|
CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
27788
|
| Min. Negotiated Rate |
$325.99 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Aetna of WY Medicare |
$383.52
|
| Rate for Payer: Beech Street Commercial |
$1,889.55
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: First Choice Health Commercial |
$1,790.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.52
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$325.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PHCS PPO |
$1,889.55
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$383.52
|
| Rate for Payer: United Healthcare Commercial |
$1,730.43
|
| Rate for Payer: United Healthcare Medicare |
$383.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,690.65
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 27786 80
|
| Hospital Charge Code |
27786
|
| Min. Negotiated Rate |
$245.74 |
| Max. Negotiated Rate |
$1,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,451.38
|
| Rate for Payer: Aetna of WY Medicare |
$289.10
|
| Rate for Payer: Beech Street Commercial |
$1,406.95
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,436.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,451.38
|
| Rate for Payer: First Choice Health Commercial |
$1,332.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.10
|
| Rate for Payer: HealthUtah PPO |
$1,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,436.57
|
| Rate for Payer: Multiplan Medicare/VA |
$245.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,451.38
|
| Rate for Payer: PacificSource Commercial |
$1,332.90
|
| Rate for Payer: PHCS PPO |
$1,406.95
|
| Rate for Payer: Three Rivers PPO |
$1,110.75
|
| Rate for Payer: TriWest Veterans Administration |
$289.10
|
| Rate for Payer: United Healthcare Commercial |
$1,288.47
|
| Rate for Payer: United Healthcare Medicare |
$289.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,258.85
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
27786
|
| Min. Negotiated Rate |
$245.74 |
| Max. Negotiated Rate |
$1,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,451.38
|
| Rate for Payer: Aetna of WY Medicare |
$289.10
|
| Rate for Payer: Beech Street Commercial |
$1,406.95
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,436.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,451.38
|
| Rate for Payer: First Choice Health Commercial |
$1,332.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.10
|
| Rate for Payer: HealthUtah PPO |
$1,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,436.57
|
| Rate for Payer: Multiplan Medicare/VA |
$245.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,451.38
|
| Rate for Payer: PacificSource Commercial |
$1,332.90
|
| Rate for Payer: PHCS PPO |
$1,406.95
|
| Rate for Payer: Three Rivers PPO |
$1,110.75
|
| Rate for Payer: TriWest Veterans Administration |
$289.10
|
| Rate for Payer: United Healthcare Commercial |
$1,288.47
|
| Rate for Payer: United Healthcare Medicare |
$289.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,258.85
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
26755
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$861.42
|
| Rate for Payer: Aetna of WY Medicare |
$275.15
|
| Rate for Payer: Beech Street Commercial |
$835.05
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$852.63
|
| Rate for Payer: Cigna of WY Commercial |
$861.42
|
| Rate for Payer: First Choice Health Commercial |
$791.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.15
|
| Rate for Payer: HealthUtah PPO |
$879.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$852.63
|
| Rate for Payer: Multiplan Medicare/VA |
$233.88
|
| Rate for Payer: One Health Plan of WY PPO |
$861.42
|
| Rate for Payer: PacificSource Commercial |
$791.10
|
| Rate for Payer: PHCS PPO |
$835.05
|
| Rate for Payer: Three Rivers PPO |
$659.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.15
|
| Rate for Payer: United Healthcare Commercial |
$764.73
|
| Rate for Payer: United Healthcare Medicare |
$275.15
|
| Rate for Payer: WINHealth Partners Commercial |
$747.15
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
26750
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$913.36
|
| Rate for Payer: Aetna of WY Medicare |
$193.47
|
| Rate for Payer: Beech Street Commercial |
$885.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$904.04
|
| Rate for Payer: Cigna of WY Commercial |
$913.36
|
| Rate for Payer: First Choice Health Commercial |
$838.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$885.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.47
|
| Rate for Payer: HealthUtah PPO |
$932.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$904.04
|
| Rate for Payer: Multiplan Medicare/VA |
$164.45
|
| Rate for Payer: One Health Plan of WY PPO |
$913.36
|
| Rate for Payer: PacificSource Commercial |
$838.80
|
| Rate for Payer: PHCS PPO |
$885.40
|
| Rate for Payer: Three Rivers PPO |
$699.00
|
| Rate for Payer: TriWest Veterans Administration |
$193.47
|
| Rate for Payer: United Healthcare Commercial |
$810.84
|
| Rate for Payer: United Healthcare Medicare |
$193.47
|
| Rate for Payer: WINHealth Partners Commercial |
$792.20
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
25600
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,204.42
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$1,167.55
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,192.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,204.42
|
| Rate for Payer: First Choice Health Commercial |
$1,106.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,167.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$1,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,192.13
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,204.42
|
| Rate for Payer: PacificSource Commercial |
$1,106.10
|
| Rate for Payer: PHCS PPO |
$1,167.55
|
| Rate for Payer: Three Rivers PPO |
$921.75
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$1,069.23
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,044.65
|
|
|
CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 25600 50
|
| Hospital Charge Code |
25600
|
| Min. Negotiated Rate |
$279.41 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,407.86
|
| Rate for Payer: Aetna of WY Medicare |
$328.72
|
| Rate for Payer: Beech Street Commercial |
$2,334.15
|
| Rate for Payer: Cash Price |
$1,719.90
|
| Rate for Payer: Cash Price |
$1,719.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,383.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,407.86
|
| Rate for Payer: First Choice Health Commercial |
$2,211.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,334.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.72
|
| Rate for Payer: HealthUtah PPO |
$2,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,383.29
|
| Rate for Payer: Multiplan Medicare/VA |
$279.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,407.86
|
| Rate for Payer: PacificSource Commercial |
$2,211.30
|
| Rate for Payer: PHCS PPO |
$2,334.15
|
| Rate for Payer: Three Rivers PPO |
$1,842.75
|
| Rate for Payer: TriWest Veterans Administration |
$328.72
|
| Rate for Payer: United Healthcare Commercial |
$2,137.59
|
| Rate for Payer: United Healthcare Medicare |
$328.72
|
| Rate for Payer: WINHealth Partners Commercial |
$2,088.45
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$3,842.00
|
|
|
Service Code
|
HCPCS 25605 50
|
| Hospital Charge Code |
25605
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$3,842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,765.16
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$3,649.90
|
| Rate for Payer: Cash Price |
$2,689.40
|
| Rate for Payer: Cash Price |
$2,689.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,726.74
|
| Rate for Payer: Cigna of WY Commercial |
$3,765.16
|
| Rate for Payer: First Choice Health Commercial |
$3,457.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,649.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$3,842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,726.74
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$3,765.16
|
| Rate for Payer: PacificSource Commercial |
$3,457.80
|
| Rate for Payer: PHCS PPO |
$3,649.90
|
| Rate for Payer: Three Rivers PPO |
$2,881.50
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$3,342.54
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,265.70
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,921.00
|
|
|
Service Code
|
HCPCS 25605 80
|
| Hospital Charge Code |
25605
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,882.58
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$1,824.95
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,863.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,882.58
|
| Rate for Payer: First Choice Health Commercial |
$1,728.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,824.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$1,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,863.37
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,882.58
|
| Rate for Payer: PacificSource Commercial |
$1,728.90
|
| Rate for Payer: PHCS PPO |
$1,824.95
|
| Rate for Payer: Three Rivers PPO |
$1,440.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$1,671.27
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,632.85
|
|
|
CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,921.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
25605
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,882.58
|
| Rate for Payer: Aetna of WY Medicare |
$507.07
|
| Rate for Payer: Beech Street Commercial |
$1,824.95
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,863.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,882.58
|
| Rate for Payer: First Choice Health Commercial |
$1,728.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,824.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.07
|
| Rate for Payer: HealthUtah PPO |
$1,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,863.37
|
| Rate for Payer: Multiplan Medicare/VA |
$431.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,882.58
|
| Rate for Payer: PacificSource Commercial |
$1,728.90
|
| Rate for Payer: PHCS PPO |
$1,824.95
|
| Rate for Payer: Three Rivers PPO |
$1,440.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.07
|
| Rate for Payer: United Healthcare Commercial |
$1,671.27
|
| Rate for Payer: United Healthcare Medicare |
$507.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,632.85
|
|
|
CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
26432
|
| Min. Negotiated Rate |
$1,983.00 |
| Max. Negotiated Rate |
$2,644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,591.12
|
| Rate for Payer: Beech Street Commercial |
$2,511.80
|
| Rate for Payer: Cash Price |
$1,850.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,564.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,591.12
|
| Rate for Payer: First Choice Health Commercial |
$2,379.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,511.80
|
| Rate for Payer: HealthUtah PPO |
$2,644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,564.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,591.12
|
| Rate for Payer: PacificSource Commercial |
$2,379.60
|
| Rate for Payer: PHCS PPO |
$2,511.80
|
| Rate for Payer: Three Rivers PPO |
$1,983.00
|
| Rate for Payer: United Healthcare Commercial |
$2,300.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,247.40
|
|
|
CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$3,508.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
27510
|
| Min. Negotiated Rate |
$563.13 |
| Max. Negotiated Rate |
$3,508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,437.84
|
| Rate for Payer: Aetna of WY Medicare |
$662.51
|
| Rate for Payer: Beech Street Commercial |
$3,332.60
|
| Rate for Payer: Cash Price |
$2,455.60
|
| Rate for Payer: Cash Price |
$2,455.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,402.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,437.84
|
| Rate for Payer: First Choice Health Commercial |
$3,157.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,332.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.51
|
| Rate for Payer: HealthUtah PPO |
$3,508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,402.76
|
| Rate for Payer: Multiplan Medicare/VA |
$563.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3,437.84
|
| Rate for Payer: PacificSource Commercial |
$3,157.20
|
| Rate for Payer: PHCS PPO |
$3,332.60
|
| Rate for Payer: Three Rivers PPO |
$2,631.00
|
| Rate for Payer: TriWest Veterans Administration |
$662.51
|
| Rate for Payer: United Healthcare Commercial |
$3,051.96
|
| Rate for Payer: United Healthcare Medicare |
$662.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,981.80
|
|
|
CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
27508
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,508.80
|
| Rate for Payer: Aetna of WY Medicare |
$491.29
|
| Rate for Payer: Beech Street Commercial |
$2,432.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,483.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,508.80
|
| Rate for Payer: First Choice Health Commercial |
$2,304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,432.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.29
|
| Rate for Payer: HealthUtah PPO |
$2,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,483.20
|
| Rate for Payer: Multiplan Medicare/VA |
$417.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,508.80
|
| Rate for Payer: PacificSource Commercial |
$2,304.00
|
| Rate for Payer: PHCS PPO |
$2,432.00
|
| Rate for Payer: Three Rivers PPO |
$1,920.00
|
| Rate for Payer: TriWest Veterans Administration |
$491.29
|
| Rate for Payer: United Healthcare Commercial |
$2,227.20
|
| Rate for Payer: United Healthcare Medicare |
$491.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,176.00
|
|
|
CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
27230
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$2,449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,400.02
|
| Rate for Payer: Aetna of WY Medicare |
$471.98
|
| Rate for Payer: Beech Street Commercial |
$2,326.55
|
| Rate for Payer: Cash Price |
$1,714.30
|
| Rate for Payer: Cash Price |
$1,714.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,375.53
|
| Rate for Payer: Cigna of WY Commercial |
$2,400.02
|
| Rate for Payer: First Choice Health Commercial |
$2,204.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,326.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.98
|
| Rate for Payer: HealthUtah PPO |
$2,449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,375.53
|
| Rate for Payer: Multiplan Medicare/VA |
$401.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,400.02
|
| Rate for Payer: PacificSource Commercial |
$2,204.10
|
| Rate for Payer: PHCS PPO |
$2,326.55
|
| Rate for Payer: Three Rivers PPO |
$1,836.75
|
| Rate for Payer: TriWest Veterans Administration |
$471.98
|
| Rate for Payer: United Healthcare Commercial |
$2,130.63
|
| Rate for Payer: United Healthcare Medicare |
$471.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,081.65
|
|
|
CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$3,918.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
27502
|
| Min. Negotiated Rate |
$618.98 |
| Max. Negotiated Rate |
$3,918.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,839.64
|
| Rate for Payer: Aetna of WY Medicare |
$728.21
|
| Rate for Payer: Beech Street Commercial |
$3,722.10
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,800.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,839.64
|
| Rate for Payer: First Choice Health Commercial |
$3,526.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,722.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.21
|
| Rate for Payer: HealthUtah PPO |
$3,918.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,800.46
|
| Rate for Payer: Multiplan Medicare/VA |
$618.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,839.64
|
| Rate for Payer: PacificSource Commercial |
$3,526.20
|
| Rate for Payer: PHCS PPO |
$3,722.10
|
| Rate for Payer: Three Rivers PPO |
$2,938.50
|
| Rate for Payer: TriWest Veterans Administration |
$728.21
|
| Rate for Payer: United Healthcare Commercial |
$3,408.66
|
| Rate for Payer: United Healthcare Medicare |
$728.21
|
| Rate for Payer: WINHealth Partners Commercial |
$3,330.30
|
|
|
CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
28495
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$748.72
|
| Rate for Payer: Aetna of WY Medicare |
$149.65
|
| Rate for Payer: Beech Street Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$534.80
|
| Rate for Payer: Cash Price |
$534.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$741.08
|
| Rate for Payer: Cigna of WY Commercial |
$748.72
|
| Rate for Payer: First Choice Health Commercial |
$687.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$725.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.65
|
| Rate for Payer: HealthUtah PPO |
$764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$741.08
|
| Rate for Payer: Multiplan Medicare/VA |
$127.20
|
| Rate for Payer: One Health Plan of WY PPO |
$748.72
|
| Rate for Payer: PacificSource Commercial |
$687.60
|
| Rate for Payer: PHCS PPO |
$725.80
|
| Rate for Payer: Three Rivers PPO |
$573.00
|
| Rate for Payer: TriWest Veterans Administration |
$149.65
|
| Rate for Payer: United Healthcare Commercial |
$664.68
|
| Rate for Payer: United Healthcare Medicare |
$149.65
|
| Rate for Payer: WINHealth Partners Commercial |
$649.40
|
|
|
CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
28490
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$626.22
|
| Rate for Payer: Aetna of WY Medicare |
$125.35
|
| Rate for Payer: Beech Street Commercial |
$607.05
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$619.83
|
| Rate for Payer: Cigna of WY Commercial |
$626.22
|
| Rate for Payer: First Choice Health Commercial |
$575.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$607.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.35
|
| Rate for Payer: HealthUtah PPO |
$639.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$619.83
|
| Rate for Payer: Multiplan Medicare/VA |
$106.55
|
| Rate for Payer: One Health Plan of WY PPO |
$626.22
|
| Rate for Payer: PacificSource Commercial |
$575.10
|
| Rate for Payer: PHCS PPO |
$607.05
|
| Rate for Payer: Three Rivers PPO |
$479.25
|
| Rate for Payer: TriWest Veterans Administration |
$125.35
|
| Rate for Payer: United Healthcare Commercial |
$555.93
|
| Rate for Payer: United Healthcare Medicare |
$125.35
|
| Rate for Payer: WINHealth Partners Commercial |
$543.15
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
28515
|
| Min. Negotiated Rate |
$122.62 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Aetna of WY Medicare |
$144.26
|
| Rate for Payer: Beech Street Commercial |
$698.25
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: First Choice Health Commercial |
$661.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.26
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$122.62
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$698.25
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.26
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$144.26
|
| Rate for Payer: WINHealth Partners Commercial |
$624.75
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
28510
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$604.66
|
| Rate for Payer: Aetna of WY Medicare |
$121.59
|
| Rate for Payer: Beech Street Commercial |
$586.15
|
| Rate for Payer: Cash Price |
$431.90
|
| Rate for Payer: Cash Price |
$431.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$598.49
|
| Rate for Payer: Cigna of WY Commercial |
$604.66
|
| Rate for Payer: First Choice Health Commercial |
$555.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$586.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.59
|
| Rate for Payer: HealthUtah PPO |
$617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$598.49
|
| Rate for Payer: Multiplan Medicare/VA |
$103.35
|
| Rate for Payer: One Health Plan of WY PPO |
$604.66
|
| Rate for Payer: PacificSource Commercial |
$555.30
|
| Rate for Payer: PHCS PPO |
$586.15
|
| Rate for Payer: Three Rivers PPO |
$462.75
|
| Rate for Payer: TriWest Veterans Administration |
$121.59
|
| Rate for Payer: United Healthcare Commercial |
$536.79
|
| Rate for Payer: United Healthcare Medicare |
$121.59
|
| Rate for Payer: WINHealth Partners Commercial |
$524.45
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
27824
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,537.62
|
| Rate for Payer: Aetna of WY Medicare |
$306.18
|
| Rate for Payer: Beech Street Commercial |
$1,490.55
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,521.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,537.62
|
| Rate for Payer: First Choice Health Commercial |
$1,412.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,490.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.18
|
| Rate for Payer: HealthUtah PPO |
$1,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,521.93
|
| Rate for Payer: Multiplan Medicare/VA |
$260.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,537.62
|
| Rate for Payer: PacificSource Commercial |
$1,412.10
|
| Rate for Payer: PHCS PPO |
$1,490.55
|
| Rate for Payer: Three Rivers PPO |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.18
|
| Rate for Payer: United Healthcare Commercial |
$1,365.03
|
| Rate for Payer: United Healthcare Medicare |
$306.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,333.65
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$5,097.00
|
|
|
Service Code
|
HCPCS 27825 50
|
| Hospital Charge Code |
27825
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$5,097.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,995.06
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$4,842.15
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,944.09
|
| Rate for Payer: Cigna of WY Commercial |
$4,995.06
|
| Rate for Payer: First Choice Health Commercial |
$4,587.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,842.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$5,097.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,944.09
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,995.06
|
| Rate for Payer: PacificSource Commercial |
$4,587.30
|
| Rate for Payer: PHCS PPO |
$4,842.15
|
| Rate for Payer: Three Rivers PPO |
$3,822.75
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$4,434.39
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4,332.45
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,548.00
|
|
|
Service Code
|
HCPCS 27825 AS
|
| Hospital Charge Code |
27825
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,497.04
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,471.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,497.04
|
| Rate for Payer: First Choice Health Commercial |
$2,293.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,420.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,471.56
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,497.04
|
| Rate for Payer: PacificSource Commercial |
$2,293.20
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,911.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$2,216.76
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,165.80
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,548.00
|
|
|
Service Code
|
HCPCS 27825 80
|
| Hospital Charge Code |
27825
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,497.04
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,471.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,497.04
|
| Rate for Payer: First Choice Health Commercial |
$2,293.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,420.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,471.56
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,497.04
|
| Rate for Payer: PacificSource Commercial |
$2,293.20
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,911.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$2,216.76
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,165.80
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,548.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
27825
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,497.04
|
| Rate for Payer: Aetna of WY Medicare |
$484.14
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: Cash Price |
$1,783.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,471.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,497.04
|
| Rate for Payer: First Choice Health Commercial |
$2,293.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,420.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.14
|
| Rate for Payer: HealthUtah PPO |
$2,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,471.56
|
| Rate for Payer: Multiplan Medicare/VA |
$411.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,497.04
|
| Rate for Payer: PacificSource Commercial |
$2,293.20
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,911.00
|
| Rate for Payer: TriWest Veterans Administration |
$484.14
|
| Rate for Payer: United Healthcare Commercial |
$2,216.76
|
| Rate for Payer: United Healthcare Medicare |
$484.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,165.80
|
|
|
CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
23620
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,259.30
|
| Rate for Payer: Aetna of WY Medicare |
$262.59
|
| Rate for Payer: Beech Street Commercial |
$1,220.75
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: Cash Price |
$899.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,246.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,259.30
|
| Rate for Payer: First Choice Health Commercial |
$1,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,220.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.59
|
| Rate for Payer: HealthUtah PPO |
$1,285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,246.45
|
| Rate for Payer: Multiplan Medicare/VA |
$223.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,259.30
|
| Rate for Payer: PacificSource Commercial |
$1,156.50
|
| Rate for Payer: PHCS PPO |
$1,220.75
|
| Rate for Payer: Three Rivers PPO |
$963.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.59
|
| Rate for Payer: United Healthcare Commercial |
$1,117.95
|
| Rate for Payer: United Healthcare Medicare |
$262.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,092.25
|
|
