|
RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$3,035.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$3,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,974.30
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$2,883.25
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,943.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,974.30
|
| Rate for Payer: First Choice Health Commercial |
$2,731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,883.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$3,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,943.95
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,974.30
|
| Rate for Payer: PacificSource Commercial |
$2,731.50
|
| Rate for Payer: PHCS PPO |
$2,883.25
|
| Rate for Payer: Three Rivers PPO |
$2,276.25
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$2,640.45
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,579.75
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 49505 AS
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$2,565.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: First Choice Health Commercial |
$2,430.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,565.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,295.00
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$2,565.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: First Choice Health Commercial |
$2,430.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,565.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,295.00
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 49505 80
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$2,565.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: First Choice Health Commercial |
$2,430.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,565.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,295.00
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$5,401.00
|
|
|
Service Code
|
HCPCS 49505 50
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$425.71 |
| Max. Negotiated Rate |
$5,401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,292.98
|
| Rate for Payer: Aetna of WY Medicare |
$500.84
|
| Rate for Payer: Beech Street Commercial |
$5,130.95
|
| Rate for Payer: Cash Price |
$3,780.70
|
| Rate for Payer: Cash Price |
$3,780.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,238.97
|
| Rate for Payer: Cigna of WY Commercial |
$5,292.98
|
| Rate for Payer: First Choice Health Commercial |
$4,860.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,130.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.84
|
| Rate for Payer: HealthUtah PPO |
$5,401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,238.97
|
| Rate for Payer: Multiplan Medicare/VA |
$425.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,292.98
|
| Rate for Payer: PacificSource Commercial |
$4,860.90
|
| Rate for Payer: PHCS PPO |
$5,130.95
|
| Rate for Payer: Three Rivers PPO |
$4,050.75
|
| Rate for Payer: TriWest Veterans Administration |
$500.84
|
| Rate for Payer: United Healthcare Commercial |
$4,698.87
|
| Rate for Payer: United Healthcare Medicare |
$500.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4,590.85
|
|
|
RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,565.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
49594
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,513.70
|
| Rate for Payer: Aetna of WY Medicare |
$701.96
|
| Rate for Payer: Beech Street Commercial |
$2,436.75
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,488.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,513.70
|
| Rate for Payer: First Choice Health Commercial |
$2,308.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$701.96
|
| Rate for Payer: HealthUtah PPO |
$2,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,488.05
|
| Rate for Payer: Multiplan Medicare/VA |
$596.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,513.70
|
| Rate for Payer: PacificSource Commercial |
$2,308.50
|
| Rate for Payer: PHCS PPO |
$2,436.75
|
| Rate for Payer: Three Rivers PPO |
$1,923.75
|
| Rate for Payer: TriWest Veterans Administration |
$701.96
|
| Rate for Payer: United Healthcare Commercial |
$2,231.55
|
| Rate for Payer: United Healthcare Medicare |
$701.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,180.25
|
|
|
RPR AA HERNIA 1ST 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
49593
|
| Min. Negotiated Rate |
$458.73 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$539.68
|
| Rate for Payer: Beech Street Commercial |
$1,871.50
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: First Choice Health Commercial |
$1,773.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.68
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$458.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,871.50
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.68
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$539.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,674.50
|
|
|
RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
49592
|
| Min. Negotiated Rate |
$380.86 |
| Max. Negotiated Rate |
$1,599.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,567.02
|
| Rate for Payer: Aetna of WY Medicare |
$448.07
|
| Rate for Payer: Beech Street Commercial |
$1,519.05
|
| Rate for Payer: Cash Price |
$1,119.30
|
| Rate for Payer: Cash Price |
$1,119.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,551.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,567.02
|
| Rate for Payer: First Choice Health Commercial |
$1,439.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,519.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.07
|
| Rate for Payer: HealthUtah PPO |
$1,599.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,551.03
|
| Rate for Payer: Multiplan Medicare/VA |
$380.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,567.02
|
| Rate for Payer: PacificSource Commercial |
$1,439.10
|
| Rate for Payer: PHCS PPO |
$1,519.05
|
| Rate for Payer: Three Rivers PPO |
$1,199.25
|
| Rate for Payer: TriWest Veterans Administration |
$448.07
|
| Rate for Payer: United Healthcare Commercial |
$1,391.13
|
| Rate for Payer: United Healthcare Medicare |
$448.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,359.15
|
|
|
RPR AA HERNIA 1ST < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
49591
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$1,354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,326.92
|
| Rate for Payer: Aetna of WY Medicare |
$322.89
|
| Rate for Payer: Beech Street Commercial |
$1,286.30
|
| Rate for Payer: Cash Price |
$947.80
|
| Rate for Payer: Cash Price |
$947.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,313.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,326.92
|
| Rate for Payer: First Choice Health Commercial |
$1,218.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,286.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.89
|
| Rate for Payer: HealthUtah PPO |
$1,354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,313.38
|
| Rate for Payer: Multiplan Medicare/VA |
$274.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,326.92
|
| Rate for Payer: PacificSource Commercial |
$1,218.60
|
| Rate for Payer: PHCS PPO |
$1,286.30
|
| Rate for Payer: Three Rivers PPO |
$1,015.50
|
| Rate for Payer: TriWest Veterans Administration |
$322.89
|
| Rate for Payer: United Healthcare Commercial |
$1,177.98
|
| Rate for Payer: United Healthcare Medicare |
$322.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,150.90
|
|
|
RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$2,113.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
49615
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,070.74
|
| Rate for Payer: Aetna of WY Medicare |
$601.88
|
| Rate for Payer: Beech Street Commercial |
$2,007.35
|
| Rate for Payer: Cash Price |
$1,479.10
|
| Rate for Payer: Cash Price |
$1,479.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,049.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,070.74
|
| Rate for Payer: First Choice Health Commercial |
$1,901.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,007.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$601.88
|
| Rate for Payer: HealthUtah PPO |
$2,113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,049.61
|
| Rate for Payer: Multiplan Medicare/VA |
$511.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,070.74
|
| Rate for Payer: PacificSource Commercial |
$1,901.70
|
| Rate for Payer: PHCS PPO |
$2,007.35
|
| Rate for Payer: Three Rivers PPO |
$1,584.75
|
| Rate for Payer: TriWest Veterans Administration |
$601.88
|
| Rate for Payer: United Healthcare Commercial |
$1,838.31
|
| Rate for Payer: United Healthcare Medicare |
$601.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,796.05
|
|
|
RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
49613
|
| Min. Negotiated Rate |
$338.31 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,369.06
|
| Rate for Payer: Aetna of WY Medicare |
$398.01
|
| Rate for Payer: Beech Street Commercial |
$1,327.15
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,355.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,369.06
|
| Rate for Payer: First Choice Health Commercial |
$1,257.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,327.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$398.01
|
| Rate for Payer: HealthUtah PPO |
$1,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,355.09
|
| Rate for Payer: Multiplan Medicare/VA |
$338.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,369.06
|
| Rate for Payer: PacificSource Commercial |
$1,257.30
|
| Rate for Payer: PHCS PPO |
$1,327.15
|
| Rate for Payer: Three Rivers PPO |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration |
$398.01
|
| Rate for Payer: United Healthcare Commercial |
$1,215.39
|
| Rate for Payer: United Healthcare Medicare |
$398.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,187.45
|
|
|
RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 26352 AS
|
| Hospital Charge Code |
26352
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$2,906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,847.88
|
| Rate for Payer: Aetna of WY Medicare |
$814.38
|
| Rate for Payer: Beech Street Commercial |
$2,760.70
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,818.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,847.88
|
| Rate for Payer: First Choice Health Commercial |
$2,615.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,760.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$814.38
|
| Rate for Payer: HealthUtah PPO |
$2,906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,818.82
|
| Rate for Payer: Multiplan Medicare/VA |
$692.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,847.88
|
| Rate for Payer: PacificSource Commercial |
$2,615.40
|
| Rate for Payer: PHCS PPO |
$2,760.70
|
| Rate for Payer: Three Rivers PPO |
$2,179.50
|
| Rate for Payer: TriWest Veterans Administration |
$814.38
|
| Rate for Payer: United Healthcare Commercial |
$2,528.22
|
| Rate for Payer: United Healthcare Medicare |
$814.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.10
|
|
|
RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 26352 80
|
| Hospital Charge Code |
26352
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$2,906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,847.88
|
| Rate for Payer: Aetna of WY Medicare |
$814.38
|
| Rate for Payer: Beech Street Commercial |
$2,760.70
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,818.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,847.88
|
| Rate for Payer: First Choice Health Commercial |
$2,615.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,760.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$814.38
|
| Rate for Payer: HealthUtah PPO |
$2,906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,818.82
|
| Rate for Payer: Multiplan Medicare/VA |
$692.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,847.88
|
| Rate for Payer: PacificSource Commercial |
$2,615.40
|
| Rate for Payer: PHCS PPO |
$2,760.70
|
| Rate for Payer: Three Rivers PPO |
$2,179.50
|
| Rate for Payer: TriWest Veterans Administration |
$814.38
|
| Rate for Payer: United Healthcare Commercial |
$2,528.22
|
| Rate for Payer: United Healthcare Medicare |
$814.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.10
|
|
|
RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 26352
|
| Hospital Charge Code |
26352
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$2,906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,847.88
|
| Rate for Payer: Aetna of WY Medicare |
$814.38
|
| Rate for Payer: Beech Street Commercial |
$2,760.70
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: Cash Price |
$2,034.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,818.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,847.88
|
| Rate for Payer: First Choice Health Commercial |
$2,615.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,760.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$814.38
|
| Rate for Payer: HealthUtah PPO |
$2,906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,818.82
|
| Rate for Payer: Multiplan Medicare/VA |
$692.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,847.88
|
| Rate for Payer: PacificSource Commercial |
$2,615.40
|
| Rate for Payer: PHCS PPO |
$2,760.70
|
| Rate for Payer: Three Rivers PPO |
$2,179.50
|
| Rate for Payer: TriWest Veterans Administration |
$814.38
|
| Rate for Payer: United Healthcare Commercial |
$2,528.22
|
| Rate for Payer: United Healthcare Medicare |
$814.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.10
|
|
|
RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$6,031.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
26350
|
| Min. Negotiated Rate |
$623.64 |
| Max. Negotiated Rate |
$6,031.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,910.38
|
| Rate for Payer: Aetna of WY Medicare |
$733.69
|
| Rate for Payer: Beech Street Commercial |
$5,729.45
|
| Rate for Payer: Cash Price |
$4,221.70
|
| Rate for Payer: Cash Price |
$4,221.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,850.07
|
| Rate for Payer: Cigna of WY Commercial |
$5,910.38
|
| Rate for Payer: First Choice Health Commercial |
$5,427.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,729.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.69
|
| Rate for Payer: HealthUtah PPO |
$6,031.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,850.07
|
| Rate for Payer: Multiplan Medicare/VA |
$623.64
|
| Rate for Payer: One Health Plan of WY PPO |
$5,910.38
|
| Rate for Payer: PacificSource Commercial |
$5,427.90
|
| Rate for Payer: PHCS PPO |
$5,729.45
|
| Rate for Payer: Three Rivers PPO |
$4,523.25
|
| Rate for Payer: TriWest Veterans Administration |
$733.69
|
| Rate for Payer: United Healthcare Commercial |
$5,246.97
|
| Rate for Payer: United Healthcare Medicare |
$733.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,126.35
|
|
|
RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$6,966.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
26356
|
| Min. Negotiated Rate |
$661.94 |
| Max. Negotiated Rate |
$6,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,826.68
|
| Rate for Payer: Aetna of WY Medicare |
$778.75
|
| Rate for Payer: Beech Street Commercial |
$6,617.70
|
| Rate for Payer: Cash Price |
$4,876.20
|
| Rate for Payer: Cash Price |
$4,876.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,757.02
|
| Rate for Payer: Cigna of WY Commercial |
$6,826.68
|
| Rate for Payer: First Choice Health Commercial |
$6,269.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,617.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.75
|
| Rate for Payer: HealthUtah PPO |
$6,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,757.02
|
| Rate for Payer: Multiplan Medicare/VA |
$661.94
|
| Rate for Payer: One Health Plan of WY PPO |
$6,826.68
|
| Rate for Payer: PacificSource Commercial |
$6,269.40
|
| Rate for Payer: PHCS PPO |
$6,617.70
|
| Rate for Payer: Three Rivers PPO |
$5,224.50
|
| Rate for Payer: TriWest Veterans Administration |
$778.75
|
| Rate for Payer: United Healthcare Commercial |
$6,060.42
|
| Rate for Payer: United Healthcare Medicare |
$778.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,921.10
|
|
|
RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,738.00
|
|
|
Service Code
|
HCPCS 26370 80
|
| Hospital Charge Code |
26370
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$2,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,683.24
|
| Rate for Payer: Aetna of WY Medicare |
$767.28
|
| Rate for Payer: Beech Street Commercial |
$2,601.10
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,655.86
|
| Rate for Payer: Cigna of WY Commercial |
$2,683.24
|
| Rate for Payer: First Choice Health Commercial |
$2,464.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,601.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$767.28
|
| Rate for Payer: HealthUtah PPO |
$2,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,655.86
|
| Rate for Payer: Multiplan Medicare/VA |
$652.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,683.24
|
| Rate for Payer: PacificSource Commercial |
$2,464.20
|
| Rate for Payer: PHCS PPO |
$2,601.10
|
| Rate for Payer: Three Rivers PPO |
$2,053.50
|
| Rate for Payer: TriWest Veterans Administration |
$767.28
|
| Rate for Payer: United Healthcare Commercial |
$2,382.06
|
| Rate for Payer: United Healthcare Medicare |
$767.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,327.30
|
|
|
RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$2,738.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
26370
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$2,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,683.24
|
| Rate for Payer: Aetna of WY Medicare |
$767.28
|
| Rate for Payer: Beech Street Commercial |
$2,601.10
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: Cash Price |
$1,916.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,655.86
|
| Rate for Payer: Cigna of WY Commercial |
$2,683.24
|
| Rate for Payer: First Choice Health Commercial |
$2,464.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,601.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$767.28
|
| Rate for Payer: HealthUtah PPO |
$2,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,655.86
|
| Rate for Payer: Multiplan Medicare/VA |
$652.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,683.24
|
| Rate for Payer: PacificSource Commercial |
$2,464.20
|
| Rate for Payer: PHCS PPO |
$2,601.10
|
| Rate for Payer: Three Rivers PPO |
$2,053.50
|
| Rate for Payer: TriWest Veterans Administration |
$767.28
|
| Rate for Payer: United Healthcare Commercial |
$2,382.06
|
| Rate for Payer: United Healthcare Medicare |
$767.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,327.30
|
|
|
RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 26372 80
|
| Hospital Charge Code |
26372
|
| Min. Negotiated Rate |
$759.48 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,391.60
|
| Rate for Payer: Aetna of WY Medicare |
$893.50
|
| Rate for Payer: Beech Street Commercial |
$1,349.00
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,377.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,391.60
|
| Rate for Payer: First Choice Health Commercial |
$1,278.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,349.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$893.50
|
| Rate for Payer: HealthUtah PPO |
$1,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,377.40
|
| Rate for Payer: Multiplan Medicare/VA |
$759.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,391.60
|
| Rate for Payer: PacificSource Commercial |
$1,278.00
|
| Rate for Payer: PHCS PPO |
$1,349.00
|
| Rate for Payer: Three Rivers PPO |
$1,065.00
|
| Rate for Payer: TriWest Veterans Administration |
$893.50
|
| Rate for Payer: United Healthcare Commercial |
$1,235.40
|
| Rate for Payer: United Healthcare Medicare |
$893.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,207.00
|
|
|
RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 26540 AS
|
| Hospital Charge Code |
26540
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$3,469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,399.62
|
| Rate for Payer: Aetna of WY Medicare |
$686.11
|
| Rate for Payer: Beech Street Commercial |
$3,295.55
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,364.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,399.62
|
| Rate for Payer: First Choice Health Commercial |
$3,122.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,295.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.11
|
| Rate for Payer: HealthUtah PPO |
$3,469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,364.93
|
| Rate for Payer: Multiplan Medicare/VA |
$583.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,399.62
|
| Rate for Payer: PacificSource Commercial |
$3,122.10
|
| Rate for Payer: PHCS PPO |
$3,295.55
|
| Rate for Payer: Three Rivers PPO |
$2,601.75
|
| Rate for Payer: TriWest Veterans Administration |
$686.11
|
| Rate for Payer: United Healthcare Commercial |
$3,018.03
|
| Rate for Payer: United Healthcare Medicare |
$686.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,948.65
|
|
|
RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
26540
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$3,469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,399.62
|
| Rate for Payer: Aetna of WY Medicare |
$686.11
|
| Rate for Payer: Beech Street Commercial |
$3,295.55
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,364.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,399.62
|
| Rate for Payer: First Choice Health Commercial |
$3,122.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,295.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.11
|
| Rate for Payer: HealthUtah PPO |
$3,469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,364.93
|
| Rate for Payer: Multiplan Medicare/VA |
$583.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,399.62
|
| Rate for Payer: PacificSource Commercial |
$3,122.10
|
| Rate for Payer: PHCS PPO |
$3,295.55
|
| Rate for Payer: Three Rivers PPO |
$2,601.75
|
| Rate for Payer: TriWest Veterans Administration |
$686.11
|
| Rate for Payer: United Healthcare Commercial |
$3,018.03
|
| Rate for Payer: United Healthcare Medicare |
$686.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,948.65
|
|
|
RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 26540 80
|
| Hospital Charge Code |
26540
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$3,469.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,399.62
|
| Rate for Payer: Aetna of WY Medicare |
$686.11
|
| Rate for Payer: Beech Street Commercial |
$3,295.55
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: Cash Price |
$2,428.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,364.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,399.62
|
| Rate for Payer: First Choice Health Commercial |
$3,122.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,295.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.11
|
| Rate for Payer: HealthUtah PPO |
$3,469.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,364.93
|
| Rate for Payer: Multiplan Medicare/VA |
$583.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,399.62
|
| Rate for Payer: PacificSource Commercial |
$3,122.10
|
| Rate for Payer: PHCS PPO |
$3,295.55
|
| Rate for Payer: Three Rivers PPO |
$2,601.75
|
| Rate for Payer: TriWest Veterans Administration |
$686.11
|
| Rate for Payer: United Healthcare Commercial |
$3,018.03
|
| Rate for Payer: United Healthcare Medicare |
$686.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,948.65
|
|
|
RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 27659 AS
|
| Hospital Charge Code |
27659
|
| Min. Negotiated Rate |
$392.42 |
| Max. Negotiated Rate |
$2,149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,106.02
|
| Rate for Payer: Aetna of WY Medicare |
$461.67
|
| Rate for Payer: Beech Street Commercial |
$2,041.55
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,084.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,106.02
|
| Rate for Payer: First Choice Health Commercial |
$1,934.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,041.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.67
|
| Rate for Payer: HealthUtah PPO |
$2,149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,084.53
|
| Rate for Payer: Multiplan Medicare/VA |
$392.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,106.02
|
| Rate for Payer: PacificSource Commercial |
$1,934.10
|
| Rate for Payer: PHCS PPO |
$2,041.55
|
| Rate for Payer: Three Rivers PPO |
$1,611.75
|
| Rate for Payer: TriWest Veterans Administration |
$461.67
|
| Rate for Payer: United Healthcare Commercial |
$1,869.63
|
| Rate for Payer: United Healthcare Medicare |
$461.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,826.65
|
|
|
RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
27659
|
| Min. Negotiated Rate |
$392.42 |
| Max. Negotiated Rate |
$2,149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,106.02
|
| Rate for Payer: Aetna of WY Medicare |
$461.67
|
| Rate for Payer: Beech Street Commercial |
$2,041.55
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: Cash Price |
$1,504.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,084.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,106.02
|
| Rate for Payer: First Choice Health Commercial |
$1,934.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,041.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$461.67
|
| Rate for Payer: HealthUtah PPO |
$2,149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,084.53
|
| Rate for Payer: Multiplan Medicare/VA |
$392.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,106.02
|
| Rate for Payer: PacificSource Commercial |
$1,934.10
|
| Rate for Payer: PHCS PPO |
$2,041.55
|
| Rate for Payer: Three Rivers PPO |
$1,611.75
|
| Rate for Payer: TriWest Veterans Administration |
$461.67
|
| Rate for Payer: United Healthcare Commercial |
$1,869.63
|
| Rate for Payer: United Healthcare Medicare |
$461.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,826.65
|
|
|
RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$2,974.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$466.34 |
| Max. Negotiated Rate |
$2,974.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,914.52
|
| Rate for Payer: Aetna of WY Medicare |
$548.64
|
| Rate for Payer: Beech Street Commercial |
$2,825.30
|
| Rate for Payer: Cash Price |
$2,081.80
|
| Rate for Payer: Cash Price |
$2,081.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,884.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,914.52
|
| Rate for Payer: First Choice Health Commercial |
$2,676.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,825.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$548.64
|
| Rate for Payer: HealthUtah PPO |
$2,974.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,884.78
|
| Rate for Payer: Multiplan Medicare/VA |
$466.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,914.52
|
| Rate for Payer: PacificSource Commercial |
$2,676.60
|
| Rate for Payer: PHCS PPO |
$2,825.30
|
| Rate for Payer: Three Rivers PPO |
$2,230.50
|
| Rate for Payer: TriWest Veterans Administration |
$548.64
|
| Rate for Payer: United Healthcare Commercial |
$2,587.38
|
| Rate for Payer: United Healthcare Medicare |
$548.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,527.90
|
|
