,218.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,397.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$668.46
|
| Rate for Payer: HealthUtah PPO |
$3,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,468.72
|
| Rate for Payer: Multiplan Medicare/VA |
$568.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,504.48
|
| Rate for Payer: PacificSource Commercial |
$3,218.40
|
| Rate for Payer: PHCS PPO |
$3,397.20
|
| Rate for Payer: Three Rivers PPO |
$2,682.00
|
| Rate for Payer: TriWest Veterans Administration |
$668.46
|
| Rate for Payer: United Healthcare Commercial |
$3,111.12
|
| Rate for Payer: United Healthcare Medicare |
$668.46
|
| Rate for Payer: WINHealth Partners Commercial |
$3,039.60
|
|
|
HC PRO ARTHROSCOPY W/ MENISCECTOMY MEDIAL
|
Professional
|
Both
|
$2,897.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
9832988001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$465.74 |
| Max. Negotiated Rate |
$2,897.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,839.06
|
| Rate for Payer: Aetna of WY Medicare |
$547.93
|
| Rate for Payer: Beech Street Commercial |
$2,752.15
|
| Rate for Payer: Cash Price |
$2,027.90
|
| Rate for Payer: Cash Price |
$2,027.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,810.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,839.06
|
| Rate for Payer: First Choice Health Commercial |
$2,607.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,752.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$547.93
|
| Rate for Payer: HealthUtah PPO |
$2,897.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,810.09
|
| Rate for Payer: Multiplan Medicare/VA |
$465.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,839.06
|
| Rate for Payer: PacificSource Commercial |
$2,607.30
|
| Rate for Payer: PHCS PPO |
$2,752.15
|
| Rate for Payer: Three Rivers PPO |
$2,172.75
|
| Rate for Payer: TriWest Veterans Administration |
$547.93
|
| Rate for Payer: United Healthcare Commercial |
$2,520.39
|
| Rate for Payer: United Healthcare Medicare |
$547.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,462.45
|
|
|
HC PRO ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE
|
Professional
|
Both
|
$3,174.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
9822510701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$516.13 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,110.52
|
| Rate for Payer: Aetna of WY Medicare |
$607.21
|
| Rate for Payer: Beech Street Commercial |
$3,015.30
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,078.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,110.52
|
| Rate for Payer: First Choice Health Commercial |
$2,856.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,015.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.21
|
| Rate for Payer: HealthUtah PPO |
$3,174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,078.78
|
| Rate for Payer: Multiplan Medicare/VA |
$516.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3,110.52
|
| Rate for Payer: PacificSource Commercial |
$2,856.60
|
| Rate for Payer: PHCS PPO |
$3,015.30
|
| Rate for Payer: Three Rivers PPO |
$2,380.50
|
| Rate for Payer: TriWest Veterans Administration |
$607.21
|
| Rate for Payer: United Healthcare Commercial |
$2,761.38
|
| Rate for Payer: United Healthcare Medicare |
$607.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2,697.90
|
|
|
HC PRO ARTHROTOMY ELBOW W/SYNOVECTOMY
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
9832410201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$512.75 |
| Max. Negotiated Rate |
$2,153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,109.94
|
| Rate for Payer: Aetna of WY Medicare |
$603.23
|
| Rate for Payer: Beech Street Commercial |
$2,045.35
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,088.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,109.94
|
| Rate for Payer: First Choice Health Commercial |
$1,937.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,045.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.23
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$512.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,109.94
|
| Rate for Payer: PacificSource Commercial |
$1,937.70
|
| Rate for Payer: PHCS PPO |
$2,045.35
|
| Rate for Payer: Three Rivers PPO |
$1,614.75
|
| Rate for Payer: TriWest Veterans Administration |
$603.23
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$603.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
|
HC PRO ARTHROTOMY GLENOHUMERAL JT W/JT EXPLORE
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 23107 NONPBBPAYER
|
| Hospital Charge Code |
9832310701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$551.09 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,312.40
|
| Rate for Payer: Aetna of WY Medicare |
$648.34
|
| Rate for Payer: Beech Street Commercial |
$3,211.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,278.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,312.40
|
| Rate for Payer: First Choice Health Commercial |
$3,042.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$648.34
|
| Rate for Payer: HealthUtah PPO |
$3,380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,278.60
|
| Rate for Payer: Multiplan Medicare/VA |
$551.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3,312.40
|
| Rate for Payer: PacificSource Commercial |
$3,042.00
|
| Rate for Payer: PHCS PPO |
$3,211.00
|
| Rate for Payer: Three Rivers PPO |
$2,535.00
|
| Rate for Payer: TriWest Veterans Administration |
$648.34
|
| Rate for Payer: United Healthcare Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare Medicare |
$648.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,873.00
|
|
|
HC PRO ARTHROTOMY GLENOHUMERAL JT W/JT EXPLORE
|
Professional
|
Both
|
$2,704.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
9832310701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$551.09 |
| Max. Negotiated Rate |
$2,704.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,649.92
|
| Rate for Payer: Aetna of WY Medicare |
$648.34
|
| Rate for Payer: Beech Street Commercial |
$2,568.80
|
| Rate for Payer: Cash Price |
$1,892.80
|
| Rate for Payer: Cash Price |
$1,892.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,622.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,649.92
|
| Rate for Payer: First Choice Health Commercial |
$2,433.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$648.34
|
| Rate for Payer: HealthUtah PPO |
$2,704.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,622.88
|
| Rate for Payer: Multiplan Medicare/VA |
$551.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,649.92
|
| Rate for Payer: PacificSource Commercial |
$2,433.60
|
| Rate for Payer: PHCS PPO |
$2,568.80
|
| Rate for Payer: Three Rivers PPO |
$2,028.00
|
| Rate for Payer: TriWest Veterans Administration |
$648.34
|
| Rate for Payer: United Healthcare Commercial |
$2,352.48
|
| Rate for Payer: United Healthcare Medicare |
$648.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,298.40
|
|
|
HC PRO ARTHROTOMY HIP W/DRAINAGE
|
Professional
|
Both
|
$4,844.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
9752703001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$767.40 |
| Max. Negotiated Rate |
$4,844.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,747.12
|
| Rate for Payer: Aetna of WY Medicare |
$902.82
|
| Rate for Payer: Beech Street Commercial |
$4,601.80
|
| Rate for Payer: Cash Price |
$3,390.80
|
| Rate for Payer: Cash Price |
$3,390.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,698.68
|
| Rate for Payer: Cigna of WY Commercial |
$4,747.12
|
| Rate for Payer: First Choice Health Commercial |
$4,359.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,601.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$902.82
|
| Rate for Payer: HealthUtah PPO |
$4,844.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,698.68
|
| Rate for Payer: Multiplan Medicare/VA |
$767.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,747.12
|
| Rate for Payer: PacificSource Commercial |
$4,359.60
|
| Rate for Payer: PHCS PPO |
$4,601.80
|
| Rate for Payer: Three Rivers PPO |
$3,633.00
|
| Rate for Payer: TriWest Veterans Administration |
$902.82
|
| Rate for Payer: United Healthcare Commercial |
$4,214.28
|
| Rate for Payer: United Healthcare Medicare |
$902.82
|
| Rate for Payer: WINHealth Partners Commercial |
$4,117.40
|
|
|
HC PRO ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$6,998.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
9832713001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,045.90 |
| Max. Negotiated Rate |
$6,998.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,858.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.47
|
| Rate for Payer: Beech Street Commercial |
$6,648.10
|
| Rate for Payer: Cash Price |
$4,898.60
|
| Rate for Payer: Cash Price |
$4,898.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,788.06
|
| Rate for Payer: Cigna of WY Commercial |
$6,858.04
|
| Rate for Payer: First Choice Health Commercial |
$6,298.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,648.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.47
|
| Rate for Payer: HealthUtah PPO |
$6,998.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,788.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,045.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,858.04
|
| Rate for Payer: PacificSource Commercial |
$6,298.20
|
| Rate for Payer: PHCS PPO |
$6,648.10
|
| Rate for Payer: Three Rivers PPO |
$5,248.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.47
|
| Rate for Payer: United Healthcare Commercial |
$6,088.26
|
| Rate for Payer: United Healthcare Medicare |
$1,230.47
|
| Rate for Payer: WINHealth Partners Commercial |
$5,948.30
|
|
|
HC PRO ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM
|
Professional
|
Both
|
$4,963.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
9822436301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,182.18 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,390.80
|
| Rate for Payer: Beech Street Commercial |
$4,714.85
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: First Choice Health Commercial |
$4,466.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,390.80
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,182.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PHCS PPO |
$4,714.85
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,390.80
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$1,390.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,218.55
|
|
|
HC PRO ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
9832544701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$6,653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,519.94
|
| Rate for Payer: Aetna of WY Medicare |
$811.05
|
| Rate for Payer: Beech Street Commercial |
$6,320.35
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: Cash Price |
$4,657.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,453.41
|
| Rate for Payer: Cigna of WY Commercial |
$6,519.94
|
| Rate for Payer: First Choice Health Commercial |
$5,987.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,320.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.05
|
| Rate for Payer: HealthUtah PPO |
$6,653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,453.41
|
| Rate for Payer: Multiplan Medicare/VA |
$689.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,519.94
|
| Rate for Payer: PacificSource Commercial |
$5,987.70
|
| Rate for Payer: PHCS PPO |
$6,320.35
|
| Rate for Payer: Three Rivers PPO |
$4,989.75
|
| Rate for Payer: TriWest Veterans Administration |
$811.05
|
| Rate for Payer: United Healthcare Commercial |
$5,788.11
|
| Rate for Payer: United Healthcare Medicare |
$811.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,655.05
|
|
