|
ONDANSETRON 8 MG DISINTEGRATING TABLET [8304]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.41
|
| Rate for Payer: Aetna of WY Medicare |
$2.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.32
|
| Rate for Payer: Altius Commercial |
$4.32
|
| Rate for Payer: Beech Street Commercial |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.69
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.36
|
| Rate for Payer: Cigna of WY Commercial |
$4.41
|
| Rate for Payer: Entrust Commercial |
$4.28
|
| Rate for Payer: First Choice Health Commercial |
$4.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.61
|
| Rate for Payer: HealthUtah PPO |
$4.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.36
|
| Rate for Payer: Multiplan Medicare/VA |
$2.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4.41
|
| Rate for Payer: PacificSource Commercial |
$4.05
|
| Rate for Payer: PHCS PPO |
$4.41
|
| Rate for Payer: Three Rivers PPO |
$3.38
|
| Rate for Payer: TriWest Veterans Administration |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
| Rate for Payer: United Healthcare Medicare |
$2.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4.41
|
| Rate for Payer: Wise Provider Network Commercial |
$4.28
|
|
|
ONDANSETRON HCL 4 MG TABLET [4672]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.88
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.74
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.61
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2.94
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
ONDANSETRON HCL 4 MG TABLET [4672]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.88
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.98
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.98
|
| Rate for Payer: United Healthcare Commercial |
$2.61
|
| Rate for Payer: United Healthcare Medicare |
$1.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
J2405
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Aetna of WY Medicare |
$0.10
|
| Rate for Payer: Beech Street Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: First Choice Health Commercial |
$6.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.65
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [42439]
|
Facility
|
OP
|
$17.57
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.11
|
| Rate for Payer: Aetna of WY Medicare |
$11.60
|
| Rate for Payer: Aetna of WY Medicare |
$10.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Altius Commercial |
$15.78
|
| Rate for Payer: Beech Street Commercial |
$16.11
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.95
|
| Rate for Payer: Cigna of WY Commercial |
$16.11
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: Entrust Commercial |
$15.62
|
| Rate for Payer: First Choice Health Commercial |
$15.62
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.54
|
| Rate for Payer: HealthUtah PPO |
$16.44
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.06
|
| Rate for Payer: One Health Plan of WY PPO |
$16.11
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.11
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$12.33
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$10.19
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.11
|
| Rate for Payer: WINHealth Partners Commercial |
$17.22
|
| Rate for Payer: Wise Provider Network Commercial |
$15.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [42439]
|
Facility
|
IP
|
$17.57
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.78
|
| Rate for Payer: Altius Commercial |
$15.78
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Beech Street Commercial |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Cigna of WY Commercial |
$16.11
|
| Rate for Payer: Entrust Commercial |
$15.62
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$15.62
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.85
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: HealthUtah PPO |
$16.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: Multiplan Medicare/VA |
$10.31
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: One Health Plan of WY PPO |
$16.11
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.11
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$12.33
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.85
|
| Rate for Payer: United Healthcare Commercial |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: United Healthcare Medicare |
$10.85
|
| Rate for Payer: WINHealth Partners Commercial |
$15.62
|
| Rate for Payer: WINHealth Partners Commercial |
$16.69
|
| Rate for Payer: Wise Provider Network Commercial |
$15.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
ON-Q PUMP [408028798]
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C9804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$344.85
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
| Rate for Payer: WINHealth Partners Commercial |
$522.50
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
ON-Q PUMP [408028798]
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C9804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.05 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$363.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$303.05
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$319.00
|
| Rate for Payer: WINHealth Partners Commercial |
$539.00
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
ON-Q SELECT FLOW 2-14ML/HR 600
|
Facility
|
OP
|
$997.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.62 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$977.55
|
| Rate for Payer: Aetna of WY Medicare |
$658.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$957.60
|
| Rate for Payer: Altius Commercial |
$957.60
|
| Rate for Payer: Beech Street Commercial |
$977.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$818.95
|
| Rate for Payer: Cash Price |
$698.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$967.58
|
| Rate for Payer: Cigna of WY Commercial |
$977.55
|
| Rate for Payer: Entrust Commercial |
$947.62
|
| Rate for Payer: First Choice Health Commercial |
$947.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$947.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$578.55
|
| Rate for Payer: HealthUtah PPO |
$997.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$967.58
|
| Rate for Payer: Multiplan Medicare/VA |
$549.62
|
| Rate for Payer: One Health Plan of WY PPO |
$977.55
|
| Rate for Payer: PacificSource Commercial |
$897.75
|
| Rate for Payer: PHCS PPO |
$977.55
|
| Rate for Payer: Three Rivers PPO |
$748.12
|
| Rate for Payer: TriWest Veterans Administration |
$578.55
|
| Rate for Payer: United Healthcare Commercial |
$867.82
|
| Rate for Payer: United Healthcare Medicare |
$578.55
|
| Rate for Payer: WINHealth Partners Commercial |
$977.55
|
| Rate for Payer: Wise Provider Network Commercial |
$947.62
|
|
|
ON-Q SELECT FLOW 2-14ML/HR 600
|
Facility
|
IP
|
$997.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$977.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$957.60
|
| Rate for Payer: Altius Commercial |
$957.60
|
| Rate for Payer: Beech Street Commercial |
$977.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$818.95
|
| Rate for Payer: Cash Price |
$698.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$967.58
|
| Rate for Payer: Cigna of WY Commercial |
$977.55
|
| Rate for Payer: Entrust Commercial |
$947.62
|
| Rate for Payer: First Choice Health Commercial |
$947.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$947.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$658.35
|
| Rate for Payer: HealthUtah PPO |
$997.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$967.58
|
| Rate for Payer: Multiplan Medicare/VA |
$625.43
|
| Rate for Payer: One Health Plan of WY PPO |
$977.55
|
| Rate for Payer: PacificSource Commercial |
$897.75
|
| Rate for Payer: PHCS PPO |
$977.55
|
| Rate for Payer: Three Rivers PPO |
$748.12
|
| Rate for Payer: TriWest Veterans Administration |
$658.35
|
| Rate for Payer: United Healthcare Commercial |
$867.82
|
| Rate for Payer: United Healthcare Medicare |
$658.35
|
| Rate for Payer: WINHealth Partners Commercial |
$947.62
|
| Rate for Payer: Wise Provider Network Commercial |
$947.62
|
|
|
OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
58940
|
| Min. Negotiated Rate |
$456.25 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,205.00
|
| Rate for Payer: Aetna of WY Medicare |
$536.77
|
| Rate for Payer: Beech Street Commercial |
$2,137.50
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,182.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,205.00
|
| Rate for Payer: First Choice Health Commercial |
$2,025.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$536.77
|
| Rate for Payer: HealthUtah PPO |
$2,250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,182.50
|
| Rate for Payer: Multiplan Medicare/VA |
$456.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,205.00
|
| Rate for Payer: PacificSource Commercial |
$2,025.00
|
| Rate for Payer: PHCS PPO |
$2,137.50
|
| Rate for Payer: Three Rivers PPO |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration |
$536.77
|
| Rate for Payer: United Healthcare Commercial |
$1,957.50
|
| Rate for Payer: United Healthcare Medicare |
$536.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1,912.50
|
|
|
OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$2,827.00
|
|
|
Service Code
|
HCPCS 64582
|
| Hospital Charge Code |
64582
|
| Min. Negotiated Rate |
$684.62 |
| Max. Negotiated Rate |
$2,827.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,770.46
|
| Rate for Payer: Aetna of WY Medicare |
$805.43
|
| Rate for Payer: Beech Street Commercial |
$2,685.65
|
| Rate for Payer: Cash Price |
$1,978.90
|
| Rate for Payer: Cash Price |
$1,978.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,742.19
|
| Rate for Payer: Cigna of WY Commercial |
$2,770.46
|
| Rate for Payer: First Choice Health Commercial |
$2,544.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,685.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$805.43
|
| Rate for Payer: HealthUtah PPO |
$2,827.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,742.19
|
| Rate for Payer: Multiplan Medicare/VA |
$684.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,770.46
|
| Rate for Payer: PacificSource Commercial |
$2,544.30
|
| Rate for Payer: PHCS PPO |
$2,685.65
|
| Rate for Payer: Three Rivers PPO |
$2,120.25
|
| Rate for Payer: TriWest Veterans Administration |
$805.43
|
| Rate for Payer: United Healthcare Commercial |
$2,459.49
|
| Rate for Payer: United Healthcare Medicare |
$805.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,402.95
|
|
|
OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$4,201.00
|
|
|
Service Code
|
HCPCS 23410 AS
|
| Hospital Charge Code |
23410
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$4,201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.98
|
| Rate for Payer: Aetna of WY Medicare |
$794.54
|
| Rate for Payer: Beech Street Commercial |
$3,990.95
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.98
|
| Rate for Payer: First Choice Health Commercial |
$3,780.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.54
|
| Rate for Payer: HealthUtah PPO |
$4,201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.97
|
| Rate for Payer: Multiplan Medicare/VA |
$675.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.98
|
| Rate for Payer: PacificSource Commercial |
$3,780.90
|
| Rate for Payer: PHCS PPO |
$3,990.95
|
| Rate for Payer: Three Rivers PPO |
$3,150.75
|
| Rate for Payer: TriWest Veterans Administration |
$794.54
|
| Rate for Payer: United Healthcare Commercial |
$3,654.87
|
| Rate for Payer: United Healthcare Medicare |
$794.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,570.85
|
|
|
OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$4,201.00
|
|
|
Service Code
|
HCPCS 23410 80
|
| Hospital Charge Code |
23410
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$4,201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.98
|
| Rate for Payer: Aetna of WY Medicare |
$794.54
|
| Rate for Payer: Beech Street Commercial |
$3,990.95
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.98
|
| Rate for Payer: First Choice Health Commercial |
$3,780.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.54
|
| Rate for Payer: HealthUtah PPO |
$4,201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.97
|
| Rate for Payer: Multiplan Medicare/VA |
$675.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.98
|
| Rate for Payer: PacificSource Commercial |
$3,780.90
|
| Rate for Payer: PHCS PPO |
$3,990.95
|
| Rate for Payer: Three Rivers PPO |
$3,150.75
|
| Rate for Payer: TriWest Veterans Administration |
$794.54
|
| Rate for Payer: United Healthcare Commercial |
$3,654.87
|
| Rate for Payer: United Healthcare Medicare |
$794.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,570.85
|
|
|
OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$4,201.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
23410
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$4,201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.98
|
| Rate for Payer: Aetna of WY Medicare |
$794.54
|
| Rate for Payer: Beech Street Commercial |
$3,990.95
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: Cash Price |
$2,940.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.98
|
| Rate for Payer: First Choice Health Commercial |
$3,780.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.54
|
| Rate for Payer: HealthUtah PPO |
$4,201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.97
|
| Rate for Payer: Multiplan Medicare/VA |
$675.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.98
|
| Rate for Payer: PacificSource Commercial |
$3,780.90
|
| Rate for Payer: PHCS PPO |
$3,990.95
|
| Rate for Payer: Three Rivers PPO |
$3,150.75
|
| Rate for Payer: TriWest Veterans Administration |
$794.54
|
| Rate for Payer: United Healthcare Commercial |
$3,654.87
|
| Rate for Payer: United Healthcare Medicare |
$794.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,570.85
|
|
|
OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$4,368.00
|
|
|
Service Code
|
HCPCS 23412 AS
|
| Hospital Charge Code |
23412
|
| Min. Negotiated Rate |
$701.76 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,280.64
|
| Rate for Payer: Aetna of WY Medicare |
$825.60
|
| Rate for Payer: Beech Street Commercial |
$4,149.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,236.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,280.64
|
| Rate for Payer: First Choice Health Commercial |
$3,931.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,149.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$825.60
|
| Rate for Payer: HealthUtah PPO |
$4,368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,236.96
|
| Rate for Payer: Multiplan Medicare/VA |
$701.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,280.64
|
| Rate for Payer: PacificSource Commercial |
$3,931.20
|
| Rate for Payer: PHCS PPO |
$4,149.60
|
| Rate for Payer: Three Rivers PPO |
$3,276.00
|
| Rate for Payer: TriWest Veterans Administration |
$825.60
|
| Rate for Payer: United Healthcare Commercial |
$3,800.16
|
| Rate for Payer: United Healthcare Medicare |
$825.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,712.80
|
|
|
OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$4,368.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
23412
|
| Min. Negotiated Rate |
$701.76 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,280.64
|
| Rate for Payer: Aetna of WY Medicare |
$825.60
|
| Rate for Payer: Beech Street Commercial |
$4,149.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,236.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,280.64
|
| Rate for Payer: First Choice Health Commercial |
$3,931.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,149.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$825.60
|
| Rate for Payer: HealthUtah PPO |
$4,368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,236.96
|
| Rate for Payer: Multiplan Medicare/VA |
$701.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,280.64
|
| Rate for Payer: PacificSource Commercial |
$3,931.20
|
| Rate for Payer: PHCS PPO |
$4,149.60
|
| Rate for Payer: Three Rivers PPO |
$3,276.00
|
| Rate for Payer: TriWest Veterans Administration |
$825.60
|
| Rate for Payer: United Healthcare Commercial |
$3,800.16
|
| Rate for Payer: United Healthcare Medicare |
$825.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,712.80
|
|
|
OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$4,368.00
|
|
|
Service Code
|
HCPCS 23412 80
|
| Hospital Charge Code |
23412
|
| Min. Negotiated Rate |
$701.76 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,280.64
|
| Rate for Payer: Aetna of WY Medicare |
$825.60
|
| Rate for Payer: Beech Street Commercial |
$4,149.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: Cash Price |
$3,057.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,236.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,280.64
|
| Rate for Payer: First Choice Health Commercial |
$3,931.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,149.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$825.60
|
| Rate for Payer: HealthUtah PPO |
$4,368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,236.96
|
| Rate for Payer: Multiplan Medicare/VA |
$701.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,280.64
|
| Rate for Payer: PacificSource Commercial |
$3,931.20
|
| Rate for Payer: PHCS PPO |
$4,149.60
|
| Rate for Payer: Three Rivers PPO |
$3,276.00
|
| Rate for Payer: TriWest Veterans Administration |
$825.60
|
| Rate for Payer: United Healthcare Commercial |
$3,800.16
|
| Rate for Payer: United Healthcare Medicare |
$825.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,712.80
|
|
|
OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 27814 AS
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$630.62 |
| Max. Negotiated Rate |
$2,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,597.00
|
| Rate for Payer: Aetna of WY Medicare |
$741.90
|
| Rate for Payer: Beech Street Commercial |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,570.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,597.00
|
| Rate for Payer: First Choice Health Commercial |
$2,385.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,517.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$741.90
|
| Rate for Payer: HealthUtah PPO |
$2,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,570.50
|
| Rate for Payer: Multiplan Medicare/VA |
$630.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,597.00
|
| Rate for Payer: PacificSource Commercial |
$2,385.00
|
| Rate for Payer: PHCS PPO |
$2,517.50
|
| Rate for Payer: Three Rivers PPO |
$1,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$741.90
|
| Rate for Payer: United Healthcare Commercial |
$2,305.50
|
| Rate for Payer: United Healthcare Medicare |
$741.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,252.50
|
|
|
OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$630.62 |
| Max. Negotiated Rate |
$2,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,597.00
|
| Rate for Payer: Aetna of WY Medicare |
$741.90
|
| Rate for Payer: Beech Street Commercial |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,570.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,597.00
|
| Rate for Payer: First Choice Health Commercial |
$2,385.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,517.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$741.90
|
| Rate for Payer: HealthUtah PPO |
$2,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,570.50
|
| Rate for Payer: Multiplan Medicare/VA |
$630.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,597.00
|
| Rate for Payer: PacificSource Commercial |
$2,385.00
|
| Rate for Payer: PHCS PPO |
$2,517.50
|
| Rate for Payer: Three Rivers PPO |
$1,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$741.90
|
| Rate for Payer: United Healthcare Commercial |
$2,305.50
|
| Rate for Payer: United Healthcare Medicare |
$741.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,252.50
|
|
|
OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 27814 80
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$630.62 |
| Max. Negotiated Rate |
$2,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,597.00
|
| Rate for Payer: Aetna of WY Medicare |
$741.90
|
| Rate for Payer: Beech Street Commercial |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: Cash Price |
$1,855.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,570.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,597.00
|
| Rate for Payer: First Choice Health Commercial |
$2,385.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,517.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$741.90
|
| Rate for Payer: HealthUtah PPO |
$2,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,570.50
|
| Rate for Payer: Multiplan Medicare/VA |
$630.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,597.00
|
| Rate for Payer: PacificSource Commercial |
$2,385.00
|
| Rate for Payer: PHCS PPO |
$2,517.50
|
| Rate for Payer: Three Rivers PPO |
$1,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$741.90
|
| Rate for Payer: United Healthcare Commercial |
$2,305.50
|
| Rate for Payer: United Healthcare Medicare |
$741.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,252.50
|
|
|
OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$5,779.00
|
|
|
Service Code
|
HCPCS 28415
|
| Hospital Charge Code |
28415
|
| Min. Negotiated Rate |
$923.22 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,663.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,086.14
|
| Rate for Payer: Beech Street Commercial |
$5,490.05
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,605.63
|
| Rate for Payer: Cigna of WY Commercial |
$5,663.42
|
| Rate for Payer: First Choice Health Commercial |
$5,201.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,490.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,086.14
|
| Rate for Payer: HealthUtah PPO |
$5,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,605.63
|
| Rate for Payer: Multiplan Medicare/VA |
$923.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5,663.42
|
| Rate for Payer: PacificSource Commercial |
$5,201.10
|
| Rate for Payer: PHCS PPO |
$5,490.05
|
| Rate for Payer: Three Rivers PPO |
$4,334.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,086.14
|
| Rate for Payer: United Healthcare Commercial |
$5,027.73
|
| Rate for Payer: United Healthcare Medicare |
$1,086.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,912.15
|
|
|
OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$5,779.00
|
|
|
Service Code
|
HCPCS 28415 AS
|
| Hospital Charge Code |
28415
|
| Min. Negotiated Rate |
$923.22 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,663.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,086.14
|
| Rate for Payer: Beech Street Commercial |
$5,490.05
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,605.63
|
| Rate for Payer: Cigna of WY Commercial |
$5,663.42
|
| Rate for Payer: First Choice Health Commercial |
$5,201.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,490.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,086.14
|
| Rate for Payer: HealthUtah PPO |
$5,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,605.63
|
| Rate for Payer: Multiplan Medicare/VA |
$923.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5,663.42
|
| Rate for Payer: PacificSource Commercial |
$5,201.10
|
| Rate for Payer: PHCS PPO |
$5,490.05
|
| Rate for Payer: Three Rivers PPO |
$4,334.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,086.14
|
| Rate for Payer: United Healthcare Commercial |
$5,027.73
|
| Rate for Payer: United Healthcare Medicare |
$1,086.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,912.15
|
|
|
OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$5,779.00
|
|
|
Service Code
|
HCPCS 28415 80
|
| Hospital Charge Code |
28415
|
| Min. Negotiated Rate |
$923.22 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,663.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,086.14
|
| Rate for Payer: Beech Street Commercial |
$5,490.05
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: Cash Price |
$4,045.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,605.63
|
| Rate for Payer: Cigna of WY Commercial |
$5,663.42
|
| Rate for Payer: First Choice Health Commercial |
$5,201.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,490.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,086.14
|
| Rate for Payer: HealthUtah PPO |
$5,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,605.63
|
| Rate for Payer: Multiplan Medicare/VA |
$923.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5,663.42
|
| Rate for Payer: PacificSource Commercial |
$5,201.10
|
| Rate for Payer: PHCS PPO |
$5,490.05
|
| Rate for Payer: Three Rivers PPO |
$4,334.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,086.14
|
| Rate for Payer: United Healthcare Commercial |
$5,027.73
|
| Rate for Payer: United Healthcare Medicare |
$1,086.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,912.15
|
|
|
OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
Both
|
$6,270.00
|
|
|
Service Code
|
HCPCS 27828 AS
|
| Hospital Charge Code |
27828
|
| Min. Negotiated Rate |
$1,088.40 |
| Max. Negotiated Rate |
$6,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,144.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,280.47
|
| Rate for Payer: Beech Street Commercial |
$5,956.50
|
| Rate for Payer: Cash Price |
$4,389.00
|
| Rate for Payer: Cash Price |
$4,389.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,081.90
|
| Rate for Payer: Cigna of WY Commercial |
$6,144.60
|
| Rate for Payer: First Choice Health Commercial |
$5,643.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,956.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,280.47
|
| Rate for Payer: HealthUtah PPO |
$6,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,081.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,088.40
|
| Rate for Payer: One Health Plan of WY PPO |
$6,144.60
|
| Rate for Payer: PacificSource Commercial |
$5,643.00
|
| Rate for Payer: PHCS PPO |
$5,956.50
|
| Rate for Payer: Three Rivers PPO |
$4,702.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,280.47
|
| Rate for Payer: United Healthcare Commercial |
$5,454.90
|
| Rate for Payer: United Healthcare Medicare |
$1,280.47
|
| Rate for Payer: WINHealth Partners Commercial |
$5,329.50
|
|
