|
ARTHROTOMY W/MENISCUS REPAIR KNEE
|
Professional
|
Both
|
$5,106.00
|
|
|
Service Code
|
HCPCS 27403
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$5,106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,003.88
|
| Rate for Payer: Aetna of WY Medicare |
$629.36
|
| Rate for Payer: Beech Street Commercial |
$4,850.70
|
| Rate for Payer: Cash Price |
$3,574.20
|
| Rate for Payer: Cash Price |
$3,574.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,952.82
|
| Rate for Payer: Cigna of WY Commercial |
$5,003.88
|
| Rate for Payer: First Choice Health Commercial |
$4,595.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,850.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.36
|
| Rate for Payer: HealthUtah PPO |
$5,106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,952.82
|
| Rate for Payer: Multiplan Medicare/VA |
$534.96
|
| Rate for Payer: One Health Plan of WY PPO |
$5,003.88
|
| Rate for Payer: PacificSource Commercial |
$4,595.40
|
| Rate for Payer: PHCS PPO |
$4,850.70
|
| Rate for Payer: Three Rivers PPO |
$3,829.50
|
| Rate for Payer: TriWest Veterans Administration |
$629.36
|
| Rate for Payer: United Healthcare Commercial |
$4,850.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,340.10
|
|
|
ARTHROTOMY W/MENISCUS REPAIR KNEE
|
Professional
|
Both
|
$5,106.00
|
|
|
Service Code
|
HCPCS 27403 AS
|
| Min. Negotiated Rate |
$534.96 |
| Max. Negotiated Rate |
$5,106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,003.88
|
| Rate for Payer: Beech Street Commercial |
$4,850.70
|
| Rate for Payer: Cash Price |
$3,574.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,952.82
|
| Rate for Payer: Cigna of WY Commercial |
$5,003.88
|
| Rate for Payer: First Choice Health Commercial |
$4,595.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,850.70
|
| Rate for Payer: HealthUtah PPO |
$5,106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,952.82
|
| Rate for Payer: One Health Plan of WY PPO |
$5,003.88
|
| Rate for Payer: PacificSource Commercial |
$4,595.40
|
| Rate for Payer: PHCS PPO |
$4,850.70
|
| Rate for Payer: Three Rivers PPO |
$3,829.50
|
| Rate for Payer: United Healthcare Commercial |
$4,850.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,340.10
|
|
|
ARTHROTOMY W/MENISCUS REPAIR KNEE
|
Professional
|
Both
|
$1,022.00
|
|
|
Service Code
|
HCPCS 27403 80
|
| Min. Negotiated Rate |
$766.50 |
| Max. Negotiated Rate |
$1,022.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,001.56
|
| Rate for Payer: Beech Street Commercial |
$970.90
|
| Rate for Payer: Cash Price |
$715.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$991.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,001.56
|
| Rate for Payer: First Choice Health Commercial |
$919.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$970.90
|
| Rate for Payer: HealthUtah PPO |
$1,022.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$991.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,001.56
|
| Rate for Payer: PacificSource Commercial |
$919.80
|
| Rate for Payer: PHCS PPO |
$970.90
|
| Rate for Payer: Three Rivers PPO |
$766.50
|
| Rate for Payer: United Healthcare Commercial |
$970.90
|
| Rate for Payer: WINHealth Partners Commercial |
$868.70
|
|
|
ARTHROTOMY WRIST JOINT WITH BIOPSY
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
HCPCS 25100
|
| Min. Negotiated Rate |
$294.36 |
| Max. Negotiated Rate |
$1,532.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,501.36
|
| Rate for Payer: Aetna of WY Medicare |
$346.30
|
| Rate for Payer: Beech Street Commercial |
$1,455.40
|
| Rate for Payer: Cash Price |
$1,072.40
|
| Rate for Payer: Cash Price |
$1,072.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,486.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,501.36
|
| Rate for Payer: First Choice Health Commercial |
$1,378.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,455.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.30
|
| Rate for Payer: HealthUtah PPO |
$1,532.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,486.04
|
| Rate for Payer: Multiplan Medicare/VA |
$294.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,501.36
|
| Rate for Payer: PacificSource Commercial |
$1,378.80
|
| Rate for Payer: PHCS PPO |
$1,455.40
|
| Rate for Payer: Three Rivers PPO |
$1,149.00
|
| Rate for Payer: TriWest Veterans Administration |
$346.30
|
| Rate for Payer: United Healthcare Commercial |
$1,455.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,302.20
|
|
|
ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 25105 AS
|
| Min. Negotiated Rate |
$407.67 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,097.20
|
| Rate for Payer: Beech Street Commercial |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,075.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,097.20
|
| Rate for Payer: First Choice Health Commercial |
$1,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.00
|
| Rate for Payer: HealthUtah PPO |
$2,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,075.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,097.20
|
| Rate for Payer: PacificSource Commercial |
$1,926.00
|
| Rate for Payer: PHCS PPO |
$2,033.00
|
| Rate for Payer: Three Rivers PPO |
$1,605.00
|
| Rate for Payer: United Healthcare Commercial |
$2,033.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.00
|
|
|
ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 25105
|
| Min. Negotiated Rate |
$407.67 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,097.20
|
| Rate for Payer: Aetna of WY Medicare |
$479.61
|
| Rate for Payer: Beech Street Commercial |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,075.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,097.20
|
| Rate for Payer: First Choice Health Commercial |
$1,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$479.61
|
| Rate for Payer: HealthUtah PPO |
$2,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,075.80
|
| Rate for Payer: Multiplan Medicare/VA |
$407.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,097.20
|
| Rate for Payer: PacificSource Commercial |
$1,926.00
|
| Rate for Payer: PHCS PPO |
$2,033.00
|
| Rate for Payer: Three Rivers PPO |
$1,605.00
|
| Rate for Payer: TriWest Veterans Administration |
$479.61
|
| Rate for Payer: United Healthcare Commercial |
$2,033.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.00
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 27626 AS
|
| Min. Negotiated Rate |
$800.25 |
| Max. Negotiated Rate |
$1,067.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,045.66
|
| Rate for Payer: Beech Street Commercial |
$1,013.65
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,034.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,045.66
|
| Rate for Payer: First Choice Health Commercial |
$960.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,013.65
|
| Rate for Payer: HealthUtah PPO |
$1,067.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,034.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,045.66
|
| Rate for Payer: PacificSource Commercial |
$960.30
|
| Rate for Payer: PHCS PPO |
$1,013.65
|
| Rate for Payer: Three Rivers PPO |
$800.25
|
| Rate for Payer: United Healthcare Commercial |
$1,013.65
|
| Rate for Payer: WINHealth Partners Commercial |
$906.95
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 27626 80
|
| Min. Negotiated Rate |
$849.00 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,109.36
|
| Rate for Payer: Beech Street Commercial |
$1,075.40
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,098.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,109.36
|
| Rate for Payer: First Choice Health Commercial |
$1,018.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,075.40
|
| Rate for Payer: HealthUtah PPO |
$1,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,098.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,109.36
|
| Rate for Payer: PacificSource Commercial |
$1,018.80
|
| Rate for Payer: PHCS PPO |
$1,075.40
|
| Rate for Payer: Three Rivers PPO |
$849.00
|
| Rate for Payer: United Healthcare Commercial |
$1,075.40
|
| Rate for Payer: WINHealth Partners Commercial |
$962.20
|
|
|
ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 27334
|
| Min. Negotiated Rate |
$568.40 |
| Max. Negotiated Rate |
$7,196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,052.08
|
| Rate for Payer: Aetna of WY Medicare |
$668.70
|
| Rate for Payer: Beech Street Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$5,037.20
|
| Rate for Payer: Cash Price |
$5,037.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,980.12
|
| Rate for Payer: Cigna of WY Commercial |
$7,052.08
|
| Rate for Payer: First Choice Health Commercial |
$6,476.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,836.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$668.70
|
| Rate for Payer: HealthUtah PPO |
$7,196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,980.12
|
| Rate for Payer: Multiplan Medicare/VA |
$568.40
|
| Rate for Payer: One Health Plan of WY PPO |
$7,052.08
|
| Rate for Payer: PacificSource Commercial |
$6,476.40
|
| Rate for Payer: PHCS PPO |
$6,836.20
|
| Rate for Payer: Three Rivers PPO |
$5,397.00
|
| Rate for Payer: TriWest Veterans Administration |
$668.70
|
| Rate for Payer: United Healthcare Commercial |
$6,836.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,116.60
|
|
|
ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 27334 AS
|
| Min. Negotiated Rate |
$568.40 |
| Max. Negotiated Rate |
$7,196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,052.08
|
| Rate for Payer: Beech Street Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$5,037.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,980.12
|
| Rate for Payer: Cigna of WY Commercial |
$7,052.08
|
| Rate for Payer: First Choice Health Commercial |
$6,476.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,836.20
|
| Rate for Payer: HealthUtah PPO |
$7,196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,980.12
|
| Rate for Payer: One Health Plan of WY PPO |
$7,052.08
|
| Rate for Payer: PacificSource Commercial |
$6,476.40
|
| Rate for Payer: PHCS PPO |
$6,836.20
|
| Rate for Payer: Three Rivers PPO |
$5,397.00
|
| Rate for Payer: United Healthcare Commercial |
$6,836.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,116.60
|
|
|
ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 27334 80
|
| Min. Negotiated Rate |
$568.40 |
| Max. Negotiated Rate |
$7,196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,052.08
|
| Rate for Payer: Beech Street Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$5,037.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,980.12
|
| Rate for Payer: Cigna of WY Commercial |
$7,052.08
|
| Rate for Payer: First Choice Health Commercial |
$6,476.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,836.20
|
| Rate for Payer: HealthUtah PPO |
$7,196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,980.12
|
| Rate for Payer: One Health Plan of WY PPO |
$7,052.08
|
| Rate for Payer: PacificSource Commercial |
$6,476.40
|
| Rate for Payer: PHCS PPO |
$6,836.20
|
| Rate for Payer: Three Rivers PPO |
$5,397.00
|
| Rate for Payer: United Healthcare Commercial |
$6,836.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,116.60
|
|
|
ARTHROTUNNELER TORNIER
|
Facility
|
IP
|
$2,257.50
|
|
| Hospital Charge Code |
3000949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.22 |
| Max. Negotiated Rate |
$2,257.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,212.35
|
| Rate for Payer: Aetna of WY Medicare |
$1,444.80
|
| Rate for Payer: Altius Commercial |
$2,167.20
|
| Rate for Payer: Beech Street Commercial |
$2,212.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,189.78
|
| Rate for Payer: Cash Price |
$1,580.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,189.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,212.35
|
| Rate for Payer: Entrust Commercial |
$2,144.62
|
| Rate for Payer: First Choice Health Commercial |
$2,144.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,144.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,377.08
|
| Rate for Payer: HealthUtah PPO |
$2,257.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,189.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1,308.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,212.35
|
| Rate for Payer: PacificSource Commercial |
$2,031.75
|
| Rate for Payer: PHCS PPO |
$2,212.35
|
| Rate for Payer: Three Rivers PPO |
$1,693.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,377.08
|
| Rate for Payer: United Healthcare Commercial |
$2,155.91
|
| Rate for Payer: United Healthcare Medicare |
$1,377.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,144.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,144.62
|
|
|
ARTHROTUNNELER TORNIER
|
Facility
|
OP
|
$2,257.50
|
|
| Hospital Charge Code |
3000949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.44 |
| Max. Negotiated Rate |
$2,257.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,212.35
|
| Rate for Payer: Aetna of WY Medicare |
$1,489.95
|
| Rate for Payer: Altius Commercial |
$2,167.20
|
| Rate for Payer: Beech Street Commercial |
$2,212.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,189.78
|
| Rate for Payer: Cash Price |
$1,580.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,189.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,212.35
|
| Rate for Payer: Entrust Commercial |
$2,144.62
|
| Rate for Payer: First Choice Health Commercial |
$2,144.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,144.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,286.78
|
| Rate for Payer: HealthUtah PPO |
$2,257.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,189.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1,222.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,212.35
|
| Rate for Payer: PacificSource Commercial |
$2,031.75
|
| Rate for Payer: PHCS PPO |
$2,212.35
|
| Rate for Payer: Three Rivers PPO |
$1,693.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,286.78
|
| Rate for Payer: United Healthcare Commercial |
$2,155.91
|
| Rate for Payer: United Healthcare Medicare |
$1,286.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2,212.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2,144.62
|
|
|
ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$5,981.00
|
|
|
Service Code
|
HCPCS 27130 80
|
| Min. Negotiated Rate |
$1,045.90 |
| Max. Negotiated Rate |
$5,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,861.38
|
| Rate for Payer: Beech Street Commercial |
$5,681.95
|
| Rate for Payer: Cash Price |
$4,186.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,801.57
|
| Rate for Payer: Cigna of WY Commercial |
$5,861.38
|
| Rate for Payer: First Choice Health Commercial |
$5,382.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.95
|
| Rate for Payer: HealthUtah PPO |
$5,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,801.57
|
| Rate for Payer: One Health Plan of WY PPO |
$5,861.38
|
| Rate for Payer: PacificSource Commercial |
$5,382.90
|
| Rate for Payer: PHCS PPO |
$5,681.95
|
| Rate for Payer: Three Rivers PPO |
$4,485.75
|
| Rate for Payer: United Healthcare Commercial |
$5,681.95
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.85
|
|
|
ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$5,981.00
|
|
|
Service Code
|
HCPCS 27130 AS
|
| Min. Negotiated Rate |
$1,045.90 |
| Max. Negotiated Rate |
$5,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,861.38
|
| Rate for Payer: Beech Street Commercial |
$5,681.95
|
| Rate for Payer: Cash Price |
$4,186.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,801.57
|
| Rate for Payer: Cigna of WY Commercial |
$5,861.38
|
| Rate for Payer: First Choice Health Commercial |
$5,382.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.95
|
| Rate for Payer: HealthUtah PPO |
$5,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,801.57
|
| Rate for Payer: One Health Plan of WY PPO |
$5,861.38
|
| Rate for Payer: PacificSource Commercial |
$5,382.90
|
| Rate for Payer: PHCS PPO |
$5,681.95
|
| Rate for Payer: Three Rivers PPO |
$4,485.75
|
| Rate for Payer: United Healthcare Commercial |
$5,681.95
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.85
|
|
|
ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT
|
Professional
|
Both
|
$5,981.00
|
|
|
Service Code
|
HCPCS 27130
|
| Min. Negotiated Rate |
$1,045.90 |
| Max. Negotiated Rate |
$5,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,861.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.47
|
| Rate for Payer: Beech Street Commercial |
$5,681.95
|
| Rate for Payer: Cash Price |
$4,186.70
|
| Rate for Payer: Cash Price |
$4,186.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,801.57
|
| Rate for Payer: Cigna of WY Commercial |
$5,861.38
|
| Rate for Payer: First Choice Health Commercial |
$5,382.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,681.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.47
|
| Rate for Payer: HealthUtah PPO |
$5,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,801.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,045.90
|
| Rate for Payer: One Health Plan of WY PPO |
$5,861.38
|
| Rate for Payer: PacificSource Commercial |
$5,382.90
|
| Rate for Payer: PHCS PPO |
$5,681.95
|
| Rate for Payer: Three Rivers PPO |
$4,485.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.47
|
| Rate for Payer: United Healthcare Commercial |
$5,681.95
|
| Rate for Payer: WINHealth Partners Commercial |
$5,083.85
|
|
|
ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM
|
Professional
|
Both
|
$9,631.00
|
|
|
Service Code
|
HCPCS 24363
|
| Min. Negotiated Rate |
$1,182.18 |
| Max. Negotiated Rate |
$9,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,438.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,390.80
|
| Rate for Payer: Beech Street Commercial |
$9,149.45
|
| Rate for Payer: Cash Price |
$6,741.70
|
| Rate for Payer: Cash Price |
$6,741.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,342.07
|
| Rate for Payer: Cigna of WY Commercial |
$9,438.38
|
| Rate for Payer: First Choice Health Commercial |
$8,667.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,149.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,390.80
|
| Rate for Payer: HealthUtah PPO |
$9,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,342.07
|
| Rate for Payer: Multiplan Medicare/VA |
$1,182.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,438.38
|
| Rate for Payer: PacificSource Commercial |
$8,667.90
|
| Rate for Payer: PHCS PPO |
$9,149.45
|
| Rate for Payer: Three Rivers PPO |
$7,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,390.80
|
| Rate for Payer: United Healthcare Commercial |
$9,149.45
|
| Rate for Payer: WINHealth Partners Commercial |
$8,186.35
|
|
|
ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM
|
Professional
|
Both
|
$1,835.00
|
|
|
Service Code
|
HCPCS 24363 80
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$1,835.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,798.30
|
| Rate for Payer: Beech Street Commercial |
$1,743.25
|
| Rate for Payer: Cash Price |
$1,284.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,779.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,798.30
|
| Rate for Payer: First Choice Health Commercial |
$1,651.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,743.25
|
| Rate for Payer: HealthUtah PPO |
$1,835.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,779.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,798.30
|
| Rate for Payer: PacificSource Commercial |
$1,651.50
|
| Rate for Payer: PHCS PPO |
$1,743.25
|
| Rate for Payer: Three Rivers PPO |
$1,376.25
|
| Rate for Payer: United Healthcare Commercial |
$1,743.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,559.75
|
|
|
ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS
|
Professional
|
Both
|
$5,686.00
|
|
|
Service Code
|
HCPCS 25447
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$5,686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,572.28
|
| Rate for Payer: Aetna of WY Medicare |
$811.05
|
| Rate for Payer: Beech Street Commercial |
$5,401.70
|
| Rate for Payer: Cash Price |
$3,980.20
|
| Rate for Payer: Cash Price |
$3,980.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,515.42
|
| Rate for Payer: Cigna of WY Commercial |
$5,572.28
|
| Rate for Payer: First Choice Health Commercial |
$5,117.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,401.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.05
|
| Rate for Payer: HealthUtah PPO |
$5,686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,515.42
|
| Rate for Payer: Multiplan Medicare/VA |
$689.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,572.28
|
| Rate for Payer: PacificSource Commercial |
$5,117.40
|
| Rate for Payer: PHCS PPO |
$5,401.70
|
| Rate for Payer: Three Rivers PPO |
$4,264.50
|
| Rate for Payer: TriWest Veterans Administration |
$811.05
|
| Rate for Payer: United Healthcare Commercial |
$5,401.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,833.10
|
|
|
ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS
|
Professional
|
Both
|
$5,686.00
|
|
|
Service Code
|
HCPCS 25447 80
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$5,686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,572.28
|
| Rate for Payer: Beech Street Commercial |
$5,401.70
|
| Rate for Payer: Cash Price |
$3,980.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,515.42
|
| Rate for Payer: Cigna of WY Commercial |
$5,572.28
|
| Rate for Payer: First Choice Health Commercial |
$5,117.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,401.70
|
| Rate for Payer: HealthUtah PPO |
$5,686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,515.42
|
| Rate for Payer: One Health Plan of WY PPO |
$5,572.28
|
| Rate for Payer: PacificSource Commercial |
$5,117.40
|
| Rate for Payer: PHCS PPO |
$5,401.70
|
| Rate for Payer: Three Rivers PPO |
$4,264.50
|
| Rate for Payer: United Healthcare Commercial |
$5,401.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,833.10
|
|
|
ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS
|
Professional
|
Both
|
$5,686.00
|
|
|
Service Code
|
HCPCS 25447 AS
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$5,686.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,572.28
|
| Rate for Payer: Beech Street Commercial |
$5,401.70
|
| Rate for Payer: Cash Price |
$3,980.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,515.42
|
| Rate for Payer: Cigna of WY Commercial |
$5,572.28
|
| Rate for Payer: First Choice Health Commercial |
$5,117.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,401.70
|
| Rate for Payer: HealthUtah PPO |
$5,686.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,515.42
|
| Rate for Payer: One Health Plan of WY PPO |
$5,572.28
|
| Rate for Payer: PacificSource Commercial |
$5,117.40
|
| Rate for Payer: PHCS PPO |
$5,401.70
|
| Rate for Payer: Three Rivers PPO |
$4,264.50
|
| Rate for Payer: United Healthcare Commercial |
$5,401.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,833.10
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$5,975.00
|
|
|
Service Code
|
HCPCS 27447 AS
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,855.50
|
| Rate for Payer: Beech Street Commercial |
$5,676.25
|
| Rate for Payer: Cash Price |
$4,182.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,795.75
|
| Rate for Payer: Cigna of WY Commercial |
$5,855.50
|
| Rate for Payer: First Choice Health Commercial |
$5,377.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,676.25
|
| Rate for Payer: HealthUtah PPO |
$5,975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,795.75
|
| Rate for Payer: One Health Plan of WY PPO |
$5,855.50
|
| Rate for Payer: PacificSource Commercial |
$5,377.50
|
| Rate for Payer: PHCS PPO |
$5,676.25
|
| Rate for Payer: Three Rivers PPO |
$4,481.25
|
| Rate for Payer: United Healthcare Commercial |
$5,676.25
|
| Rate for Payer: WINHealth Partners Commercial |
$5,078.75
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$11,949.00
|
|
|
Service Code
|
HCPCS 27447 50
|
| Min. Negotiated Rate |
$8,961.75 |
| Max. Negotiated Rate |
$11,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,710.02
|
| Rate for Payer: Beech Street Commercial |
$11,351.55
|
| Rate for Payer: Cash Price |
$8,364.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,590.53
|
| Rate for Payer: Cigna of WY Commercial |
$11,710.02
|
| Rate for Payer: First Choice Health Commercial |
$10,754.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,351.55
|
| Rate for Payer: HealthUtah PPO |
$11,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,590.53
|
| Rate for Payer: One Health Plan of WY PPO |
$11,710.02
|
| Rate for Payer: PacificSource Commercial |
$10,754.10
|
| Rate for Payer: PHCS PPO |
$11,351.55
|
| Rate for Payer: Three Rivers PPO |
$8,961.75
|
| Rate for Payer: United Healthcare Commercial |
$11,351.55
|
| Rate for Payer: WINHealth Partners Commercial |
$10,156.65
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$5,975.00
|
|
|
Service Code
|
HCPCS 27447
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,855.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.67
|
| Rate for Payer: Beech Street Commercial |
$5,676.25
|
| Rate for Payer: Cash Price |
$4,182.50
|
| Rate for Payer: Cash Price |
$4,182.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,795.75
|
| Rate for Payer: Cigna of WY Commercial |
$5,855.50
|
| Rate for Payer: First Choice Health Commercial |
$5,377.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,676.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.67
|
| Rate for Payer: HealthUtah PPO |
$5,975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,795.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,044.37
|
| Rate for Payer: One Health Plan of WY PPO |
$5,855.50
|
| Rate for Payer: PacificSource Commercial |
$5,377.50
|
| Rate for Payer: PHCS PPO |
$5,676.25
|
| Rate for Payer: Three Rivers PPO |
$4,481.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$5,676.25
|
| Rate for Payer: WINHealth Partners Commercial |
$5,078.75
|
|
|
ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$5,975.00
|
|
|
Service Code
|
HCPCS 27447 80
|
| Min. Negotiated Rate |
$1,044.37 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,855.50
|
| Rate for Payer: Beech Street Commercial |
$5,676.25
|
| Rate for Payer: Cash Price |
$4,182.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,795.75
|
| Rate for Payer: Cigna of WY Commercial |
$5,855.50
|
| Rate for Payer: First Choice Health Commercial |
$5,377.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,676.25
|
| Rate for Payer: HealthUtah PPO |
$5,975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,795.75
|
| Rate for Payer: One Health Plan of WY PPO |
$5,855.50
|
| Rate for Payer: PacificSource Commercial |
$5,377.50
|
| Rate for Payer: PHCS PPO |
$5,676.25
|
| Rate for Payer: Three Rivers PPO |
$4,481.25
|
| Rate for Payer: United Healthcare Commercial |
$5,676.25
|
| Rate for Payer: WINHealth Partners Commercial |
$5,078.75
|
|
