|
OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$6,901.00
|
|
|
Service Code
|
HCPCS 27506
|
| 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/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$5,012.00
|
|
|
Service Code
|
HCPCS 27507 AS
|
| Hospital Charge Code |
27507
|
| Min. Negotiated Rate |
$790.17 |
| Max. Negotiated Rate |
$5,012.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,911.76
|
| Rate for Payer: Aetna of WY Medicare |
$929.61
|
| Rate for Payer: Beech Street Commercial |
$4,761.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,861.64
|
| Rate for Payer: Cigna of WY Commercial |
$4,911.76
|
| Rate for Payer: First Choice Health Commercial |
$4,510.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$929.61
|
| Rate for Payer: HealthUtah PPO |
$5,012.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,861.64
|
| Rate for Payer: Multiplan Medicare/VA |
$790.17
|
| Rate for Payer: One Health Plan of WY PPO |
$4,911.76
|
| Rate for Payer: PacificSource Commercial |
$4,510.80
|
| Rate for Payer: PHCS PPO |
$4,761.40
|
| Rate for Payer: Three Rivers PPO |
$3,759.00
|
| Rate for Payer: TriWest Veterans Administration |
$929.61
|
| Rate for Payer: United Healthcare Commercial |
$4,360.44
|
| Rate for Payer: United Healthcare Medicare |
$929.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4,260.20
|
|
|
OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$5,012.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
27507
|
| Min. Negotiated Rate |
$790.17 |
| Max. Negotiated Rate |
$5,012.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,911.76
|
| Rate for Payer: Aetna of WY Medicare |
$929.61
|
| Rate for Payer: Beech Street Commercial |
$4,761.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,861.64
|
| Rate for Payer: Cigna of WY Commercial |
$4,911.76
|
| Rate for Payer: First Choice Health Commercial |
$4,510.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$929.61
|
| Rate for Payer: HealthUtah PPO |
$5,012.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,861.64
|
| Rate for Payer: Multiplan Medicare/VA |
$790.17
|
| Rate for Payer: One Health Plan of WY PPO |
$4,911.76
|
| Rate for Payer: PacificSource Commercial |
$4,510.80
|
| Rate for Payer: PHCS PPO |
$4,761.40
|
| Rate for Payer: Three Rivers PPO |
$3,759.00
|
| Rate for Payer: TriWest Veterans Administration |
$929.61
|
| Rate for Payer: United Healthcare Commercial |
$4,360.44
|
| Rate for Payer: United Healthcare Medicare |
$929.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4,260.20
|
|
|
OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$5,012.00
|
|
|
Service Code
|
HCPCS 27507 80
|
| Hospital Charge Code |
27507
|
| Min. Negotiated Rate |
$790.17 |
| Max. Negotiated Rate |
$5,012.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,911.76
|
| Rate for Payer: Aetna of WY Medicare |
$929.61
|
| Rate for Payer: Beech Street Commercial |
$4,761.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: Cash Price |
$3,508.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,861.64
|
| Rate for Payer: Cigna of WY Commercial |
$4,911.76
|
| Rate for Payer: First Choice Health Commercial |
$4,510.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$929.61
|
| Rate for Payer: HealthUtah PPO |
$5,012.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,861.64
|
| Rate for Payer: Multiplan Medicare/VA |
$790.17
|
| Rate for Payer: One Health Plan of WY PPO |
$4,911.76
|
| Rate for Payer: PacificSource Commercial |
$4,510.80
|
| Rate for Payer: PHCS PPO |
$4,761.40
|
| Rate for Payer: Three Rivers PPO |
$3,759.00
|
| Rate for Payer: TriWest Veterans Administration |
$929.61
|
| Rate for Payer: United Healthcare Commercial |
$4,360.44
|
| Rate for Payer: United Healthcare Medicare |
$929.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4,260.20
|
|
|
OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$3,993.00
|
|
|
Service Code
|
HCPCS 23630 AS
|
| Hospital Charge Code |
23630
|
| Min. Negotiated Rate |
$645.90 |
| Max. Negotiated Rate |
$3,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,913.14
|
| Rate for Payer: Aetna of WY Medicare |
$759.88
|
| Rate for Payer: Beech Street Commercial |
$3,793.35
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,873.21
|
| Rate for Payer: Cigna of WY Commercial |
$3,913.14
|
| Rate for Payer: First Choice Health Commercial |
$3,593.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,793.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$759.88
|
| Rate for Payer: HealthUtah PPO |
$3,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,873.21
|
| Rate for Payer: Multiplan Medicare/VA |
$645.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,913.14
|
| Rate for Payer: PacificSource Commercial |
$3,593.70
|
| Rate for Payer: PHCS PPO |
$3,793.35
|
| Rate for Payer: Three Rivers PPO |
$2,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$759.88
|
| Rate for Payer: United Healthcare Commercial |
$3,473.91
|
| Rate for Payer: United Healthcare Medicare |
$759.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,394.05
|
|
|
OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$3,993.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
23630
|
| Min. Negotiated Rate |
$645.90 |
| Max. Negotiated Rate |
$3,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,913.14
|
| Rate for Payer: Aetna of WY Medicare |
$759.88
|
| Rate for Payer: Beech Street Commercial |
$3,793.35
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,873.21
|
| Rate for Payer: Cigna of WY Commercial |
$3,913.14
|
| Rate for Payer: First Choice Health Commercial |
$3,593.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,793.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$759.88
|
| Rate for Payer: HealthUtah PPO |
$3,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,873.21
|
| Rate for Payer: Multiplan Medicare/VA |
$645.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,913.14
|
| Rate for Payer: PacificSource Commercial |
$3,593.70
|
| Rate for Payer: PHCS PPO |
$3,793.35
|
| Rate for Payer: Three Rivers PPO |
$2,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$759.88
|
| Rate for Payer: United Healthcare Commercial |
$3,473.91
|
| Rate for Payer: United Healthcare Medicare |
$759.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,394.05
|
|
|
OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$4,536.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
24515
|
| Min. Negotiated Rate |
$725.96 |
| Max. Negotiated Rate |
$4,536.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,445.28
|
| Rate for Payer: Aetna of WY Medicare |
$854.07
|
| Rate for Payer: Beech Street Commercial |
$4,309.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,399.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,445.28
|
| Rate for Payer: First Choice Health Commercial |
$4,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,309.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$854.07
|
| Rate for Payer: HealthUtah PPO |
$4,536.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,399.92
|
| Rate for Payer: Multiplan Medicare/VA |
$725.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,445.28
|
| Rate for Payer: PacificSource Commercial |
$4,082.40
|
| Rate for Payer: PHCS PPO |
$4,309.20
|
| Rate for Payer: Three Rivers PPO |
$3,402.00
|
| Rate for Payer: TriWest Veterans Administration |
$854.07
|
| Rate for Payer: United Healthcare Commercial |
$3,946.32
|
| Rate for Payer: United Healthcare Medicare |
$854.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,855.60
|
|
|
OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$4,536.00
|
|
|
Service Code
|
HCPCS 24515 AS
|
| Hospital Charge Code |
24515
|
| Min. Negotiated Rate |
$725.96 |
| Max. Negotiated Rate |
$4,536.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,445.28
|
| Rate for Payer: Aetna of WY Medicare |
$854.07
|
| Rate for Payer: Beech Street Commercial |
$4,309.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,399.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,445.28
|
| Rate for Payer: First Choice Health Commercial |
$4,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,309.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$854.07
|
| Rate for Payer: HealthUtah PPO |
$4,536.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,399.92
|
| Rate for Payer: Multiplan Medicare/VA |
$725.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,445.28
|
| Rate for Payer: PacificSource Commercial |
$4,082.40
|
| Rate for Payer: PHCS PPO |
$4,309.20
|
| Rate for Payer: Three Rivers PPO |
$3,402.00
|
| Rate for Payer: TriWest Veterans Administration |
$854.07
|
| Rate for Payer: United Healthcare Commercial |
$3,946.32
|
| Rate for Payer: United Healthcare Medicare |
$854.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,855.60
|
|
|
OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$4,536.00
|
|
|
Service Code
|
HCPCS 24515 80
|
| Hospital Charge Code |
24515
|
| Min. Negotiated Rate |
$725.96 |
| Max. Negotiated Rate |
$4,536.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,445.28
|
| Rate for Payer: Aetna of WY Medicare |
$854.07
|
| Rate for Payer: Beech Street Commercial |
$4,309.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: Cash Price |
$3,175.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,399.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,445.28
|
| Rate for Payer: First Choice Health Commercial |
$4,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,309.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$854.07
|
| Rate for Payer: HealthUtah PPO |
$4,536.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,399.92
|
| Rate for Payer: Multiplan Medicare/VA |
$725.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,445.28
|
| Rate for Payer: PacificSource Commercial |
$4,082.40
|
| Rate for Payer: PHCS PPO |
$4,309.20
|
| Rate for Payer: Three Rivers PPO |
$3,402.00
|
| Rate for Payer: TriWest Veterans Administration |
$854.07
|
| Rate for Payer: United Healthcare Commercial |
$3,946.32
|
| Rate for Payer: United Healthcare Medicare |
$854.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,855.60
|
|
|
OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
27566
|
| Min. Negotiated Rate |
$734.04 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,020.36
|
| Rate for Payer: Aetna of WY Medicare |
$863.58
|
| Rate for Payer: Beech Street Commercial |
$2,927.90
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,989.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,020.36
|
| Rate for Payer: First Choice Health Commercial |
$2,773.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$863.58
|
| Rate for Payer: HealthUtah PPO |
$3,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,989.54
|
| Rate for Payer: Multiplan Medicare/VA |
$734.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,020.36
|
| Rate for Payer: PacificSource Commercial |
$2,773.80
|
| Rate for Payer: PHCS PPO |
$2,927.90
|
| Rate for Payer: Three Rivers PPO |
$2,311.50
|
| Rate for Payer: TriWest Veterans Administration |
$863.58
|
| Rate for Payer: United Healthcare Commercial |
$2,681.34
|
| Rate for Payer: United Healthcare Medicare |
$863.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,619.70
|
|
|
OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 27566 AS
|
| Hospital Charge Code |
27566
|
| Min. Negotiated Rate |
$734.04 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,020.36
|
| Rate for Payer: Aetna of WY Medicare |
$863.58
|
| Rate for Payer: Beech Street Commercial |
$2,927.90
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,989.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,020.36
|
| Rate for Payer: First Choice Health Commercial |
$2,773.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$863.58
|
| Rate for Payer: HealthUtah PPO |
$3,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,989.54
|
| Rate for Payer: Multiplan Medicare/VA |
$734.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,020.36
|
| Rate for Payer: PacificSource Commercial |
$2,773.80
|
| Rate for Payer: PHCS PPO |
$2,927.90
|
| Rate for Payer: Three Rivers PPO |
$2,311.50
|
| Rate for Payer: TriWest Veterans Administration |
$863.58
|
| Rate for Payer: United Healthcare Commercial |
$2,681.34
|
| Rate for Payer: United Healthcare Medicare |
$863.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,619.70
|
|
|
OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 27566 80
|
| Hospital Charge Code |
27566
|
| Min. Negotiated Rate |
$734.04 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,020.36
|
| Rate for Payer: Aetna of WY Medicare |
$863.58
|
| Rate for Payer: Beech Street Commercial |
$2,927.90
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: Cash Price |
$2,157.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,989.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,020.36
|
| Rate for Payer: First Choice Health Commercial |
$2,773.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$863.58
|
| Rate for Payer: HealthUtah PPO |
$3,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,989.54
|
| Rate for Payer: Multiplan Medicare/VA |
$734.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,020.36
|
| Rate for Payer: PacificSource Commercial |
$2,773.80
|
| Rate for Payer: PHCS PPO |
$2,927.90
|
| Rate for Payer: Three Rivers PPO |
$2,311.50
|
| Rate for Payer: TriWest Veterans Administration |
$863.58
|
| Rate for Payer: United Healthcare Commercial |
$2,681.34
|
| Rate for Payer: United Healthcare Medicare |
$863.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,619.70
|
|
|
OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 27524 AS
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$621.76 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,557.80
|
| Rate for Payer: Aetna of WY Medicare |
$731.48
|
| Rate for Payer: Beech Street Commercial |
$2,479.50
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,531.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,557.80
|
| Rate for Payer: First Choice Health Commercial |
$2,349.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,479.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.48
|
| Rate for Payer: HealthUtah PPO |
$2,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,531.70
|
| Rate for Payer: Multiplan Medicare/VA |
$621.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,557.80
|
| Rate for Payer: PacificSource Commercial |
$2,349.00
|
| Rate for Payer: PHCS PPO |
$2,479.50
|
| Rate for Payer: Three Rivers PPO |
$1,957.50
|
| Rate for Payer: TriWest Veterans Administration |
$731.48
|
| Rate for Payer: United Healthcare Commercial |
$2,270.70
|
| Rate for Payer: United Healthcare Medicare |
$731.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,218.50
|
|
|
OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 27524 80
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$621.76 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,557.80
|
| Rate for Payer: Aetna of WY Medicare |
$731.48
|
| Rate for Payer: Beech Street Commercial |
$2,479.50
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,531.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,557.80
|
| Rate for Payer: First Choice Health Commercial |
$2,349.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,479.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.48
|
| Rate for Payer: HealthUtah PPO |
$2,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,531.70
|
| Rate for Payer: Multiplan Medicare/VA |
$621.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,557.80
|
| Rate for Payer: PacificSource Commercial |
$2,349.00
|
| Rate for Payer: PHCS PPO |
$2,479.50
|
| Rate for Payer: Three Rivers PPO |
$1,957.50
|
| Rate for Payer: TriWest Veterans Administration |
$731.48
|
| Rate for Payer: United Healthcare Commercial |
$2,270.70
|
| Rate for Payer: United Healthcare Medicare |
$731.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,218.50
|
|
|
OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$621.76 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,557.80
|
| Rate for Payer: Aetna of WY Medicare |
$731.48
|
| Rate for Payer: Beech Street Commercial |
$2,479.50
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,531.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,557.80
|
| Rate for Payer: First Choice Health Commercial |
$2,349.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,479.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.48
|
| Rate for Payer: HealthUtah PPO |
$2,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,531.70
|
| Rate for Payer: Multiplan Medicare/VA |
$621.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,557.80
|
| Rate for Payer: PacificSource Commercial |
$2,349.00
|
| Rate for Payer: PHCS PPO |
$2,479.50
|
| Rate for Payer: Three Rivers PPO |
$1,957.50
|
| Rate for Payer: TriWest Veterans Administration |
$731.48
|
| Rate for Payer: United Healthcare Commercial |
$2,270.70
|
| Rate for Payer: United Healthcare Medicare |
$731.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,218.50
|
|
|
OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
24586
|
| Min. Negotiated Rate |
$890.79 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,724.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,047.99
|
| Rate for Payer: Beech Street Commercial |
$3,610.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,686.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,724.00
|
| Rate for Payer: First Choice Health Commercial |
$3,420.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,610.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,047.99
|
| Rate for Payer: HealthUtah PPO |
$3,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,686.00
|
| Rate for Payer: Multiplan Medicare/VA |
$890.79
|
| Rate for Payer: One Health Plan of WY PPO |
$3,724.00
|
| Rate for Payer: PacificSource Commercial |
$3,420.00
|
| Rate for Payer: PHCS PPO |
$3,610.00
|
| Rate for Payer: Three Rivers PPO |
$2,850.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,047.99
|
| Rate for Payer: United Healthcare Commercial |
$3,306.00
|
| Rate for Payer: United Healthcare Medicare |
$1,047.99
|
| Rate for Payer: WINHealth Partners Commercial |
$3,230.00
|
|
|
OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$4,527.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$727.69 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,436.46
|
| Rate for Payer: Aetna of WY Medicare |
$856.11
|
| Rate for Payer: Beech Street Commercial |
$4,300.65
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,391.19
|
| Rate for Payer: Cigna of WY Commercial |
$4,436.46
|
| Rate for Payer: First Choice Health Commercial |
$4,074.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,300.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.11
|
| Rate for Payer: HealthUtah PPO |
$4,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,391.19
|
| Rate for Payer: Multiplan Medicare/VA |
$727.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,436.46
|
| Rate for Payer: PacificSource Commercial |
$4,074.30
|
| Rate for Payer: PHCS PPO |
$4,300.65
|
| Rate for Payer: Three Rivers PPO |
$3,395.25
|
| Rate for Payer: TriWest Veterans Administration |
$856.11
|
| Rate for Payer: United Healthcare Commercial |
$3,938.49
|
| Rate for Payer: United Healthcare Medicare |
$856.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,847.95
|
|
|
OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$4,527.00
|
|
|
Service Code
|
HCPCS 23615 AS
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$727.69 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,436.46
|
| Rate for Payer: Aetna of WY Medicare |
$856.11
|
| Rate for Payer: Beech Street Commercial |
$4,300.65
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,391.19
|
| Rate for Payer: Cigna of WY Commercial |
$4,436.46
|
| Rate for Payer: First Choice Health Commercial |
$4,074.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,300.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.11
|
| Rate for Payer: HealthUtah PPO |
$4,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,391.19
|
| Rate for Payer: Multiplan Medicare/VA |
$727.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,436.46
|
| Rate for Payer: PacificSource Commercial |
$4,074.30
|
| Rate for Payer: PHCS PPO |
$4,300.65
|
| Rate for Payer: Three Rivers PPO |
$3,395.25
|
| Rate for Payer: TriWest Veterans Administration |
$856.11
|
| Rate for Payer: United Healthcare Commercial |
$3,938.49
|
| Rate for Payer: United Healthcare Medicare |
$856.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,847.95
|
|
|
OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$4,527.00
|
|
|
Service Code
|
HCPCS 23615 80
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$727.69 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,436.46
|
| Rate for Payer: Aetna of WY Medicare |
$856.11
|
| Rate for Payer: Beech Street Commercial |
$4,300.65
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: Cash Price |
$3,168.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,391.19
|
| Rate for Payer: Cigna of WY Commercial |
$4,436.46
|
| Rate for Payer: First Choice Health Commercial |
$4,074.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,300.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.11
|
| Rate for Payer: HealthUtah PPO |
$4,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,391.19
|
| Rate for Payer: Multiplan Medicare/VA |
$727.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4,436.46
|
| Rate for Payer: PacificSource Commercial |
$4,074.30
|
| Rate for Payer: PHCS PPO |
$4,300.65
|
| Rate for Payer: Three Rivers PPO |
$3,395.25
|
| Rate for Payer: TriWest Veterans Administration |
$856.11
|
| Rate for Payer: United Healthcare Commercial |
$3,938.49
|
| Rate for Payer: United Healthcare Medicare |
$856.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,847.95
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$3,136.00
|
|
|
Service Code
|
HCPCS 25575 AS
|
| Hospital Charge Code |
25575
|
| Min. Negotiated Rate |
$746.97 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,073.28
|
| Rate for Payer: Aetna of WY Medicare |
$878.79
|
| Rate for Payer: Beech Street Commercial |
$2,979.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,041.92
|
| Rate for Payer: Cigna of WY Commercial |
$3,073.28
|
| Rate for Payer: First Choice Health Commercial |
$2,822.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.79
|
| Rate for Payer: HealthUtah PPO |
$3,136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,041.92
|
| Rate for Payer: Multiplan Medicare/VA |
$746.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,073.28
|
| Rate for Payer: PacificSource Commercial |
$2,822.40
|
| Rate for Payer: PHCS PPO |
$2,979.20
|
| Rate for Payer: Three Rivers PPO |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration |
$878.79
|
| Rate for Payer: United Healthcare Commercial |
$2,728.32
|
| Rate for Payer: United Healthcare Medicare |
$878.79
|
| Rate for Payer: WINHealth Partners Commercial |
$2,665.60
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$3,136.00
|
|
|
Service Code
|
HCPCS 25575 80
|
| Hospital Charge Code |
25575
|
| Min. Negotiated Rate |
$746.97 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,073.28
|
| Rate for Payer: Aetna of WY Medicare |
$878.79
|
| Rate for Payer: Beech Street Commercial |
$2,979.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,041.92
|
| Rate for Payer: Cigna of WY Commercial |
$3,073.28
|
| Rate for Payer: First Choice Health Commercial |
$2,822.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.79
|
| Rate for Payer: HealthUtah PPO |
$3,136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,041.92
|
| Rate for Payer: Multiplan Medicare/VA |
$746.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,073.28
|
| Rate for Payer: PacificSource Commercial |
$2,822.40
|
| Rate for Payer: PHCS PPO |
$2,979.20
|
| Rate for Payer: Three Rivers PPO |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration |
$878.79
|
| Rate for Payer: United Healthcare Commercial |
$2,728.32
|
| Rate for Payer: United Healthcare Medicare |
$878.79
|
| Rate for Payer: WINHealth Partners Commercial |
$2,665.60
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$3,136.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
25575
|
| Min. Negotiated Rate |
$746.97 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,073.28
|
| Rate for Payer: Aetna of WY Medicare |
$878.79
|
| Rate for Payer: Beech Street Commercial |
$2,979.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,041.92
|
| Rate for Payer: Cigna of WY Commercial |
$3,073.28
|
| Rate for Payer: First Choice Health Commercial |
$2,822.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.79
|
| Rate for Payer: HealthUtah PPO |
$3,136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,041.92
|
| Rate for Payer: Multiplan Medicare/VA |
$746.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,073.28
|
| Rate for Payer: PacificSource Commercial |
$2,822.40
|
| Rate for Payer: PHCS PPO |
$2,979.20
|
| Rate for Payer: Three Rivers PPO |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration |
$878.79
|
| Rate for Payer: United Healthcare Commercial |
$2,728.32
|
| Rate for Payer: United Healthcare Medicare |
$878.79
|
| Rate for Payer: WINHealth Partners Commercial |
$2,665.60
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$6,505.00
|
|
|
Service Code
|
HCPCS 25574 80
|
| Hospital Charge Code |
25574
|
| Min. Negotiated Rate |
$561.12 |
| Max. Negotiated Rate |
$6,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,374.90
|
| Rate for Payer: Aetna of WY Medicare |
$660.14
|
| Rate for Payer: Beech Street Commercial |
$6,179.75
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,309.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,374.90
|
| Rate for Payer: First Choice Health Commercial |
$5,854.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,179.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.14
|
| Rate for Payer: HealthUtah PPO |
$6,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,309.85
|
| Rate for Payer: Multiplan Medicare/VA |
$561.12
|
| Rate for Payer: One Health Plan of WY PPO |
$6,374.90
|
| Rate for Payer: PacificSource Commercial |
$5,854.50
|
| Rate for Payer: PHCS PPO |
$6,179.75
|
| Rate for Payer: Three Rivers PPO |
$4,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.14
|
| Rate for Payer: United Healthcare Commercial |
$5,659.35
|
| Rate for Payer: United Healthcare Medicare |
$660.14
|
| Rate for Payer: WINHealth Partners Commercial |
$5,529.25
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$6,505.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
25574
|
| Min. Negotiated Rate |
$561.12 |
| Max. Negotiated Rate |
$6,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,374.90
|
| Rate for Payer: Aetna of WY Medicare |
$660.14
|
| Rate for Payer: Beech Street Commercial |
$6,179.75
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,309.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,374.90
|
| Rate for Payer: First Choice Health Commercial |
$5,854.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,179.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.14
|
| Rate for Payer: HealthUtah PPO |
$6,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,309.85
|
| Rate for Payer: Multiplan Medicare/VA |
$561.12
|
| Rate for Payer: One Health Plan of WY PPO |
$6,374.90
|
| Rate for Payer: PacificSource Commercial |
$5,854.50
|
| Rate for Payer: PHCS PPO |
$6,179.75
|
| Rate for Payer: Three Rivers PPO |
$4,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.14
|
| Rate for Payer: United Healthcare Commercial |
$5,659.35
|
| Rate for Payer: United Healthcare Medicare |
$660.14
|
| Rate for Payer: WINHealth Partners Commercial |
$5,529.25
|
|
|
OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$6,505.00
|
|
|
Service Code
|
HCPCS 25574 AS
|
| Hospital Charge Code |
25574
|
| Min. Negotiated Rate |
$561.12 |
| Max. Negotiated Rate |
$6,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,374.90
|
| Rate for Payer: Aetna of WY Medicare |
$660.14
|
| Rate for Payer: Beech Street Commercial |
$6,179.75
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: Cash Price |
$4,553.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,309.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,374.90
|
| Rate for Payer: First Choice Health Commercial |
$5,854.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,179.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.14
|
| Rate for Payer: HealthUtah PPO |
$6,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,309.85
|
| Rate for Payer: Multiplan Medicare/VA |
$561.12
|
| Rate for Payer: One Health Plan of WY PPO |
$6,374.90
|
| Rate for Payer: PacificSource Commercial |
$5,854.50
|
| Rate for Payer: PHCS PPO |
$6,179.75
|
| Rate for Payer: Three Rivers PPO |
$4,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.14
|
| Rate for Payer: United Healthcare Commercial |
$5,659.35
|
| Rate for Payer: United Healthcare Medicare |
$660.14
|
| Rate for Payer: WINHealth Partners Commercial |
$5,529.25
|
|
