|
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 MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,623.00
|
|
|
Service Code
|
HCPCS 24345
|
| Hospital Charge Code |
24345
|
| Min. Negotiated Rate |
$591.17 |
| Max. Negotiated Rate |
$3,623.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,550.54
|
| Rate for Payer: Aetna of WY Medicare |
$695.49
|
| Rate for Payer: Beech Street Commercial |
$3,441.85
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,514.31
|
| Rate for Payer: Cigna of WY Commercial |
$3,550.54
|
| Rate for Payer: First Choice Health Commercial |
$3,260.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,441.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.49
|
| Rate for Payer: HealthUtah PPO |
$3,623.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,514.31
|
| Rate for Payer: Multiplan Medicare/VA |
$591.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,550.54
|
| Rate for Payer: PacificSource Commercial |
$3,260.70
|
| Rate for Payer: PHCS PPO |
$3,441.85
|
| Rate for Payer: Three Rivers PPO |
$2,717.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.49
|
| Rate for Payer: United Healthcare Commercial |
$3,152.01
|
| Rate for Payer: United Healthcare Medicare |
$695.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,079.55
|
|
|
REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,623.00
|
|
|
Service Code
|
HCPCS 24345 80
|
| Hospital Charge Code |
24345
|
| Min. Negotiated Rate |
$591.17 |
| Max. Negotiated Rate |
$3,623.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,550.54
|
| Rate for Payer: Aetna of WY Medicare |
$695.49
|
| Rate for Payer: Beech Street Commercial |
$3,441.85
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,514.31
|
| Rate for Payer: Cigna of WY Commercial |
$3,550.54
|
| Rate for Payer: First Choice Health Commercial |
$3,260.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,441.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.49
|
| Rate for Payer: HealthUtah PPO |
$3,623.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,514.31
|
| Rate for Payer: Multiplan Medicare/VA |
$591.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,550.54
|
| Rate for Payer: PacificSource Commercial |
$3,260.70
|
| Rate for Payer: PHCS PPO |
$3,441.85
|
| Rate for Payer: Three Rivers PPO |
$2,717.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.49
|
| Rate for Payer: United Healthcare Commercial |
$3,152.01
|
| Rate for Payer: United Healthcare Medicare |
$695.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,079.55
|
|
|
REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,623.00
|
|
|
Service Code
|
HCPCS 24345 AS
|
| Hospital Charge Code |
24345
|
| Min. Negotiated Rate |
$591.17 |
| Max. Negotiated Rate |
$3,623.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,550.54
|
| Rate for Payer: Aetna of WY Medicare |
$695.49
|
| Rate for Payer: Beech Street Commercial |
$3,441.85
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: Cash Price |
$2,536.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,514.31
|
| Rate for Payer: Cigna of WY Commercial |
$3,550.54
|
| Rate for Payer: First Choice Health Commercial |
$3,260.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,441.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.49
|
| Rate for Payer: HealthUtah PPO |
$3,623.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,514.31
|
| Rate for Payer: Multiplan Medicare/VA |
$591.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,550.54
|
| Rate for Payer: PacificSource Commercial |
$3,260.70
|
| Rate for Payer: PHCS PPO |
$3,441.85
|
| Rate for Payer: Three Rivers PPO |
$2,717.25
|
| Rate for Payer: TriWest Veterans Administration |
$695.49
|
| Rate for Payer: United Healthcare Commercial |
$3,152.01
|
| Rate for Payer: United Healthcare Medicare |
$695.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,079.55
|
|
|
REPAIR NAIL BED
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
11760
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Medicare |
$106.10
|
| Rate for Payer: Beech Street Commercial |
$611.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: First Choice Health Commercial |
$579.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.10
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$90.18
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$611.80
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$106.10
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$106.10
|
| Rate for Payer: WINHealth Partners Commercial |
$547.40
|
|
|
REPAIR NAIL BED
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11760 AS
|
| Hospital Charge Code |
11760
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Medicare |
$106.10
|
| Rate for Payer: Beech Street Commercial |
$611.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: First Choice Health Commercial |
$579.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.10
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$90.18
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$611.80
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$106.10
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$106.10
|
| Rate for Payer: WINHealth Partners Commercial |
$547.40
|
|
|
REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
30630
|
| Min. Negotiated Rate |
$555.42 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,285.36
|
| Rate for Payer: Aetna of WY Medicare |
$653.43
|
| Rate for Payer: Beech Street Commercial |
$2,215.40
|
| Rate for Payer: Cash Price |
$1,632.40
|
| Rate for Payer: Cash Price |
$1,632.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,262.04
|
| Rate for Payer: Cigna of WY Commercial |
$2,285.36
|
| Rate for Payer: First Choice Health Commercial |
$2,098.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,215.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.43
|
| Rate for Payer: HealthUtah PPO |
$2,332.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,262.04
|
| Rate for Payer: Multiplan Medicare/VA |
$555.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,285.36
|
| Rate for Payer: PacificSource Commercial |
$2,098.80
|
| Rate for Payer: PHCS PPO |
$2,215.40
|
| Rate for Payer: Three Rivers PPO |
$1,749.00
|
| Rate for Payer: TriWest Veterans Administration |
$653.43
|
| Rate for Payer: United Healthcare Commercial |
$2,028.84
|
| Rate for Payer: United Healthcare Medicare |
$653.43
|
| Rate for Payer: WINHealth Partners Commercial |
$1,982.20
|
|
|
REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
30465
|
| Min. Negotiated Rate |
$849.59 |
| Max. Negotiated Rate |
$3,566.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,494.68
|
| Rate for Payer: Aetna of WY Medicare |
$999.52
|
| Rate for Payer: Beech Street Commercial |
$3,387.70
|
| Rate for Payer: Cash Price |
$2,496.20
|
| Rate for Payer: Cash Price |
$2,496.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,459.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,494.68
|
| Rate for Payer: First Choice Health Commercial |
$3,209.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,387.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$999.52
|
| Rate for Payer: HealthUtah PPO |
$3,566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,459.02
|
| Rate for Payer: Multiplan Medicare/VA |
$849.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,494.68
|
| Rate for Payer: PacificSource Commercial |
$3,209.40
|
| Rate for Payer: PHCS PPO |
$3,387.70
|
| Rate for Payer: Three Rivers PPO |
$2,674.50
|
| Rate for Payer: TriWest Veterans Administration |
$999.52
|
| Rate for Payer: United Healthcare Commercial |
$3,102.42
|
| Rate for Payer: United Healthcare Medicare |
$999.52
|
| Rate for Payer: WINHealth Partners Commercial |
$3,031.10
|
|
|
REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 24435
|
| Hospital Charge Code |
24435
|
| Min. Negotiated Rate |
$889.15 |
| Max. Negotiated Rate |
$3,732.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,657.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,046.06
|
| Rate for Payer: Beech Street Commercial |
$3,545.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: Cash Price |
$2,612.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,620.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,657.36
|
| Rate for Payer: First Choice Health Commercial |
$3,358.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,545.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,046.06
|
| Rate for Payer: HealthUtah PPO |
$3,732.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,620.04
|
| Rate for Payer: Multiplan Medicare/VA |
$889.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,657.36
|
| Rate for Payer: PacificSource Commercial |
$3,358.80
|
| Rate for Payer: PHCS PPO |
$3,545.40
|
| Rate for Payer: Three Rivers PPO |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,046.06
|
| Rate for Payer: United Healthcare Commercial |
$3,246.84
|
| Rate for Payer: United Healthcare Medicare |
$1,046.06
|
| Rate for Payer: WINHealth Partners Commercial |
$3,172.20
|
|
|
REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
24430
|
| Min. Negotiated Rate |
$865.91 |
| Max. Negotiated Rate |
$3,635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,562.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,018.72
|
| Rate for Payer: Beech Street Commercial |
$3,453.25
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,525.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,562.30
|
| Rate for Payer: First Choice Health Commercial |
$3,271.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,453.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,018.72
|
| Rate for Payer: HealthUtah PPO |
$3,635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,525.95
|
| Rate for Payer: Multiplan Medicare/VA |
$865.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,562.30
|
| Rate for Payer: PacificSource Commercial |
$3,271.50
|
| Rate for Payer: PHCS PPO |
$3,453.25
|
| Rate for Payer: Three Rivers PPO |
$2,726.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,018.72
|
| Rate for Payer: United Healthcare Commercial |
$3,162.45
|
| Rate for Payer: United Healthcare Medicare |
$1,018.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,089.75
|
|
|
REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$3,635.00
|
|
|
Service Code
|
HCPCS 24430 AS
|
| Hospital Charge Code |
24430
|
| Min. Negotiated Rate |
$865.91 |
| Max. Negotiated Rate |
$3,635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,562.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,018.72
|
| Rate for Payer: Beech Street Commercial |
$3,453.25
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: Cash Price |
$2,544.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,525.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,562.30
|
| Rate for Payer: First Choice Health Commercial |
$3,271.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,453.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,018.72
|
| Rate for Payer: HealthUtah PPO |
$3,635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,525.95
|
| Rate for Payer: Multiplan Medicare/VA |
$865.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,562.30
|
| Rate for Payer: PacificSource Commercial |
$3,271.50
|
| Rate for Payer: PHCS PPO |
$3,453.25
|
| Rate for Payer: Three Rivers PPO |
$2,726.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,018.72
|
| Rate for Payer: United Healthcare Commercial |
$3,162.45
|
| Rate for Payer: United Healthcare Medicare |
$1,018.72
|
| Rate for Payer: WINHealth Partners Commercial |
$3,089.75
|
|
|
REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 28320
|
| Hospital Charge Code |
28320
|
| Min. Negotiated Rate |
$509.52 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,459.22
|
| Rate for Payer: Aetna of WY Medicare |
$599.44
|
| Rate for Payer: Beech Street Commercial |
$1,414.55
|
| Rate for Payer: Cash Price |
$1,042.30
|
| Rate for Payer: Cash Price |
$1,042.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,444.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,459.22
|
| Rate for Payer: First Choice Health Commercial |
$1,340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,414.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.44
|
| Rate for Payer: HealthUtah PPO |
$1,489.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,444.33
|
| Rate for Payer: Multiplan Medicare/VA |
$509.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,459.22
|
| Rate for Payer: PacificSource Commercial |
$1,340.10
|
| Rate for Payer: PHCS PPO |
$1,414.55
|
| Rate for Payer: Three Rivers PPO |
$1,116.75
|
| Rate for Payer: TriWest Veterans Administration |
$599.44
|
| Rate for Payer: United Healthcare Commercial |
$1,295.43
|
| Rate for Payer: United Healthcare Medicare |
$599.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,265.65
|
|
|
REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$8,520.00
|
|
|
Service Code
|
HCPCS 27720
|
| Hospital Charge Code |
27720
|
| Min. Negotiated Rate |
$717.90 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,349.60
|
| Rate for Payer: Aetna of WY Medicare |
$844.59
|
| Rate for Payer: Beech Street Commercial |
$8,094.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,264.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,349.60
|
| Rate for Payer: First Choice Health Commercial |
$7,668.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$844.59
|
| Rate for Payer: HealthUtah PPO |
$8,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,264.40
|
| Rate for Payer: Multiplan Medicare/VA |
$717.90
|
| Rate for Payer: One Health Plan of WY PPO |
$8,349.60
|
| Rate for Payer: PacificSource Commercial |
$7,668.00
|
| Rate for Payer: PHCS PPO |
$8,094.00
|
| Rate for Payer: Three Rivers PPO |
$6,390.00
|
| Rate for Payer: TriWest Veterans Administration |
$844.59
|
| Rate for Payer: United Healthcare Commercial |
$7,412.40
|
| Rate for Payer: United Healthcare Medicare |
$844.59
|
| Rate for Payer: WINHealth Partners Commercial |
$7,242.00
|
|
|
REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 27650 AS
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,885.12
|
| Rate for Payer: Aetna of WY Medicare |
$640.70
|
| Rate for Payer: Beech Street Commercial |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,855.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,885.12
|
| Rate for Payer: First Choice Health Commercial |
$2,649.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,796.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.70
|
| Rate for Payer: HealthUtah PPO |
$2,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,855.68
|
| Rate for Payer: Multiplan Medicare/VA |
$544.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,885.12
|
| Rate for Payer: PacificSource Commercial |
$2,649.60
|
| Rate for Payer: PHCS PPO |
$2,796.80
|
| Rate for Payer: Three Rivers PPO |
$2,208.00
|
| Rate for Payer: TriWest Veterans Administration |
$640.70
|
| Rate for Payer: United Healthcare Commercial |
$2,561.28
|
| Rate for Payer: United Healthcare Medicare |
$640.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,502.40
|
|
|
REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,885.12
|
| Rate for Payer: Aetna of WY Medicare |
$640.70
|
| Rate for Payer: Beech Street Commercial |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,855.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,885.12
|
| Rate for Payer: First Choice Health Commercial |
$2,649.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,796.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.70
|
| Rate for Payer: HealthUtah PPO |
$2,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,855.68
|
| Rate for Payer: Multiplan Medicare/VA |
$544.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,885.12
|
| Rate for Payer: PacificSource Commercial |
$2,649.60
|
| Rate for Payer: PHCS PPO |
$2,796.80
|
| Rate for Payer: Three Rivers PPO |
$2,208.00
|
| Rate for Payer: TriWest Veterans Administration |
$640.70
|
| Rate for Payer: United Healthcare Commercial |
$2,561.28
|
| Rate for Payer: United Healthcare Medicare |
$640.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,502.40
|
|
|
REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS 27650 80
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,885.12
|
| Rate for Payer: Aetna of WY Medicare |
$640.70
|
| Rate for Payer: Beech Street Commercial |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: Cash Price |
$2,060.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,855.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,885.12
|
| Rate for Payer: First Choice Health Commercial |
$2,649.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,796.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.70
|
| Rate for Payer: HealthUtah PPO |
$2,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,855.68
|
| Rate for Payer: Multiplan Medicare/VA |
$544.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,885.12
|
| Rate for Payer: PacificSource Commercial |
$2,649.60
|
| Rate for Payer: PHCS PPO |
$2,796.80
|
| Rate for Payer: Three Rivers PPO |
$2,208.00
|
| Rate for Payer: TriWest Veterans Administration |
$640.70
|
| Rate for Payer: United Healthcare Commercial |
$2,561.28
|
| Rate for Payer: United Healthcare Medicare |
$640.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,502.40
|
|
|
REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$2,764.00
|
|
|
Service Code
|
HCPCS 27407
|
| Hospital Charge Code |
27407
|
| Min. Negotiated Rate |
$658.18 |
| Max. Negotiated Rate |
$2,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,708.72
|
| Rate for Payer: Aetna of WY Medicare |
$774.33
|
| Rate for Payer: Beech Street Commercial |
$2,625.80
|
| Rate for Payer: Cash Price |
$1,934.80
|
| Rate for Payer: Cash Price |
$1,934.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,681.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,708.72
|
| Rate for Payer: First Choice Health Commercial |
$2,487.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,625.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$774.33
|
| Rate for Payer: HealthUtah PPO |
$2,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,681.08
|
| Rate for Payer: Multiplan Medicare/VA |
$658.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,708.72
|
| Rate for Payer: PacificSource Commercial |
$2,487.60
|
| Rate for Payer: PHCS PPO |
$2,625.80
|
| Rate for Payer: Three Rivers PPO |
$2,073.00
|
| Rate for Payer: TriWest Veterans Administration |
$774.33
|
| Rate for Payer: United Healthcare Commercial |
$2,404.68
|
| Rate for Payer: United Healthcare Medicare |
$774.33
|
| Rate for Payer: WINHealth Partners Commercial |
$2,349.40
|
|
|
REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$2,764.00
|
|
|
Service Code
|
HCPCS 27407 AS
|
| Hospital Charge Code |
27407
|
| Min. Negotiated Rate |
$658.18 |
| Max. Negotiated Rate |
$2,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,708.72
|
| Rate for Payer: Aetna of WY Medicare |
$774.33
|
| Rate for Payer: Beech Street Commercial |
$2,625.80
|
| Rate for Payer: Cash Price |
$1,934.80
|
| Rate for Payer: Cash Price |
$1,934.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,681.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,708.72
|
| Rate for Payer: First Choice Health Commercial |
$2,487.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,625.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$774.33
|
| Rate for Payer: HealthUtah PPO |
$2,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,681.08
|
| Rate for Payer: Multiplan Medicare/VA |
$658.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,708.72
|
| Rate for Payer: PacificSource Commercial |
$2,487.60
|
| Rate for Payer: PHCS PPO |
$2,625.80
|
| Rate for Payer: Three Rivers PPO |
$2,073.00
|
| Rate for Payer: TriWest Veterans Administration |
$774.33
|
| Rate for Payer: United Healthcare Commercial |
$2,404.68
|
| Rate for Payer: United Healthcare Medicare |
$774.33
|
| Rate for Payer: WINHealth Partners Commercial |
$2,349.40
|
|
|
REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$3,103.00
|
|
|
Service Code
|
HCPCS 27654 AS
|
| Hospital Charge Code |
27654
|
| Min. Negotiated Rate |
$592.28 |
| Max. Negotiated Rate |
$3,103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,040.94
|
| Rate for Payer: Aetna of WY Medicare |
$696.80
|
| Rate for Payer: Beech Street Commercial |
$2,947.85
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,009.91
|
| Rate for Payer: Cigna of WY Commercial |
$3,040.94
|
| Rate for Payer: First Choice Health Commercial |
$2,792.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,947.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.80
|
| Rate for Payer: HealthUtah PPO |
$3,103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,009.91
|
| Rate for Payer: Multiplan Medicare/VA |
$592.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,040.94
|
| Rate for Payer: PacificSource Commercial |
$2,792.70
|
| Rate for Payer: PHCS PPO |
$2,947.85
|
| Rate for Payer: Three Rivers PPO |
$2,327.25
|
| Rate for Payer: TriWest Veterans Administration |
$696.80
|
| Rate for Payer: United Healthcare Commercial |
$2,699.61
|
| Rate for Payer: United Healthcare Medicare |
$696.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,637.55
|
|
|
REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$3,103.00
|
|
|
Service Code
|
HCPCS 27654 80
|
| Hospital Charge Code |
27654
|
| Min. Negotiated Rate |
$592.28 |
| Max. Negotiated Rate |
$3,103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,040.94
|
| Rate for Payer: Aetna of WY Medicare |
$696.80
|
| Rate for Payer: Beech Street Commercial |
$2,947.85
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,009.91
|
| Rate for Payer: Cigna of WY Commercial |
$3,040.94
|
| Rate for Payer: First Choice Health Commercial |
$2,792.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,947.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.80
|
| Rate for Payer: HealthUtah PPO |
$3,103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,009.91
|
| Rate for Payer: Multiplan Medicare/VA |
$592.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,040.94
|
| Rate for Payer: PacificSource Commercial |
$2,792.70
|
| Rate for Payer: PHCS PPO |
$2,947.85
|
| Rate for Payer: Three Rivers PPO |
$2,327.25
|
| Rate for Payer: TriWest Veterans Administration |
$696.80
|
| Rate for Payer: United Healthcare Commercial |
$2,699.61
|
| Rate for Payer: United Healthcare Medicare |
$696.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,637.55
|
|
|
REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$3,103.00
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
27654
|
| Min. Negotiated Rate |
$592.28 |
| Max. Negotiated Rate |
$3,103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,040.94
|
| Rate for Payer: Aetna of WY Medicare |
$696.80
|
| Rate for Payer: Beech Street Commercial |
$2,947.85
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: Cash Price |
$2,172.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,009.91
|
| Rate for Payer: Cigna of WY Commercial |
$3,040.94
|
| Rate for Payer: First Choice Health Commercial |
$2,792.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,947.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.80
|
| Rate for Payer: HealthUtah PPO |
$3,103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,009.91
|
| Rate for Payer: Multiplan Medicare/VA |
$592.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,040.94
|
| Rate for Payer: PacificSource Commercial |
$2,792.70
|
| Rate for Payer: PHCS PPO |
$2,947.85
|
| Rate for Payer: Three Rivers PPO |
$2,327.25
|
| Rate for Payer: TriWest Veterans Administration |
$696.80
|
| Rate for Payer: United Healthcare Commercial |
$2,699.61
|
| Rate for Payer: United Healthcare Medicare |
$696.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,637.55
|
|
|
REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$7,101.00
|
|
|
Service Code
|
HCPCS 27698 AS
|
| Hospital Charge Code |
27698
|
| Min. Negotiated Rate |
$526.63 |
| Max. Negotiated Rate |
$7,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,958.98
|
| Rate for Payer: Aetna of WY Medicare |
$619.56
|
| Rate for Payer: Beech Street Commercial |
$6,745.95
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,887.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,958.98
|
| Rate for Payer: First Choice Health Commercial |
$6,390.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,745.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$619.56
|
| Rate for Payer: HealthUtah PPO |
$7,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,887.97
|
| Rate for Payer: Multiplan Medicare/VA |
$526.63
|
| Rate for Payer: One Health Plan of WY PPO |
$6,958.98
|
| Rate for Payer: PacificSource Commercial |
$6,390.90
|
| Rate for Payer: PHCS PPO |
$6,745.95
|
| Rate for Payer: Three Rivers PPO |
$5,325.75
|
| Rate for Payer: TriWest Veterans Administration |
$619.56
|
| Rate for Payer: United Healthcare Commercial |
$6,177.87
|
| Rate for Payer: United Healthcare Medicare |
$619.56
|
| Rate for Payer: WINHealth Partners Commercial |
$6,035.85
|
|
|
REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$7,101.00
|
|
|
Service Code
|
HCPCS 27698 80
|
| Hospital Charge Code |
27698
|
| Min. Negotiated Rate |
$526.63 |
| Max. Negotiated Rate |
$7,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,958.98
|
| Rate for Payer: Aetna of WY Medicare |
$619.56
|
| Rate for Payer: Beech Street Commercial |
$6,745.95
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,887.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,958.98
|
| Rate for Payer: First Choice Health Commercial |
$6,390.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,745.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$619.56
|
| Rate for Payer: HealthUtah PPO |
$7,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,887.97
|
| Rate for Payer: Multiplan Medicare/VA |
$526.63
|
| Rate for Payer: One Health Plan of WY PPO |
$6,958.98
|
| Rate for Payer: PacificSource Commercial |
$6,390.90
|
| Rate for Payer: PHCS PPO |
$6,745.95
|
| Rate for Payer: Three Rivers PPO |
$5,325.75
|
| Rate for Payer: TriWest Veterans Administration |
$619.56
|
| Rate for Payer: United Healthcare Commercial |
$6,177.87
|
| Rate for Payer: United Healthcare Medicare |
$619.56
|
| Rate for Payer: WINHealth Partners Commercial |
$6,035.85
|
|
|
REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$7,101.00
|
|
|
Service Code
|
HCPCS 27698
|
| Hospital Charge Code |
27698
|
| Min. Negotiated Rate |
$526.63 |
| Max. Negotiated Rate |
$7,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,958.98
|
| Rate for Payer: Aetna of WY Medicare |
$619.56
|
| Rate for Payer: Beech Street Commercial |
$6,745.95
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,887.97
|
| Rate for Payer: Cigna of WY Commercial |
$6,958.98
|
| Rate for Payer: First Choice Health Commercial |
$6,390.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,745.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$619.56
|
| Rate for Payer: HealthUtah PPO |
$7,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,887.97
|
| Rate for Payer: Multiplan Medicare/VA |
$526.63
|
| Rate for Payer: One Health Plan of WY PPO |
$6,958.98
|
| Rate for Payer: PacificSource Commercial |
$6,390.90
|
| Rate for Payer: PHCS PPO |
$6,745.95
|
| Rate for Payer: Three Rivers PPO |
$5,325.75
|
| Rate for Payer: TriWest Veterans Administration |
$619.56
|
| Rate for Payer: United Healthcare Commercial |
$6,177.87
|
| Rate for Payer: United Healthcare Medicare |
$619.56
|
| Rate for Payer: WINHealth Partners Commercial |
$6,035.85
|
|
|
REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
28208
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
| Rate for Payer: Aetna of WY Medicare |
$314.64
|
| Rate for Payer: Beech Street Commercial |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
| Rate for Payer: First Choice Health Commercial |
$1,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.64
|
| Rate for Payer: HealthUtah PPO |
$1,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
| Rate for Payer: Multiplan Medicare/VA |
$267.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
| Rate for Payer: PacificSource Commercial |
$1,474.20
|
| Rate for Payer: PHCS PPO |
$1,556.10
|
| Rate for Payer: Three Rivers PPO |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration |
$314.64
|
| Rate for Payer: United Healthcare Commercial |
$1,425.06
|
| Rate for Payer: United Healthcare Medicare |
$314.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,392.30
|
|
