|
RPR RECRT FEM HRNA INCARCERATED
|
Professional
|
Both
|
$3,749.00
|
|
|
Service Code
|
HCPCS 49557
|
| Hospital Charge Code |
49557
|
| Min. Negotiated Rate |
$585.61 |
| Max. Negotiated Rate |
$3,749.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,674.02
|
| Rate for Payer: Aetna of WY Medicare |
$688.95
|
| Rate for Payer: Beech Street Commercial |
$3,561.55
|
| Rate for Payer: Cash Price |
$2,624.30
|
| Rate for Payer: Cash Price |
$2,624.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,636.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,674.02
|
| Rate for Payer: First Choice Health Commercial |
$3,374.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,561.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.95
|
| Rate for Payer: HealthUtah PPO |
$3,749.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,636.53
|
| Rate for Payer: Multiplan Medicare/VA |
$585.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,674.02
|
| Rate for Payer: PacificSource Commercial |
$3,374.10
|
| Rate for Payer: PHCS PPO |
$3,561.55
|
| Rate for Payer: Three Rivers PPO |
$2,811.75
|
| Rate for Payer: TriWest Veterans Administration |
$688.95
|
| Rate for Payer: United Healthcare Commercial |
$3,261.63
|
| Rate for Payer: United Healthcare Medicare |
$688.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,186.65
|
|
|
RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 49520 80
|
| Hospital Charge Code |
49520
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$3,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,206.56
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$3,108.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,173.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,206.56
|
| Rate for Payer: First Choice Health Commercial |
$2,944.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$3,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,173.84
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,206.56
|
| Rate for Payer: PacificSource Commercial |
$2,944.80
|
| Rate for Payer: PHCS PPO |
$3,108.40
|
| Rate for Payer: Three Rivers PPO |
$2,454.00
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,781.20
|
|
|
RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
49520
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$3,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,206.56
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$3,108.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,173.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,206.56
|
| Rate for Payer: First Choice Health Commercial |
$2,944.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$3,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,173.84
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,206.56
|
| Rate for Payer: PacificSource Commercial |
$2,944.80
|
| Rate for Payer: PHCS PPO |
$3,108.40
|
| Rate for Payer: Three Rivers PPO |
$2,454.00
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,781.20
|
|
|
RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 49520 AS
|
| Hospital Charge Code |
49520
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$3,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,206.56
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$3,108.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,173.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,206.56
|
| Rate for Payer: First Choice Health Commercial |
$2,944.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$3,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,173.84
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,206.56
|
| Rate for Payer: PacificSource Commercial |
$2,944.80
|
| Rate for Payer: PHCS PPO |
$3,108.40
|
| Rate for Payer: Three Rivers PPO |
$2,454.00
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,781.20
|
|
|
RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$6,545.00
|
|
|
Service Code
|
HCPCS 49520 50
|
| Hospital Charge Code |
49520
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$6,545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,414.10
|
| Rate for Payer: Aetna of WY Medicare |
$605.10
|
| Rate for Payer: Beech Street Commercial |
$6,217.75
|
| Rate for Payer: Cash Price |
$4,581.50
|
| Rate for Payer: Cash Price |
$4,581.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,348.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,414.10
|
| Rate for Payer: First Choice Health Commercial |
$5,890.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,217.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.10
|
| Rate for Payer: HealthUtah PPO |
$6,545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,348.65
|
| Rate for Payer: Multiplan Medicare/VA |
$514.34
|
| Rate for Payer: One Health Plan of WY PPO |
$6,414.10
|
| Rate for Payer: PacificSource Commercial |
$5,890.50
|
| Rate for Payer: PHCS PPO |
$6,217.75
|
| Rate for Payer: Three Rivers PPO |
$4,908.75
|
| Rate for Payer: TriWest Veterans Administration |
$605.10
|
| Rate for Payer: United Healthcare Commercial |
$5,694.15
|
| Rate for Payer: United Healthcare Medicare |
$605.10
|
| Rate for Payer: WINHealth Partners Commercial |
$5,563.25
|
|
|
RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
49521
|
| Min. Negotiated Rate |
$580.82 |
| Max. Negotiated Rate |
$1,956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,916.88
|
| Rate for Payer: Aetna of WY Medicare |
$683.32
|
| Rate for Payer: Beech Street Commercial |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,897.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,916.88
|
| Rate for Payer: First Choice Health Commercial |
$1,760.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$683.32
|
| Rate for Payer: HealthUtah PPO |
$1,956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,897.32
|
| Rate for Payer: Multiplan Medicare/VA |
$580.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,916.88
|
| Rate for Payer: PacificSource Commercial |
$1,760.40
|
| Rate for Payer: PHCS PPO |
$1,858.20
|
| Rate for Payer: Three Rivers PPO |
$1,467.00
|
| Rate for Payer: TriWest Veterans Administration |
$683.32
|
| Rate for Payer: United Healthcare Commercial |
$1,701.72
|
| Rate for Payer: United Healthcare Medicare |
$683.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.60
|
|
|
RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 28200 80
|
| Hospital Charge Code |
28200
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$319.88
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.88
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$271.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$319.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
28200
|
| Min. Negotiated Rate |
$271.90 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$319.88
|
| Rate for Payer: Beech Street Commercial |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: First Choice Health Commercial |
$1,548.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.88
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$271.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,634.00
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$319.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,462.00
|
|
|
RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
25260
|
| Min. Negotiated Rate |
$528.77 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,509.96
|
| Rate for Payer: Aetna of WY Medicare |
$622.08
|
| Rate for Payer: Beech Street Commercial |
$4,371.90
|
| Rate for Payer: Cash Price |
$3,221.40
|
| Rate for Payer: Cash Price |
$3,221.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,463.94
|
| Rate for Payer: Cigna of WY Commercial |
$4,509.96
|
| Rate for Payer: First Choice Health Commercial |
$4,141.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,371.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$622.08
|
| Rate for Payer: HealthUtah PPO |
$4,602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,463.94
|
| Rate for Payer: Multiplan Medicare/VA |
$528.77
|
| Rate for Payer: One Health Plan of WY PPO |
$4,509.96
|
| Rate for Payer: PacificSource Commercial |
$4,141.80
|
| Rate for Payer: PHCS PPO |
$4,371.90
|
| Rate for Payer: Three Rivers PPO |
$3,451.50
|
| Rate for Payer: TriWest Veterans Administration |
$622.08
|
| Rate for Payer: United Healthcare Commercial |
$4,003.74
|
| Rate for Payer: United Healthcare Medicare |
$622.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,911.70
|
|
|
RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 25270 80
|
| Hospital Charge Code |
25270
|
| Min. Negotiated Rate |
$413.23 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,700.30
|
| Rate for Payer: Aetna of WY Medicare |
$486.15
|
| Rate for Payer: Beech Street Commercial |
$1,648.25
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,682.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,700.30
|
| Rate for Payer: First Choice Health Commercial |
$1,561.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,648.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.15
|
| Rate for Payer: HealthUtah PPO |
$1,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,682.95
|
| Rate for Payer: Multiplan Medicare/VA |
$413.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,700.30
|
| Rate for Payer: PacificSource Commercial |
$1,561.50
|
| Rate for Payer: PHCS PPO |
$1,648.25
|
| Rate for Payer: Three Rivers PPO |
$1,301.25
|
| Rate for Payer: TriWest Veterans Administration |
$486.15
|
| Rate for Payer: United Healthcare Commercial |
$1,509.45
|
| Rate for Payer: United Healthcare Medicare |
$486.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,474.75
|
|
|
RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 25270 AS
|
| Hospital Charge Code |
25270
|
| Min. Negotiated Rate |
$413.23 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,700.30
|
| Rate for Payer: Aetna of WY Medicare |
$486.15
|
| Rate for Payer: Beech Street Commercial |
$1,648.25
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,682.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,700.30
|
| Rate for Payer: First Choice Health Commercial |
$1,561.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,648.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.15
|
| Rate for Payer: HealthUtah PPO |
$1,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,682.95
|
| Rate for Payer: Multiplan Medicare/VA |
$413.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,700.30
|
| Rate for Payer: PacificSource Commercial |
$1,561.50
|
| Rate for Payer: PHCS PPO |
$1,648.25
|
| Rate for Payer: Three Rivers PPO |
$1,301.25
|
| Rate for Payer: TriWest Veterans Administration |
$486.15
|
| Rate for Payer: United Healthcare Commercial |
$1,509.45
|
| Rate for Payer: United Healthcare Medicare |
$486.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,474.75
|
|
|
RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
25270
|
| Min. Negotiated Rate |
$413.23 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,700.30
|
| Rate for Payer: Aetna of WY Medicare |
$486.15
|
| Rate for Payer: Beech Street Commercial |
$1,648.25
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,682.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,700.30
|
| Rate for Payer: First Choice Health Commercial |
$1,561.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,648.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.15
|
| Rate for Payer: HealthUtah PPO |
$1,735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,682.95
|
| Rate for Payer: Multiplan Medicare/VA |
$413.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,700.30
|
| Rate for Payer: PacificSource Commercial |
$1,561.50
|
| Rate for Payer: PHCS PPO |
$1,648.25
|
| Rate for Payer: Three Rivers PPO |
$1,301.25
|
| Rate for Payer: TriWest Veterans Administration |
$486.15
|
| Rate for Payer: United Healthcare Commercial |
$1,509.45
|
| Rate for Payer: United Healthcare Medicare |
$486.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,474.75
|
|
|
RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$3,173.00
|
|
|
Service Code
|
HCPCS 25275 AS
|
| Hospital Charge Code |
25275
|
| Min. Negotiated Rate |
$558.42 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,109.54
|
| Rate for Payer: Aetna of WY Medicare |
$656.97
|
| Rate for Payer: Beech Street Commercial |
$3,014.35
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,077.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,109.54
|
| Rate for Payer: First Choice Health Commercial |
$2,855.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,014.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.97
|
| Rate for Payer: HealthUtah PPO |
$3,173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,077.81
|
| Rate for Payer: Multiplan Medicare/VA |
$558.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,109.54
|
| Rate for Payer: PacificSource Commercial |
$2,855.70
|
| Rate for Payer: PHCS PPO |
$3,014.35
|
| Rate for Payer: Three Rivers PPO |
$2,379.75
|
| Rate for Payer: TriWest Veterans Administration |
$656.97
|
| Rate for Payer: United Healthcare Commercial |
$2,760.51
|
| Rate for Payer: United Healthcare Medicare |
$656.97
|
| Rate for Payer: WINHealth Partners Commercial |
$2,697.05
|
|
|
RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$3,173.00
|
|
|
Service Code
|
HCPCS 25275
|
| Hospital Charge Code |
25275
|
| Min. Negotiated Rate |
$558.42 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,109.54
|
| Rate for Payer: Aetna of WY Medicare |
$656.97
|
| Rate for Payer: Beech Street Commercial |
$3,014.35
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: Cash Price |
$2,221.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,077.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,109.54
|
| Rate for Payer: First Choice Health Commercial |
$2,855.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,014.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.97
|
| Rate for Payer: HealthUtah PPO |
$3,173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,077.81
|
| Rate for Payer: Multiplan Medicare/VA |
$558.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,109.54
|
| Rate for Payer: PacificSource Commercial |
$2,855.70
|
| Rate for Payer: PHCS PPO |
$3,014.35
|
| Rate for Payer: Three Rivers PPO |
$2,379.75
|
| Rate for Payer: TriWest Veterans Administration |
$656.97
|
| Rate for Payer: United Healthcare Commercial |
$2,760.51
|
| Rate for Payer: United Healthcare Medicare |
$656.97
|
| Rate for Payer: WINHealth Partners Commercial |
$2,697.05
|
|
|
RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,783.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
26428
|
| Min. Negotiated Rate |
$662.99 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,727.34
|
| Rate for Payer: Aetna of WY Medicare |
$779.99
|
| Rate for Payer: Beech Street Commercial |
$2,643.85
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,699.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,727.34
|
| Rate for Payer: First Choice Health Commercial |
$2,504.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,643.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$779.99
|
| Rate for Payer: HealthUtah PPO |
$2,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,699.51
|
| Rate for Payer: Multiplan Medicare/VA |
$662.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,727.34
|
| Rate for Payer: PacificSource Commercial |
$2,504.70
|
| Rate for Payer: PHCS PPO |
$2,643.85
|
| Rate for Payer: Three Rivers PPO |
$2,087.25
|
| Rate for Payer: TriWest Veterans Administration |
$779.99
|
| Rate for Payer: United Healthcare Commercial |
$2,421.21
|
| Rate for Payer: United Healthcare Medicare |
$779.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,365.55
|
|
|
RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
26426
|
| Min. Negotiated Rate |
$421.23 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,733.62
|
| Rate for Payer: Aetna of WY Medicare |
$495.56
|
| Rate for Payer: Beech Street Commercial |
$1,680.55
|
| Rate for Payer: Cash Price |
$1,238.30
|
| Rate for Payer: Cash Price |
$1,238.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,715.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,733.62
|
| Rate for Payer: First Choice Health Commercial |
$1,592.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,680.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.56
|
| Rate for Payer: HealthUtah PPO |
$1,769.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,715.93
|
| Rate for Payer: Multiplan Medicare/VA |
$421.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,733.62
|
| Rate for Payer: PacificSource Commercial |
$1,592.10
|
| Rate for Payer: PHCS PPO |
$1,680.55
|
| Rate for Payer: Three Rivers PPO |
$1,326.75
|
| Rate for Payer: TriWest Veterans Administration |
$495.56
|
| Rate for Payer: United Healthcare Commercial |
$1,539.03
|
| Rate for Payer: United Healthcare Medicare |
$495.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,503.65
|
|
|
RRECRT INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$4,860.00
|
|
|
Service Code
|
HCPCS 49566
|
| Hospital Charge Code |
49566
|
| Min. Negotiated Rate |
$3,645.00 |
| Max. Negotiated Rate |
$4,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,762.80
|
| Rate for Payer: Beech Street Commercial |
$4,617.00
|
| Rate for Payer: Cash Price |
$3,402.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,714.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,762.80
|
| Rate for Payer: First Choice Health Commercial |
$4,374.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,617.00
|
| Rate for Payer: HealthUtah PPO |
$4,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,714.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,762.80
|
| Rate for Payer: PacificSource Commercial |
$4,374.00
|
| Rate for Payer: PHCS PPO |
$4,617.00
|
| Rate for Payer: Three Rivers PPO |
$3,645.00
|
| Rate for Payer: United Healthcare Commercial |
$4,228.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,131.00
|
|
|
RRECRT INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$4,860.00
|
|
|
Service Code
|
HCPCS 49566 80
|
| Hospital Charge Code |
49566
|
| Min. Negotiated Rate |
$3,645.00 |
| Max. Negotiated Rate |
$4,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,762.80
|
| Rate for Payer: Beech Street Commercial |
$4,617.00
|
| Rate for Payer: Cash Price |
$3,402.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,714.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,762.80
|
| Rate for Payer: First Choice Health Commercial |
$4,374.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,617.00
|
| Rate for Payer: HealthUtah PPO |
$4,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,714.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,762.80
|
| Rate for Payer: PacificSource Commercial |
$4,374.00
|
| Rate for Payer: PHCS PPO |
$4,617.00
|
| Rate for Payer: Three Rivers PPO |
$3,645.00
|
| Rate for Payer: United Healthcare Commercial |
$4,228.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,131.00
|
|
|
RRECRT INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$4,860.00
|
|
|
Service Code
|
HCPCS 49566 AS
|
| Hospital Charge Code |
49566
|
| Min. Negotiated Rate |
$3,645.00 |
| Max. Negotiated Rate |
$4,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,762.80
|
| Rate for Payer: Beech Street Commercial |
$4,617.00
|
| Rate for Payer: Cash Price |
$3,402.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,714.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,762.80
|
| Rate for Payer: First Choice Health Commercial |
$4,374.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,617.00
|
| Rate for Payer: HealthUtah PPO |
$4,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,714.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,762.80
|
| Rate for Payer: PacificSource Commercial |
$4,374.00
|
| Rate for Payer: PHCS PPO |
$4,617.00
|
| Rate for Payer: Three Rivers PPO |
$3,645.00
|
| Rate for Payer: United Healthcare Commercial |
$4,228.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,131.00
|
|
|
RRECRT INCAL/VNT HERNIA REDUCIBLE
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 49565 AS
|
| Hospital Charge Code |
49565
|
| Min. Negotiated Rate |
$2,986.50 |
| Max. Negotiated Rate |
$3,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,902.36
|
| Rate for Payer: Beech Street Commercial |
$3,782.90
|
| Rate for Payer: Cash Price |
$2,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,862.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,902.36
|
| Rate for Payer: First Choice Health Commercial |
$3,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,782.90
|
| Rate for Payer: HealthUtah PPO |
$3,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,862.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,902.36
|
| Rate for Payer: PacificSource Commercial |
$3,583.80
|
| Rate for Payer: PHCS PPO |
$3,782.90
|
| Rate for Payer: Three Rivers PPO |
$2,986.50
|
| Rate for Payer: United Healthcare Commercial |
$3,464.34
|
| Rate for Payer: WINHealth Partners Commercial |
$3,384.70
|
|
|
RRECRT INCAL/VNT HERNIA REDUCIBLE
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 49565
|
| Hospital Charge Code |
49565
|
| Min. Negotiated Rate |
$2,986.50 |
| Max. Negotiated Rate |
$3,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,902.36
|
| Rate for Payer: Beech Street Commercial |
$3,782.90
|
| Rate for Payer: Cash Price |
$2,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,862.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,902.36
|
| Rate for Payer: First Choice Health Commercial |
$3,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,782.90
|
| Rate for Payer: HealthUtah PPO |
$3,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,862.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,902.36
|
| Rate for Payer: PacificSource Commercial |
$3,583.80
|
| Rate for Payer: PHCS PPO |
$3,782.90
|
| Rate for Payer: Three Rivers PPO |
$2,986.50
|
| Rate for Payer: United Healthcare Commercial |
$3,464.34
|
| Rate for Payer: WINHealth Partners Commercial |
$3,384.70
|
|
|
RRECRT INCAL/VNT HERNIA REDUCIBLE
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 49565 80
|
| Hospital Charge Code |
49565
|
| Min. Negotiated Rate |
$2,986.50 |
| Max. Negotiated Rate |
$3,982.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,902.36
|
| Rate for Payer: Beech Street Commercial |
$3,782.90
|
| Rate for Payer: Cash Price |
$2,787.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,862.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,902.36
|
| Rate for Payer: First Choice Health Commercial |
$3,583.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,782.90
|
| Rate for Payer: HealthUtah PPO |
$3,982.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,862.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,902.36
|
| Rate for Payer: PacificSource Commercial |
$3,583.80
|
| Rate for Payer: PHCS PPO |
$3,782.90
|
| Rate for Payer: Three Rivers PPO |
$2,986.50
|
| Rate for Payer: United Healthcare Commercial |
$3,464.34
|
| Rate for Payer: WINHealth Partners Commercial |
$3,384.70
|
|
|
RSVPREF3 ANTIGEN-AS01E ADJUVANT(PF) 120 MCG/0.5 ML IM SUSPENSION, KIT [182049]
|
Facility
|
OP
|
$367.50
|
|
|
Service Code
|
NDC 5816084811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Aetna of WY Medicare |
$242.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$352.80
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.72
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.15
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$202.49
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$213.15
|
| Rate for Payer: United Healthcare Commercial |
$319.72
|
| Rate for Payer: United Healthcare Medicare |
$213.15
|
| Rate for Payer: WINHealth Partners Commercial |
$360.15
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
|
RSVPREF3 ANTIGEN-AS01E ADJUVANT(PF) 120 MCG/0.5 ML IM SUSPENSION, KIT [182049]
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 5816084811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$352.80
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.72
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$242.55
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$230.42
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$242.55
|
| Rate for Payer: United Healthcare Commercial |
$319.72
|
| Rate for Payer: United Healthcare Medicare |
$242.55
|
| Rate for Payer: WINHealth Partners Commercial |
$349.12
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
|
RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
90678
|
| Min. Negotiated Rate |
$595.50 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$778.12
|
| Rate for Payer: Beech Street Commercial |
$754.30
|
| Rate for Payer: Cash Price |
$555.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$770.18
|
| Rate for Payer: Cigna of WY Commercial |
$778.12
|
| Rate for Payer: First Choice Health Commercial |
$714.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$754.30
|
| Rate for Payer: HealthUtah PPO |
$794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$770.18
|
| Rate for Payer: One Health Plan of WY PPO |
$778.12
|
| Rate for Payer: PacificSource Commercial |
$714.60
|
| Rate for Payer: PHCS PPO |
$754.30
|
| Rate for Payer: Three Rivers PPO |
$595.50
|
| Rate for Payer: United Healthcare Commercial |
$690.78
|
| Rate for Payer: WINHealth Partners Commercial |
$794.00
|
|
