|
CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
23500
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,096.62
|
| Rate for Payer: Aetna of WY Medicare |
$231.34
|
| Rate for Payer: Beech Street Commercial |
$1,063.05
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,085.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,096.62
|
| Rate for Payer: First Choice Health Commercial |
$1,007.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.34
|
| Rate for Payer: HealthUtah PPO |
$1,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,085.43
|
| Rate for Payer: Multiplan Medicare/VA |
$196.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,096.62
|
| Rate for Payer: PacificSource Commercial |
$1,007.10
|
| Rate for Payer: PHCS PPO |
$1,063.05
|
| Rate for Payer: Three Rivers PPO |
$839.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.34
|
| Rate for Payer: United Healthcare Commercial |
$973.53
|
| Rate for Payer: United Healthcare Medicare |
$231.34
|
| Rate for Payer: WINHealth Partners Commercial |
$951.15
|
|
|
CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
24500
|
| Min. Negotiated Rate |
$286.67 |
| Max. Negotiated Rate |
$1,698.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,664.04
|
| Rate for Payer: Aetna of WY Medicare |
$337.26
|
| Rate for Payer: Beech Street Commercial |
$1,613.10
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,647.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,664.04
|
| Rate for Payer: First Choice Health Commercial |
$1,528.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,613.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.26
|
| Rate for Payer: HealthUtah PPO |
$1,698.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,647.06
|
| Rate for Payer: Multiplan Medicare/VA |
$286.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,664.04
|
| Rate for Payer: PacificSource Commercial |
$1,528.20
|
| Rate for Payer: PHCS PPO |
$1,613.10
|
| Rate for Payer: Three Rivers PPO |
$1,273.50
|
| Rate for Payer: TriWest Veterans Administration |
$337.26
|
| Rate for Payer: United Healthcare Commercial |
$1,477.26
|
| Rate for Payer: United Healthcare Medicare |
$337.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,443.30
|
|
|
CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
27197
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$129.64
|
| Rate for Payer: Beech Street Commercial |
$627.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: First Choice Health Commercial |
$594.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.64
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$110.19
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$627.00
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$129.64
|
| Rate for Payer: WINHealth Partners Commercial |
$561.00
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
23655
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,974.70
|
| Rate for Payer: Aetna of WY Medicare |
$404.29
|
| Rate for Payer: Beech Street Commercial |
$1,914.25
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,954.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,974.70
|
| Rate for Payer: First Choice Health Commercial |
$1,813.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,914.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.29
|
| Rate for Payer: HealthUtah PPO |
$2,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,954.55
|
| Rate for Payer: Multiplan Medicare/VA |
$343.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,974.70
|
| Rate for Payer: PacificSource Commercial |
$1,813.50
|
| Rate for Payer: PHCS PPO |
$1,914.25
|
| Rate for Payer: Three Rivers PPO |
$1,511.25
|
| Rate for Payer: TriWest Veterans Administration |
$404.29
|
| Rate for Payer: United Healthcare Commercial |
$1,753.05
|
| Rate for Payer: United Healthcare Medicare |
$404.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.75
|
|
|
CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
23650
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,416.10
|
| Rate for Payer: Aetna of WY Medicare |
$301.56
|
| Rate for Payer: Beech Street Commercial |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,401.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,416.10
|
| Rate for Payer: First Choice Health Commercial |
$1,300.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,372.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.56
|
| Rate for Payer: HealthUtah PPO |
$1,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,401.65
|
| Rate for Payer: Multiplan Medicare/VA |
$256.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,416.10
|
| Rate for Payer: PacificSource Commercial |
$1,300.50
|
| Rate for Payer: PHCS PPO |
$1,372.75
|
| Rate for Payer: Three Rivers PPO |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration |
$301.56
|
| Rate for Payer: United Healthcare Commercial |
$1,257.15
|
| Rate for Payer: United Healthcare Medicare |
$301.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,228.25
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 44625 80
|
| Hospital Charge Code |
44625
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,133.24
|
| Rate for Payer: Aetna of WY Medicare |
$958.48
|
| Rate for Payer: Beech Street Commercial |
$4,976.10
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,080.86
|
| Rate for Payer: Cigna of WY Commercial |
$5,133.24
|
| Rate for Payer: First Choice Health Commercial |
$4,714.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,976.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$958.48
|
| Rate for Payer: HealthUtah PPO |
$5,238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,080.86
|
| Rate for Payer: Multiplan Medicare/VA |
$814.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,133.24
|
| Rate for Payer: PacificSource Commercial |
$4,714.20
|
| Rate for Payer: PHCS PPO |
$4,976.10
|
| Rate for Payer: Three Rivers PPO |
$3,928.50
|
| Rate for Payer: TriWest Veterans Administration |
$958.48
|
| Rate for Payer: United Healthcare Commercial |
$4,557.06
|
| Rate for Payer: United Healthcare Medicare |
$958.48
|
| Rate for Payer: WINHealth Partners Commercial |
$4,452.30
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
44625
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,133.24
|
| Rate for Payer: Aetna of WY Medicare |
$958.48
|
| Rate for Payer: Beech Street Commercial |
$4,976.10
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,080.86
|
| Rate for Payer: Cigna of WY Commercial |
$5,133.24
|
| Rate for Payer: First Choice Health Commercial |
$4,714.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,976.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$958.48
|
| Rate for Payer: HealthUtah PPO |
$5,238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,080.86
|
| Rate for Payer: Multiplan Medicare/VA |
$814.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,133.24
|
| Rate for Payer: PacificSource Commercial |
$4,714.20
|
| Rate for Payer: PHCS PPO |
$4,976.10
|
| Rate for Payer: Three Rivers PPO |
$3,928.50
|
| Rate for Payer: TriWest Veterans Administration |
$958.48
|
| Rate for Payer: United Healthcare Commercial |
$4,557.06
|
| Rate for Payer: United Healthcare Medicare |
$958.48
|
| Rate for Payer: WINHealth Partners Commercial |
$4,452.30
|
|
|
CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$5,238.00
|
|
|
Service Code
|
HCPCS 44625 AS
|
| Hospital Charge Code |
44625
|
| Min. Negotiated Rate |
$814.71 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,133.24
|
| Rate for Payer: Aetna of WY Medicare |
$958.48
|
| Rate for Payer: Beech Street Commercial |
$4,976.10
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: Cash Price |
$3,666.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,080.86
|
| Rate for Payer: Cigna of WY Commercial |
$5,133.24
|
| Rate for Payer: First Choice Health Commercial |
$4,714.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,976.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$958.48
|
| Rate for Payer: HealthUtah PPO |
$5,238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,080.86
|
| Rate for Payer: Multiplan Medicare/VA |
$814.71
|
| Rate for Payer: One Health Plan of WY PPO |
$5,133.24
|
| Rate for Payer: PacificSource Commercial |
$4,714.20
|
| Rate for Payer: PHCS PPO |
$4,976.10
|
| Rate for Payer: Three Rivers PPO |
$3,928.50
|
| Rate for Payer: TriWest Veterans Administration |
$958.48
|
| Rate for Payer: United Healthcare Commercial |
$4,557.06
|
| Rate for Payer: United Healthcare Medicare |
$958.48
|
| Rate for Payer: WINHealth Partners Commercial |
$4,452.30
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 44626 AS
|
| Hospital Charge Code |
44626
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,499.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 44626 80
|
| Hospital Charge Code |
44626
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,499.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 44626 81
|
| Hospital Charge Code |
44626
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,499.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
44626
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,499.00
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,499.00
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,274.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,499.00
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,499.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
57305
|
| Min. Negotiated Rate |
$798.88 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.42
|
| Rate for Payer: Aetna of WY Medicare |
$939.86
|
| Rate for Payer: Beech Street Commercial |
$1,737.55
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.42
|
| Rate for Payer: First Choice Health Commercial |
$1,646.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,737.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.86
|
| Rate for Payer: HealthUtah PPO |
$1,829.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.13
|
| Rate for Payer: Multiplan Medicare/VA |
$798.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.42
|
| Rate for Payer: PacificSource Commercial |
$1,646.10
|
| Rate for Payer: PHCS PPO |
$1,737.55
|
| Rate for Payer: Three Rivers PPO |
$1,371.75
|
| Rate for Payer: TriWest Veterans Administration |
$939.86
|
| Rate for Payer: United Healthcare Commercial |
$1,591.23
|
| Rate for Payer: United Healthcare Medicare |
$939.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,554.65
|
|
|
CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 57305 80
|
| Hospital Charge Code |
57305
|
| Min. Negotiated Rate |
$798.88 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.42
|
| Rate for Payer: Aetna of WY Medicare |
$939.86
|
| Rate for Payer: Beech Street Commercial |
$1,737.55
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.42
|
| Rate for Payer: First Choice Health Commercial |
$1,646.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,737.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$939.86
|
| Rate for Payer: HealthUtah PPO |
$1,829.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.13
|
| Rate for Payer: Multiplan Medicare/VA |
$798.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.42
|
| Rate for Payer: PacificSource Commercial |
$1,646.10
|
| Rate for Payer: PHCS PPO |
$1,737.55
|
| Rate for Payer: Three Rivers PPO |
$1,371.75
|
| Rate for Payer: TriWest Veterans Administration |
$939.86
|
| Rate for Payer: United Healthcare Commercial |
$1,591.23
|
| Rate for Payer: United Healthcare Medicare |
$939.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,554.65
|
|
|
CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$4,620.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
27222
|
| Min. Negotiated Rate |
$804.11 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,527.60
|
| Rate for Payer: Aetna of WY Medicare |
$946.01
|
| Rate for Payer: Beech Street Commercial |
$4,389.00
|
| Rate for Payer: Cash Price |
$3,234.00
|
| Rate for Payer: Cash Price |
$3,234.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,481.40
|
| Rate for Payer: Cigna of WY Commercial |
$4,527.60
|
| Rate for Payer: First Choice Health Commercial |
$4,158.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,389.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.01
|
| Rate for Payer: HealthUtah PPO |
$4,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,481.40
|
| Rate for Payer: Multiplan Medicare/VA |
$804.11
|
| Rate for Payer: One Health Plan of WY PPO |
$4,527.60
|
| Rate for Payer: PacificSource Commercial |
$4,158.00
|
| Rate for Payer: PHCS PPO |
$4,389.00
|
| Rate for Payer: Three Rivers PPO |
$3,465.00
|
| Rate for Payer: TriWest Veterans Administration |
$946.01
|
| Rate for Payer: United Healthcare Commercial |
$4,019.40
|
| Rate for Payer: United Healthcare Medicare |
$946.01
|
| Rate for Payer: WINHealth Partners Commercial |
$3,927.00
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 27220 80
|
| Hospital Charge Code |
27220
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,144.24
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$2,078.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,122.36
|
| Rate for Payer: Cigna of WY Commercial |
$2,144.24
|
| Rate for Payer: First Choice Health Commercial |
$1,969.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$2,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,122.36
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,144.24
|
| Rate for Payer: PacificSource Commercial |
$1,969.20
|
| Rate for Payer: PHCS PPO |
$2,078.60
|
| Rate for Payer: Three Rivers PPO |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,903.56
|
| Rate for Payer: United Healthcare Medicare |
$403.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,859.80
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 27220 AS
|
| Hospital Charge Code |
27220
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,144.24
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$2,078.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,122.36
|
| Rate for Payer: Cigna of WY Commercial |
$2,144.24
|
| Rate for Payer: First Choice Health Commercial |
$1,969.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$2,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,122.36
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,144.24
|
| Rate for Payer: PacificSource Commercial |
$1,969.20
|
| Rate for Payer: PHCS PPO |
$2,078.60
|
| Rate for Payer: Three Rivers PPO |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,903.56
|
| Rate for Payer: United Healthcare Medicare |
$403.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,859.80
|
|
|
CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
27220
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,144.24
|
| Rate for Payer: Aetna of WY Medicare |
$403.82
|
| Rate for Payer: Beech Street Commercial |
$2,078.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: Cash Price |
$1,531.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,122.36
|
| Rate for Payer: Cigna of WY Commercial |
$2,144.24
|
| Rate for Payer: First Choice Health Commercial |
$1,969.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,078.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.82
|
| Rate for Payer: HealthUtah PPO |
$2,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,122.36
|
| Rate for Payer: Multiplan Medicare/VA |
$343.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,144.24
|
| Rate for Payer: PacificSource Commercial |
$1,969.20
|
| Rate for Payer: PHCS PPO |
$2,078.60
|
| Rate for Payer: Three Rivers PPO |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration |
$403.82
|
| Rate for Payer: United Healthcare Commercial |
$1,903.56
|
| Rate for Payer: United Healthcare Medicare |
$403.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,859.80
|
|
|
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
27842
|
| Min. Negotiated Rate |
$411.54 |
| Max. Negotiated Rate |
$2,537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.26
|
| Rate for Payer: Aetna of WY Medicare |
$484.17
|
| Rate for Payer: Beech Street Commercial |
$2,410.15
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,460.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.26
|
| Rate for Payer: First Choice Health Commercial |
$2,283.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.17
|
| Rate for Payer: HealthUtah PPO |
$2,537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Medicare/VA |
$411.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.26
|
| Rate for Payer: PacificSource Commercial |
$2,283.30
|
| Rate for Payer: PHCS PPO |
$2,410.15
|
| Rate for Payer: Three Rivers PPO |
$1,902.75
|
| Rate for Payer: TriWest Veterans Administration |
$484.17
|
| Rate for Payer: United Healthcare Commercial |
$2,207.19
|
| Rate for Payer: United Healthcare Medicare |
$484.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,156.45
|
|
|
CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
26742
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$1,679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,645.42
|
| Rate for Payer: Aetna of WY Medicare |
$335.18
|
| Rate for Payer: Beech Street Commercial |
$1,595.05
|
| Rate for Payer: Cash Price |
$1,175.30
|
| Rate for Payer: Cash Price |
$1,175.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,628.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,645.42
|
| Rate for Payer: First Choice Health Commercial |
$1,511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,595.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.18
|
| Rate for Payer: HealthUtah PPO |
$1,679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,628.63
|
| Rate for Payer: Multiplan Medicare/VA |
$284.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,645.42
|
| Rate for Payer: PacificSource Commercial |
$1,511.10
|
| Rate for Payer: PHCS PPO |
$1,595.05
|
| Rate for Payer: Three Rivers PPO |
$1,259.25
|
| Rate for Payer: TriWest Veterans Administration |
$335.18
|
| Rate for Payer: United Healthcare Commercial |
$1,460.73
|
| Rate for Payer: United Healthcare Medicare |
$335.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,427.15
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
26740
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Medicare |
$223.91
|
| Rate for Payer: Beech Street Commercial |
$1,037.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| Rate for Payer: First Choice Health Commercial |
$982.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.91
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$190.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PHCS PPO |
$1,037.40
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: TriWest Veterans Administration |
$223.91
|
| Rate for Payer: United Healthcare Commercial |
$950.04
|
| Rate for Payer: United Healthcare Medicare |
$223.91
|
| Rate for Payer: WINHealth Partners Commercial |
$928.20
|
|
|
CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
25630
|
| Min. Negotiated Rate |
$243.77 |
| Max. Negotiated Rate |
$1,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
| Rate for Payer: Aetna of WY Medicare |
$286.79
|
| Rate for Payer: Beech Street Commercial |
$1,384.15
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
| Rate for Payer: First Choice Health Commercial |
$1,311.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$286.79
|
| Rate for Payer: HealthUtah PPO |
$1,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
| Rate for Payer: Multiplan Medicare/VA |
$243.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
| Rate for Payer: PacificSource Commercial |
$1,311.30
|
| Rate for Payer: PHCS PPO |
$1,384.15
|
| Rate for Payer: Three Rivers PPO |
$1,092.75
|
| Rate for Payer: TriWest Veterans Administration |
$286.79
|
| Rate for Payer: United Healthcare Commercial |
$1,267.59
|
| Rate for Payer: United Healthcare Medicare |
$286.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|
|
CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$2,028.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
26645
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$2,028.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,987.44
|
| Rate for Payer: Aetna of WY Medicare |
$394.31
|
| Rate for Payer: Beech Street Commercial |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,967.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,987.44
|
| Rate for Payer: First Choice Health Commercial |
$1,825.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,926.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.31
|
| Rate for Payer: HealthUtah PPO |
$2,028.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,967.16
|
| Rate for Payer: Multiplan Medicare/VA |
$335.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,987.44
|
| Rate for Payer: PacificSource Commercial |
$1,825.20
|
| Rate for Payer: PHCS PPO |
$1,926.60
|
| Rate for Payer: Three Rivers PPO |
$1,521.00
|
| Rate for Payer: TriWest Veterans Administration |
$394.31
|
| Rate for Payer: United Healthcare Commercial |
$1,764.36
|
| Rate for Payer: United Healthcare Medicare |
$394.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,723.80
|
|
|
CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
26670
|
| Min. Negotiated Rate |
$267.16 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$314.31
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.31
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$267.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$314.31
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$314.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
|
CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,652.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
26675
|
| Min. Negotiated Rate |
$358.10 |
| Max. Negotiated Rate |
$1,652.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,618.96
|
| Rate for Payer: Aetna of WY Medicare |
$421.30
|
| Rate for Payer: Beech Street Commercial |
$1,569.40
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,602.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,618.96
|
| Rate for Payer: First Choice Health Commercial |
$1,486.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,569.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$421.30
|
| Rate for Payer: HealthUtah PPO |
$1,652.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,602.44
|
| Rate for Payer: Multiplan Medicare/VA |
$358.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,618.96
|
| Rate for Payer: PacificSource Commercial |
$1,486.80
|
| Rate for Payer: PHCS PPO |
$1,569.40
|
| Rate for Payer: Three Rivers PPO |
$1,239.00
|
| Rate for Payer: TriWest Veterans Administration |
$421.30
|
| Rate for Payer: United Healthcare Commercial |
$1,437.24
|
| Rate for Payer: United Healthcare Medicare |
$421.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,404.20
|
|
