|
TENDON ACHILLES ALLOGRAFT N/IR
|
Facility
|
IP
|
$11,200.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.40 |
| Max. Negotiated Rate |
$11,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,976.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10,752.00
|
| Rate for Payer: Altius Commercial |
$10,752.00
|
| Rate for Payer: Beech Street Commercial |
$10,976.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,195.20
|
| Rate for Payer: Cash Price |
$7,840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,864.00
|
| Rate for Payer: Cigna of WY Commercial |
$10,976.00
|
| Rate for Payer: Entrust Commercial |
$10,640.00
|
| Rate for Payer: First Choice Health Commercial |
$10,640.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,640.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,392.00
|
| Rate for Payer: HealthUtah PPO |
$11,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,864.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,022.40
|
| Rate for Payer: One Health Plan of WY PPO |
$10,976.00
|
| Rate for Payer: PacificSource Commercial |
$10,080.00
|
| Rate for Payer: PHCS PPO |
$10,976.00
|
| Rate for Payer: Three Rivers PPO |
$8,400.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,392.00
|
| Rate for Payer: United Healthcare Commercial |
$9,744.00
|
| Rate for Payer: United Healthcare Medicare |
$7,392.00
|
| Rate for Payer: WINHealth Partners Commercial |
$10,640.00
|
| Rate for Payer: Wise Provider Network Commercial |
$10,640.00
|
|
|
TENDON ACHILLES ALLOGRAFT N/IR
|
Facility
|
OP
|
$11,200.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,171.20 |
| Max. Negotiated Rate |
$11,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,976.00
|
| Rate for Payer: Aetna of WY Medicare |
$7,392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10,752.00
|
| Rate for Payer: Altius Commercial |
$10,752.00
|
| Rate for Payer: Beech Street Commercial |
$10,976.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,195.20
|
| Rate for Payer: Cash Price |
$7,840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,864.00
|
| Rate for Payer: Cigna of WY Commercial |
$10,976.00
|
| Rate for Payer: Entrust Commercial |
$10,640.00
|
| Rate for Payer: First Choice Health Commercial |
$10,640.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,640.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,496.00
|
| Rate for Payer: HealthUtah PPO |
$11,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,864.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,171.20
|
| Rate for Payer: One Health Plan of WY PPO |
$10,976.00
|
| Rate for Payer: PacificSource Commercial |
$10,080.00
|
| Rate for Payer: PHCS PPO |
$10,976.00
|
| Rate for Payer: Three Rivers PPO |
$8,400.00
|
| Rate for Payer: TriWest Veterans Administration |
$6,496.00
|
| Rate for Payer: United Healthcare Commercial |
$9,744.00
|
| Rate for Payer: United Healthcare Medicare |
$6,496.00
|
| Rate for Payer: WINHealth Partners Commercial |
$10,976.00
|
| Rate for Payer: Wise Provider Network Commercial |
$10,640.00
|
|
|
TENDON ANTERIOR TIB NON-IRRIAT
|
Facility
|
IP
|
$9,100.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,705.70 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,918.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,736.00
|
| Rate for Payer: Altius Commercial |
$8,736.00
|
| Rate for Payer: Beech Street Commercial |
$8,918.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,471.10
|
| Rate for Payer: Cash Price |
$6,370.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,827.00
|
| Rate for Payer: Cigna of WY Commercial |
$8,918.00
|
| Rate for Payer: Entrust Commercial |
$8,645.00
|
| Rate for Payer: First Choice Health Commercial |
$8,645.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,645.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,006.00
|
| Rate for Payer: HealthUtah PPO |
$9,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,827.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,705.70
|
| Rate for Payer: One Health Plan of WY PPO |
$8,918.00
|
| Rate for Payer: PacificSource Commercial |
$8,190.00
|
| Rate for Payer: PHCS PPO |
$8,918.00
|
| Rate for Payer: Three Rivers PPO |
$6,825.00
|
| Rate for Payer: TriWest Veterans Administration |
$6,006.00
|
| Rate for Payer: United Healthcare Commercial |
$7,917.00
|
| Rate for Payer: United Healthcare Medicare |
$6,006.00
|
| Rate for Payer: WINHealth Partners Commercial |
$8,645.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,645.00
|
|
|
TENDON ANTERIOR TIB NON-IRRIAT
|
Facility
|
OP
|
$9,100.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.10 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,918.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,006.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,736.00
|
| Rate for Payer: Altius Commercial |
$8,736.00
|
| Rate for Payer: Beech Street Commercial |
$8,918.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,471.10
|
| Rate for Payer: Cash Price |
$6,370.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,827.00
|
| Rate for Payer: Cigna of WY Commercial |
$8,918.00
|
| Rate for Payer: Entrust Commercial |
$8,645.00
|
| Rate for Payer: First Choice Health Commercial |
$8,645.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,645.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,278.00
|
| Rate for Payer: HealthUtah PPO |
$9,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,827.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,014.10
|
| Rate for Payer: One Health Plan of WY PPO |
$8,918.00
|
| Rate for Payer: PacificSource Commercial |
$8,190.00
|
| Rate for Payer: PHCS PPO |
$8,918.00
|
| Rate for Payer: Three Rivers PPO |
$6,825.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,278.00
|
| Rate for Payer: United Healthcare Commercial |
$7,917.00
|
| Rate for Payer: United Healthcare Medicare |
$5,278.00
|
| Rate for Payer: WINHealth Partners Commercial |
$8,918.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,645.00
|
|
|
TENDON GRAFT FROM A DISTANCE
|
Professional
|
Both
|
$2,595.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
20924
|
| Min. Negotiated Rate |
$417.38 |
| Max. Negotiated Rate |
$2,595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,543.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.04
|
| Rate for Payer: Beech Street Commercial |
$2,465.25
|
| Rate for Payer: Cash Price |
$1,816.50
|
| Rate for Payer: Cash Price |
$1,816.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,517.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,543.10
|
| Rate for Payer: First Choice Health Commercial |
$2,335.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,465.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.04
|
| Rate for Payer: HealthUtah PPO |
$2,595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,517.15
|
| Rate for Payer: Multiplan Medicare/VA |
$417.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,543.10
|
| Rate for Payer: PacificSource Commercial |
$2,335.50
|
| Rate for Payer: PHCS PPO |
$2,465.25
|
| Rate for Payer: Three Rivers PPO |
$1,946.25
|
| Rate for Payer: TriWest Veterans Administration |
$491.04
|
| Rate for Payer: United Healthcare Commercial |
$2,257.65
|
| Rate for Payer: United Healthcare Medicare |
$491.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,205.75
|
|
|
TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 24305
|
| Hospital Charge Code |
24305
|
| Min. Negotiated Rate |
$482.66 |
| 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 |
$567.84
|
| 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 |
$567.84
|
| Rate for Payer: HealthUtah PPO |
$2,906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,818.82
|
| Rate for Payer: Multiplan Medicare/VA |
$482.66
|
| 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 |
$567.84
|
| Rate for Payer: United Healthcare Commercial |
$2,528.22
|
| Rate for Payer: United Healthcare Medicare |
$567.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.10
|
|
|
TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 24305 AS
|
| Hospital Charge Code |
24305
|
| Min. Negotiated Rate |
$482.66 |
| 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 |
$567.84
|
| 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 |
$567.84
|
| Rate for Payer: HealthUtah PPO |
$2,906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,818.82
|
| Rate for Payer: Multiplan Medicare/VA |
$482.66
|
| 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 |
$567.84
|
| Rate for Payer: United Healthcare Commercial |
$2,528.22
|
| Rate for Payer: United Healthcare Medicare |
$567.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.10
|
|
|
TENDON SHEATH INCISION
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 26055 80
|
| Hospital Charge Code |
26055
|
| Min. Negotiated Rate |
$245.65 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,021.74
|
| Rate for Payer: Aetna of WY Medicare |
$289.00
|
| Rate for Payer: Beech Street Commercial |
$1,959.85
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,001.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,021.74
|
| Rate for Payer: First Choice Health Commercial |
$1,856.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.00
|
| Rate for Payer: HealthUtah PPO |
$2,063.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,001.11
|
| Rate for Payer: Multiplan Medicare/VA |
$245.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,021.74
|
| Rate for Payer: PacificSource Commercial |
$1,856.70
|
| Rate for Payer: PHCS PPO |
$1,959.85
|
| Rate for Payer: Three Rivers PPO |
$1,547.25
|
| Rate for Payer: TriWest Veterans Administration |
$289.00
|
| Rate for Payer: United Healthcare Commercial |
$1,794.81
|
| Rate for Payer: United Healthcare Medicare |
$289.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,753.55
|
|
|
TENDON SHEATH INCISION
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
26055
|
| Min. Negotiated Rate |
$245.65 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,021.74
|
| Rate for Payer: Aetna of WY Medicare |
$289.00
|
| Rate for Payer: Beech Street Commercial |
$1,959.85
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,001.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,021.74
|
| Rate for Payer: First Choice Health Commercial |
$1,856.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.00
|
| Rate for Payer: HealthUtah PPO |
$2,063.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,001.11
|
| Rate for Payer: Multiplan Medicare/VA |
$245.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,021.74
|
| Rate for Payer: PacificSource Commercial |
$1,856.70
|
| Rate for Payer: PHCS PPO |
$1,959.85
|
| Rate for Payer: Three Rivers PPO |
$1,547.25
|
| Rate for Payer: TriWest Veterans Administration |
$289.00
|
| Rate for Payer: United Healthcare Commercial |
$1,794.81
|
| Rate for Payer: United Healthcare Medicare |
$289.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,753.55
|
|
|
TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT
|
Professional
|
Both
|
$5,308.00
|
|
|
Service Code
|
HCPCS 26483 AS
|
| Hospital Charge Code |
26483
|
| Min. Negotiated Rate |
$724.75 |
| Max. Negotiated Rate |
$5,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,201.84
|
| Rate for Payer: Aetna of WY Medicare |
$852.65
|
| Rate for Payer: Beech Street Commercial |
$5,042.60
|
| Rate for Payer: Cash Price |
$3,715.60
|
| Rate for Payer: Cash Price |
$3,715.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,148.76
|
| Rate for Payer: Cigna of WY Commercial |
$5,201.84
|
| Rate for Payer: First Choice Health Commercial |
$4,777.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,042.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$852.65
|
| Rate for Payer: HealthUtah PPO |
$5,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,148.76
|
| Rate for Payer: Multiplan Medicare/VA |
$724.75
|
| Rate for Payer: One Health Plan of WY PPO |
$5,201.84
|
| Rate for Payer: PacificSource Commercial |
$4,777.20
|
| Rate for Payer: PHCS PPO |
$5,042.60
|
| Rate for Payer: Three Rivers PPO |
$3,981.00
|
| Rate for Payer: TriWest Veterans Administration |
$852.65
|
| Rate for Payer: United Healthcare Commercial |
$4,617.96
|
| Rate for Payer: United Healthcare Medicare |
$852.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,511.80
|
|
|
TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT
|
Professional
|
Both
|
$5,308.00
|
|
|
Service Code
|
HCPCS 26483
|
| Hospital Charge Code |
26483
|
| Min. Negotiated Rate |
$724.75 |
| Max. Negotiated Rate |
$5,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,201.84
|
| Rate for Payer: Aetna of WY Medicare |
$852.65
|
| Rate for Payer: Beech Street Commercial |
$5,042.60
|
| Rate for Payer: Cash Price |
$3,715.60
|
| Rate for Payer: Cash Price |
$3,715.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,148.76
|
| Rate for Payer: Cigna of WY Commercial |
$5,201.84
|
| Rate for Payer: First Choice Health Commercial |
$4,777.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,042.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$852.65
|
| Rate for Payer: HealthUtah PPO |
$5,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,148.76
|
| Rate for Payer: Multiplan Medicare/VA |
$724.75
|
| Rate for Payer: One Health Plan of WY PPO |
$5,201.84
|
| Rate for Payer: PacificSource Commercial |
$4,777.20
|
| Rate for Payer: PHCS PPO |
$5,042.60
|
| Rate for Payer: Three Rivers PPO |
$3,981.00
|
| Rate for Payer: TriWest Veterans Administration |
$852.65
|
| Rate for Payer: United Healthcare Commercial |
$4,617.96
|
| Rate for Payer: United Healthcare Medicare |
$852.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,511.80
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [152058]
|
Facility
|
IP
|
$12,460.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,812.98 |
| Max. Negotiated Rate |
$12,460.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,211.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,962.45
|
| Rate for Payer: Altius Commercial |
$11,962.45
|
| Rate for Payer: Beech Street Commercial |
$12,211.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,230.39
|
| Rate for Payer: Cash Price |
$8,722.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,087.06
|
| Rate for Payer: Cigna of WY Commercial |
$12,211.67
|
| Rate for Payer: Entrust Commercial |
$11,837.85
|
| Rate for Payer: First Choice Health Commercial |
$11,837.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,837.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,224.19
|
| Rate for Payer: HealthUtah PPO |
$12,460.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,087.06
|
| Rate for Payer: Multiplan Medicare/VA |
$7,812.98
|
| Rate for Payer: One Health Plan of WY PPO |
$12,211.67
|
| Rate for Payer: PacificSource Commercial |
$11,214.80
|
| Rate for Payer: PHCS PPO |
$12,211.67
|
| Rate for Payer: Three Rivers PPO |
$9,345.67
|
| Rate for Payer: TriWest Veterans Administration |
$8,224.19
|
| Rate for Payer: United Healthcare Commercial |
$10,840.97
|
| Rate for Payer: United Healthcare Medicare |
$8,224.19
|
| Rate for Payer: WINHealth Partners Commercial |
$11,837.85
|
| Rate for Payer: Wise Provider Network Commercial |
$11,837.85
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [152058]
|
Facility
|
OP
|
$12,460.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,865.95 |
| Max. Negotiated Rate |
$12,460.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,211.67
|
| Rate for Payer: Aetna of WY Medicare |
$8,224.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,962.45
|
| Rate for Payer: Altius Commercial |
$11,962.45
|
| Rate for Payer: Beech Street Commercial |
$12,211.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,230.39
|
| Rate for Payer: Cash Price |
$8,722.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,087.06
|
| Rate for Payer: Cigna of WY Commercial |
$12,211.67
|
| Rate for Payer: Entrust Commercial |
$11,837.85
|
| Rate for Payer: First Choice Health Commercial |
$11,837.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,837.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,227.32
|
| Rate for Payer: HealthUtah PPO |
$12,460.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,087.06
|
| Rate for Payer: Multiplan Medicare/VA |
$6,865.95
|
| Rate for Payer: One Health Plan of WY PPO |
$12,211.67
|
| Rate for Payer: PacificSource Commercial |
$11,214.80
|
| Rate for Payer: PHCS PPO |
$12,211.67
|
| Rate for Payer: Three Rivers PPO |
$9,345.67
|
| Rate for Payer: TriWest Veterans Administration |
$7,227.32
|
| Rate for Payer: United Healthcare Commercial |
$10,840.97
|
| Rate for Payer: United Healthcare Medicare |
$7,227.32
|
| Rate for Payer: WINHealth Partners Commercial |
$12,211.67
|
| Rate for Payer: Wise Provider Network Commercial |
$11,837.85
|
|
|
TENECTEPLASE 50 MG IV SOLN STEMI WRAPPER [40815205801]
|
Facility
|
OP
|
$12,445.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,857.69 |
| Max. Negotiated Rate |
$12,445.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,196.97
|
| Rate for Payer: Aetna of WY Medicare |
$8,214.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,948.05
|
| Rate for Payer: Altius Commercial |
$11,948.05
|
| Rate for Payer: Beech Street Commercial |
$12,196.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,218.08
|
| Rate for Payer: Cash Price |
$8,712.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,072.51
|
| Rate for Payer: Cigna of WY Commercial |
$12,196.97
|
| Rate for Payer: Entrust Commercial |
$11,823.60
|
| Rate for Payer: First Choice Health Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,218.62
|
| Rate for Payer: HealthUtah PPO |
$12,445.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,072.51
|
| Rate for Payer: Multiplan Medicare/VA |
$6,857.69
|
| Rate for Payer: One Health Plan of WY PPO |
$12,196.97
|
| Rate for Payer: PacificSource Commercial |
$11,201.30
|
| Rate for Payer: PHCS PPO |
$12,196.97
|
| Rate for Payer: Three Rivers PPO |
$9,334.42
|
| Rate for Payer: TriWest Veterans Administration |
$7,218.62
|
| Rate for Payer: United Healthcare Commercial |
$10,827.92
|
| Rate for Payer: United Healthcare Medicare |
$7,218.62
|
| Rate for Payer: WINHealth Partners Commercial |
$12,196.97
|
| Rate for Payer: Wise Provider Network Commercial |
$11,823.60
|
|
|
TENECTEPLASE 50 MG IV SOLN STEMI WRAPPER [40815205801]
|
Facility
|
IP
|
$12,445.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,803.57 |
| Max. Negotiated Rate |
$12,445.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,196.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,948.05
|
| Rate for Payer: Altius Commercial |
$11,948.05
|
| Rate for Payer: Beech Street Commercial |
$12,196.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,218.08
|
| Rate for Payer: Cash Price |
$8,712.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,072.51
|
| Rate for Payer: Cigna of WY Commercial |
$12,196.97
|
| Rate for Payer: Entrust Commercial |
$11,823.60
|
| Rate for Payer: First Choice Health Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,214.29
|
| Rate for Payer: HealthUtah PPO |
$12,445.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,072.51
|
| Rate for Payer: Multiplan Medicare/VA |
$7,803.57
|
| Rate for Payer: One Health Plan of WY PPO |
$12,196.97
|
| Rate for Payer: PacificSource Commercial |
$11,201.30
|
| Rate for Payer: PHCS PPO |
$12,196.97
|
| Rate for Payer: Three Rivers PPO |
$9,334.42
|
| Rate for Payer: TriWest Veterans Administration |
$8,214.29
|
| Rate for Payer: United Healthcare Commercial |
$10,827.92
|
| Rate for Payer: United Healthcare Medicare |
$8,214.29
|
| Rate for Payer: WINHealth Partners Commercial |
$11,823.60
|
| Rate for Payer: Wise Provider Network Commercial |
$11,823.60
|
|
|
TENECTEPLASE IV SOLN STROKE WRAPPER [40815205802]
|
Facility
|
IP
|
$12,445.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,803.57 |
| Max. Negotiated Rate |
$12,445.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,196.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,948.05
|
| Rate for Payer: Altius Commercial |
$11,948.05
|
| Rate for Payer: Beech Street Commercial |
$12,196.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,218.08
|
| Rate for Payer: Cash Price |
$8,712.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,072.51
|
| Rate for Payer: Cigna of WY Commercial |
$12,196.97
|
| Rate for Payer: Entrust Commercial |
$11,823.60
|
| Rate for Payer: First Choice Health Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,214.29
|
| Rate for Payer: HealthUtah PPO |
$12,445.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,072.51
|
| Rate for Payer: Multiplan Medicare/VA |
$7,803.57
|
| Rate for Payer: One Health Plan of WY PPO |
$12,196.97
|
| Rate for Payer: PacificSource Commercial |
$11,201.30
|
| Rate for Payer: PHCS PPO |
$12,196.97
|
| Rate for Payer: Three Rivers PPO |
$9,334.42
|
| Rate for Payer: TriWest Veterans Administration |
$8,214.29
|
| Rate for Payer: United Healthcare Commercial |
$10,827.92
|
| Rate for Payer: United Healthcare Medicare |
$8,214.29
|
| Rate for Payer: WINHealth Partners Commercial |
$11,823.60
|
| Rate for Payer: Wise Provider Network Commercial |
$11,823.60
|
|
|
TENECTEPLASE IV SOLN STROKE WRAPPER [40815205802]
|
Facility
|
OP
|
$12,445.89
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,857.69 |
| Max. Negotiated Rate |
$12,445.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,196.97
|
| Rate for Payer: Aetna of WY Medicare |
$8,214.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,948.05
|
| Rate for Payer: Altius Commercial |
$11,948.05
|
| Rate for Payer: Beech Street Commercial |
$12,196.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,218.08
|
| Rate for Payer: Cash Price |
$8,712.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,072.51
|
| Rate for Payer: Cigna of WY Commercial |
$12,196.97
|
| Rate for Payer: Entrust Commercial |
$11,823.60
|
| Rate for Payer: First Choice Health Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,823.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,218.62
|
| Rate for Payer: HealthUtah PPO |
$12,445.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,072.51
|
| Rate for Payer: Multiplan Medicare/VA |
$6,857.69
|
| Rate for Payer: One Health Plan of WY PPO |
$12,196.97
|
| Rate for Payer: PacificSource Commercial |
$11,201.30
|
| Rate for Payer: PHCS PPO |
$12,196.97
|
| Rate for Payer: Three Rivers PPO |
$9,334.42
|
| Rate for Payer: TriWest Veterans Administration |
$7,218.62
|
| Rate for Payer: United Healthcare Commercial |
$10,827.92
|
| Rate for Payer: United Healthcare Medicare |
$7,218.62
|
| Rate for Payer: WINHealth Partners Commercial |
$12,196.97
|
| Rate for Payer: Wise Provider Network Commercial |
$11,823.60
|
|
|
TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 24340
|
| Hospital Charge Code |
24340
|
| Min. Negotiated Rate |
$496.71 |
| Max. Negotiated Rate |
$2,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,043.30
|
| Rate for Payer: Aetna of WY Medicare |
$584.36
|
| Rate for Payer: Beech Street Commercial |
$1,980.75
|
| Rate for Payer: Cash Price |
$1,459.50
|
| Rate for Payer: Cash Price |
$1,459.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,022.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,043.30
|
| Rate for Payer: First Choice Health Commercial |
$1,876.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,980.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$584.36
|
| Rate for Payer: HealthUtah PPO |
$2,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,022.45
|
| Rate for Payer: Multiplan Medicare/VA |
$496.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,043.30
|
| Rate for Payer: PacificSource Commercial |
$1,876.50
|
| Rate for Payer: PHCS PPO |
$1,980.75
|
| Rate for Payer: Three Rivers PPO |
$1,563.75
|
| Rate for Payer: TriWest Veterans Administration |
$584.36
|
| Rate for Payer: United Healthcare Commercial |
$1,813.95
|
| Rate for Payer: United Healthcare Medicare |
$584.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,772.25
|
|
|
TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 24340 AS
|
| Hospital Charge Code |
24340
|
| Min. Negotiated Rate |
$496.71 |
| Max. Negotiated Rate |
$2,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,043.30
|
| Rate for Payer: Aetna of WY Medicare |
$584.36
|
| Rate for Payer: Beech Street Commercial |
$1,980.75
|
| Rate for Payer: Cash Price |
$1,459.50
|
| Rate for Payer: Cash Price |
$1,459.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,022.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,043.30
|
| Rate for Payer: First Choice Health Commercial |
$1,876.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,980.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$584.36
|
| Rate for Payer: HealthUtah PPO |
$2,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,022.45
|
| Rate for Payer: Multiplan Medicare/VA |
$496.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,043.30
|
| Rate for Payer: PacificSource Commercial |
$1,876.50
|
| Rate for Payer: PHCS PPO |
$1,980.75
|
| Rate for Payer: Three Rivers PPO |
$1,563.75
|
| Rate for Payer: TriWest Veterans Administration |
$584.36
|
| Rate for Payer: United Healthcare Commercial |
$1,813.95
|
| Rate for Payer: United Healthcare Medicare |
$584.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,772.25
|
|
|
TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$723.82
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.82
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$615.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$723.82
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$723.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 23430 80
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$723.82
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.82
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$615.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$723.82
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$723.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 23430 AS
|
| Hospital Charge Code |
23430
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$723.82
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.82
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$615.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$723.82
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$723.82
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
TENODESIS PROX IMPL SYST 2290
|
Facility
|
IP
|
$2,759.40
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,730.14 |
| Max. Negotiated Rate |
$2,759.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,704.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,649.02
|
| Rate for Payer: Altius Commercial |
$2,649.02
|
| Rate for Payer: Beech Street Commercial |
$2,704.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,265.47
|
| Rate for Payer: Cash Price |
$1,931.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,676.62
|
| Rate for Payer: Cigna of WY Commercial |
$2,704.21
|
| Rate for Payer: Entrust Commercial |
$2,621.43
|
| Rate for Payer: First Choice Health Commercial |
$2,621.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,621.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,821.20
|
| Rate for Payer: HealthUtah PPO |
$2,759.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,676.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,730.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,704.21
|
| Rate for Payer: PacificSource Commercial |
$2,483.46
|
| Rate for Payer: PHCS PPO |
$2,704.21
|
| Rate for Payer: Three Rivers PPO |
$2,069.55
|
| Rate for Payer: TriWest Veterans Administration |
$1,821.20
|
| Rate for Payer: United Healthcare Commercial |
$2,400.68
|
| Rate for Payer: United Healthcare Medicare |
$1,821.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,621.43
|
| Rate for Payer: Wise Provider Network Commercial |
$2,621.43
|
|
|
TENODESIS PROX IMPL SYST 2290
|
Facility
|
OP
|
$2,759.40
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.43 |
| Max. Negotiated Rate |
$2,759.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,704.21
|
| Rate for Payer: Aetna of WY Medicare |
$1,821.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,649.02
|
| Rate for Payer: Altius Commercial |
$2,649.02
|
| Rate for Payer: Beech Street Commercial |
$2,704.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,265.47
|
| Rate for Payer: Cash Price |
$1,931.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,676.62
|
| Rate for Payer: Cigna of WY Commercial |
$2,704.21
|
| Rate for Payer: Entrust Commercial |
$2,621.43
|
| Rate for Payer: First Choice Health Commercial |
$2,621.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,621.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,600.45
|
| Rate for Payer: HealthUtah PPO |
$2,759.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,676.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,520.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,704.21
|
| Rate for Payer: PacificSource Commercial |
$2,483.46
|
| Rate for Payer: PHCS PPO |
$2,704.21
|
| Rate for Payer: Three Rivers PPO |
$2,069.55
|
| Rate for Payer: TriWest Veterans Administration |
$1,600.45
|
| Rate for Payer: United Healthcare Commercial |
$2,400.68
|
| Rate for Payer: United Healthcare Medicare |
$1,600.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2,704.21
|
| Rate for Payer: Wise Provider Network Commercial |
$2,621.43
|
|
|
TENODESIS WRIST EXTENSORS FINGERS
|
Professional
|
Both
|
$3,043.00
|
|
|
Service Code
|
HCPCS 25301
|
| Hospital Charge Code |
25301
|
| Min. Negotiated Rate |
$535.07 |
| Max. Negotiated Rate |
$3,043.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,982.14
|
| Rate for Payer: Aetna of WY Medicare |
$629.49
|
| Rate for Payer: Beech Street Commercial |
$2,890.85
|
| Rate for Payer: Cash Price |
$2,130.10
|
| Rate for Payer: Cash Price |
$2,130.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,951.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,982.14
|
| Rate for Payer: First Choice Health Commercial |
$2,738.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,890.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.49
|
| Rate for Payer: HealthUtah PPO |
$3,043.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,951.71
|
| Rate for Payer: Multiplan Medicare/VA |
$535.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,982.14
|
| Rate for Payer: PacificSource Commercial |
$2,738.70
|
| Rate for Payer: PHCS PPO |
$2,890.85
|
| Rate for Payer: Three Rivers PPO |
$2,282.25
|
| Rate for Payer: TriWest Veterans Administration |
$629.49
|
| Rate for Payer: United Healthcare Commercial |
$2,647.41
|
| Rate for Payer: United Healthcare Medicare |
$629.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,586.55
|
|
