|
CAPR FILTER CARTRIDGE 2167-10
|
Facility
|
OP
|
$1,021.62
|
|
| Hospital Charge Code |
2100146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$553.21 |
| Max. Negotiated Rate |
$1,021.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,001.19
|
| Rate for Payer: Aetna of WY Medicare |
$674.27
|
| Rate for Payer: Altius Commercial |
$980.76
|
| Rate for Payer: Beech Street Commercial |
$1,001.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.97
|
| Rate for Payer: Cash Price |
$715.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$990.97
|
| Rate for Payer: Cigna of WY Commercial |
$1,001.19
|
| Rate for Payer: Entrust Commercial |
$970.54
|
| Rate for Payer: First Choice Health Commercial |
$970.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$970.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$582.32
|
| Rate for Payer: HealthUtah PPO |
$1,021.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$990.97
|
| Rate for Payer: Multiplan Medicare/VA |
$553.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,001.19
|
| Rate for Payer: PacificSource Commercial |
$919.46
|
| Rate for Payer: PHCS PPO |
$1,001.19
|
| Rate for Payer: Three Rivers PPO |
$766.22
|
| Rate for Payer: TriWest Veterans Administration |
$582.32
|
| Rate for Payer: United Healthcare Commercial |
$975.65
|
| Rate for Payer: United Healthcare Medicare |
$582.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,001.19
|
| Rate for Payer: Wise Provider Network Commercial |
$970.54
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$1,289.00
|
|
|
Service Code
|
HCPCS 25320 80
|
| Min. Negotiated Rate |
$966.75 |
| Max. Negotiated Rate |
$1,289.00 |
| Rate for Payer: One Health Plan of WY PPO |
$1,263.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,263.22
|
| Rate for Payer: Beech Street Commercial |
$1,224.55
|
| Rate for Payer: Cash Price |
$902.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,250.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,263.22
|
| Rate for Payer: First Choice Health Commercial |
$1,160.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,224.55
|
| Rate for Payer: HealthUtah PPO |
$1,289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,250.33
|
| Rate for Payer: PacificSource Commercial |
$1,160.10
|
| Rate for Payer: PHCS PPO |
$1,224.55
|
| Rate for Payer: Three Rivers PPO |
$966.75
|
| Rate for Payer: United Healthcare Commercial |
$1,224.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,095.65
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$10,363.00
|
|
|
Service Code
|
HCPCS 25320 50
|
| Min. Negotiated Rate |
$7,772.25 |
| Max. Negotiated Rate |
$10,363.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,155.74
|
| Rate for Payer: Beech Street Commercial |
$9,844.85
|
| Rate for Payer: Cash Price |
$7,254.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,052.11
|
| Rate for Payer: Cigna of WY Commercial |
$10,155.74
|
| Rate for Payer: First Choice Health Commercial |
$9,326.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,844.85
|
| Rate for Payer: HealthUtah PPO |
$10,363.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,052.11
|
| Rate for Payer: One Health Plan of WY PPO |
$10,155.74
|
| Rate for Payer: PacificSource Commercial |
$9,326.70
|
| Rate for Payer: PHCS PPO |
$9,844.85
|
| Rate for Payer: Three Rivers PPO |
$7,772.25
|
| Rate for Payer: United Healthcare Commercial |
$9,844.85
|
| Rate for Payer: WINHealth Partners Commercial |
$8,808.55
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$6,445.00
|
|
|
Service Code
|
HCPCS 25320 AS
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$6,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,316.10
|
| Rate for Payer: Beech Street Commercial |
$6,122.75
|
| Rate for Payer: Cash Price |
$4,511.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,251.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,316.10
|
| Rate for Payer: First Choice Health Commercial |
$5,800.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,122.75
|
| Rate for Payer: HealthUtah PPO |
$6,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,251.65
|
| Rate for Payer: One Health Plan of WY PPO |
$6,316.10
|
| Rate for Payer: PacificSource Commercial |
$5,800.50
|
| Rate for Payer: PHCS PPO |
$6,122.75
|
| Rate for Payer: Three Rivers PPO |
$4,833.75
|
| Rate for Payer: United Healthcare Commercial |
$6,122.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,478.25
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$6,445.00
|
|
|
Service Code
|
HCPCS 25320
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$6,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,316.10
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$6,122.75
|
| Rate for Payer: Cash Price |
$4,511.50
|
| Rate for Payer: Cash Price |
$4,511.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,251.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,316.10
|
| Rate for Payer: First Choice Health Commercial |
$5,800.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,122.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$6,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,251.65
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$6,316.10
|
| Rate for Payer: PacificSource Commercial |
$5,800.50
|
| Rate for Payer: PHCS PPO |
$6,122.75
|
| Rate for Payer: Three Rivers PPO |
$4,833.75
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$6,122.75
|
| Rate for Payer: WINHealth Partners Commercial |
$5,478.25
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 23020 AS
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$2,781.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,725.38
|
| Rate for Payer: Beech Street Commercial |
$2,641.95
|
| Rate for Payer: Cash Price |
$1,946.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,697.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,725.38
|
| Rate for Payer: First Choice Health Commercial |
$2,502.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,641.95
|
| Rate for Payer: HealthUtah PPO |
$2,781.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,697.57
|
| Rate for Payer: One Health Plan of WY PPO |
$2,725.38
|
| Rate for Payer: PacificSource Commercial |
$2,502.90
|
| Rate for Payer: PHCS PPO |
$2,641.95
|
| Rate for Payer: Three Rivers PPO |
$2,085.75
|
| Rate for Payer: United Healthcare Commercial |
$2,641.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,363.85
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 23020
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$2,781.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,725.38
|
| Rate for Payer: Aetna of WY Medicare |
$671.56
|
| Rate for Payer: Beech Street Commercial |
$2,641.95
|
| Rate for Payer: Cash Price |
$1,946.70
|
| Rate for Payer: Cash Price |
$1,946.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,697.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,725.38
|
| Rate for Payer: First Choice Health Commercial |
$2,502.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,641.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.56
|
| Rate for Payer: HealthUtah PPO |
$2,781.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,697.57
|
| Rate for Payer: Multiplan Medicare/VA |
$570.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,725.38
|
| Rate for Payer: PacificSource Commercial |
$2,502.90
|
| Rate for Payer: PHCS PPO |
$2,641.95
|
| Rate for Payer: Three Rivers PPO |
$2,085.75
|
| Rate for Payer: TriWest Veterans Administration |
$671.56
|
| Rate for Payer: United Healthcare Commercial |
$2,641.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,363.85
|
|
|
CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$3,562.00
|
|
|
Service Code
|
HCPCS 26525 80
|
| Min. Negotiated Rate |
$2,671.50 |
| Max. Negotiated Rate |
$3,562.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,490.76
|
| Rate for Payer: Beech Street Commercial |
$3,383.90
|
| Rate for Payer: Cash Price |
$2,493.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,455.14
|
| Rate for Payer: Cigna of WY Commercial |
$3,490.76
|
| Rate for Payer: First Choice Health Commercial |
$3,205.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,383.90
|
| Rate for Payer: HealthUtah PPO |
$3,562.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,455.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3,490.76
|
| Rate for Payer: PacificSource Commercial |
$3,205.80
|
| Rate for Payer: PHCS PPO |
$3,383.90
|
| Rate for Payer: Three Rivers PPO |
$2,671.50
|
| Rate for Payer: United Healthcare Commercial |
$3,383.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3,027.70
|
|
|
CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$2,912.00
|
|
|
Service Code
|
HCPCS 26520
|
| Min. Negotiated Rate |
$569.42 |
| Max. Negotiated Rate |
$2,912.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,853.76
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Beech Street Commercial |
$2,766.40
|
| Rate for Payer: Cash Price |
$2,038.40
|
| Rate for Payer: Cash Price |
$2,038.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,824.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,853.76
|
| Rate for Payer: First Choice Health Commercial |
$2,620.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,766.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$2,912.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,824.64
|
| Rate for Payer: Multiplan Medicare/VA |
$569.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,853.76
|
| Rate for Payer: PacificSource Commercial |
$2,620.80
|
| Rate for Payer: PHCS PPO |
$2,766.40
|
| Rate for Payer: Three Rivers PPO |
$2,184.00
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$2,766.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,475.20
|
|
|
CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$2,360.00
|
|
|
Service Code
|
HCPCS 26520 80
|
| Min. Negotiated Rate |
$1,770.00 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,312.80
|
| Rate for Payer: Beech Street Commercial |
$2,242.00
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,289.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,312.80
|
| Rate for Payer: First Choice Health Commercial |
$2,124.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,242.00
|
| Rate for Payer: HealthUtah PPO |
$2,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,289.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,312.80
|
| Rate for Payer: PacificSource Commercial |
$2,124.00
|
| Rate for Payer: PHCS PPO |
$2,242.00
|
| Rate for Payer: Three Rivers PPO |
$1,770.00
|
| Rate for Payer: United Healthcare Commercial |
$2,242.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,006.00
|
|
|
CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$3,911.00
|
|
|
Service Code
|
HCPCS 26516
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$3,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,832.78
|
| Rate for Payer: Aetna of WY Medicare |
$728.47
|
| Rate for Payer: Beech Street Commercial |
$3,715.45
|
| Rate for Payer: Cash Price |
$2,737.70
|
| Rate for Payer: Cash Price |
$2,737.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,793.67
|
| Rate for Payer: Cigna of WY Commercial |
$3,832.78
|
| Rate for Payer: First Choice Health Commercial |
$3,519.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,715.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.47
|
| Rate for Payer: HealthUtah PPO |
$3,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,793.67
|
| Rate for Payer: Multiplan Medicare/VA |
$619.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3,832.78
|
| Rate for Payer: PacificSource Commercial |
$3,519.90
|
| Rate for Payer: PHCS PPO |
$3,715.45
|
| Rate for Payer: Three Rivers PPO |
$2,933.25
|
| Rate for Payer: TriWest Veterans Administration |
$728.47
|
| Rate for Payer: United Healthcare Commercial |
$3,715.45
|
| Rate for Payer: WINHealth Partners Commercial |
$3,324.35
|
|
|
CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$3,911.00
|
|
|
Service Code
|
HCPCS 26516 AS
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$3,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,832.78
|
| Rate for Payer: Beech Street Commercial |
$3,715.45
|
| Rate for Payer: Cash Price |
$2,737.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,793.67
|
| Rate for Payer: Cigna of WY Commercial |
$3,832.78
|
| Rate for Payer: First Choice Health Commercial |
$3,519.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,715.45
|
| Rate for Payer: HealthUtah PPO |
$3,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,793.67
|
| Rate for Payer: One Health Plan of WY PPO |
$3,832.78
|
| Rate for Payer: PacificSource Commercial |
$3,519.90
|
| Rate for Payer: PHCS PPO |
$3,715.45
|
| Rate for Payer: Three Rivers PPO |
$2,933.25
|
| Rate for Payer: United Healthcare Commercial |
$3,715.45
|
| Rate for Payer: WINHealth Partners Commercial |
$3,324.35
|
|
|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
HCPCS 23462 80
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$4,679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,585.42
|
| Rate for Payer: Beech Street Commercial |
$4,445.05
|
| Rate for Payer: Cash Price |
$3,275.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,538.63
|
| Rate for Payer: Cigna of WY Commercial |
$4,585.42
|
| Rate for Payer: First Choice Health Commercial |
$4,211.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,445.05
|
| Rate for Payer: HealthUtah PPO |
$4,679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,538.63
|
| Rate for Payer: One Health Plan of WY PPO |
$4,585.42
|
| Rate for Payer: PacificSource Commercial |
$4,211.10
|
| Rate for Payer: PHCS PPO |
$4,445.05
|
| Rate for Payer: Three Rivers PPO |
$3,509.25
|
| Rate for Payer: United Healthcare Commercial |
$4,445.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3,977.15
|
|
|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
HCPCS 23462 AS
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$4,679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,585.42
|
| Rate for Payer: Beech Street Commercial |
$4,445.05
|
| Rate for Payer: Cash Price |
$3,275.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,538.63
|
| Rate for Payer: Cigna of WY Commercial |
$4,585.42
|
| Rate for Payer: First Choice Health Commercial |
$4,211.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,445.05
|
| Rate for Payer: HealthUtah PPO |
$4,679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,538.63
|
| Rate for Payer: One Health Plan of WY PPO |
$4,585.42
|
| Rate for Payer: PacificSource Commercial |
$4,211.10
|
| Rate for Payer: PHCS PPO |
$4,445.05
|
| Rate for Payer: Three Rivers PPO |
$3,509.25
|
| Rate for Payer: United Healthcare Commercial |
$4,445.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3,977.15
|
|
|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
HCPCS 23462
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$4,679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,585.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,027.90
|
| Rate for Payer: Beech Street Commercial |
$4,445.05
|
| Rate for Payer: Cash Price |
$3,275.30
|
| Rate for Payer: Cash Price |
$3,275.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,538.63
|
| Rate for Payer: Cigna of WY Commercial |
$4,585.42
|
| Rate for Payer: First Choice Health Commercial |
$4,211.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,445.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,027.90
|
| Rate for Payer: HealthUtah PPO |
$4,679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,538.63
|
| Rate for Payer: Multiplan Medicare/VA |
$873.72
|
| Rate for Payer: One Health Plan of WY PPO |
$4,585.42
|
| Rate for Payer: PacificSource Commercial |
$4,211.10
|
| Rate for Payer: PHCS PPO |
$4,445.05
|
| Rate for Payer: Three Rivers PPO |
$3,509.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,027.90
|
| Rate for Payer: United Healthcare Commercial |
$4,445.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3,977.15
|
|
|
CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$4,353.00
|
|
|
Service Code
|
HCPCS 23455 AS
|
| Min. Negotiated Rate |
$808.42 |
| Max. Negotiated Rate |
$4,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,265.94
|
| Rate for Payer: Beech Street Commercial |
$4,135.35
|
| Rate for Payer: Cash Price |
$3,047.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,222.41
|
| Rate for Payer: Cigna of WY Commercial |
$4,265.94
|
| Rate for Payer: First Choice Health Commercial |
$3,917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,135.35
|
| Rate for Payer: HealthUtah PPO |
$4,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,222.41
|
| Rate for Payer: One Health Plan of WY PPO |
$4,265.94
|
| Rate for Payer: PacificSource Commercial |
$3,917.70
|
| Rate for Payer: PHCS PPO |
$4,135.35
|
| Rate for Payer: Three Rivers PPO |
$3,264.75
|
| Rate for Payer: United Healthcare Commercial |
$4,135.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,700.05
|
|
|
CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$4,353.00
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$808.42 |
| Max. Negotiated Rate |
$4,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,265.94
|
| Rate for Payer: Aetna of WY Medicare |
$951.08
|
| Rate for Payer: Beech Street Commercial |
$4,135.35
|
| Rate for Payer: Cash Price |
$3,047.10
|
| Rate for Payer: Cash Price |
$3,047.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,222.41
|
| Rate for Payer: Cigna of WY Commercial |
$4,265.94
|
| Rate for Payer: First Choice Health Commercial |
$3,917.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,135.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$951.08
|
| Rate for Payer: HealthUtah PPO |
$4,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,222.41
|
| Rate for Payer: Multiplan Medicare/VA |
$808.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4,265.94
|
| Rate for Payer: PacificSource Commercial |
$3,917.70
|
| Rate for Payer: PHCS PPO |
$4,135.35
|
| Rate for Payer: Three Rivers PPO |
$3,264.75
|
| Rate for Payer: TriWest Veterans Administration |
$951.08
|
| Rate for Payer: United Healthcare Commercial |
$4,135.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,700.05
|
|
|
CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$4,838.00
|
|
|
Service Code
|
HCPCS 23465
|
| Min. Negotiated Rate |
$915.70 |
| Max. Negotiated Rate |
$4,838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,741.24
|
| Rate for Payer: Aetna of WY Medicare |
$1,077.30
|
| Rate for Payer: Beech Street Commercial |
$4,596.10
|
| Rate for Payer: Cash Price |
$3,386.60
|
| Rate for Payer: Cash Price |
$3,386.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,692.86
|
| Rate for Payer: Cigna of WY Commercial |
$4,741.24
|
| Rate for Payer: First Choice Health Commercial |
$4,354.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,596.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,077.30
|
| Rate for Payer: HealthUtah PPO |
$4,838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,692.86
|
| Rate for Payer: Multiplan Medicare/VA |
$915.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4,741.24
|
| Rate for Payer: PacificSource Commercial |
$4,354.20
|
| Rate for Payer: PHCS PPO |
$4,596.10
|
| Rate for Payer: Three Rivers PPO |
$3,628.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,077.30
|
| Rate for Payer: United Healthcare Commercial |
$4,596.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,112.30
|
|
|
CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$4,838.00
|
|
|
Service Code
|
HCPCS 23465 AS
|
| Min. Negotiated Rate |
$915.70 |
| Max. Negotiated Rate |
$4,838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,741.24
|
| Rate for Payer: Beech Street Commercial |
$4,596.10
|
| Rate for Payer: Cash Price |
$3,386.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,692.86
|
| Rate for Payer: Cigna of WY Commercial |
$4,741.24
|
| Rate for Payer: First Choice Health Commercial |
$4,354.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,596.10
|
| Rate for Payer: HealthUtah PPO |
$4,838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,692.86
|
| Rate for Payer: One Health Plan of WY PPO |
$4,741.24
|
| Rate for Payer: PacificSource Commercial |
$4,354.20
|
| Rate for Payer: PHCS PPO |
$4,596.10
|
| Rate for Payer: Three Rivers PPO |
$3,628.50
|
| Rate for Payer: United Healthcare Commercial |
$4,596.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,112.30
|
|
|
CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS
|
Professional
|
Both
|
$4,799.00
|
|
|
Service Code
|
HCPCS 23466
|
| Min. Negotiated Rate |
$922.16 |
| Max. Negotiated Rate |
$4,799.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,703.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,084.89
|
| Rate for Payer: Beech Street Commercial |
$4,559.05
|
| Rate for Payer: Cash Price |
$3,359.30
|
| Rate for Payer: Cash Price |
$3,359.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,655.03
|
| Rate for Payer: Cigna of WY Commercial |
$4,703.02
|
| Rate for Payer: First Choice Health Commercial |
$4,319.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,559.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.89
|
| Rate for Payer: HealthUtah PPO |
$4,799.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,655.03
|
| Rate for Payer: Multiplan Medicare/VA |
$922.16
|
| Rate for Payer: One Health Plan of WY PPO |
$4,703.02
|
| Rate for Payer: PacificSource Commercial |
$4,319.10
|
| Rate for Payer: PHCS PPO |
$4,559.05
|
| Rate for Payer: Three Rivers PPO |
$3,599.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.89
|
| Rate for Payer: United Healthcare Commercial |
$4,559.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4,079.15
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 27435
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,498.60
|
| Rate for Payer: Aetna of WY Medicare |
$784.66
|
| Rate for Payer: Beech Street Commercial |
$3,391.50
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,462.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,498.60
|
| Rate for Payer: First Choice Health Commercial |
$3,213.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,391.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$784.66
|
| Rate for Payer: HealthUtah PPO |
$3,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,462.90
|
| Rate for Payer: Multiplan Medicare/VA |
$666.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,498.60
|
| Rate for Payer: PacificSource Commercial |
$3,213.00
|
| Rate for Payer: PHCS PPO |
$3,391.50
|
| Rate for Payer: Three Rivers PPO |
$2,677.50
|
| Rate for Payer: TriWest Veterans Administration |
$784.66
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,034.50
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 27435 AS
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,498.60
|
| Rate for Payer: Beech Street Commercial |
$3,391.50
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,462.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,498.60
|
| Rate for Payer: First Choice Health Commercial |
$3,213.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,391.50
|
| Rate for Payer: HealthUtah PPO |
$3,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,462.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,498.60
|
| Rate for Payer: PacificSource Commercial |
$3,213.00
|
| Rate for Payer: PHCS PPO |
$3,391.50
|
| Rate for Payer: Three Rivers PPO |
$2,677.50
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,034.50
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 27435 80
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,498.60
|
| Rate for Payer: Beech Street Commercial |
$3,391.50
|
| Rate for Payer: Cash Price |
$2,499.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,462.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,498.60
|
| Rate for Payer: First Choice Health Commercial |
$3,213.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,391.50
|
| Rate for Payer: HealthUtah PPO |
$3,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,462.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,498.60
|
| Rate for Payer: PacificSource Commercial |
$3,213.00
|
| Rate for Payer: PHCS PPO |
$3,391.50
|
| Rate for Payer: Three Rivers PPO |
$2,677.50
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,034.50
|
|
|
CAPSULOTOMY WRIST
|
Professional
|
Both
|
$1,981.00
|
|
|
Service Code
|
HCPCS 25085
|
| Min. Negotiated Rate |
$375.76 |
| Max. Negotiated Rate |
$1,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,941.38
|
| Rate for Payer: Aetna of WY Medicare |
$442.07
|
| Rate for Payer: Beech Street Commercial |
$1,881.95
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: Cash Price |
$1,386.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,921.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,941.38
|
| Rate for Payer: First Choice Health Commercial |
$1,782.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,881.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.07
|
| Rate for Payer: HealthUtah PPO |
$1,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,921.57
|
| Rate for Payer: Multiplan Medicare/VA |
$375.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,941.38
|
| Rate for Payer: PacificSource Commercial |
$1,782.90
|
| Rate for Payer: PHCS PPO |
$1,881.95
|
| Rate for Payer: Three Rivers PPO |
$1,485.75
|
| Rate for Payer: TriWest Veterans Administration |
$442.07
|
| Rate for Payer: United Healthcare Commercial |
$1,881.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,683.85
|
|
|
CARBAMAZEPINE 200 MG TABLET [9411]
|
Facility
|
IP
|
$18.58
|
|
|
Service Code
|
NDC 6808444411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.21
|
| Rate for Payer: Aetna of WY Medicare |
$11.89
|
| Rate for Payer: Altius Commercial |
$17.84
|
| Rate for Payer: Beech Street Commercial |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.02
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.02
|
| Rate for Payer: Cigna of WY Commercial |
$18.21
|
| Rate for Payer: Entrust Commercial |
$17.65
|
| Rate for Payer: First Choice Health Commercial |
$17.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.33
|
| Rate for Payer: HealthUtah PPO |
$18.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.02
|
| Rate for Payer: Multiplan Medicare/VA |
$10.77
|
| Rate for Payer: One Health Plan of WY PPO |
$18.21
|
| Rate for Payer: PacificSource Commercial |
$16.72
|
| Rate for Payer: PHCS PPO |
$18.21
|
| Rate for Payer: Three Rivers PPO |
$13.94
|
| Rate for Payer: TriWest Veterans Administration |
$11.33
|
| Rate for Payer: United Healthcare Commercial |
$17.74
|
| Rate for Payer: United Healthcare Medicare |
$11.33
|
| Rate for Payer: WINHealth Partners Commercial |
$17.65
|
| Rate for Payer: Wise Provider Network Commercial |
$17.65
|
|
