|
REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$2,112.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
26410
|
| Min. Negotiated Rate |
$502.93 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,069.76
|
| Rate for Payer: Aetna of WY Medicare |
$591.68
|
| Rate for Payer: Beech Street Commercial |
$2,006.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,048.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,069.76
|
| Rate for Payer: First Choice Health Commercial |
$1,900.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,006.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.68
|
| Rate for Payer: HealthUtah PPO |
$2,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,048.64
|
| Rate for Payer: Multiplan Medicare/VA |
$502.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,069.76
|
| Rate for Payer: PacificSource Commercial |
$1,900.80
|
| Rate for Payer: PHCS PPO |
$2,006.40
|
| Rate for Payer: Three Rivers PPO |
$1,584.00
|
| Rate for Payer: TriWest Veterans Administration |
$591.68
|
| Rate for Payer: United Healthcare Commercial |
$1,837.44
|
| Rate for Payer: United Healthcare Medicare |
$591.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,795.20
|
|
|
REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$2,112.00
|
|
|
Service Code
|
HCPCS 26410 AS
|
| Hospital Charge Code |
26410
|
| Min. Negotiated Rate |
$502.93 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,069.76
|
| Rate for Payer: Aetna of WY Medicare |
$591.68
|
| Rate for Payer: Beech Street Commercial |
$2,006.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: Cash Price |
$1,478.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,048.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,069.76
|
| Rate for Payer: First Choice Health Commercial |
$1,900.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,006.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.68
|
| Rate for Payer: HealthUtah PPO |
$2,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,048.64
|
| Rate for Payer: Multiplan Medicare/VA |
$502.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,069.76
|
| Rate for Payer: PacificSource Commercial |
$1,900.80
|
| Rate for Payer: PHCS PPO |
$2,006.40
|
| Rate for Payer: Three Rivers PPO |
$1,584.00
|
| Rate for Payer: TriWest Veterans Administration |
$591.68
|
| Rate for Payer: United Healthcare Commercial |
$1,837.44
|
| Rate for Payer: United Healthcare Medicare |
$591.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,795.20
|
|
|
REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,943.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
27726
|
| Min. Negotiated Rate |
$783.06 |
| Max. Negotiated Rate |
$4,943.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,844.14
|
| Rate for Payer: Aetna of WY Medicare |
$921.25
|
| Rate for Payer: Beech Street Commercial |
$4,695.85
|
| Rate for Payer: Cash Price |
$3,460.10
|
| Rate for Payer: Cash Price |
$3,460.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,794.71
|
| Rate for Payer: Cigna of WY Commercial |
$4,844.14
|
| Rate for Payer: First Choice Health Commercial |
$4,448.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,695.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$921.25
|
| Rate for Payer: HealthUtah PPO |
$4,943.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,794.71
|
| Rate for Payer: Multiplan Medicare/VA |
$783.06
|
| Rate for Payer: One Health Plan of WY PPO |
$4,844.14
|
| Rate for Payer: PacificSource Commercial |
$4,448.70
|
| Rate for Payer: PHCS PPO |
$4,695.85
|
| Rate for Payer: Three Rivers PPO |
$3,707.25
|
| Rate for Payer: TriWest Veterans Administration |
$921.25
|
| Rate for Payer: United Healthcare Commercial |
$4,300.41
|
| Rate for Payer: United Healthcare Medicare |
$921.25
|
| Rate for Payer: WINHealth Partners Commercial |
$4,201.55
|
|
|
REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
HCPCS 49560 80
|
| Hospital Charge Code |
49560
|
| Min. Negotiated Rate |
$2,868.00 |
| Max. Negotiated Rate |
$3,824.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,747.52
|
| Rate for Payer: Beech Street Commercial |
$3,632.80
|
| Rate for Payer: Cash Price |
$2,676.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,709.28
|
| Rate for Payer: Cigna of WY Commercial |
$3,747.52
|
| Rate for Payer: First Choice Health Commercial |
$3,441.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,632.80
|
| Rate for Payer: HealthUtah PPO |
$3,824.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,709.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,747.52
|
| Rate for Payer: PacificSource Commercial |
$3,441.60
|
| Rate for Payer: PHCS PPO |
$3,632.80
|
| Rate for Payer: Three Rivers PPO |
$2,868.00
|
| Rate for Payer: United Healthcare Commercial |
$3,326.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.40
|
|
|
REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
HCPCS 49560
|
| Hospital Charge Code |
49560
|
| Min. Negotiated Rate |
$2,868.00 |
| Max. Negotiated Rate |
$3,824.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,747.52
|
| Rate for Payer: Beech Street Commercial |
$3,632.80
|
| Rate for Payer: Cash Price |
$2,676.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,709.28
|
| Rate for Payer: Cigna of WY Commercial |
$3,747.52
|
| Rate for Payer: First Choice Health Commercial |
$3,441.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,632.80
|
| Rate for Payer: HealthUtah PPO |
$3,824.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,709.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,747.52
|
| Rate for Payer: PacificSource Commercial |
$3,441.60
|
| Rate for Payer: PHCS PPO |
$3,632.80
|
| Rate for Payer: Three Rivers PPO |
$2,868.00
|
| Rate for Payer: United Healthcare Commercial |
$3,326.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.40
|
|
|
REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
HCPCS 49560 AS
|
| Hospital Charge Code |
49560
|
| Min. Negotiated Rate |
$2,868.00 |
| Max. Negotiated Rate |
$3,824.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,747.52
|
| Rate for Payer: Beech Street Commercial |
$3,632.80
|
| Rate for Payer: Cash Price |
$2,676.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,709.28
|
| Rate for Payer: Cigna of WY Commercial |
$3,747.52
|
| Rate for Payer: First Choice Health Commercial |
$3,441.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,632.80
|
| Rate for Payer: HealthUtah PPO |
$3,824.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,709.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,747.52
|
| Rate for Payer: PacificSource Commercial |
$3,441.60
|
| Rate for Payer: PHCS PPO |
$3,632.80
|
| Rate for Payer: Three Rivers PPO |
$2,868.00
|
| Rate for Payer: United Healthcare Commercial |
$3,326.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.40
|
|
|
REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 27658 80
|
| Hospital Charge Code |
27658
|
| Min. Negotiated Rate |
$307.54 |
| Max. Negotiated Rate |
$1,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,900.22
|
| Rate for Payer: Aetna of WY Medicare |
$361.81
|
| Rate for Payer: Beech Street Commercial |
$1,842.05
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,880.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,900.22
|
| Rate for Payer: First Choice Health Commercial |
$1,745.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,842.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.81
|
| Rate for Payer: HealthUtah PPO |
$1,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,880.83
|
| Rate for Payer: Multiplan Medicare/VA |
$307.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,900.22
|
| Rate for Payer: PacificSource Commercial |
$1,745.10
|
| Rate for Payer: PHCS PPO |
$1,842.05
|
| Rate for Payer: Three Rivers PPO |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration |
$361.81
|
| Rate for Payer: United Healthcare Commercial |
$1,686.93
|
| Rate for Payer: United Healthcare Medicare |
$361.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,648.15
|
|
|
REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 27658 AS
|
| Hospital Charge Code |
27658
|
| Min. Negotiated Rate |
$307.54 |
| Max. Negotiated Rate |
$1,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,900.22
|
| Rate for Payer: Aetna of WY Medicare |
$361.81
|
| Rate for Payer: Beech Street Commercial |
$1,842.05
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,880.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,900.22
|
| Rate for Payer: First Choice Health Commercial |
$1,745.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,842.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.81
|
| Rate for Payer: HealthUtah PPO |
$1,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,880.83
|
| Rate for Payer: Multiplan Medicare/VA |
$307.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,900.22
|
| Rate for Payer: PacificSource Commercial |
$1,745.10
|
| Rate for Payer: PHCS PPO |
$1,842.05
|
| Rate for Payer: Three Rivers PPO |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration |
$361.81
|
| Rate for Payer: United Healthcare Commercial |
$1,686.93
|
| Rate for Payer: United Healthcare Medicare |
$361.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,648.15
|
|
|
REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 27658
|
| Hospital Charge Code |
27658
|
| Min. Negotiated Rate |
$307.54 |
| Max. Negotiated Rate |
$1,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,900.22
|
| Rate for Payer: Aetna of WY Medicare |
$361.81
|
| Rate for Payer: Beech Street Commercial |
$1,842.05
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: Cash Price |
$1,357.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,880.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,900.22
|
| Rate for Payer: First Choice Health Commercial |
$1,745.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,842.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.81
|
| Rate for Payer: HealthUtah PPO |
$1,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,880.83
|
| Rate for Payer: Multiplan Medicare/VA |
$307.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,900.22
|
| Rate for Payer: PacificSource Commercial |
$1,745.10
|
| Rate for Payer: PHCS PPO |
$1,842.05
|
| Rate for Payer: Three Rivers PPO |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration |
$361.81
|
| Rate for Payer: United Healthcare Commercial |
$1,686.93
|
| Rate for Payer: United Healthcare Medicare |
$361.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,648.15
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$1,094.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
54163
|
| Min. Negotiated Rate |
$181.07 |
| Max. Negotiated Rate |
$1,094.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,072.12
|
| Rate for Payer: Aetna of WY Medicare |
$213.02
|
| Rate for Payer: Beech Street Commercial |
$1,039.30
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,061.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,072.12
|
| Rate for Payer: First Choice Health Commercial |
$984.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,039.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.02
|
| Rate for Payer: HealthUtah PPO |
$1,094.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,061.18
|
| Rate for Payer: Multiplan Medicare/VA |
$181.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,072.12
|
| Rate for Payer: PacificSource Commercial |
$984.60
|
| Rate for Payer: PHCS PPO |
$1,039.30
|
| Rate for Payer: Three Rivers PPO |
$820.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.02
|
| Rate for Payer: United Healthcare Commercial |
$951.78
|
| Rate for Payer: United Healthcare Medicare |
$213.02
|
| Rate for Payer: WINHealth Partners Commercial |
$929.90
|
|
|
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$163.69
|
| Rate for Payer: Beech Street Commercial |
$803.70
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$820.62
|
| Rate for Payer: Cigna of WY Commercial |
$829.08
|
| Rate for Payer: First Choice Health Commercial |
$761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.69
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$139.14
|
| Rate for Payer: One Health Plan of WY PPO |
$829.08
|
| Rate for Payer: PacificSource Commercial |
$761.40
|
| Rate for Payer: PHCS PPO |
$803.70
|
| Rate for Payer: Three Rivers PPO |
$634.50
|
| Rate for Payer: TriWest Veterans Administration |
$163.69
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$163.69
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$982.94
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$952.85
|
| Rate for Payer: Cash Price |
$702.10
|
| Rate for Payer: Cash Price |
$702.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$972.91
|
| Rate for Payer: Cigna of WY Commercial |
$982.94
|
| Rate for Payer: First Choice Health Commercial |
$902.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$952.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$1,003.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$972.91
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$982.94
|
| Rate for Payer: PacificSource Commercial |
$902.70
|
| Rate for Payer: PHCS PPO |
$952.85
|
| Rate for Payer: Three Rivers PPO |
$752.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$872.61
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$852.55
|
|
|
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$176.33 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,058.40
|
| Rate for Payer: Aetna of WY Medicare |
$207.45
|
| Rate for Payer: Beech Street Commercial |
$1,026.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,047.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,058.40
|
| Rate for Payer: First Choice Health Commercial |
$972.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.45
|
| Rate for Payer: HealthUtah PPO |
$1,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,047.60
|
| Rate for Payer: Multiplan Medicare/VA |
$176.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,058.40
|
| Rate for Payer: PacificSource Commercial |
$972.00
|
| Rate for Payer: PHCS PPO |
$1,026.00
|
| Rate for Payer: Three Rivers PPO |
$810.00
|
| Rate for Payer: TriWest Veterans Administration |
$207.45
|
| Rate for Payer: United Healthcare Commercial |
$939.60
|
| Rate for Payer: United Healthcare Medicare |
$207.45
|
| Rate for Payer: WINHealth Partners Commercial |
$918.00
|
|
|
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$179.64 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,081.92
|
| Rate for Payer: Aetna of WY Medicare |
$211.34
|
| Rate for Payer: Beech Street Commercial |
$1,048.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,070.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,081.92
|
| Rate for Payer: First Choice Health Commercial |
$993.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,048.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.34
|
| Rate for Payer: HealthUtah PPO |
$1,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Medicare/VA |
$179.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,081.92
|
| Rate for Payer: PacificSource Commercial |
$993.60
|
| Rate for Payer: PHCS PPO |
$1,048.80
|
| Rate for Payer: Three Rivers PPO |
$828.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.34
|
| Rate for Payer: United Healthcare Commercial |
$960.48
|
| Rate for Payer: United Healthcare Medicare |
$211.34
|
| Rate for Payer: WINHealth Partners Commercial |
$938.40
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
12045
|
| Min. Negotiated Rate |
$223.77 |
| Max. Negotiated Rate |
$1,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,653.26
|
| Rate for Payer: Aetna of WY Medicare |
$263.26
|
| Rate for Payer: Beech Street Commercial |
$1,602.65
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,636.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,653.26
|
| Rate for Payer: First Choice Health Commercial |
$1,518.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,602.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.26
|
| Rate for Payer: HealthUtah PPO |
$1,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,636.39
|
| Rate for Payer: Multiplan Medicare/VA |
$223.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,653.26
|
| Rate for Payer: PacificSource Commercial |
$1,518.30
|
| Rate for Payer: PHCS PPO |
$1,602.65
|
| Rate for Payer: Three Rivers PPO |
$1,265.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.26
|
| Rate for Payer: United Healthcare Commercial |
$1,467.69
|
| Rate for Payer: United Healthcare Medicare |
$263.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,433.95
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$119.19 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.28
|
| Rate for Payer: Aetna of WY Medicare |
$140.22
|
| Rate for Payer: Beech Street Commercial |
$699.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.92
|
| Rate for Payer: Cigna of WY Commercial |
$721.28
|
| Rate for Payer: First Choice Health Commercial |
$662.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.22
|
| Rate for Payer: HealthUtah PPO |
$736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.92
|
| Rate for Payer: Multiplan Medicare/VA |
$119.19
|
| Rate for Payer: One Health Plan of WY PPO |
$721.28
|
| Rate for Payer: PacificSource Commercial |
$662.40
|
| Rate for Payer: PHCS PPO |
$699.20
|
| Rate for Payer: Three Rivers PPO |
$552.00
|
| Rate for Payer: TriWest Veterans Administration |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$640.32
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
| Rate for Payer: WINHealth Partners Commercial |
$625.60
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$160.70 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$966.28
|
| Rate for Payer: Aetna of WY Medicare |
$189.06
|
| Rate for Payer: Beech Street Commercial |
$936.70
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$956.42
|
| Rate for Payer: Cigna of WY Commercial |
$966.28
|
| Rate for Payer: First Choice Health Commercial |
$887.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$936.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.06
|
| Rate for Payer: HealthUtah PPO |
$986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$956.42
|
| Rate for Payer: Multiplan Medicare/VA |
$160.70
|
| Rate for Payer: One Health Plan of WY PPO |
$966.28
|
| Rate for Payer: PacificSource Commercial |
$887.40
|
| Rate for Payer: PHCS PPO |
$936.70
|
| Rate for Payer: Three Rivers PPO |
$739.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.06
|
| Rate for Payer: United Healthcare Commercial |
$857.82
|
| Rate for Payer: United Healthcare Medicare |
$189.06
|
| Rate for Payer: WINHealth Partners Commercial |
$838.10
|
|
|
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$1,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,051.54
|
| Rate for Payer: Aetna of WY Medicare |
$206.37
|
| Rate for Payer: Beech Street Commercial |
$1,019.35
|
| Rate for Payer: Cash Price |
$751.10
|
| Rate for Payer: Cash Price |
$751.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,040.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,051.54
|
| Rate for Payer: First Choice Health Commercial |
$965.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,019.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.37
|
| Rate for Payer: HealthUtah PPO |
$1,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,040.81
|
| Rate for Payer: Multiplan Medicare/VA |
$175.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,051.54
|
| Rate for Payer: PacificSource Commercial |
$965.70
|
| Rate for Payer: PHCS PPO |
$1,019.35
|
| Rate for Payer: Three Rivers PPO |
$804.75
|
| Rate for Payer: TriWest Veterans Administration |
$206.37
|
| Rate for Payer: United Healthcare Commercial |
$933.51
|
| Rate for Payer: United Healthcare Medicare |
$206.37
|
| Rate for Payer: WINHealth Partners Commercial |
$912.05
|
|
|
REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$196.93 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,182.86
|
| Rate for Payer: Aetna of WY Medicare |
$231.68
|
| Rate for Payer: Beech Street Commercial |
$1,146.65
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: Cash Price |
$844.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,170.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,182.86
|
| Rate for Payer: First Choice Health Commercial |
$1,086.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,146.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.68
|
| Rate for Payer: HealthUtah PPO |
$1,207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,170.79
|
| Rate for Payer: Multiplan Medicare/VA |
$196.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,182.86
|
| Rate for Payer: PacificSource Commercial |
$1,086.30
|
| Rate for Payer: PHCS PPO |
$1,146.65
|
| Rate for Payer: Three Rivers PPO |
$905.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.68
|
| Rate for Payer: United Healthcare Commercial |
$1,050.09
|
| Rate for Payer: United Healthcare Medicare |
$231.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,025.95
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$745.78
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Beech Street Commercial |
$722.95
|
| Rate for Payer: Cash Price |
$532.70
|
| Rate for Payer: Cash Price |
$532.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$738.17
|
| Rate for Payer: Cigna of WY Commercial |
$745.78
|
| Rate for Payer: First Choice Health Commercial |
$684.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$722.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.52
|
| Rate for Payer: HealthUtah PPO |
$761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$738.17
|
| Rate for Payer: Multiplan Medicare/VA |
$124.54
|
| Rate for Payer: One Health Plan of WY PPO |
$745.78
|
| Rate for Payer: PacificSource Commercial |
$684.90
|
| Rate for Payer: PHCS PPO |
$722.95
|
| Rate for Payer: Three Rivers PPO |
$570.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.52
|
| Rate for Payer: United Healthcare Commercial |
$662.07
|
| Rate for Payer: United Healthcare Medicare |
$146.52
|
| Rate for Payer: WINHealth Partners Commercial |
$646.85
|
|
|
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.88
|
| Rate for Payer: Aetna of WY Medicare |
$184.16
|
| Rate for Payer: Beech Street Commercial |
$908.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$927.32
|
| Rate for Payer: Cigna of WY Commercial |
$936.88
|
| Rate for Payer: First Choice Health Commercial |
$860.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$908.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.16
|
| Rate for Payer: HealthUtah PPO |
$956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$927.32
|
| Rate for Payer: Multiplan Medicare/VA |
$156.54
|
| Rate for Payer: One Health Plan of WY PPO |
$936.88
|
| Rate for Payer: PacificSource Commercial |
$860.40
|
| Rate for Payer: PHCS PPO |
$908.20
|
| Rate for Payer: Three Rivers PPO |
$717.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.16
|
| Rate for Payer: United Healthcare Commercial |
$831.72
|
| Rate for Payer: United Healthcare Medicare |
$184.16
|
| Rate for Payer: WINHealth Partners Commercial |
$812.60
|
|
|
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$168.27 |
| 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 |
$197.96
|
| 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 |
$197.96
|
| Rate for Payer: HealthUtah PPO |
$1,031.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,000.07
|
| Rate for Payer: Multiplan Medicare/VA |
$168.27
|
| 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 |
$197.96
|
| Rate for Payer: United Healthcare Commercial |
$896.97
|
| Rate for Payer: United Healthcare Medicare |
$197.96
|
| Rate for Payer: WINHealth Partners Commercial |
$876.35
|
|
|
REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$1,506.00
|
|
|
Service Code
|
HCPCS 26591
|
| Hospital Charge Code |
26591
|
| Min. Negotiated Rate |
$410.48 |
| Max. Negotiated Rate |
$1,506.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,475.88
|
| Rate for Payer: Aetna of WY Medicare |
$482.92
|
| Rate for Payer: Beech Street Commercial |
$1,430.70
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: Cash Price |
$1,054.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,460.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,475.88
|
| Rate for Payer: First Choice Health Commercial |
$1,355.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,430.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$482.92
|
| Rate for Payer: HealthUtah PPO |
$1,506.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,460.82
|
| Rate for Payer: Multiplan Medicare/VA |
$410.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,475.88
|
| Rate for Payer: PacificSource Commercial |
$1,355.40
|
| Rate for Payer: PHCS PPO |
$1,430.70
|
| Rate for Payer: Three Rivers PPO |
$1,129.50
|
| Rate for Payer: TriWest Veterans Administration |
$482.92
|
| Rate for Payer: United Healthcare Commercial |
$1,310.22
|
| Rate for Payer: United Healthcare Medicare |
$482.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,280.10
|
|
|
REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,656.00
|
|
|
Service Code
|
HCPCS 24343 80
|
| Hospital Charge Code |
24343
|
| Min. Negotiated Rate |
$594.02 |
| Max. Negotiated Rate |
$3,656.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,582.88
|
| Rate for Payer: Aetna of WY Medicare |
$698.85
|
| Rate for Payer: Beech Street Commercial |
$3,473.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,546.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,582.88
|
| Rate for Payer: First Choice Health Commercial |
$3,290.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,473.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.85
|
| Rate for Payer: HealthUtah PPO |
$3,656.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,546.32
|
| Rate for Payer: Multiplan Medicare/VA |
$594.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,582.88
|
| Rate for Payer: PacificSource Commercial |
$3,290.40
|
| Rate for Payer: PHCS PPO |
$3,473.20
|
| Rate for Payer: Three Rivers PPO |
$2,742.00
|
| Rate for Payer: TriWest Veterans Administration |
$698.85
|
| Rate for Payer: United Healthcare Commercial |
$3,180.72
|
| Rate for Payer: United Healthcare Medicare |
$698.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,107.60
|
|
|
REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,656.00
|
|
|
Service Code
|
HCPCS 24343 AS
|
| Hospital Charge Code |
24343
|
| Min. Negotiated Rate |
$594.02 |
| Max. Negotiated Rate |
$3,656.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,582.88
|
| Rate for Payer: Aetna of WY Medicare |
$698.85
|
| Rate for Payer: Beech Street Commercial |
$3,473.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: Cash Price |
$2,559.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,546.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,582.88
|
| Rate for Payer: First Choice Health Commercial |
$3,290.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,473.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.85
|
| Rate for Payer: HealthUtah PPO |
$3,656.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,546.32
|
| Rate for Payer: Multiplan Medicare/VA |
$594.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,582.88
|
| Rate for Payer: PacificSource Commercial |
$3,290.40
|
| Rate for Payer: PHCS PPO |
$3,473.20
|
| Rate for Payer: Three Rivers PPO |
$2,742.00
|
| Rate for Payer: TriWest Veterans Administration |
$698.85
|
| Rate for Payer: United Healthcare Commercial |
$3,180.72
|
| Rate for Payer: United Healthcare Medicare |
$698.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,107.60
|
|
