|
TENODESIS WRIST FLEXORS FINGERS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 25300
|
| Hospital Charge Code |
25300
|
| Min. Negotiated Rate |
$572.99 |
| Max. Negotiated Rate |
$2,406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,357.88
|
| Rate for Payer: Aetna of WY Medicare |
$674.11
|
| Rate for Payer: Beech Street Commercial |
$2,285.70
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,333.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,357.88
|
| Rate for Payer: First Choice Health Commercial |
$2,165.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,285.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$674.11
|
| Rate for Payer: HealthUtah PPO |
$2,406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,333.82
|
| Rate for Payer: Multiplan Medicare/VA |
$572.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,357.88
|
| Rate for Payer: PacificSource Commercial |
$2,165.40
|
| Rate for Payer: PHCS PPO |
$2,285.70
|
| Rate for Payer: Three Rivers PPO |
$1,804.50
|
| Rate for Payer: TriWest Veterans Administration |
$674.11
|
| Rate for Payer: United Healthcare Commercial |
$2,093.22
|
| Rate for Payer: United Healthcare Medicare |
$674.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,045.10
|
|
|
TENODESIS WRIST FLEXORS FINGERS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 25300 80
|
| Hospital Charge Code |
25300
|
| Min. Negotiated Rate |
$572.99 |
| Max. Negotiated Rate |
$2,406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,357.88
|
| Rate for Payer: Aetna of WY Medicare |
$674.11
|
| Rate for Payer: Beech Street Commercial |
$2,285.70
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,333.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,357.88
|
| Rate for Payer: First Choice Health Commercial |
$2,165.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,285.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$674.11
|
| Rate for Payer: HealthUtah PPO |
$2,406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,333.82
|
| Rate for Payer: Multiplan Medicare/VA |
$572.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,357.88
|
| Rate for Payer: PacificSource Commercial |
$2,165.40
|
| Rate for Payer: PHCS PPO |
$2,285.70
|
| Rate for Payer: Three Rivers PPO |
$1,804.50
|
| Rate for Payer: TriWest Veterans Administration |
$674.11
|
| Rate for Payer: United Healthcare Commercial |
$2,093.22
|
| Rate for Payer: United Healthcare Medicare |
$674.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,045.10
|
|
|
TENODESIS WRIST FLEXORS FINGERS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 25300 AS
|
| Hospital Charge Code |
25300
|
| Min. Negotiated Rate |
$572.99 |
| Max. Negotiated Rate |
$2,406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,357.88
|
| Rate for Payer: Aetna of WY Medicare |
$674.11
|
| Rate for Payer: Beech Street Commercial |
$2,285.70
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: Cash Price |
$1,684.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,333.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,357.88
|
| Rate for Payer: First Choice Health Commercial |
$2,165.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,285.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$674.11
|
| Rate for Payer: HealthUtah PPO |
$2,406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,333.82
|
| Rate for Payer: Multiplan Medicare/VA |
$572.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,357.88
|
| Rate for Payer: PacificSource Commercial |
$2,165.40
|
| Rate for Payer: PHCS PPO |
$2,285.70
|
| Rate for Payer: Three Rivers PPO |
$1,804.50
|
| Rate for Payer: TriWest Veterans Administration |
$674.11
|
| Rate for Payer: United Healthcare Commercial |
$2,093.22
|
| Rate for Payer: United Healthcare Medicare |
$674.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,045.10
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [16394]
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 6909753302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.69
|
| Rate for Payer: Altius Commercial |
$3.69
|
| Rate for Payer: Beech Street Commercial |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.72
|
| Rate for Payer: Cigna of WY Commercial |
$3.76
|
| Rate for Payer: Entrust Commercial |
$3.65
|
| Rate for Payer: First Choice Health Commercial |
$3.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.53
|
| Rate for Payer: HealthUtah PPO |
$3.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.72
|
| Rate for Payer: Multiplan Medicare/VA |
$2.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3.76
|
| Rate for Payer: PacificSource Commercial |
$3.46
|
| Rate for Payer: PHCS PPO |
$3.76
|
| Rate for Payer: Three Rivers PPO |
$2.88
|
| Rate for Payer: TriWest Veterans Administration |
$2.53
|
| Rate for Payer: United Healthcare Commercial |
$3.34
|
| Rate for Payer: United Healthcare Medicare |
$2.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3.65
|
| Rate for Payer: Wise Provider Network Commercial |
$3.65
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [16394]
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 6909753302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.76
|
| Rate for Payer: Aetna of WY Medicare |
$2.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.69
|
| Rate for Payer: Altius Commercial |
$3.69
|
| Rate for Payer: Beech Street Commercial |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.72
|
| Rate for Payer: Cigna of WY Commercial |
$3.76
|
| Rate for Payer: Entrust Commercial |
$3.65
|
| Rate for Payer: First Choice Health Commercial |
$3.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.23
|
| Rate for Payer: HealthUtah PPO |
$3.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.72
|
| Rate for Payer: Multiplan Medicare/VA |
$2.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3.76
|
| Rate for Payer: PacificSource Commercial |
$3.46
|
| Rate for Payer: PHCS PPO |
$3.76
|
| Rate for Payer: Three Rivers PPO |
$2.88
|
| Rate for Payer: TriWest Veterans Administration |
$2.23
|
| Rate for Payer: United Healthcare Commercial |
$3.34
|
| Rate for Payer: United Healthcare Medicare |
$2.23
|
| Rate for Payer: WINHealth Partners Commercial |
$3.76
|
| Rate for Payer: Wise Provider Network Commercial |
$3.65
|
|
|
TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH
|
Professional
|
Both
|
$3,024.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
26445
|
| Min. Negotiated Rate |
$505.54 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,963.52
|
| Rate for Payer: Aetna of WY Medicare |
$594.75
|
| Rate for Payer: Beech Street Commercial |
$2,872.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,933.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,963.52
|
| Rate for Payer: First Choice Health Commercial |
$2,721.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.75
|
| Rate for Payer: HealthUtah PPO |
$3,024.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,933.28
|
| Rate for Payer: Multiplan Medicare/VA |
$505.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,963.52
|
| Rate for Payer: PacificSource Commercial |
$2,721.60
|
| Rate for Payer: PHCS PPO |
$2,872.80
|
| Rate for Payer: Three Rivers PPO |
$2,268.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.75
|
| Rate for Payer: United Healthcare Commercial |
$2,630.88
|
| Rate for Payer: United Healthcare Medicare |
$594.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,570.40
|
|
|
TENOLYSIS FLEXOR FOOT SINGLE TENDON
|
Professional
|
Both
|
$4,685.00
|
|
|
Service Code
|
HCPCS 28220
|
| Hospital Charge Code |
28220
|
| Min. Negotiated Rate |
$254.46 |
| Max. Negotiated Rate |
$4,685.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,591.30
|
| Rate for Payer: Aetna of WY Medicare |
$299.37
|
| Rate for Payer: Beech Street Commercial |
$4,450.75
|
| Rate for Payer: Cash Price |
$3,279.50
|
| Rate for Payer: Cash Price |
$3,279.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,544.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,591.30
|
| Rate for Payer: First Choice Health Commercial |
$4,216.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,450.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.37
|
| Rate for Payer: HealthUtah PPO |
$4,685.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,544.45
|
| Rate for Payer: Multiplan Medicare/VA |
$254.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,591.30
|
| Rate for Payer: PacificSource Commercial |
$4,216.50
|
| Rate for Payer: PHCS PPO |
$4,450.75
|
| Rate for Payer: Three Rivers PPO |
$3,513.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.37
|
| Rate for Payer: United Healthcare Commercial |
$4,075.95
|
| Rate for Payer: United Healthcare Medicare |
$299.37
|
| Rate for Payer: WINHealth Partners Commercial |
$3,982.25
|
|
|
TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON
|
Professional
|
Both
|
$3,946.00
|
|
|
Service Code
|
HCPCS 26440
|
| Hospital Charge Code |
26440
|
| Min. Negotiated Rate |
$543.48 |
| Max. Negotiated Rate |
$3,946.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,867.08
|
| Rate for Payer: Aetna of WY Medicare |
$639.39
|
| Rate for Payer: Beech Street Commercial |
$3,748.70
|
| Rate for Payer: Cash Price |
$2,762.20
|
| Rate for Payer: Cash Price |
$2,762.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,827.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,867.08
|
| Rate for Payer: First Choice Health Commercial |
$3,551.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,748.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$639.39
|
| Rate for Payer: HealthUtah PPO |
$3,946.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,827.62
|
| Rate for Payer: Multiplan Medicare/VA |
$543.48
|
| Rate for Payer: One Health Plan of WY PPO |
$3,867.08
|
| Rate for Payer: PacificSource Commercial |
$3,551.40
|
| Rate for Payer: PHCS PPO |
$3,748.70
|
| Rate for Payer: Three Rivers PPO |
$2,959.50
|
| Rate for Payer: TriWest Veterans Administration |
$639.39
|
| Rate for Payer: United Healthcare Commercial |
$3,433.02
|
| Rate for Payer: United Healthcare Medicare |
$639.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,354.10
|
|
|
TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH
|
Professional
|
Both
|
$6,495.00
|
|
|
Service Code
|
HCPCS 27680
|
| Hospital Charge Code |
27680
|
| Min. Negotiated Rate |
$349.87 |
| Max. Negotiated Rate |
$6,495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,365.10
|
| Rate for Payer: Aetna of WY Medicare |
$411.61
|
| Rate for Payer: Beech Street Commercial |
$6,170.25
|
| Rate for Payer: Cash Price |
$4,546.50
|
| Rate for Payer: Cash Price |
$4,546.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,300.15
|
| Rate for Payer: Cigna of WY Commercial |
$6,365.10
|
| Rate for Payer: First Choice Health Commercial |
$5,845.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,170.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.61
|
| Rate for Payer: HealthUtah PPO |
$6,495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,300.15
|
| Rate for Payer: Multiplan Medicare/VA |
$349.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6,365.10
|
| Rate for Payer: PacificSource Commercial |
$5,845.50
|
| Rate for Payer: PHCS PPO |
$6,170.25
|
| Rate for Payer: Three Rivers PPO |
$4,871.25
|
| Rate for Payer: TriWest Veterans Administration |
$411.61
|
| Rate for Payer: United Healthcare Commercial |
$5,650.65
|
| Rate for Payer: United Healthcare Medicare |
$411.61
|
| Rate for Payer: WINHealth Partners Commercial |
$5,520.75
|
|
|
TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 27006 AS
|
| Hospital Charge Code |
27006
|
| Min. Negotiated Rate |
$592.28 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,312.40
|
| Rate for Payer: Aetna of WY Medicare |
$696.80
|
| Rate for Payer: Beech Street Commercial |
$3,211.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,278.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,312.40
|
| Rate for Payer: First Choice Health Commercial |
$3,042.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.80
|
| Rate for Payer: HealthUtah PPO |
$3,380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,278.60
|
| Rate for Payer: Multiplan Medicare/VA |
$592.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,312.40
|
| Rate for Payer: PacificSource Commercial |
$3,042.00
|
| Rate for Payer: PHCS PPO |
$3,211.00
|
| Rate for Payer: Three Rivers PPO |
$2,535.00
|
| Rate for Payer: TriWest Veterans Administration |
$696.80
|
| Rate for Payer: United Healthcare Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare Medicare |
$696.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,873.00
|
|
|
TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
27006
|
| Min. Negotiated Rate |
$592.28 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,312.40
|
| Rate for Payer: Aetna of WY Medicare |
$696.80
|
| Rate for Payer: Beech Street Commercial |
$3,211.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: Cash Price |
$2,366.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,278.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,312.40
|
| Rate for Payer: First Choice Health Commercial |
$3,042.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.80
|
| Rate for Payer: HealthUtah PPO |
$3,380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,278.60
|
| Rate for Payer: Multiplan Medicare/VA |
$592.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,312.40
|
| Rate for Payer: PacificSource Commercial |
$3,042.00
|
| Rate for Payer: PHCS PPO |
$3,211.00
|
| Rate for Payer: Three Rivers PPO |
$2,535.00
|
| Rate for Payer: TriWest Veterans Administration |
$696.80
|
| Rate for Payer: United Healthcare Commercial |
$2,940.60
|
| Rate for Payer: United Healthcare Medicare |
$696.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,873.00
|
|
|
TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 24357 80
|
| Hospital Charge Code |
24357
|
| Min. Negotiated Rate |
$348.94 |
| Max. Negotiated Rate |
$1,618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,585.64
|
| Rate for Payer: Aetna of WY Medicare |
$410.52
|
| Rate for Payer: Beech Street Commercial |
$1,537.10
|
| Rate for Payer: Cash Price |
$1,132.60
|
| Rate for Payer: Cash Price |
$1,132.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,569.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,585.64
|
| Rate for Payer: First Choice Health Commercial |
$1,456.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,537.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.52
|
| Rate for Payer: HealthUtah PPO |
$1,618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,569.46
|
| Rate for Payer: Multiplan Medicare/VA |
$348.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,585.64
|
| Rate for Payer: PacificSource Commercial |
$1,456.20
|
| Rate for Payer: PHCS PPO |
$1,537.10
|
| Rate for Payer: Three Rivers PPO |
$1,213.50
|
| Rate for Payer: TriWest Veterans Administration |
$410.52
|
| Rate for Payer: United Healthcare Commercial |
$1,407.66
|
| Rate for Payer: United Healthcare Medicare |
$410.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,375.30
|
|
|
TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
24357
|
| Min. Negotiated Rate |
$348.94 |
| Max. Negotiated Rate |
$1,618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,585.64
|
| Rate for Payer: Aetna of WY Medicare |
$410.52
|
| Rate for Payer: Beech Street Commercial |
$1,537.10
|
| Rate for Payer: Cash Price |
$1,132.60
|
| Rate for Payer: Cash Price |
$1,132.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,569.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,585.64
|
| Rate for Payer: First Choice Health Commercial |
$1,456.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,537.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.52
|
| Rate for Payer: HealthUtah PPO |
$1,618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,569.46
|
| Rate for Payer: Multiplan Medicare/VA |
$348.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,585.64
|
| Rate for Payer: PacificSource Commercial |
$1,456.20
|
| Rate for Payer: PHCS PPO |
$1,537.10
|
| Rate for Payer: Three Rivers PPO |
$1,213.50
|
| Rate for Payer: TriWest Veterans Administration |
$410.52
|
| Rate for Payer: United Healthcare Commercial |
$1,407.66
|
| Rate for Payer: United Healthcare Medicare |
$410.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,375.30
|
|
|
TENOTOMY FLEXOR FINGER OPEN EACH TENDON
|
Professional
|
Both
|
$1,415.00
|
|
|
Service Code
|
HCPCS 26455
|
| Hospital Charge Code |
26455
|
| Min. Negotiated Rate |
$386.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$454.89
|
| Rate for Payer: Beech Street Commercial |
$1,344.25
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: First Choice Health Commercial |
$1,273.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.89
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$386.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,344.25
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$454.89
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$454.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,202.75
|
|
|
TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON
|
Professional
|
Both
|
$3,228.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
28234
|
| Min. Negotiated Rate |
$225.62 |
| Max. Negotiated Rate |
$3,228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,163.44
|
| Rate for Payer: Aetna of WY Medicare |
$265.43
|
| Rate for Payer: Beech Street Commercial |
$3,066.60
|
| Rate for Payer: Cash Price |
$2,259.60
|
| Rate for Payer: Cash Price |
$2,259.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,131.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,163.44
|
| Rate for Payer: First Choice Health Commercial |
$2,905.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,066.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.43
|
| Rate for Payer: HealthUtah PPO |
$3,228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,131.16
|
| Rate for Payer: Multiplan Medicare/VA |
$225.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,163.44
|
| Rate for Payer: PacificSource Commercial |
$2,905.20
|
| Rate for Payer: PHCS PPO |
$3,066.60
|
| Rate for Payer: Three Rivers PPO |
$2,421.00
|
| Rate for Payer: TriWest Veterans Administration |
$265.43
|
| Rate for Payer: United Healthcare Commercial |
$2,808.36
|
| Rate for Payer: United Healthcare Medicare |
$265.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,743.80
|
|
|
TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
27606
|
| Min. Negotiated Rate |
$221.98 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$261.15
|
| Rate for Payer: Beech Street Commercial |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: First Choice Health Commercial |
$1,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.15
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$221.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,358.50
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.15
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$261.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,215.50
|
|
|
TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27606 80
|
| Hospital Charge Code |
27606
|
| Min. Negotiated Rate |
$221.98 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$261.15
|
| Rate for Payer: Beech Street Commercial |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: First Choice Health Commercial |
$1,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.15
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$221.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,358.50
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.15
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$261.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,215.50
|
|
|
TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27606 AS
|
| Hospital Charge Code |
27606
|
| Min. Negotiated Rate |
$221.98 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$261.15
|
| Rate for Payer: Beech Street Commercial |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: First Choice Health Commercial |
$1,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.15
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$221.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,358.50
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.15
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$261.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,215.50
|
|
|
TENOTOMY SHOULDER AREA 1 TENDON
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
23405
|
| Min. Negotiated Rate |
$509.49 |
| Max. Negotiated Rate |
$3,175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,111.50
|
| Rate for Payer: Aetna of WY Medicare |
$599.40
|
| Rate for Payer: Beech Street Commercial |
$3,016.25
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,079.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,111.50
|
| Rate for Payer: First Choice Health Commercial |
$2,857.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,016.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.40
|
| Rate for Payer: HealthUtah PPO |
$3,175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,079.75
|
| Rate for Payer: Multiplan Medicare/VA |
$509.49
|
| Rate for Payer: One Health Plan of WY PPO |
$3,111.50
|
| Rate for Payer: PacificSource Commercial |
$2,857.50
|
| Rate for Payer: PHCS PPO |
$3,016.25
|
| Rate for Payer: Three Rivers PPO |
$2,381.25
|
| Rate for Payer: TriWest Veterans Administration |
$599.40
|
| Rate for Payer: United Healthcare Commercial |
$2,762.25
|
| Rate for Payer: United Healthcare Medicare |
$599.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,698.75
|
|
|
TENS SUPPL 2 LEAD PER MONTH
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS A4595
|
| Hospital Charge Code |
A4595
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$12.26
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.26
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$10.42
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$12.26
|
| Rate for Payer: United Healthcare Commercial |
$93.96
|
| Rate for Payer: United Healthcare Medicare |
$12.26
|
| Rate for Payer: WINHealth Partners Commercial |
$102.60
|
|
|
TENS TWO LEAD
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS E0720
|
| Hospital Charge Code |
E0720
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Beech Street Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: First Choice Health Commercial |
$58.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$61.75
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
|
|
TERAZOSIN 1 MG CAPSULE [7208]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 5974638306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.68
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
TERAZOSIN 1 MG CAPSULE [7208]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 5974638306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.71
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
TERAZOSIN 5 MG CAPSULE [684]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 5026876611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.23
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.22
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$2.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
|
TERAZOSIN 5 MG CAPSULE [684]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 5026876611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Aetna of WY Medicare |
$2.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.23
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.95
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1.85
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3.29
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
