|
PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$7,955.00
|
|
|
Service Code
|
HCPCS 63650 AS
|
| Hospital Charge Code |
63650
|
| Min. Negotiated Rate |
$339.73 |
| Max. Negotiated Rate |
$7,955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,795.90
|
| Rate for Payer: Aetna of WY Medicare |
$399.68
|
| Rate for Payer: Beech Street Commercial |
$7,557.25
|
| Rate for Payer: Cash Price |
$5,568.50
|
| Rate for Payer: Cash Price |
$5,568.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,716.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,795.90
|
| Rate for Payer: First Choice Health Commercial |
$7,159.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,557.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.68
|
| Rate for Payer: HealthUtah PPO |
$7,955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,716.35
|
| Rate for Payer: Multiplan Medicare/VA |
$339.73
|
| Rate for Payer: One Health Plan of WY PPO |
$7,795.90
|
| Rate for Payer: PacificSource Commercial |
$7,159.50
|
| Rate for Payer: PHCS PPO |
$7,557.25
|
| Rate for Payer: Three Rivers PPO |
$5,966.25
|
| Rate for Payer: TriWest Veterans Administration |
$399.68
|
| Rate for Payer: United Healthcare Commercial |
$6,920.85
|
| Rate for Payer: United Healthcare Medicare |
$399.68
|
| Rate for Payer: WINHealth Partners Commercial |
$6,761.75
|
|
|
PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY
|
Professional
|
Both
|
$3,425.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
62264
|
| Min. Negotiated Rate |
$199.70 |
| Max. Negotiated Rate |
$3,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,356.50
|
| Rate for Payer: Aetna of WY Medicare |
$234.94
|
| Rate for Payer: Beech Street Commercial |
$3,253.75
|
| Rate for Payer: Cash Price |
$2,397.50
|
| Rate for Payer: Cash Price |
$2,397.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,322.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,356.50
|
| Rate for Payer: First Choice Health Commercial |
$3,082.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,253.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.94
|
| Rate for Payer: HealthUtah PPO |
$3,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,322.25
|
| Rate for Payer: Multiplan Medicare/VA |
$199.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,356.50
|
| Rate for Payer: PacificSource Commercial |
$3,082.50
|
| Rate for Payer: PHCS PPO |
$3,253.75
|
| Rate for Payer: Three Rivers PPO |
$2,568.75
|
| Rate for Payer: TriWest Veterans Administration |
$234.94
|
| Rate for Payer: United Healthcare Commercial |
$2,979.75
|
| Rate for Payer: United Healthcare Medicare |
$234.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,911.25
|
|
|
PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,463.00
|
|
|
Service Code
|
HCPCS 27756
|
| Hospital Charge Code |
27756
|
| Min. Negotiated Rate |
$480.79 |
| Max. Negotiated Rate |
$2,463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,413.74
|
| Rate for Payer: Aetna of WY Medicare |
$565.63
|
| Rate for Payer: Beech Street Commercial |
$2,339.85
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,389.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,413.74
|
| Rate for Payer: First Choice Health Commercial |
$2,216.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,339.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.63
|
| Rate for Payer: HealthUtah PPO |
$2,463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,389.11
|
| Rate for Payer: Multiplan Medicare/VA |
$480.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,413.74
|
| Rate for Payer: PacificSource Commercial |
$2,216.70
|
| Rate for Payer: PHCS PPO |
$2,339.85
|
| Rate for Payer: Three Rivers PPO |
$1,847.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.63
|
| Rate for Payer: United Healthcare Commercial |
$2,142.81
|
| Rate for Payer: United Healthcare Medicare |
$565.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,093.55
|
|
|
PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,463.00
|
|
|
Service Code
|
HCPCS 27756 AS
|
| Hospital Charge Code |
27756
|
| Min. Negotiated Rate |
$480.79 |
| Max. Negotiated Rate |
$2,463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,413.74
|
| Rate for Payer: Aetna of WY Medicare |
$565.63
|
| Rate for Payer: Beech Street Commercial |
$2,339.85
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,389.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,413.74
|
| Rate for Payer: First Choice Health Commercial |
$2,216.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,339.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.63
|
| Rate for Payer: HealthUtah PPO |
$2,463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,389.11
|
| Rate for Payer: Multiplan Medicare/VA |
$480.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,413.74
|
| Rate for Payer: PacificSource Commercial |
$2,216.70
|
| Rate for Payer: PHCS PPO |
$2,339.85
|
| Rate for Payer: Three Rivers PPO |
$1,847.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.63
|
| Rate for Payer: United Healthcare Commercial |
$2,142.81
|
| Rate for Payer: United Healthcare Medicare |
$565.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,093.55
|
|
|
PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,463.00
|
|
|
Service Code
|
HCPCS 27756 80
|
| Hospital Charge Code |
27756
|
| Min. Negotiated Rate |
$480.79 |
| Max. Negotiated Rate |
$2,463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,413.74
|
| Rate for Payer: Aetna of WY Medicare |
$565.63
|
| Rate for Payer: Beech Street Commercial |
$2,339.85
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,724.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,389.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,413.74
|
| Rate for Payer: First Choice Health Commercial |
$2,216.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,339.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.63
|
| Rate for Payer: HealthUtah PPO |
$2,463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,389.11
|
| Rate for Payer: Multiplan Medicare/VA |
$480.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,413.74
|
| Rate for Payer: PacificSource Commercial |
$2,216.70
|
| Rate for Payer: PHCS PPO |
$2,339.85
|
| Rate for Payer: Three Rivers PPO |
$1,847.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.63
|
| Rate for Payer: United Healthcare Commercial |
$2,142.81
|
| Rate for Payer: United Healthcare Medicare |
$565.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,093.55
|
|
|
PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$3,695.00
|
|
|
Service Code
|
HCPCS 26608 80
|
| Hospital Charge Code |
26608
|
| Min. Negotiated Rate |
$405.12 |
| Max. Negotiated Rate |
$3,695.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,621.10
|
| Rate for Payer: Aetna of WY Medicare |
$476.61
|
| Rate for Payer: Beech Street Commercial |
$3,510.25
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,584.15
|
| Rate for Payer: Cigna of WY Commercial |
$3,621.10
|
| Rate for Payer: First Choice Health Commercial |
$3,325.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,510.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.61
|
| Rate for Payer: HealthUtah PPO |
$3,695.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,584.15
|
| Rate for Payer: Multiplan Medicare/VA |
$405.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,621.10
|
| Rate for Payer: PacificSource Commercial |
$3,325.50
|
| Rate for Payer: PHCS PPO |
$3,510.25
|
| Rate for Payer: Three Rivers PPO |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration |
$476.61
|
| Rate for Payer: United Healthcare Commercial |
$3,214.65
|
| Rate for Payer: United Healthcare Medicare |
$476.61
|
| Rate for Payer: WINHealth Partners Commercial |
$3,140.75
|
|
|
PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$3,695.00
|
|
|
Service Code
|
HCPCS 26608
|
| Hospital Charge Code |
26608
|
| Min. Negotiated Rate |
$405.12 |
| Max. Negotiated Rate |
$3,695.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,621.10
|
| Rate for Payer: Aetna of WY Medicare |
$476.61
|
| Rate for Payer: Beech Street Commercial |
$3,510.25
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,584.15
|
| Rate for Payer: Cigna of WY Commercial |
$3,621.10
|
| Rate for Payer: First Choice Health Commercial |
$3,325.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,510.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.61
|
| Rate for Payer: HealthUtah PPO |
$3,695.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,584.15
|
| Rate for Payer: Multiplan Medicare/VA |
$405.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,621.10
|
| Rate for Payer: PacificSource Commercial |
$3,325.50
|
| Rate for Payer: PHCS PPO |
$3,510.25
|
| Rate for Payer: Three Rivers PPO |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration |
$476.61
|
| Rate for Payer: United Healthcare Commercial |
$3,214.65
|
| Rate for Payer: United Healthcare Medicare |
$476.61
|
| Rate for Payer: WINHealth Partners Commercial |
$3,140.75
|
|
|
PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$3,695.00
|
|
|
Service Code
|
HCPCS 26608 AS
|
| Hospital Charge Code |
26608
|
| Min. Negotiated Rate |
$405.12 |
| Max. Negotiated Rate |
$3,695.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,621.10
|
| Rate for Payer: Aetna of WY Medicare |
$476.61
|
| Rate for Payer: Beech Street Commercial |
$3,510.25
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: Cash Price |
$2,586.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,584.15
|
| Rate for Payer: Cigna of WY Commercial |
$3,621.10
|
| Rate for Payer: First Choice Health Commercial |
$3,325.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,510.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.61
|
| Rate for Payer: HealthUtah PPO |
$3,695.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,584.15
|
| Rate for Payer: Multiplan Medicare/VA |
$405.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,621.10
|
| Rate for Payer: PacificSource Commercial |
$3,325.50
|
| Rate for Payer: PHCS PPO |
$3,510.25
|
| Rate for Payer: Three Rivers PPO |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration |
$476.61
|
| Rate for Payer: United Healthcare Commercial |
$3,214.65
|
| Rate for Payer: United Healthcare Medicare |
$476.61
|
| Rate for Payer: WINHealth Partners Commercial |
$3,140.75
|
|
|
PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
26676
|
| Min. Negotiated Rate |
$429.19 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,555.84
|
| Rate for Payer: Aetna of WY Medicare |
$504.93
|
| Rate for Payer: Beech Street Commercial |
$2,477.60
|
| Rate for Payer: Cash Price |
$1,825.60
|
| Rate for Payer: Cash Price |
$1,825.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,529.76
|
| Rate for Payer: Cigna of WY Commercial |
$2,555.84
|
| Rate for Payer: First Choice Health Commercial |
$2,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,477.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.93
|
| Rate for Payer: HealthUtah PPO |
$2,608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,529.76
|
| Rate for Payer: Multiplan Medicare/VA |
$429.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,555.84
|
| Rate for Payer: PacificSource Commercial |
$2,347.20
|
| Rate for Payer: PHCS PPO |
$2,477.60
|
| Rate for Payer: Three Rivers PPO |
$1,956.00
|
| Rate for Payer: TriWest Veterans Administration |
$504.93
|
| Rate for Payer: United Healthcare Commercial |
$2,268.96
|
| Rate for Payer: United Healthcare Medicare |
$504.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,216.80
|
|
|
PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 26756 AS
|
| Hospital Charge Code |
26756
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,472.94
|
| Rate for Payer: Beech Street Commercial |
$1,427.85
|
| Rate for Payer: Cash Price |
$1,052.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,457.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,472.94
|
| Rate for Payer: First Choice Health Commercial |
$1,352.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,427.85
|
| Rate for Payer: HealthUtah PPO |
$1,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,457.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,472.94
|
| Rate for Payer: PacificSource Commercial |
$1,352.70
|
| Rate for Payer: PHCS PPO |
$1,427.85
|
| Rate for Payer: Three Rivers PPO |
$1,127.25
|
| Rate for Payer: United Healthcare Commercial |
$1,307.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,277.55
|
|
|
PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 26756
|
| Hospital Charge Code |
26756
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,472.94
|
| Rate for Payer: Beech Street Commercial |
$1,427.85
|
| Rate for Payer: Cash Price |
$1,052.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,457.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,472.94
|
| Rate for Payer: First Choice Health Commercial |
$1,352.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,427.85
|
| Rate for Payer: HealthUtah PPO |
$1,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,457.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,472.94
|
| Rate for Payer: PacificSource Commercial |
$1,352.70
|
| Rate for Payer: PHCS PPO |
$1,427.85
|
| Rate for Payer: Three Rivers PPO |
$1,127.25
|
| Rate for Payer: United Healthcare Commercial |
$1,307.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,277.55
|
|
|
PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 27235 AS
|
| Hospital Charge Code |
27235
|
| Min. Negotiated Rate |
$744.27 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,062.50
|
| Rate for Payer: Aetna of WY Medicare |
$875.61
|
| Rate for Payer: Beech Street Commercial |
$2,968.75
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,031.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,062.50
|
| Rate for Payer: First Choice Health Commercial |
$2,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.61
|
| Rate for Payer: HealthUtah PPO |
$3,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,031.25
|
| Rate for Payer: Multiplan Medicare/VA |
$744.27
|
| Rate for Payer: One Health Plan of WY PPO |
$3,062.50
|
| Rate for Payer: PacificSource Commercial |
$2,812.50
|
| Rate for Payer: PHCS PPO |
$2,968.75
|
| Rate for Payer: Three Rivers PPO |
$2,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$875.61
|
| Rate for Payer: United Healthcare Commercial |
$2,718.75
|
| Rate for Payer: United Healthcare Medicare |
$875.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,656.25
|
|
|
PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 27235 80
|
| Hospital Charge Code |
27235
|
| Min. Negotiated Rate |
$744.27 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,062.50
|
| Rate for Payer: Aetna of WY Medicare |
$875.61
|
| Rate for Payer: Beech Street Commercial |
$2,968.75
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,031.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,062.50
|
| Rate for Payer: First Choice Health Commercial |
$2,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.61
|
| Rate for Payer: HealthUtah PPO |
$3,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,031.25
|
| Rate for Payer: Multiplan Medicare/VA |
$744.27
|
| Rate for Payer: One Health Plan of WY PPO |
$3,062.50
|
| Rate for Payer: PacificSource Commercial |
$2,812.50
|
| Rate for Payer: PHCS PPO |
$2,968.75
|
| Rate for Payer: Three Rivers PPO |
$2,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$875.61
|
| Rate for Payer: United Healthcare Commercial |
$2,718.75
|
| Rate for Payer: United Healthcare Medicare |
$875.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,656.25
|
|
|
PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
27235
|
| Min. Negotiated Rate |
$744.27 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,062.50
|
| Rate for Payer: Aetna of WY Medicare |
$875.61
|
| Rate for Payer: Beech Street Commercial |
$2,968.75
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,031.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,062.50
|
| Rate for Payer: First Choice Health Commercial |
$2,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.61
|
| Rate for Payer: HealthUtah PPO |
$3,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,031.25
|
| Rate for Payer: Multiplan Medicare/VA |
$744.27
|
| Rate for Payer: One Health Plan of WY PPO |
$3,062.50
|
| Rate for Payer: PacificSource Commercial |
$2,812.50
|
| Rate for Payer: PHCS PPO |
$2,968.75
|
| Rate for Payer: Three Rivers PPO |
$2,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$875.61
|
| Rate for Payer: United Healthcare Commercial |
$2,718.75
|
| Rate for Payer: United Healthcare Medicare |
$875.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,656.25
|
|
|
PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
28496
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$1,246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,221.08
|
| Rate for Payer: Aetna of WY Medicare |
$271.76
|
| Rate for Payer: Beech Street Commercial |
$1,183.70
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: Cash Price |
$872.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,208.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,221.08
|
| Rate for Payer: First Choice Health Commercial |
$1,121.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,183.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$271.76
|
| Rate for Payer: HealthUtah PPO |
$1,246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,208.62
|
| Rate for Payer: Multiplan Medicare/VA |
$231.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,221.08
|
| Rate for Payer: PacificSource Commercial |
$1,121.40
|
| Rate for Payer: PHCS PPO |
$1,183.70
|
| Rate for Payer: Three Rivers PPO |
$934.50
|
| Rate for Payer: TriWest Veterans Administration |
$271.76
|
| Rate for Payer: United Healthcare Commercial |
$1,084.02
|
| Rate for Payer: United Healthcare Medicare |
$271.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,059.10
|
|
|
PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$2,883.00
|
|
|
Service Code
|
HCPCS 24582
|
| Hospital Charge Code |
24582
|
| Min. Negotiated Rate |
$678.68 |
| Max. Negotiated Rate |
$2,883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,825.34
|
| Rate for Payer: Aetna of WY Medicare |
$798.45
|
| Rate for Payer: Beech Street Commercial |
$2,738.85
|
| Rate for Payer: Cash Price |
$2,018.10
|
| Rate for Payer: Cash Price |
$2,018.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,796.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,825.34
|
| Rate for Payer: First Choice Health Commercial |
$2,594.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,738.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$798.45
|
| Rate for Payer: HealthUtah PPO |
$2,883.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,796.51
|
| Rate for Payer: Multiplan Medicare/VA |
$678.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,825.34
|
| Rate for Payer: PacificSource Commercial |
$2,594.70
|
| Rate for Payer: PHCS PPO |
$2,738.85
|
| Rate for Payer: Three Rivers PPO |
$2,162.25
|
| Rate for Payer: TriWest Veterans Administration |
$798.45
|
| Rate for Payer: United Healthcare Commercial |
$2,508.21
|
| Rate for Payer: United Healthcare Medicare |
$798.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.55
|
|
|
PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ
|
Professional
|
Both
|
$2,237.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
26776
|
| Min. Negotiated Rate |
$379.07 |
| Max. Negotiated Rate |
$2,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,192.26
|
| Rate for Payer: Aetna of WY Medicare |
$445.96
|
| Rate for Payer: Beech Street Commercial |
$2,125.15
|
| Rate for Payer: Cash Price |
$1,565.90
|
| Rate for Payer: Cash Price |
$1,565.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,169.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,192.26
|
| Rate for Payer: First Choice Health Commercial |
$2,013.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,125.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.96
|
| Rate for Payer: HealthUtah PPO |
$2,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,169.89
|
| Rate for Payer: Multiplan Medicare/VA |
$379.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,192.26
|
| Rate for Payer: PacificSource Commercial |
$2,013.30
|
| Rate for Payer: PHCS PPO |
$2,125.15
|
| Rate for Payer: Three Rivers PPO |
$1,677.75
|
| Rate for Payer: TriWest Veterans Administration |
$445.96
|
| Rate for Payer: United Healthcare Commercial |
$1,946.19
|
| Rate for Payer: United Healthcare Medicare |
$445.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,901.45
|
|
|
PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 26706
|
| Hospital Charge Code |
26706
|
| Min. Negotiated Rate |
$376.85 |
| Max. Negotiated Rate |
$2,278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,232.44
|
| Rate for Payer: Aetna of WY Medicare |
$443.35
|
| Rate for Payer: Beech Street Commercial |
$2,164.10
|
| Rate for Payer: Cash Price |
$1,594.60
|
| Rate for Payer: Cash Price |
$1,594.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,209.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,232.44
|
| Rate for Payer: First Choice Health Commercial |
$2,050.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,164.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.35
|
| Rate for Payer: HealthUtah PPO |
$2,278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,209.66
|
| Rate for Payer: Multiplan Medicare/VA |
$376.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,232.44
|
| Rate for Payer: PacificSource Commercial |
$2,050.20
|
| Rate for Payer: PHCS PPO |
$2,164.10
|
| Rate for Payer: Three Rivers PPO |
$1,708.50
|
| Rate for Payer: TriWest Veterans Administration |
$443.35
|
| Rate for Payer: United Healthcare Commercial |
$1,981.86
|
| Rate for Payer: United Healthcare Medicare |
$443.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,936.30
|
|
|
PRQ SKEL FIXJ METAR FX W/MANJ
|
Professional
|
Both
|
$7,170.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
28476
|
| Min. Negotiated Rate |
$325.82 |
| Max. Negotiated Rate |
$7,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,026.60
|
| Rate for Payer: Aetna of WY Medicare |
$383.32
|
| Rate for Payer: Beech Street Commercial |
$6,811.50
|
| Rate for Payer: Cash Price |
$5,019.00
|
| Rate for Payer: Cash Price |
$5,019.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,954.90
|
| Rate for Payer: Cigna of WY Commercial |
$7,026.60
|
| Rate for Payer: First Choice Health Commercial |
$6,453.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,811.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.32
|
| Rate for Payer: HealthUtah PPO |
$7,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,954.90
|
| Rate for Payer: Multiplan Medicare/VA |
$325.82
|
| Rate for Payer: One Health Plan of WY PPO |
$7,026.60
|
| Rate for Payer: PacificSource Commercial |
$6,453.00
|
| Rate for Payer: PHCS PPO |
$6,811.50
|
| Rate for Payer: Three Rivers PPO |
$5,377.50
|
| Rate for Payer: TriWest Veterans Administration |
$383.32
|
| Rate for Payer: United Healthcare Commercial |
$6,237.90
|
| Rate for Payer: United Healthcare Medicare |
$383.32
|
| Rate for Payer: WINHealth Partners Commercial |
$6,094.50
|
|
|
PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
28636
|
| Min. Negotiated Rate |
$185.19 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,010.38
|
| Rate for Payer: Aetna of WY Medicare |
$217.87
|
| Rate for Payer: Beech Street Commercial |
$979.45
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,000.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,010.38
|
| Rate for Payer: First Choice Health Commercial |
$927.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$979.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.87
|
| Rate for Payer: HealthUtah PPO |
$1,031.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,000.07
|
| Rate for Payer: Multiplan Medicare/VA |
$185.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,010.38
|
| Rate for Payer: PacificSource Commercial |
$927.90
|
| Rate for Payer: PHCS PPO |
$979.45
|
| Rate for Payer: Three Rivers PPO |
$773.25
|
| Rate for Payer: TriWest Veterans Administration |
$217.87
|
| Rate for Payer: United Healthcare Commercial |
$896.97
|
| Rate for Payer: United Healthcare Medicare |
$217.87
|
| Rate for Payer: WINHealth Partners Commercial |
$876.35
|
|
|
PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$2,431.00
|
|
|
Service Code
|
HCPCS 26727 AS
|
| Hospital Charge Code |
26727
|
| Min. Negotiated Rate |
$399.56 |
| Max. Negotiated Rate |
$2,431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,382.38
|
| Rate for Payer: Aetna of WY Medicare |
$470.07
|
| Rate for Payer: Beech Street Commercial |
$2,309.45
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,358.07
|
| Rate for Payer: Cigna of WY Commercial |
$2,382.38
|
| Rate for Payer: First Choice Health Commercial |
$2,187.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,309.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$470.07
|
| Rate for Payer: HealthUtah PPO |
$2,431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,358.07
|
| Rate for Payer: Multiplan Medicare/VA |
$399.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,382.38
|
| Rate for Payer: PacificSource Commercial |
$2,187.90
|
| Rate for Payer: PHCS PPO |
$2,309.45
|
| Rate for Payer: Three Rivers PPO |
$1,823.25
|
| Rate for Payer: TriWest Veterans Administration |
$470.07
|
| Rate for Payer: United Healthcare Commercial |
$2,114.97
|
| Rate for Payer: United Healthcare Medicare |
$470.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,066.35
|
|
|
PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$2,431.00
|
|
|
Service Code
|
HCPCS 26727
|
| Hospital Charge Code |
26727
|
| Min. Negotiated Rate |
$399.56 |
| Max. Negotiated Rate |
$2,431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,382.38
|
| Rate for Payer: Aetna of WY Medicare |
$470.07
|
| Rate for Payer: Beech Street Commercial |
$2,309.45
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,358.07
|
| Rate for Payer: Cigna of WY Commercial |
$2,382.38
|
| Rate for Payer: First Choice Health Commercial |
$2,187.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,309.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$470.07
|
| Rate for Payer: HealthUtah PPO |
$2,431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,358.07
|
| Rate for Payer: Multiplan Medicare/VA |
$399.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,382.38
|
| Rate for Payer: PacificSource Commercial |
$2,187.90
|
| Rate for Payer: PHCS PPO |
$2,309.45
|
| Rate for Payer: Three Rivers PPO |
$1,823.25
|
| Rate for Payer: TriWest Veterans Administration |
$470.07
|
| Rate for Payer: United Healthcare Commercial |
$2,114.97
|
| Rate for Payer: United Healthcare Medicare |
$470.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,066.35
|
|
|
PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$2,431.00
|
|
|
Service Code
|
HCPCS 26727 80
|
| Hospital Charge Code |
26727
|
| Min. Negotiated Rate |
$399.56 |
| Max. Negotiated Rate |
$2,431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,382.38
|
| Rate for Payer: Aetna of WY Medicare |
$470.07
|
| Rate for Payer: Beech Street Commercial |
$2,309.45
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: Cash Price |
$1,701.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,358.07
|
| Rate for Payer: Cigna of WY Commercial |
$2,382.38
|
| Rate for Payer: First Choice Health Commercial |
$2,187.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,309.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$470.07
|
| Rate for Payer: HealthUtah PPO |
$2,431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,358.07
|
| Rate for Payer: Multiplan Medicare/VA |
$399.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,382.38
|
| Rate for Payer: PacificSource Commercial |
$2,187.90
|
| Rate for Payer: PHCS PPO |
$2,309.45
|
| Rate for Payer: Three Rivers PPO |
$1,823.25
|
| Rate for Payer: TriWest Veterans Administration |
$470.07
|
| Rate for Payer: United Healthcare Commercial |
$2,114.97
|
| Rate for Payer: United Healthcare Medicare |
$470.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,066.35
|
|
|
PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$3,938.00
|
|
|
Service Code
|
HCPCS 24538 80
|
| Hospital Charge Code |
24538
|
| Min. Negotiated Rate |
$654.70 |
| Max. Negotiated Rate |
$3,938.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,859.24
|
| Rate for Payer: Aetna of WY Medicare |
$770.23
|
| Rate for Payer: Beech Street Commercial |
$3,741.10
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,819.86
|
| Rate for Payer: Cigna of WY Commercial |
$3,859.24
|
| Rate for Payer: First Choice Health Commercial |
$3,544.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,741.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.23
|
| Rate for Payer: HealthUtah PPO |
$3,938.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,819.86
|
| Rate for Payer: Multiplan Medicare/VA |
$654.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,859.24
|
| Rate for Payer: PacificSource Commercial |
$3,544.20
|
| Rate for Payer: PHCS PPO |
$3,741.10
|
| Rate for Payer: Three Rivers PPO |
$2,953.50
|
| Rate for Payer: TriWest Veterans Administration |
$770.23
|
| Rate for Payer: United Healthcare Commercial |
$3,426.06
|
| Rate for Payer: United Healthcare Medicare |
$770.23
|
| Rate for Payer: WINHealth Partners Commercial |
$3,347.30
|
|
|
PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$3,938.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
24538
|
| Min. Negotiated Rate |
$654.70 |
| Max. Negotiated Rate |
$3,938.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,859.24
|
| Rate for Payer: Aetna of WY Medicare |
$770.23
|
| Rate for Payer: Beech Street Commercial |
$3,741.10
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,819.86
|
| Rate for Payer: Cigna of WY Commercial |
$3,859.24
|
| Rate for Payer: First Choice Health Commercial |
$3,544.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,741.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.23
|
| Rate for Payer: HealthUtah PPO |
$3,938.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,819.86
|
| Rate for Payer: Multiplan Medicare/VA |
$654.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,859.24
|
| Rate for Payer: PacificSource Commercial |
$3,544.20
|
| Rate for Payer: PHCS PPO |
$3,741.10
|
| Rate for Payer: Three Rivers PPO |
$2,953.50
|
| Rate for Payer: TriWest Veterans Administration |
$770.23
|
| Rate for Payer: United Healthcare Commercial |
$3,426.06
|
| Rate for Payer: United Healthcare Medicare |
$770.23
|
| Rate for Payer: WINHealth Partners Commercial |
$3,347.30
|
|
