|
RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
41250
|
| Min. Negotiated Rate |
$126.39 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$966.28
|
| Rate for Payer: Aetna of WY Medicare |
$148.69
|
| 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 |
$148.69
|
| Rate for Payer: HealthUtah PPO |
$986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$956.42
|
| Rate for Payer: Multiplan Medicare/VA |
$126.39
|
| 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 |
$148.69
|
| Rate for Payer: United Healthcare Commercial |
$857.82
|
| Rate for Payer: United Healthcare Medicare |
$148.69
|
| Rate for Payer: WINHealth Partners Commercial |
$838.10
|
|
|
RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$6,503.00
|
|
|
Service Code
|
HCPCS 27724 80
|
| Hospital Charge Code |
27724
|
| Min. Negotiated Rate |
$1,021.78 |
| Max. Negotiated Rate |
$6,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,372.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,202.09
|
| Rate for Payer: Beech Street Commercial |
$6,177.85
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,307.91
|
| Rate for Payer: Cigna of WY Commercial |
$6,372.94
|
| Rate for Payer: First Choice Health Commercial |
$5,852.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,177.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,202.09
|
| Rate for Payer: HealthUtah PPO |
$6,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,307.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1,021.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,372.94
|
| Rate for Payer: PacificSource Commercial |
$5,852.70
|
| Rate for Payer: PHCS PPO |
$6,177.85
|
| Rate for Payer: Three Rivers PPO |
$4,877.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,202.09
|
| Rate for Payer: United Healthcare Commercial |
$5,657.61
|
| Rate for Payer: United Healthcare Medicare |
$1,202.09
|
| Rate for Payer: WINHealth Partners Commercial |
$5,527.55
|
|
|
RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$6,503.00
|
|
|
Service Code
|
HCPCS 27724 AS
|
| Hospital Charge Code |
27724
|
| Min. Negotiated Rate |
$1,021.78 |
| Max. Negotiated Rate |
$6,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,372.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,202.09
|
| Rate for Payer: Beech Street Commercial |
$6,177.85
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,307.91
|
| Rate for Payer: Cigna of WY Commercial |
$6,372.94
|
| Rate for Payer: First Choice Health Commercial |
$5,852.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,177.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,202.09
|
| Rate for Payer: HealthUtah PPO |
$6,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,307.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1,021.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,372.94
|
| Rate for Payer: PacificSource Commercial |
$5,852.70
|
| Rate for Payer: PHCS PPO |
$6,177.85
|
| Rate for Payer: Three Rivers PPO |
$4,877.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,202.09
|
| Rate for Payer: United Healthcare Commercial |
$5,657.61
|
| Rate for Payer: United Healthcare Medicare |
$1,202.09
|
| Rate for Payer: WINHealth Partners Commercial |
$5,527.55
|
|
|
RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$6,503.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
27724
|
| Min. Negotiated Rate |
$1,021.78 |
| Max. Negotiated Rate |
$6,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,372.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,202.09
|
| Rate for Payer: Beech Street Commercial |
$6,177.85
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: Cash Price |
$4,552.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,307.91
|
| Rate for Payer: Cigna of WY Commercial |
$6,372.94
|
| Rate for Payer: First Choice Health Commercial |
$5,852.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,177.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,202.09
|
| Rate for Payer: HealthUtah PPO |
$6,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,307.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1,021.78
|
| Rate for Payer: One Health Plan of WY PPO |
$6,372.94
|
| Rate for Payer: PacificSource Commercial |
$5,852.70
|
| Rate for Payer: PHCS PPO |
$6,177.85
|
| Rate for Payer: Three Rivers PPO |
$4,877.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,202.09
|
| Rate for Payer: United Healthcare Commercial |
$5,657.61
|
| Rate for Payer: United Healthcare Medicare |
$1,202.09
|
| Rate for Payer: WINHealth Partners Commercial |
$5,527.55
|
|
|
RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 28322 AS
|
| Hospital Charge Code |
28322
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$562.81
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.81
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$478.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$562.81
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$562.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
28322
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$562.81
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.81
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$478.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$562.81
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$562.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 28322 80
|
| Hospital Charge Code |
28322
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$562.81
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.81
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$478.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$562.81
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$562.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 25405 80
|
| Hospital Charge Code |
25405
|
| Min. Negotiated Rate |
$851.28 |
| Max. Negotiated Rate |
$3,573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,501.54
|
| Rate for Payer: Aetna of WY Medicare |
$1,001.50
|
| Rate for Payer: Beech Street Commercial |
$3,394.35
|
| Rate for Payer: Cash Price |
$2,501.10
|
| Rate for Payer: Cash Price |
$2,501.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,465.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,501.54
|
| Rate for Payer: First Choice Health Commercial |
$3,215.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,394.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,001.50
|
| Rate for Payer: HealthUtah PPO |
$3,573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,465.81
|
| Rate for Payer: Multiplan Medicare/VA |
$851.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,501.54
|
| Rate for Payer: PacificSource Commercial |
$3,215.70
|
| Rate for Payer: PHCS PPO |
$3,394.35
|
| Rate for Payer: Three Rivers PPO |
$2,679.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,001.50
|
| Rate for Payer: United Healthcare Commercial |
$3,108.51
|
| Rate for Payer: United Healthcare Medicare |
$1,001.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,037.05
|
|
|
RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 25405
|
| Hospital Charge Code |
25405
|
| Min. Negotiated Rate |
$851.28 |
| Max. Negotiated Rate |
$3,573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,501.54
|
| Rate for Payer: Aetna of WY Medicare |
$1,001.50
|
| Rate for Payer: Beech Street Commercial |
$3,394.35
|
| Rate for Payer: Cash Price |
$2,501.10
|
| Rate for Payer: Cash Price |
$2,501.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,465.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,501.54
|
| Rate for Payer: First Choice Health Commercial |
$3,215.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,394.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,001.50
|
| Rate for Payer: HealthUtah PPO |
$3,573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,465.81
|
| Rate for Payer: Multiplan Medicare/VA |
$851.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,501.54
|
| Rate for Payer: PacificSource Commercial |
$3,215.70
|
| Rate for Payer: PHCS PPO |
$3,394.35
|
| Rate for Payer: Three Rivers PPO |
$2,679.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,001.50
|
| Rate for Payer: United Healthcare Commercial |
$3,108.51
|
| Rate for Payer: United Healthcare Medicare |
$1,001.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,037.05
|
|
|
RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,339.00
|
|
|
Service Code
|
HCPCS 25415
|
| Hospital Charge Code |
25415
|
| Min. Negotiated Rate |
$795.22 |
| Max. Negotiated Rate |
$3,339.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,272.22
|
| Rate for Payer: Aetna of WY Medicare |
$935.55
|
| Rate for Payer: Beech Street Commercial |
$3,172.05
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,238.83
|
| Rate for Payer: Cigna of WY Commercial |
$3,272.22
|
| Rate for Payer: First Choice Health Commercial |
$3,005.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,172.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$935.55
|
| Rate for Payer: HealthUtah PPO |
$3,339.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,238.83
|
| Rate for Payer: Multiplan Medicare/VA |
$795.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,272.22
|
| Rate for Payer: PacificSource Commercial |
$3,005.10
|
| Rate for Payer: PHCS PPO |
$3,172.05
|
| Rate for Payer: Three Rivers PPO |
$2,504.25
|
| Rate for Payer: TriWest Veterans Administration |
$935.55
|
| Rate for Payer: United Healthcare Commercial |
$2,904.93
|
| Rate for Payer: United Healthcare Medicare |
$935.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,838.15
|
|
|
RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
25400
|
| Min. Negotiated Rate |
$661.89 |
| Max. Negotiated Rate |
$2,779.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,723.42
|
| Rate for Payer: Aetna of WY Medicare |
$778.69
|
| Rate for Payer: Beech Street Commercial |
$2,640.05
|
| Rate for Payer: Cash Price |
$1,945.30
|
| Rate for Payer: Cash Price |
$1,945.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,695.63
|
| Rate for Payer: Cigna of WY Commercial |
$2,723.42
|
| Rate for Payer: First Choice Health Commercial |
$2,501.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,640.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.69
|
| Rate for Payer: HealthUtah PPO |
$2,779.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,695.63
|
| Rate for Payer: Multiplan Medicare/VA |
$661.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,723.42
|
| Rate for Payer: PacificSource Commercial |
$2,501.10
|
| Rate for Payer: PHCS PPO |
$2,640.05
|
| Rate for Payer: Three Rivers PPO |
$2,084.25
|
| Rate for Payer: TriWest Veterans Administration |
$778.69
|
| Rate for Payer: United Healthcare Commercial |
$2,417.73
|
| Rate for Payer: United Healthcare Medicare |
$778.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2,362.15
|
|
|
RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$5,199.00
|
|
|
Service Code
|
HCPCS 26546 AS
|
| Hospital Charge Code |
26546
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$5,199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,095.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,014.58
|
| Rate for Payer: Beech Street Commercial |
$4,939.05
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,043.03
|
| Rate for Payer: Cigna of WY Commercial |
$5,095.02
|
| Rate for Payer: First Choice Health Commercial |
$4,679.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,939.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,014.58
|
| Rate for Payer: HealthUtah PPO |
$5,199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,043.03
|
| Rate for Payer: Multiplan Medicare/VA |
$862.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,095.02
|
| Rate for Payer: PacificSource Commercial |
$4,679.10
|
| Rate for Payer: PHCS PPO |
$4,939.05
|
| Rate for Payer: Three Rivers PPO |
$3,899.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,014.58
|
| Rate for Payer: United Healthcare Commercial |
$4,523.13
|
| Rate for Payer: United Healthcare Medicare |
$1,014.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4,419.15
|
|
|
RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$5,199.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
26546
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$5,199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,095.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,014.58
|
| Rate for Payer: Beech Street Commercial |
$4,939.05
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: Cash Price |
$3,639.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,043.03
|
| Rate for Payer: Cigna of WY Commercial |
$5,095.02
|
| Rate for Payer: First Choice Health Commercial |
$4,679.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,939.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,014.58
|
| Rate for Payer: HealthUtah PPO |
$5,199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,043.03
|
| Rate for Payer: Multiplan Medicare/VA |
$862.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,095.02
|
| Rate for Payer: PacificSource Commercial |
$4,679.10
|
| Rate for Payer: PHCS PPO |
$4,939.05
|
| Rate for Payer: Three Rivers PPO |
$3,899.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,014.58
|
| Rate for Payer: United Healthcare Commercial |
$4,523.13
|
| Rate for Payer: United Healthcare Medicare |
$1,014.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4,419.15
|
|
|
RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$2,669.00
|
|
|
Service Code
|
HCPCS 25440 AS
|
| Hospital Charge Code |
25440
|
| Min. Negotiated Rate |
$635.63 |
| Max. Negotiated Rate |
$2,669.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,615.62
|
| Rate for Payer: Aetna of WY Medicare |
$747.80
|
| Rate for Payer: Beech Street Commercial |
$2,535.55
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,588.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,615.62
|
| Rate for Payer: First Choice Health Commercial |
$2,402.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,535.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.80
|
| Rate for Payer: HealthUtah PPO |
$2,669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,588.93
|
| Rate for Payer: Multiplan Medicare/VA |
$635.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,615.62
|
| Rate for Payer: PacificSource Commercial |
$2,402.10
|
| Rate for Payer: PHCS PPO |
$2,535.55
|
| Rate for Payer: Three Rivers PPO |
$2,001.75
|
| Rate for Payer: TriWest Veterans Administration |
$747.80
|
| Rate for Payer: United Healthcare Commercial |
$2,322.03
|
| Rate for Payer: United Healthcare Medicare |
$747.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,268.65
|
|
|
RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$2,669.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
25440
|
| Min. Negotiated Rate |
$635.63 |
| Max. Negotiated Rate |
$2,669.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,615.62
|
| Rate for Payer: Aetna of WY Medicare |
$747.80
|
| Rate for Payer: Beech Street Commercial |
$2,535.55
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: Cash Price |
$1,868.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,588.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,615.62
|
| Rate for Payer: First Choice Health Commercial |
$2,402.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,535.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.80
|
| Rate for Payer: HealthUtah PPO |
$2,669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,588.93
|
| Rate for Payer: Multiplan Medicare/VA |
$635.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,615.62
|
| Rate for Payer: PacificSource Commercial |
$2,402.10
|
| Rate for Payer: PHCS PPO |
$2,535.55
|
| Rate for Payer: Three Rivers PPO |
$2,001.75
|
| Rate for Payer: TriWest Veterans Administration |
$747.80
|
| Rate for Payer: United Healthcare Commercial |
$2,322.03
|
| Rate for Payer: United Healthcare Medicare |
$747.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,268.65
|
|
|
RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$9,211.00
|
|
|
Service Code
|
HCPCS 30468
|
| Hospital Charge Code |
30468
|
| Min. Negotiated Rate |
$137.93 |
| Max. Negotiated Rate |
$9,211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,026.78
|
| Rate for Payer: Aetna of WY Medicare |
$162.27
|
| Rate for Payer: Beech Street Commercial |
$8,750.45
|
| Rate for Payer: Cash Price |
$6,447.70
|
| Rate for Payer: Cash Price |
$6,447.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,934.67
|
| Rate for Payer: Cigna of WY Commercial |
$9,026.78
|
| Rate for Payer: First Choice Health Commercial |
$8,289.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,750.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.27
|
| Rate for Payer: HealthUtah PPO |
$9,211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,934.67
|
| Rate for Payer: Multiplan Medicare/VA |
$137.93
|
| Rate for Payer: One Health Plan of WY PPO |
$9,026.78
|
| Rate for Payer: PacificSource Commercial |
$8,289.90
|
| Rate for Payer: PHCS PPO |
$8,750.45
|
| Rate for Payer: Three Rivers PPO |
$6,908.25
|
| Rate for Payer: TriWest Veterans Administration |
$162.27
|
| Rate for Payer: United Healthcare Commercial |
$8,013.57
|
| Rate for Payer: United Healthcare Medicare |
$162.27
|
| Rate for Payer: WINHealth Partners Commercial |
$7,829.35
|
|
|
RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 27695
|
| Hospital Charge Code |
27695
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$5,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,288.08
|
| Rate for Payer: Aetna of WY Medicare |
$475.23
|
| Rate for Payer: Beech Street Commercial |
$5,126.20
|
| Rate for Payer: Cash Price |
$3,777.20
|
| Rate for Payer: Cash Price |
$3,777.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,234.12
|
| Rate for Payer: Cigna of WY Commercial |
$5,288.08
|
| Rate for Payer: First Choice Health Commercial |
$4,856.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,126.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.23
|
| Rate for Payer: HealthUtah PPO |
$5,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,234.12
|
| Rate for Payer: Multiplan Medicare/VA |
$403.95
|
| Rate for Payer: One Health Plan of WY PPO |
$5,288.08
|
| Rate for Payer: PacificSource Commercial |
$4,856.40
|
| Rate for Payer: PHCS PPO |
$5,126.20
|
| Rate for Payer: Three Rivers PPO |
$4,047.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.23
|
| Rate for Payer: United Healthcare Commercial |
$4,694.52
|
| Rate for Payer: United Healthcare Medicare |
$475.23
|
| Rate for Payer: WINHealth Partners Commercial |
$4,586.60
|
|
|
RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 27652 AS
|
| Hospital Charge Code |
27652
|
| Min. Negotiated Rate |
$555.46 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$653.48
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.48
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$555.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.48
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$653.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
27652
|
| Min. Negotiated Rate |
$555.46 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$653.48
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.48
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$555.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.48
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$653.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 27652 80
|
| Hospital Charge Code |
27652
|
| Min. Negotiated Rate |
$555.46 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,150.70
|
| Rate for Payer: Aetna of WY Medicare |
$653.48
|
| Rate for Payer: Beech Street Commercial |
$3,054.25
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,118.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,150.70
|
| Rate for Payer: First Choice Health Commercial |
$2,893.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,054.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.48
|
| Rate for Payer: HealthUtah PPO |
$3,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,118.55
|
| Rate for Payer: Multiplan Medicare/VA |
$555.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,150.70
|
| Rate for Payer: PacificSource Commercial |
$2,893.50
|
| Rate for Payer: PHCS PPO |
$3,054.25
|
| Rate for Payer: Three Rivers PPO |
$2,411.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.48
|
| Rate for Payer: United Healthcare Commercial |
$2,797.05
|
| Rate for Payer: United Healthcare Medicare |
$653.48
|
| Rate for Payer: WINHealth Partners Commercial |
$2,732.75
|
|
|
RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 27405 80
|
| Hospital Charge Code |
27405
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$2,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,305.94
|
| Rate for Payer: Aetna of WY Medicare |
$659.30
|
| Rate for Payer: Beech Street Commercial |
$2,235.35
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,282.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,305.94
|
| Rate for Payer: First Choice Health Commercial |
$2,117.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,235.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$659.30
|
| Rate for Payer: HealthUtah PPO |
$2,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,282.41
|
| Rate for Payer: Multiplan Medicare/VA |
$560.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,305.94
|
| Rate for Payer: PacificSource Commercial |
$2,117.70
|
| Rate for Payer: PHCS PPO |
$2,235.35
|
| Rate for Payer: Three Rivers PPO |
$1,764.75
|
| Rate for Payer: TriWest Veterans Administration |
$659.30
|
| Rate for Payer: United Healthcare Commercial |
$2,047.11
|
| Rate for Payer: United Healthcare Medicare |
$659.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,000.05
|
|
|
RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 27405 AS
|
| Hospital Charge Code |
27405
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$2,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,305.94
|
| Rate for Payer: Aetna of WY Medicare |
$659.30
|
| Rate for Payer: Beech Street Commercial |
$2,235.35
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,282.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,305.94
|
| Rate for Payer: First Choice Health Commercial |
$2,117.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,235.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$659.30
|
| Rate for Payer: HealthUtah PPO |
$2,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,282.41
|
| Rate for Payer: Multiplan Medicare/VA |
$560.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,305.94
|
| Rate for Payer: PacificSource Commercial |
$2,117.70
|
| Rate for Payer: PHCS PPO |
$2,235.35
|
| Rate for Payer: Three Rivers PPO |
$1,764.75
|
| Rate for Payer: TriWest Veterans Administration |
$659.30
|
| Rate for Payer: United Healthcare Commercial |
$2,047.11
|
| Rate for Payer: United Healthcare Medicare |
$659.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,000.05
|
|
|
RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
27405
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$2,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,305.94
|
| Rate for Payer: Aetna of WY Medicare |
$659.30
|
| Rate for Payer: Beech Street Commercial |
$2,235.35
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: Cash Price |
$1,647.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,282.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,305.94
|
| Rate for Payer: First Choice Health Commercial |
$2,117.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,235.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$659.30
|
| Rate for Payer: HealthUtah PPO |
$2,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,282.41
|
| Rate for Payer: Multiplan Medicare/VA |
$560.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,305.94
|
| Rate for Payer: PacificSource Commercial |
$2,117.70
|
| Rate for Payer: PHCS PPO |
$2,235.35
|
| Rate for Payer: Three Rivers PPO |
$1,764.75
|
| Rate for Payer: TriWest Veterans Administration |
$659.30
|
| Rate for Payer: United Healthcare Commercial |
$2,047.11
|
| Rate for Payer: United Healthcare Medicare |
$659.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,000.05
|
|
|
RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL
|
Professional
|
Both
|
$3,990.00
|
|
|
Service Code
|
HCPCS 26548
|
| Hospital Charge Code |
26548
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,910.20
|
| Rate for Payer: Aetna of WY Medicare |
$782.68
|
| Rate for Payer: Beech Street Commercial |
$3,790.50
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,870.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,910.20
|
| Rate for Payer: First Choice Health Commercial |
$3,591.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,790.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$782.68
|
| Rate for Payer: HealthUtah PPO |
$3,990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,870.30
|
| Rate for Payer: Multiplan Medicare/VA |
$665.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,910.20
|
| Rate for Payer: PacificSource Commercial |
$3,591.00
|
| Rate for Payer: PHCS PPO |
$3,790.50
|
| Rate for Payer: Three Rivers PPO |
$2,992.50
|
| Rate for Payer: TriWest Veterans Administration |
$782.68
|
| Rate for Payer: United Healthcare Commercial |
$3,471.30
|
| Rate for Payer: United Healthcare Medicare |
$782.68
|
| Rate for Payer: WINHealth Partners Commercial |
$3,391.50
|
|
|
RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL
|
Professional
|
Both
|
$3,990.00
|
|
|
Service Code
|
HCPCS 26548 AS
|
| Hospital Charge Code |
26548
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,910.20
|
| Rate for Payer: Aetna of WY Medicare |
$782.68
|
| Rate for Payer: Beech Street Commercial |
$3,790.50
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: Cash Price |
$2,793.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,870.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,910.20
|
| Rate for Payer: First Choice Health Commercial |
$3,591.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,790.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$782.68
|
| Rate for Payer: HealthUtah PPO |
$3,990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,870.30
|
| Rate for Payer: Multiplan Medicare/VA |
$665.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,910.20
|
| Rate for Payer: PacificSource Commercial |
$3,591.00
|
| Rate for Payer: PHCS PPO |
$3,790.50
|
| Rate for Payer: Three Rivers PPO |
$2,992.50
|
| Rate for Payer: TriWest Veterans Administration |
$782.68
|
| Rate for Payer: United Healthcare Commercial |
$3,471.30
|
| Rate for Payer: United Healthcare Medicare |
$782.68
|
| Rate for Payer: WINHealth Partners Commercial |
$3,391.50
|
|
