|
OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$4,473.00
|
|
|
Service Code
|
HCPCS 27822 80
|
| Hospital Charge Code |
27822
|
| Min. Negotiated Rate |
$721.46 |
| Max. Negotiated Rate |
$4,473.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,383.54
|
| Rate for Payer: Aetna of WY Medicare |
$848.78
|
| Rate for Payer: Beech Street Commercial |
$4,249.35
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,338.81
|
| Rate for Payer: Cigna of WY Commercial |
$4,383.54
|
| Rate for Payer: First Choice Health Commercial |
$4,025.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,249.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$848.78
|
| Rate for Payer: HealthUtah PPO |
$4,473.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,338.81
|
| Rate for Payer: Multiplan Medicare/VA |
$721.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,383.54
|
| Rate for Payer: PacificSource Commercial |
$4,025.70
|
| Rate for Payer: PHCS PPO |
$4,249.35
|
| Rate for Payer: Three Rivers PPO |
$3,354.75
|
| Rate for Payer: TriWest Veterans Administration |
$848.78
|
| Rate for Payer: United Healthcare Commercial |
$3,891.51
|
| Rate for Payer: United Healthcare Medicare |
$848.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.05
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$4,473.00
|
|
|
Service Code
|
HCPCS 27822 AS
|
| Hospital Charge Code |
27822
|
| Min. Negotiated Rate |
$721.46 |
| Max. Negotiated Rate |
$4,473.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,383.54
|
| Rate for Payer: Aetna of WY Medicare |
$848.78
|
| Rate for Payer: Beech Street Commercial |
$4,249.35
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,338.81
|
| Rate for Payer: Cigna of WY Commercial |
$4,383.54
|
| Rate for Payer: First Choice Health Commercial |
$4,025.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,249.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$848.78
|
| Rate for Payer: HealthUtah PPO |
$4,473.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,338.81
|
| Rate for Payer: Multiplan Medicare/VA |
$721.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,383.54
|
| Rate for Payer: PacificSource Commercial |
$4,025.70
|
| Rate for Payer: PHCS PPO |
$4,249.35
|
| Rate for Payer: Three Rivers PPO |
$3,354.75
|
| Rate for Payer: TriWest Veterans Administration |
$848.78
|
| Rate for Payer: United Healthcare Commercial |
$3,891.51
|
| Rate for Payer: United Healthcare Medicare |
$848.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.05
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$4,473.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
27822
|
| Min. Negotiated Rate |
$721.46 |
| Max. Negotiated Rate |
$4,473.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,383.54
|
| Rate for Payer: Aetna of WY Medicare |
$848.78
|
| Rate for Payer: Beech Street Commercial |
$4,249.35
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: Cash Price |
$3,131.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,338.81
|
| Rate for Payer: Cigna of WY Commercial |
$4,383.54
|
| Rate for Payer: First Choice Health Commercial |
$4,025.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,249.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$848.78
|
| Rate for Payer: HealthUtah PPO |
$4,473.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,338.81
|
| Rate for Payer: Multiplan Medicare/VA |
$721.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,383.54
|
| Rate for Payer: PacificSource Commercial |
$4,025.70
|
| Rate for Payer: PHCS PPO |
$4,249.35
|
| Rate for Payer: Three Rivers PPO |
$3,354.75
|
| Rate for Payer: TriWest Veterans Administration |
$848.78
|
| Rate for Payer: United Healthcare Commercial |
$3,891.51
|
| Rate for Payer: United Healthcare Medicare |
$848.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.05
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [39114]
|
Facility
|
IP
|
$18.30
|
|
|
Service Code
|
NDC 9999939114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$18.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.57
|
| Rate for Payer: Altius Commercial |
$17.57
|
| Rate for Payer: Beech Street Commercial |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.02
|
| Rate for Payer: Cash Price |
$12.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.75
|
| Rate for Payer: Cigna of WY Commercial |
$17.93
|
| Rate for Payer: Entrust Commercial |
$17.38
|
| Rate for Payer: First Choice Health Commercial |
$17.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.08
|
| Rate for Payer: HealthUtah PPO |
$18.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.75
|
| Rate for Payer: Multiplan Medicare/VA |
$11.47
|
| Rate for Payer: One Health Plan of WY PPO |
$17.93
|
| Rate for Payer: PacificSource Commercial |
$16.47
|
| Rate for Payer: PHCS PPO |
$17.93
|
| Rate for Payer: Three Rivers PPO |
$13.72
|
| Rate for Payer: TriWest Veterans Administration |
$12.08
|
| Rate for Payer: United Healthcare Commercial |
$15.92
|
| Rate for Payer: United Healthcare Medicare |
$12.08
|
| Rate for Payer: WINHealth Partners Commercial |
$17.38
|
| Rate for Payer: Wise Provider Network Commercial |
$17.38
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [39114]
|
Facility
|
OP
|
$18.32
|
|
|
Service Code
|
NDC 4279921701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.95
|
| Rate for Payer: Aetna of WY Medicare |
$12.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.59
|
| Rate for Payer: Altius Commercial |
$17.59
|
| Rate for Payer: Beech Street Commercial |
$17.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.77
|
| Rate for Payer: Cigna of WY Commercial |
$17.95
|
| Rate for Payer: Entrust Commercial |
$17.40
|
| Rate for Payer: First Choice Health Commercial |
$17.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.63
|
| Rate for Payer: HealthUtah PPO |
$18.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.77
|
| Rate for Payer: Multiplan Medicare/VA |
$10.09
|
| Rate for Payer: One Health Plan of WY PPO |
$17.95
|
| Rate for Payer: PacificSource Commercial |
$16.49
|
| Rate for Payer: PHCS PPO |
$17.95
|
| Rate for Payer: Three Rivers PPO |
$13.74
|
| Rate for Payer: TriWest Veterans Administration |
$10.63
|
| Rate for Payer: United Healthcare Commercial |
$15.94
|
| Rate for Payer: United Healthcare Medicare |
$10.63
|
| Rate for Payer: WINHealth Partners Commercial |
$17.95
|
| Rate for Payer: Wise Provider Network Commercial |
$17.40
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [39114]
|
Facility
|
OP
|
$18.30
|
|
|
Service Code
|
NDC 9999939114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$18.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.93
|
| Rate for Payer: Aetna of WY Medicare |
$12.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.57
|
| Rate for Payer: Altius Commercial |
$17.57
|
| Rate for Payer: Beech Street Commercial |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.02
|
| Rate for Payer: Cash Price |
$12.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.75
|
| Rate for Payer: Cigna of WY Commercial |
$17.93
|
| Rate for Payer: Entrust Commercial |
$17.38
|
| Rate for Payer: First Choice Health Commercial |
$17.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.61
|
| Rate for Payer: HealthUtah PPO |
$18.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.75
|
| Rate for Payer: Multiplan Medicare/VA |
$10.08
|
| Rate for Payer: One Health Plan of WY PPO |
$17.93
|
| Rate for Payer: PacificSource Commercial |
$16.47
|
| Rate for Payer: PHCS PPO |
$17.93
|
| Rate for Payer: Three Rivers PPO |
$13.72
|
| Rate for Payer: TriWest Veterans Administration |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$15.92
|
| Rate for Payer: United Healthcare Medicare |
$10.61
|
| Rate for Payer: WINHealth Partners Commercial |
$17.93
|
| Rate for Payer: Wise Provider Network Commercial |
$17.38
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [39114]
|
Facility
|
IP
|
$18.32
|
|
|
Service Code
|
NDC 4279921701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.59
|
| Rate for Payer: Altius Commercial |
$17.59
|
| Rate for Payer: Beech Street Commercial |
$17.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.77
|
| Rate for Payer: Cigna of WY Commercial |
$17.95
|
| Rate for Payer: Entrust Commercial |
$17.40
|
| Rate for Payer: First Choice Health Commercial |
$17.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.09
|
| Rate for Payer: HealthUtah PPO |
$18.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.77
|
| Rate for Payer: Multiplan Medicare/VA |
$11.49
|
| Rate for Payer: One Health Plan of WY PPO |
$17.95
|
| Rate for Payer: PacificSource Commercial |
$16.49
|
| Rate for Payer: PHCS PPO |
$17.95
|
| Rate for Payer: Three Rivers PPO |
$13.74
|
| Rate for Payer: TriWest Veterans Administration |
$12.09
|
| Rate for Payer: United Healthcare Commercial |
$15.94
|
| Rate for Payer: United Healthcare Medicare |
$12.09
|
| Rate for Payer: WINHealth Partners Commercial |
$17.40
|
| Rate for Payer: Wise Provider Network Commercial |
$17.40
|
|
|
OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
23552
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,157.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,093.86
|
| Rate for Payer: Aetna of WY Medicare |
$633.39
|
| Rate for Payer: Beech Street Commercial |
$2,999.15
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,062.29
|
| Rate for Payer: Cigna of WY Commercial |
$3,093.86
|
| Rate for Payer: First Choice Health Commercial |
$2,841.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,999.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.39
|
| Rate for Payer: HealthUtah PPO |
$3,157.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,062.29
|
| Rate for Payer: Multiplan Medicare/VA |
$538.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,093.86
|
| Rate for Payer: PacificSource Commercial |
$2,841.30
|
| Rate for Payer: PHCS PPO |
$2,999.15
|
| Rate for Payer: Three Rivers PPO |
$2,367.75
|
| Rate for Payer: TriWest Veterans Administration |
$633.39
|
| Rate for Payer: United Healthcare Commercial |
$2,746.59
|
| Rate for Payer: United Healthcare Medicare |
$633.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,683.45
|
|
|
OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 23552 AS
|
| Hospital Charge Code |
23552
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,157.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,093.86
|
| Rate for Payer: Aetna of WY Medicare |
$633.39
|
| Rate for Payer: Beech Street Commercial |
$2,999.15
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,062.29
|
| Rate for Payer: Cigna of WY Commercial |
$3,093.86
|
| Rate for Payer: First Choice Health Commercial |
$2,841.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,999.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.39
|
| Rate for Payer: HealthUtah PPO |
$3,157.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,062.29
|
| Rate for Payer: Multiplan Medicare/VA |
$538.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,093.86
|
| Rate for Payer: PacificSource Commercial |
$2,841.30
|
| Rate for Payer: PHCS PPO |
$2,999.15
|
| Rate for Payer: Three Rivers PPO |
$2,367.75
|
| Rate for Payer: TriWest Veterans Administration |
$633.39
|
| Rate for Payer: United Healthcare Commercial |
$2,746.59
|
| Rate for Payer: United Healthcare Medicare |
$633.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,683.45
|
|
|
OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 23552 80
|
| Hospital Charge Code |
23552
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,157.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,093.86
|
| Rate for Payer: Aetna of WY Medicare |
$633.39
|
| Rate for Payer: Beech Street Commercial |
$2,999.15
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: Cash Price |
$2,209.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,062.29
|
| Rate for Payer: Cigna of WY Commercial |
$3,093.86
|
| Rate for Payer: First Choice Health Commercial |
$2,841.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,999.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.39
|
| Rate for Payer: HealthUtah PPO |
$3,157.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,062.29
|
| Rate for Payer: Multiplan Medicare/VA |
$538.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,093.86
|
| Rate for Payer: PacificSource Commercial |
$2,841.30
|
| Rate for Payer: PHCS PPO |
$2,999.15
|
| Rate for Payer: Three Rivers PPO |
$2,367.75
|
| Rate for Payer: TriWest Veterans Administration |
$633.39
|
| Rate for Payer: United Healthcare Commercial |
$2,746.59
|
| Rate for Payer: United Healthcare Medicare |
$633.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,683.45
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,882.00
|
|
|
Service Code
|
HCPCS 25608 AS
|
| Hospital Charge Code |
25608
|
| Min. Negotiated Rate |
$686.38 |
| Max. Negotiated Rate |
$2,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,824.36
|
| Rate for Payer: Aetna of WY Medicare |
$807.51
|
| Rate for Payer: Beech Street Commercial |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,795.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,824.36
|
| Rate for Payer: First Choice Health Commercial |
$2,593.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,737.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.51
|
| Rate for Payer: HealthUtah PPO |
$2,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,795.54
|
| Rate for Payer: Multiplan Medicare/VA |
$686.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,824.36
|
| Rate for Payer: PacificSource Commercial |
$2,593.80
|
| Rate for Payer: PHCS PPO |
$2,737.90
|
| Rate for Payer: Three Rivers PPO |
$2,161.50
|
| Rate for Payer: TriWest Veterans Administration |
$807.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.34
|
| Rate for Payer: United Healthcare Medicare |
$807.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.70
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,882.00
|
|
|
Service Code
|
HCPCS 25608 80
|
| Hospital Charge Code |
25608
|
| Min. Negotiated Rate |
$686.38 |
| Max. Negotiated Rate |
$2,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,824.36
|
| Rate for Payer: Aetna of WY Medicare |
$807.51
|
| Rate for Payer: Beech Street Commercial |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,795.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,824.36
|
| Rate for Payer: First Choice Health Commercial |
$2,593.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,737.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.51
|
| Rate for Payer: HealthUtah PPO |
$2,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,795.54
|
| Rate for Payer: Multiplan Medicare/VA |
$686.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,824.36
|
| Rate for Payer: PacificSource Commercial |
$2,593.80
|
| Rate for Payer: PHCS PPO |
$2,737.90
|
| Rate for Payer: Three Rivers PPO |
$2,161.50
|
| Rate for Payer: TriWest Veterans Administration |
$807.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.34
|
| Rate for Payer: United Healthcare Medicare |
$807.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.70
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,882.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
25608
|
| Min. Negotiated Rate |
$686.38 |
| Max. Negotiated Rate |
$2,882.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,824.36
|
| Rate for Payer: Aetna of WY Medicare |
$807.51
|
| Rate for Payer: Beech Street Commercial |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,795.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,824.36
|
| Rate for Payer: First Choice Health Commercial |
$2,593.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,737.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.51
|
| Rate for Payer: HealthUtah PPO |
$2,882.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,795.54
|
| Rate for Payer: Multiplan Medicare/VA |
$686.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,824.36
|
| Rate for Payer: PacificSource Commercial |
$2,593.80
|
| Rate for Payer: PHCS PPO |
$2,737.90
|
| Rate for Payer: Three Rivers PPO |
$2,161.50
|
| Rate for Payer: TriWest Veterans Administration |
$807.51
|
| Rate for Payer: United Healthcare Commercial |
$2,507.34
|
| Rate for Payer: United Healthcare Medicare |
$807.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.70
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 25609 AS
|
| Hospital Charge Code |
25609
|
| Min. Negotiated Rate |
$868.78 |
| Max. Negotiated Rate |
$3,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,577.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,022.09
|
| Rate for Payer: Beech Street Commercial |
$3,467.50
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,540.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,577.00
|
| Rate for Payer: First Choice Health Commercial |
$3,285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,467.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,022.09
|
| Rate for Payer: HealthUtah PPO |
$3,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,540.50
|
| Rate for Payer: Multiplan Medicare/VA |
$868.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,577.00
|
| Rate for Payer: PacificSource Commercial |
$3,285.00
|
| Rate for Payer: PHCS PPO |
$3,467.50
|
| Rate for Payer: Three Rivers PPO |
$2,737.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,022.09
|
| Rate for Payer: United Healthcare Commercial |
$3,175.50
|
| Rate for Payer: United Healthcare Medicare |
$1,022.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3,102.50
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$7,301.00
|
|
|
Service Code
|
HCPCS 25609 50
|
| Hospital Charge Code |
25609
|
| Min. Negotiated Rate |
$868.78 |
| Max. Negotiated Rate |
$7,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,154.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,022.09
|
| Rate for Payer: Beech Street Commercial |
$6,935.95
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,081.97
|
| Rate for Payer: Cigna of WY Commercial |
$7,154.98
|
| Rate for Payer: First Choice Health Commercial |
$6,570.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,935.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,022.09
|
| Rate for Payer: HealthUtah PPO |
$7,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,081.97
|
| Rate for Payer: Multiplan Medicare/VA |
$868.78
|
| Rate for Payer: One Health Plan of WY PPO |
$7,154.98
|
| Rate for Payer: PacificSource Commercial |
$6,570.90
|
| Rate for Payer: PHCS PPO |
$6,935.95
|
| Rate for Payer: Three Rivers PPO |
$5,475.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,022.09
|
| Rate for Payer: United Healthcare Commercial |
$6,351.87
|
| Rate for Payer: United Healthcare Medicare |
$1,022.09
|
| Rate for Payer: WINHealth Partners Commercial |
$6,205.85
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
25609
|
| Min. Negotiated Rate |
$868.78 |
| Max. Negotiated Rate |
$3,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,577.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,022.09
|
| Rate for Payer: Beech Street Commercial |
$3,467.50
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,540.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,577.00
|
| Rate for Payer: First Choice Health Commercial |
$3,285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,467.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,022.09
|
| Rate for Payer: HealthUtah PPO |
$3,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,540.50
|
| Rate for Payer: Multiplan Medicare/VA |
$868.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,577.00
|
| Rate for Payer: PacificSource Commercial |
$3,285.00
|
| Rate for Payer: PHCS PPO |
$3,467.50
|
| Rate for Payer: Three Rivers PPO |
$2,737.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,022.09
|
| Rate for Payer: United Healthcare Commercial |
$3,175.50
|
| Rate for Payer: United Healthcare Medicare |
$1,022.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3,102.50
|
|
|
OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 25609 80
|
| Hospital Charge Code |
25609
|
| Min. Negotiated Rate |
$868.78 |
| Max. Negotiated Rate |
$3,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,577.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,022.09
|
| Rate for Payer: Beech Street Commercial |
$3,467.50
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: Cash Price |
$2,555.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,540.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,577.00
|
| Rate for Payer: First Choice Health Commercial |
$3,285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,467.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,022.09
|
| Rate for Payer: HealthUtah PPO |
$3,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,540.50
|
| Rate for Payer: Multiplan Medicare/VA |
$868.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,577.00
|
| Rate for Payer: PacificSource Commercial |
$3,285.00
|
| Rate for Payer: PHCS PPO |
$3,467.50
|
| Rate for Payer: Three Rivers PPO |
$2,737.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,022.09
|
| Rate for Payer: United Healthcare Commercial |
$3,175.50
|
| Rate for Payer: United Healthcare Medicare |
$1,022.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3,102.50
|
|
|
OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$3,794.00
|
|
|
Service Code
|
HCPCS 25607 AS
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$615.43 |
| Max. Negotiated Rate |
$3,794.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,718.12
|
| Rate for Payer: Aetna of WY Medicare |
$724.04
|
| Rate for Payer: Beech Street Commercial |
$3,604.30
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,680.18
|
| Rate for Payer: Cigna of WY Commercial |
$3,718.12
|
| Rate for Payer: First Choice Health Commercial |
$3,414.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,604.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$724.04
|
| Rate for Payer: HealthUtah PPO |
$3,794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,680.18
|
| Rate for Payer: Multiplan Medicare/VA |
$615.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,718.12
|
| Rate for Payer: PacificSource Commercial |
$3,414.60
|
| Rate for Payer: PHCS PPO |
$3,604.30
|
| Rate for Payer: Three Rivers PPO |
$2,845.50
|
| Rate for Payer: TriWest Veterans Administration |
$724.04
|
| Rate for Payer: United Healthcare Commercial |
$3,300.78
|
| Rate for Payer: United Healthcare Medicare |
$724.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3,224.90
|
|
|
OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$3,794.00
|
|
|
Service Code
|
HCPCS 25607 80
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$615.43 |
| Max. Negotiated Rate |
$3,794.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,718.12
|
| Rate for Payer: Aetna of WY Medicare |
$724.04
|
| Rate for Payer: Beech Street Commercial |
$3,604.30
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,680.18
|
| Rate for Payer: Cigna of WY Commercial |
$3,718.12
|
| Rate for Payer: First Choice Health Commercial |
$3,414.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,604.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$724.04
|
| Rate for Payer: HealthUtah PPO |
$3,794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,680.18
|
| Rate for Payer: Multiplan Medicare/VA |
$615.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,718.12
|
| Rate for Payer: PacificSource Commercial |
$3,414.60
|
| Rate for Payer: PHCS PPO |
$3,604.30
|
| Rate for Payer: Three Rivers PPO |
$2,845.50
|
| Rate for Payer: TriWest Veterans Administration |
$724.04
|
| Rate for Payer: United Healthcare Commercial |
$3,300.78
|
| Rate for Payer: United Healthcare Medicare |
$724.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3,224.90
|
|
|
OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$3,794.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$615.43 |
| Max. Negotiated Rate |
$3,794.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,718.12
|
| Rate for Payer: Aetna of WY Medicare |
$724.04
|
| Rate for Payer: Beech Street Commercial |
$3,604.30
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: Cash Price |
$2,655.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,680.18
|
| Rate for Payer: Cigna of WY Commercial |
$3,718.12
|
| Rate for Payer: First Choice Health Commercial |
$3,414.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,604.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$724.04
|
| Rate for Payer: HealthUtah PPO |
$3,794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,680.18
|
| Rate for Payer: Multiplan Medicare/VA |
$615.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,718.12
|
| Rate for Payer: PacificSource Commercial |
$3,414.60
|
| Rate for Payer: PHCS PPO |
$3,604.30
|
| Rate for Payer: Three Rivers PPO |
$2,845.50
|
| Rate for Payer: TriWest Veterans Administration |
$724.04
|
| Rate for Payer: United Healthcare Commercial |
$3,300.78
|
| Rate for Payer: United Healthcare Medicare |
$724.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3,224.90
|
|
|
OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 27236 AS
|
| Hospital Charge Code |
27236
|
| Min. Negotiated Rate |
$975.54 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,013.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,147.70
|
| Rate for Payer: Beech Street Commercial |
$3,890.25
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,972.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,013.10
|
| Rate for Payer: First Choice Health Commercial |
$3,685.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,890.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,147.70
|
| Rate for Payer: HealthUtah PPO |
$4,095.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,972.15
|
| Rate for Payer: Multiplan Medicare/VA |
$975.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,013.10
|
| Rate for Payer: PacificSource Commercial |
$3,685.50
|
| Rate for Payer: PHCS PPO |
$3,890.25
|
| Rate for Payer: Three Rivers PPO |
$3,071.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,147.70
|
| Rate for Payer: United Healthcare Commercial |
$3,562.65
|
| Rate for Payer: United Healthcare Medicare |
$1,147.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,480.75
|
|
|
OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
27236
|
| Min. Negotiated Rate |
$975.54 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,013.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,147.70
|
| Rate for Payer: Beech Street Commercial |
$3,890.25
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,972.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,013.10
|
| Rate for Payer: First Choice Health Commercial |
$3,685.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,890.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,147.70
|
| Rate for Payer: HealthUtah PPO |
$4,095.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,972.15
|
| Rate for Payer: Multiplan Medicare/VA |
$975.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,013.10
|
| Rate for Payer: PacificSource Commercial |
$3,685.50
|
| Rate for Payer: PHCS PPO |
$3,890.25
|
| Rate for Payer: Three Rivers PPO |
$3,071.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,147.70
|
| Rate for Payer: United Healthcare Commercial |
$3,562.65
|
| Rate for Payer: United Healthcare Medicare |
$1,147.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,480.75
|
|
|
OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 27236 80
|
| Hospital Charge Code |
27236
|
| Min. Negotiated Rate |
$975.54 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,013.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,147.70
|
| Rate for Payer: Beech Street Commercial |
$3,890.25
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: Cash Price |
$2,866.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,972.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,013.10
|
| Rate for Payer: First Choice Health Commercial |
$3,685.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,890.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,147.70
|
| Rate for Payer: HealthUtah PPO |
$4,095.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,972.15
|
| Rate for Payer: Multiplan Medicare/VA |
$975.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,013.10
|
| Rate for Payer: PacificSource Commercial |
$3,685.50
|
| Rate for Payer: PHCS PPO |
$3,890.25
|
| Rate for Payer: Three Rivers PPO |
$3,071.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,147.70
|
| Rate for Payer: United Healthcare Commercial |
$3,562.65
|
| Rate for Payer: United Healthcare Medicare |
$1,147.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,480.75
|
|
|
OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$6,901.00
|
|
|
Service Code
|
HCPCS 27506 AS
|
| Hospital Charge Code |
27506
|
| Min. Negotiated Rate |
$1,093.57 |
| Max. Negotiated Rate |
$6,901.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,762.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,286.55
|
| Rate for Payer: Beech Street Commercial |
$6,555.95
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,693.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,762.98
|
| Rate for Payer: First Choice Health Commercial |
$6,210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,555.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,286.55
|
| Rate for Payer: HealthUtah PPO |
$6,901.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,693.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,093.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,762.98
|
| Rate for Payer: PacificSource Commercial |
$6,210.90
|
| Rate for Payer: PHCS PPO |
$6,555.95
|
| Rate for Payer: Three Rivers PPO |
$5,175.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,286.55
|
| Rate for Payer: United Healthcare Commercial |
$6,003.87
|
| Rate for Payer: United Healthcare Medicare |
$1,286.55
|
| Rate for Payer: WINHealth Partners Commercial |
$5,865.85
|
|
|
OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$6,901.00
|
|
|
Service Code
|
HCPCS 27506 80
|
| Hospital Charge Code |
27506
|
| Min. Negotiated Rate |
$1,093.57 |
| Max. Negotiated Rate |
$6,901.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,762.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,286.55
|
| Rate for Payer: Beech Street Commercial |
$6,555.95
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: Cash Price |
$4,830.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,693.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,762.98
|
| Rate for Payer: First Choice Health Commercial |
$6,210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,555.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,286.55
|
| Rate for Payer: HealthUtah PPO |
$6,901.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,693.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,093.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,762.98
|
| Rate for Payer: PacificSource Commercial |
$6,210.90
|
| Rate for Payer: PHCS PPO |
$6,555.95
|
| Rate for Payer: Three Rivers PPO |
$5,175.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,286.55
|
| Rate for Payer: United Healthcare Commercial |
$6,003.87
|
| Rate for Payer: United Healthcare Medicare |
$1,286.55
|
| Rate for Payer: WINHealth Partners Commercial |
$5,865.85
|
|
