|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Professional
|
Both
|
$2,511.00
|
|
|
Service Code
|
HCPCS 26765 AS
|
| Hospital Charge Code |
26765
|
| Min. Negotiated Rate |
$422.64 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,460.78
|
| Rate for Payer: Aetna of WY Medicare |
$497.22
|
| Rate for Payer: Beech Street Commercial |
$2,385.45
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,435.67
|
| Rate for Payer: Cigna of WY Commercial |
$2,460.78
|
| Rate for Payer: First Choice Health Commercial |
$2,259.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.22
|
| Rate for Payer: HealthUtah PPO |
$2,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,435.67
|
| Rate for Payer: Multiplan Medicare/VA |
$422.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,460.78
|
| Rate for Payer: PacificSource Commercial |
$2,259.90
|
| Rate for Payer: PHCS PPO |
$2,385.45
|
| Rate for Payer: Three Rivers PPO |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.22
|
| Rate for Payer: United Healthcare Commercial |
$2,184.57
|
| Rate for Payer: United Healthcare Medicare |
$497.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,134.35
|
|
|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Professional
|
Both
|
$2,511.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
26765
|
| Min. Negotiated Rate |
$422.64 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,460.78
|
| Rate for Payer: Aetna of WY Medicare |
$497.22
|
| Rate for Payer: Beech Street Commercial |
$2,385.45
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,435.67
|
| Rate for Payer: Cigna of WY Commercial |
$2,460.78
|
| Rate for Payer: First Choice Health Commercial |
$2,259.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.22
|
| Rate for Payer: HealthUtah PPO |
$2,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,435.67
|
| Rate for Payer: Multiplan Medicare/VA |
$422.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,460.78
|
| Rate for Payer: PacificSource Commercial |
$2,259.90
|
| Rate for Payer: PHCS PPO |
$2,385.45
|
| Rate for Payer: Three Rivers PPO |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.22
|
| Rate for Payer: United Healthcare Commercial |
$2,184.57
|
| Rate for Payer: United Healthcare Medicare |
$497.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,134.35
|
|
|
OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$7,703.00
|
|
|
Service Code
|
HCPCS 25676
|
| Hospital Charge Code |
25676
|
| Min. Negotiated Rate |
$525.14 |
| Max. Negotiated Rate |
$7,703.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,548.94
|
| Rate for Payer: Aetna of WY Medicare |
$617.81
|
| Rate for Payer: Beech Street Commercial |
$7,317.85
|
| Rate for Payer: Cash Price |
$5,392.10
|
| Rate for Payer: Cash Price |
$5,392.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,471.91
|
| Rate for Payer: Cigna of WY Commercial |
$7,548.94
|
| Rate for Payer: First Choice Health Commercial |
$6,932.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,317.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.81
|
| Rate for Payer: HealthUtah PPO |
$7,703.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,471.91
|
| Rate for Payer: Multiplan Medicare/VA |
$525.14
|
| Rate for Payer: One Health Plan of WY PPO |
$7,548.94
|
| Rate for Payer: PacificSource Commercial |
$6,932.70
|
| Rate for Payer: PHCS PPO |
$7,317.85
|
| Rate for Payer: Three Rivers PPO |
$5,777.25
|
| Rate for Payer: TriWest Veterans Administration |
$617.81
|
| Rate for Payer: United Healthcare Commercial |
$6,701.61
|
| Rate for Payer: United Healthcare Medicare |
$617.81
|
| Rate for Payer: WINHealth Partners Commercial |
$6,547.55
|
|
|
OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$7,703.00
|
|
|
Service Code
|
HCPCS 25676 AS
|
| Hospital Charge Code |
25676
|
| Min. Negotiated Rate |
$525.14 |
| Max. Negotiated Rate |
$7,703.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,548.94
|
| Rate for Payer: Aetna of WY Medicare |
$617.81
|
| Rate for Payer: Beech Street Commercial |
$7,317.85
|
| Rate for Payer: Cash Price |
$5,392.10
|
| Rate for Payer: Cash Price |
$5,392.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,471.91
|
| Rate for Payer: Cigna of WY Commercial |
$7,548.94
|
| Rate for Payer: First Choice Health Commercial |
$6,932.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,317.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.81
|
| Rate for Payer: HealthUtah PPO |
$7,703.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,471.91
|
| Rate for Payer: Multiplan Medicare/VA |
$525.14
|
| Rate for Payer: One Health Plan of WY PPO |
$7,548.94
|
| Rate for Payer: PacificSource Commercial |
$6,932.70
|
| Rate for Payer: PHCS PPO |
$7,317.85
|
| Rate for Payer: Three Rivers PPO |
$5,777.25
|
| Rate for Payer: TriWest Veterans Administration |
$617.81
|
| Rate for Payer: United Healthcare Commercial |
$6,701.61
|
| Rate for Payer: United Healthcare Medicare |
$617.81
|
| Rate for Payer: WINHealth Partners Commercial |
$6,547.55
|
|
|
OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$3,618.00
|
|
|
Service Code
|
HCPCS 27829 AS
|
| Hospital Charge Code |
27829
|
| Min. Negotiated Rate |
$585.93 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,545.64
|
| Rate for Payer: Aetna of WY Medicare |
$689.33
|
| Rate for Payer: Beech Street Commercial |
$3,437.10
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,509.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,545.64
|
| Rate for Payer: First Choice Health Commercial |
$3,256.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,437.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.33
|
| Rate for Payer: HealthUtah PPO |
$3,618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,509.46
|
| Rate for Payer: Multiplan Medicare/VA |
$585.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,545.64
|
| Rate for Payer: PacificSource Commercial |
$3,256.20
|
| Rate for Payer: PHCS PPO |
$3,437.10
|
| Rate for Payer: Three Rivers PPO |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration |
$689.33
|
| Rate for Payer: United Healthcare Commercial |
$3,147.66
|
| Rate for Payer: United Healthcare Medicare |
$689.33
|
| Rate for Payer: WINHealth Partners Commercial |
$3,075.30
|
|
|
OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$3,618.00
|
|
|
Service Code
|
HCPCS 27829 80
|
| Hospital Charge Code |
27829
|
| Min. Negotiated Rate |
$585.93 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,545.64
|
| Rate for Payer: Aetna of WY Medicare |
$689.33
|
| Rate for Payer: Beech Street Commercial |
$3,437.10
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,509.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,545.64
|
| Rate for Payer: First Choice Health Commercial |
$3,256.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,437.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.33
|
| Rate for Payer: HealthUtah PPO |
$3,618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,509.46
|
| Rate for Payer: Multiplan Medicare/VA |
$585.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,545.64
|
| Rate for Payer: PacificSource Commercial |
$3,256.20
|
| Rate for Payer: PHCS PPO |
$3,437.10
|
| Rate for Payer: Three Rivers PPO |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration |
$689.33
|
| Rate for Payer: United Healthcare Commercial |
$3,147.66
|
| Rate for Payer: United Healthcare Medicare |
$689.33
|
| Rate for Payer: WINHealth Partners Commercial |
$3,075.30
|
|
|
OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$7,235.00
|
|
|
Service Code
|
HCPCS 27829 50
|
| Hospital Charge Code |
27829
|
| Min. Negotiated Rate |
$585.93 |
| Max. Negotiated Rate |
$7,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,090.30
|
| Rate for Payer: Aetna of WY Medicare |
$689.33
|
| Rate for Payer: Beech Street Commercial |
$6,873.25
|
| Rate for Payer: Cash Price |
$5,064.50
|
| Rate for Payer: Cash Price |
$5,064.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,017.95
|
| Rate for Payer: Cigna of WY Commercial |
$7,090.30
|
| Rate for Payer: First Choice Health Commercial |
$6,511.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,873.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.33
|
| Rate for Payer: HealthUtah PPO |
$7,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,017.95
|
| Rate for Payer: Multiplan Medicare/VA |
$585.93
|
| Rate for Payer: One Health Plan of WY PPO |
$7,090.30
|
| Rate for Payer: PacificSource Commercial |
$6,511.50
|
| Rate for Payer: PHCS PPO |
$6,873.25
|
| Rate for Payer: Three Rivers PPO |
$5,426.25
|
| Rate for Payer: TriWest Veterans Administration |
$689.33
|
| Rate for Payer: United Healthcare Commercial |
$6,294.45
|
| Rate for Payer: United Healthcare Medicare |
$689.33
|
| Rate for Payer: WINHealth Partners Commercial |
$6,149.75
|
|
|
OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$3,618.00
|
|
|
Service Code
|
HCPCS 27829
|
| Hospital Charge Code |
27829
|
| Min. Negotiated Rate |
$585.93 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,545.64
|
| Rate for Payer: Aetna of WY Medicare |
$689.33
|
| Rate for Payer: Beech Street Commercial |
$3,437.10
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,509.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,545.64
|
| Rate for Payer: First Choice Health Commercial |
$3,256.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,437.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.33
|
| Rate for Payer: HealthUtah PPO |
$3,618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,509.46
|
| Rate for Payer: Multiplan Medicare/VA |
$585.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,545.64
|
| Rate for Payer: PacificSource Commercial |
$3,256.20
|
| Rate for Payer: PHCS PPO |
$3,437.10
|
| Rate for Payer: Three Rivers PPO |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration |
$689.33
|
| Rate for Payer: United Healthcare Commercial |
$3,147.66
|
| Rate for Payer: United Healthcare Medicare |
$689.33
|
| Rate for Payer: WINHealth Partners Commercial |
$3,075.30
|
|
|
OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES
|
Professional
|
Both
|
$2,572.00
|
|
|
Service Code
|
HCPCS 28505 80
|
| Hospital Charge Code |
28505
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,520.56
|
| Rate for Payer: Aetna of WY Medicare |
$484.94
|
| Rate for Payer: Beech Street Commercial |
$2,443.40
|
| Rate for Payer: Cash Price |
$1,800.40
|
| Rate for Payer: Cash Price |
$1,800.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,494.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,520.56
|
| Rate for Payer: First Choice Health Commercial |
$2,314.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,443.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.94
|
| Rate for Payer: HealthUtah PPO |
$2,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,494.84
|
| Rate for Payer: Multiplan Medicare/VA |
$412.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,520.56
|
| Rate for Payer: PacificSource Commercial |
$2,314.80
|
| Rate for Payer: PHCS PPO |
$2,443.40
|
| Rate for Payer: Three Rivers PPO |
$1,929.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.94
|
| Rate for Payer: United Healthcare Commercial |
$2,237.64
|
| Rate for Payer: United Healthcare Medicare |
$484.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,186.20
|
|
|
OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES
|
Professional
|
Both
|
$2,572.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
28505
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,520.56
|
| Rate for Payer: Aetna of WY Medicare |
$484.94
|
| Rate for Payer: Beech Street Commercial |
$2,443.40
|
| Rate for Payer: Cash Price |
$1,800.40
|
| Rate for Payer: Cash Price |
$1,800.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,494.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,520.56
|
| Rate for Payer: First Choice Health Commercial |
$2,314.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,443.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.94
|
| Rate for Payer: HealthUtah PPO |
$2,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,494.84
|
| Rate for Payer: Multiplan Medicare/VA |
$412.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,520.56
|
| Rate for Payer: PacificSource Commercial |
$2,314.80
|
| Rate for Payer: PHCS PPO |
$2,443.40
|
| Rate for Payer: Three Rivers PPO |
$1,929.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.94
|
| Rate for Payer: United Healthcare Commercial |
$2,237.64
|
| Rate for Payer: United Healthcare Medicare |
$484.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,186.20
|
|
|
OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE
|
Professional
|
Both
|
$1,987.00
|
|
|
Service Code
|
HCPCS 28525
|
| Hospital Charge Code |
28525
|
| Min. Negotiated Rate |
$339.83 |
| Max. Negotiated Rate |
$1,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,947.26
|
| Rate for Payer: Aetna of WY Medicare |
$399.80
|
| Rate for Payer: Beech Street Commercial |
$1,887.65
|
| Rate for Payer: Cash Price |
$1,390.90
|
| Rate for Payer: Cash Price |
$1,390.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,927.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,947.26
|
| Rate for Payer: First Choice Health Commercial |
$1,788.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,887.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.80
|
| Rate for Payer: HealthUtah PPO |
$1,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,927.39
|
| Rate for Payer: Multiplan Medicare/VA |
$339.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,947.26
|
| Rate for Payer: PacificSource Commercial |
$1,788.30
|
| Rate for Payer: PHCS PPO |
$1,887.65
|
| Rate for Payer: Three Rivers PPO |
$1,490.25
|
| Rate for Payer: TriWest Veterans Administration |
$399.80
|
| Rate for Payer: United Healthcare Commercial |
$1,728.69
|
| Rate for Payer: United Healthcare Medicare |
$399.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,688.95
|
|
|
OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE
|
Professional
|
Both
|
$1,987.00
|
|
|
Service Code
|
HCPCS 28525 AS
|
| Hospital Charge Code |
28525
|
| Min. Negotiated Rate |
$339.83 |
| Max. Negotiated Rate |
$1,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,947.26
|
| Rate for Payer: Aetna of WY Medicare |
$399.80
|
| Rate for Payer: Beech Street Commercial |
$1,887.65
|
| Rate for Payer: Cash Price |
$1,390.90
|
| Rate for Payer: Cash Price |
$1,390.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,927.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,947.26
|
| Rate for Payer: First Choice Health Commercial |
$1,788.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,887.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.80
|
| Rate for Payer: HealthUtah PPO |
$1,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,927.39
|
| Rate for Payer: Multiplan Medicare/VA |
$339.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,947.26
|
| Rate for Payer: PacificSource Commercial |
$1,788.30
|
| Rate for Payer: PHCS PPO |
$1,887.65
|
| Rate for Payer: Three Rivers PPO |
$1,490.25
|
| Rate for Payer: TriWest Veterans Administration |
$399.80
|
| Rate for Payer: United Healthcare Commercial |
$1,728.69
|
| Rate for Payer: United Healthcare Medicare |
$399.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,688.95
|
|
|
OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
24575
|
| Min. Negotiated Rate |
$607.76 |
| Max. Negotiated Rate |
$3,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,703.42
|
| Rate for Payer: Aetna of WY Medicare |
$715.01
|
| Rate for Payer: Beech Street Commercial |
$3,590.05
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,665.63
|
| Rate for Payer: Cigna of WY Commercial |
$3,703.42
|
| Rate for Payer: First Choice Health Commercial |
$3,401.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,590.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$715.01
|
| Rate for Payer: HealthUtah PPO |
$3,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,665.63
|
| Rate for Payer: Multiplan Medicare/VA |
$607.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,703.42
|
| Rate for Payer: PacificSource Commercial |
$3,401.10
|
| Rate for Payer: PHCS PPO |
$3,590.05
|
| Rate for Payer: Three Rivers PPO |
$2,834.25
|
| Rate for Payer: TriWest Veterans Administration |
$715.01
|
| Rate for Payer: United Healthcare Commercial |
$3,287.73
|
| Rate for Payer: United Healthcare Medicare |
$715.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,212.15
|
|
|
OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 24575 AS
|
| Hospital Charge Code |
24575
|
| Min. Negotiated Rate |
$607.76 |
| Max. Negotiated Rate |
$3,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,703.42
|
| Rate for Payer: Aetna of WY Medicare |
$715.01
|
| Rate for Payer: Beech Street Commercial |
$3,590.05
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,665.63
|
| Rate for Payer: Cigna of WY Commercial |
$3,703.42
|
| Rate for Payer: First Choice Health Commercial |
$3,401.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,590.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$715.01
|
| Rate for Payer: HealthUtah PPO |
$3,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,665.63
|
| Rate for Payer: Multiplan Medicare/VA |
$607.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,703.42
|
| Rate for Payer: PacificSource Commercial |
$3,401.10
|
| Rate for Payer: PHCS PPO |
$3,590.05
|
| Rate for Payer: Three Rivers PPO |
$2,834.25
|
| Rate for Payer: TriWest Veterans Administration |
$715.01
|
| Rate for Payer: United Healthcare Commercial |
$3,287.73
|
| Rate for Payer: United Healthcare Medicare |
$715.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,212.15
|
|
|
OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 24575 80
|
| Hospital Charge Code |
24575
|
| Min. Negotiated Rate |
$607.76 |
| Max. Negotiated Rate |
$3,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,703.42
|
| Rate for Payer: Aetna of WY Medicare |
$715.01
|
| Rate for Payer: Beech Street Commercial |
$3,590.05
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: Cash Price |
$2,645.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,665.63
|
| Rate for Payer: Cigna of WY Commercial |
$3,703.42
|
| Rate for Payer: First Choice Health Commercial |
$3,401.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,590.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$715.01
|
| Rate for Payer: HealthUtah PPO |
$3,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,665.63
|
| Rate for Payer: Multiplan Medicare/VA |
$607.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,703.42
|
| Rate for Payer: PacificSource Commercial |
$3,401.10
|
| Rate for Payer: PHCS PPO |
$3,590.05
|
| Rate for Payer: Three Rivers PPO |
$2,834.25
|
| Rate for Payer: TriWest Veterans Administration |
$715.01
|
| Rate for Payer: United Healthcare Commercial |
$3,287.73
|
| Rate for Payer: United Healthcare Medicare |
$715.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,212.15
|
|
|
OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$4,796.00
|
|
|
Service Code
|
HCPCS 24545 AS
|
| Hospital Charge Code |
24545
|
| Min. Negotiated Rate |
$763.95 |
| Max. Negotiated Rate |
$4,796.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,700.08
|
| Rate for Payer: Aetna of WY Medicare |
$898.77
|
| Rate for Payer: Beech Street Commercial |
$4,556.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,652.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,700.08
|
| Rate for Payer: First Choice Health Commercial |
$4,316.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$898.77
|
| Rate for Payer: HealthUtah PPO |
$4,796.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,652.12
|
| Rate for Payer: Multiplan Medicare/VA |
$763.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,700.08
|
| Rate for Payer: PacificSource Commercial |
$4,316.40
|
| Rate for Payer: PHCS PPO |
$4,556.20
|
| Rate for Payer: Three Rivers PPO |
$3,597.00
|
| Rate for Payer: TriWest Veterans Administration |
$898.77
|
| Rate for Payer: United Healthcare Commercial |
$4,172.52
|
| Rate for Payer: United Healthcare Medicare |
$898.77
|
| Rate for Payer: WINHealth Partners Commercial |
$4,076.60
|
|
|
OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$4,796.00
|
|
|
Service Code
|
HCPCS 24545 80
|
| Hospital Charge Code |
24545
|
| Min. Negotiated Rate |
$763.95 |
| Max. Negotiated Rate |
$4,796.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,700.08
|
| Rate for Payer: Aetna of WY Medicare |
$898.77
|
| Rate for Payer: Beech Street Commercial |
$4,556.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,652.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,700.08
|
| Rate for Payer: First Choice Health Commercial |
$4,316.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$898.77
|
| Rate for Payer: HealthUtah PPO |
$4,796.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,652.12
|
| Rate for Payer: Multiplan Medicare/VA |
$763.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,700.08
|
| Rate for Payer: PacificSource Commercial |
$4,316.40
|
| Rate for Payer: PHCS PPO |
$4,556.20
|
| Rate for Payer: Three Rivers PPO |
$3,597.00
|
| Rate for Payer: TriWest Veterans Administration |
$898.77
|
| Rate for Payer: United Healthcare Commercial |
$4,172.52
|
| Rate for Payer: United Healthcare Medicare |
$898.77
|
| Rate for Payer: WINHealth Partners Commercial |
$4,076.60
|
|
|
OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$4,796.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
24545
|
| Min. Negotiated Rate |
$763.95 |
| Max. Negotiated Rate |
$4,796.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,700.08
|
| Rate for Payer: Aetna of WY Medicare |
$898.77
|
| Rate for Payer: Beech Street Commercial |
$4,556.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: Cash Price |
$3,357.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,652.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,700.08
|
| Rate for Payer: First Choice Health Commercial |
$4,316.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$898.77
|
| Rate for Payer: HealthUtah PPO |
$4,796.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,652.12
|
| Rate for Payer: Multiplan Medicare/VA |
$763.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,700.08
|
| Rate for Payer: PacificSource Commercial |
$4,316.40
|
| Rate for Payer: PHCS PPO |
$4,556.20
|
| Rate for Payer: Three Rivers PPO |
$3,597.00
|
| Rate for Payer: TriWest Veterans Administration |
$898.77
|
| Rate for Payer: United Healthcare Commercial |
$4,172.52
|
| Rate for Payer: United Healthcare Medicare |
$898.77
|
| Rate for Payer: WINHealth Partners Commercial |
$4,076.60
|
|
|
OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 27540 80
|
| Hospital Charge Code |
27540
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,758.70
|
| Rate for Payer: Aetna of WY Medicare |
$788.80
|
| Rate for Payer: Beech Street Commercial |
$2,674.25
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,730.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,758.70
|
| Rate for Payer: First Choice Health Commercial |
$2,533.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,674.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.80
|
| Rate for Payer: HealthUtah PPO |
$2,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,730.55
|
| Rate for Payer: Multiplan Medicare/VA |
$670.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,758.70
|
| Rate for Payer: PacificSource Commercial |
$2,533.50
|
| Rate for Payer: PHCS PPO |
$2,674.25
|
| Rate for Payer: Three Rivers PPO |
$2,111.25
|
| Rate for Payer: TriWest Veterans Administration |
$788.80
|
| Rate for Payer: United Healthcare Commercial |
$2,449.05
|
| Rate for Payer: United Healthcare Medicare |
$788.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,392.75
|
|
|
OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
27540
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,758.70
|
| Rate for Payer: Aetna of WY Medicare |
$788.80
|
| Rate for Payer: Beech Street Commercial |
$2,674.25
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,730.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,758.70
|
| Rate for Payer: First Choice Health Commercial |
$2,533.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,674.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.80
|
| Rate for Payer: HealthUtah PPO |
$2,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,730.55
|
| Rate for Payer: Multiplan Medicare/VA |
$670.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,758.70
|
| Rate for Payer: PacificSource Commercial |
$2,533.50
|
| Rate for Payer: PHCS PPO |
$2,674.25
|
| Rate for Payer: Three Rivers PPO |
$2,111.25
|
| Rate for Payer: TriWest Veterans Administration |
$788.80
|
| Rate for Payer: United Healthcare Commercial |
$2,449.05
|
| Rate for Payer: United Healthcare Medicare |
$788.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,392.75
|
|
|
OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 27540 AS
|
| Hospital Charge Code |
27540
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,758.70
|
| Rate for Payer: Aetna of WY Medicare |
$788.80
|
| Rate for Payer: Beech Street Commercial |
$2,674.25
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: Cash Price |
$1,970.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,730.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,758.70
|
| Rate for Payer: First Choice Health Commercial |
$2,533.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,674.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.80
|
| Rate for Payer: HealthUtah PPO |
$2,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,730.55
|
| Rate for Payer: Multiplan Medicare/VA |
$670.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,758.70
|
| Rate for Payer: PacificSource Commercial |
$2,533.50
|
| Rate for Payer: PHCS PPO |
$2,674.25
|
| Rate for Payer: Three Rivers PPO |
$2,111.25
|
| Rate for Payer: TriWest Veterans Administration |
$788.80
|
| Rate for Payer: United Healthcare Commercial |
$2,449.05
|
| Rate for Payer: United Healthcare Medicare |
$788.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,392.75
|
|
|
OPEN TX INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,923.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
26785
|
| Min. Negotiated Rate |
$458.16 |
| Max. Negotiated Rate |
$1,923.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,884.54
|
| Rate for Payer: Aetna of WY Medicare |
$539.01
|
| Rate for Payer: Beech Street Commercial |
$1,826.85
|
| Rate for Payer: Cash Price |
$1,346.10
|
| Rate for Payer: Cash Price |
$1,346.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,865.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,884.54
|
| Rate for Payer: First Choice Health Commercial |
$1,730.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,826.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.01
|
| Rate for Payer: HealthUtah PPO |
$1,923.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,865.31
|
| Rate for Payer: Multiplan Medicare/VA |
$458.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,884.54
|
| Rate for Payer: PacificSource Commercial |
$1,730.70
|
| Rate for Payer: PHCS PPO |
$1,826.85
|
| Rate for Payer: Three Rivers PPO |
$1,442.25
|
| Rate for Payer: TriWest Veterans Administration |
$539.01
|
| Rate for Payer: United Healthcare Commercial |
$1,673.01
|
| Rate for Payer: United Healthcare Medicare |
$539.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,634.55
|
|
|
OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$3,572.00
|
|
|
Service Code
|
HCPCS 27557 AS
|
| Hospital Charge Code |
27557
|
| Min. Negotiated Rate |
$850.88 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,500.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,001.03
|
| Rate for Payer: Beech Street Commercial |
$3,393.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,464.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,500.56
|
| Rate for Payer: First Choice Health Commercial |
$3,214.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,393.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,001.03
|
| Rate for Payer: HealthUtah PPO |
$3,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,464.84
|
| Rate for Payer: Multiplan Medicare/VA |
$850.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,500.56
|
| Rate for Payer: PacificSource Commercial |
$3,214.80
|
| Rate for Payer: PHCS PPO |
$3,393.40
|
| Rate for Payer: Three Rivers PPO |
$2,679.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,001.03
|
| Rate for Payer: United Healthcare Commercial |
$3,107.64
|
| Rate for Payer: United Healthcare Medicare |
$1,001.03
|
| Rate for Payer: WINHealth Partners Commercial |
$3,036.20
|
|
|
OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$3,572.00
|
|
|
Service Code
|
HCPCS 27557
|
| Hospital Charge Code |
27557
|
| Min. Negotiated Rate |
$850.88 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,500.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,001.03
|
| Rate for Payer: Beech Street Commercial |
$3,393.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,464.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,500.56
|
| Rate for Payer: First Choice Health Commercial |
$3,214.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,393.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,001.03
|
| Rate for Payer: HealthUtah PPO |
$3,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,464.84
|
| Rate for Payer: Multiplan Medicare/VA |
$850.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,500.56
|
| Rate for Payer: PacificSource Commercial |
$3,214.80
|
| Rate for Payer: PHCS PPO |
$3,393.40
|
| Rate for Payer: Three Rivers PPO |
$2,679.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,001.03
|
| Rate for Payer: United Healthcare Commercial |
$3,107.64
|
| Rate for Payer: United Healthcare Medicare |
$1,001.03
|
| Rate for Payer: WINHealth Partners Commercial |
$3,036.20
|
|
|
OPEN TX METACARPAL FRACTURE SINGLE EA BONE
|
Professional
|
Both
|
$2,019.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
26615
|
| Min. Negotiated Rate |
$480.88 |
| Max. Negotiated Rate |
$2,019.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,978.62
|
| Rate for Payer: Aetna of WY Medicare |
$565.74
|
| Rate for Payer: Beech Street Commercial |
$1,918.05
|
| Rate for Payer: Cash Price |
$1,413.30
|
| Rate for Payer: Cash Price |
$1,413.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,958.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,978.62
|
| Rate for Payer: First Choice Health Commercial |
$1,817.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,918.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.74
|
| Rate for Payer: HealthUtah PPO |
$2,019.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,958.43
|
| Rate for Payer: Multiplan Medicare/VA |
$480.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,978.62
|
| Rate for Payer: PacificSource Commercial |
$1,817.10
|
| Rate for Payer: PHCS PPO |
$1,918.05
|
| Rate for Payer: Three Rivers PPO |
$1,514.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.74
|
| Rate for Payer: United Healthcare Commercial |
$1,756.53
|
| Rate for Payer: United Healthcare Medicare |
$565.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,716.15
|
|
