|
CLTX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
27246
|
| Min. Negotiated Rate |
$324.57 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,349.46
|
| Rate for Payer: Aetna of WY Medicare |
$381.85
|
| Rate for Payer: Beech Street Commercial |
$1,308.15
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,335.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,349.46
|
| Rate for Payer: First Choice Health Commercial |
$1,239.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,308.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.85
|
| Rate for Payer: HealthUtah PPO |
$1,377.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,335.69
|
| Rate for Payer: Multiplan Medicare/VA |
$324.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,349.46
|
| Rate for Payer: PacificSource Commercial |
$1,239.30
|
| Rate for Payer: PHCS PPO |
$1,308.15
|
| Rate for Payer: Three Rivers PPO |
$1,032.75
|
| Rate for Payer: TriWest Veterans Administration |
$381.85
|
| Rate for Payer: United Healthcare Commercial |
$1,197.99
|
| Rate for Payer: United Healthcare Medicare |
$381.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,170.45
|
|
|
CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Professional
|
Both
|
$6,305.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
27252
|
| Min. Negotiated Rate |
$615.38 |
| Max. Negotiated Rate |
$6,305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,178.90
|
| Rate for Payer: Aetna of WY Medicare |
$723.98
|
| Rate for Payer: Beech Street Commercial |
$5,989.75
|
| Rate for Payer: Cash Price |
$4,413.50
|
| Rate for Payer: Cash Price |
$4,413.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,115.85
|
| Rate for Payer: Cigna of WY Commercial |
$6,178.90
|
| Rate for Payer: First Choice Health Commercial |
$5,674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,989.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$723.98
|
| Rate for Payer: HealthUtah PPO |
$6,305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,115.85
|
| Rate for Payer: Multiplan Medicare/VA |
$615.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,178.90
|
| Rate for Payer: PacificSource Commercial |
$5,674.50
|
| Rate for Payer: PHCS PPO |
$5,989.75
|
| Rate for Payer: Three Rivers PPO |
$4,728.75
|
| Rate for Payer: TriWest Veterans Administration |
$723.98
|
| Rate for Payer: United Healthcare Commercial |
$5,485.35
|
| Rate for Payer: United Healthcare Medicare |
$723.98
|
| Rate for Payer: WINHealth Partners Commercial |
$5,359.25
|
|
|
CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
24576
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$981.96
|
| Rate for Payer: Aetna of WY Medicare |
$317.32
|
| Rate for Payer: Beech Street Commercial |
$951.90
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$971.94
|
| Rate for Payer: Cigna of WY Commercial |
$981.96
|
| Rate for Payer: First Choice Health Commercial |
$901.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.32
|
| Rate for Payer: HealthUtah PPO |
$1,002.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$971.94
|
| Rate for Payer: Multiplan Medicare/VA |
$269.72
|
| Rate for Payer: One Health Plan of WY PPO |
$981.96
|
| Rate for Payer: PacificSource Commercial |
$901.80
|
| Rate for Payer: PHCS PPO |
$951.90
|
| Rate for Payer: Three Rivers PPO |
$751.50
|
| Rate for Payer: TriWest Veterans Administration |
$317.32
|
| Rate for Payer: United Healthcare Commercial |
$871.74
|
| Rate for Payer: United Healthcare Medicare |
$317.32
|
| Rate for Payer: WINHealth Partners Commercial |
$851.70
|
|
|
CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
24560
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.72
|
| Rate for Payer: Aetna of WY Medicare |
$297.51
|
| Rate for Payer: Beech Street Commercial |
$535.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$547.08
|
| Rate for Payer: Cigna of WY Commercial |
$552.72
|
| Rate for Payer: First Choice Health Commercial |
$507.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.51
|
| Rate for Payer: HealthUtah PPO |
$564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$547.08
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: One Health Plan of WY PPO |
$552.72
|
| Rate for Payer: PacificSource Commercial |
$507.60
|
| Rate for Payer: PHCS PPO |
$535.80
|
| Rate for Payer: Three Rivers PPO |
$423.00
|
| Rate for Payer: TriWest Veterans Administration |
$297.51
|
| Rate for Payer: United Healthcare Commercial |
$490.68
|
| Rate for Payer: United Healthcare Medicare |
$297.51
|
| Rate for Payer: WINHealth Partners Commercial |
$479.40
|
|
|
CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$2,318.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
24505
|
| Min. Negotiated Rate |
$382.28 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,271.64
|
| Rate for Payer: Aetna of WY Medicare |
$449.74
|
| Rate for Payer: Beech Street Commercial |
$2,202.10
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,248.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,271.64
|
| Rate for Payer: First Choice Health Commercial |
$2,086.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,202.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.74
|
| Rate for Payer: HealthUtah PPO |
$2,318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,248.46
|
| Rate for Payer: Multiplan Medicare/VA |
$382.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,271.64
|
| Rate for Payer: PacificSource Commercial |
$2,086.20
|
| Rate for Payer: PHCS PPO |
$2,202.10
|
| Rate for Payer: Three Rivers PPO |
$1,738.50
|
| Rate for Payer: TriWest Veterans Administration |
$449.74
|
| Rate for Payer: United Healthcare Commercial |
$2,016.66
|
| Rate for Payer: United Healthcare Medicare |
$449.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,970.30
|
|
|
CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
28660
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$458.64
|
| Rate for Payer: Aetna of WY Medicare |
$92.25
|
| Rate for Payer: Beech Street Commercial |
$444.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$453.96
|
| Rate for Payer: Cigna of WY Commercial |
$458.64
|
| Rate for Payer: First Choice Health Commercial |
$421.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.25
|
| Rate for Payer: HealthUtah PPO |
$468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$453.96
|
| Rate for Payer: Multiplan Medicare/VA |
$78.41
|
| Rate for Payer: One Health Plan of WY PPO |
$458.64
|
| Rate for Payer: PacificSource Commercial |
$421.20
|
| Rate for Payer: PHCS PPO |
$444.60
|
| Rate for Payer: Three Rivers PPO |
$351.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$407.16
|
| Rate for Payer: United Healthcare Medicare |
$92.25
|
| Rate for Payer: WINHealth Partners Commercial |
$397.80
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
26775
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,702.26
|
| Rate for Payer: Aetna of WY Medicare |
$356.81
|
| Rate for Payer: Beech Street Commercial |
$1,650.15
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,684.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,702.26
|
| Rate for Payer: First Choice Health Commercial |
$1,563.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,650.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.81
|
| Rate for Payer: HealthUtah PPO |
$1,737.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,684.89
|
| Rate for Payer: Multiplan Medicare/VA |
$303.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,702.26
|
| Rate for Payer: PacificSource Commercial |
$1,563.30
|
| Rate for Payer: PHCS PPO |
$1,650.15
|
| Rate for Payer: Three Rivers PPO |
$1,302.75
|
| Rate for Payer: TriWest Veterans Administration |
$356.81
|
| Rate for Payer: United Healthcare Commercial |
$1,511.19
|
| Rate for Payer: United Healthcare Medicare |
$356.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,476.45
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
26770
|
| Min. Negotiated Rate |
$225.11 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,021.16
|
| Rate for Payer: Aetna of WY Medicare |
$264.84
|
| Rate for Payer: Beech Street Commercial |
$989.90
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,010.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,021.16
|
| Rate for Payer: First Choice Health Commercial |
$937.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$989.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.84
|
| Rate for Payer: HealthUtah PPO |
$1,042.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,010.74
|
| Rate for Payer: Multiplan Medicare/VA |
$225.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,021.16
|
| Rate for Payer: PacificSource Commercial |
$937.80
|
| Rate for Payer: PHCS PPO |
$989.90
|
| Rate for Payer: Three Rivers PPO |
$781.50
|
| Rate for Payer: TriWest Veterans Administration |
$264.84
|
| Rate for Payer: United Healthcare Commercial |
$906.54
|
| Rate for Payer: United Healthcare Medicare |
$264.84
|
| Rate for Payer: WINHealth Partners Commercial |
$885.70
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
27760
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,549.38
|
| Rate for Payer: Aetna of WY Medicare |
$310.13
|
| Rate for Payer: Beech Street Commercial |
$1,501.95
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,533.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,549.38
|
| Rate for Payer: First Choice Health Commercial |
$1,422.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.13
|
| Rate for Payer: HealthUtah PPO |
$1,581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,533.57
|
| Rate for Payer: Multiplan Medicare/VA |
$263.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,549.38
|
| Rate for Payer: PacificSource Commercial |
$1,422.90
|
| Rate for Payer: PHCS PPO |
$1,501.95
|
| Rate for Payer: Three Rivers PPO |
$1,185.75
|
| Rate for Payer: TriWest Veterans Administration |
$310.13
|
| Rate for Payer: United Healthcare Commercial |
$1,375.47
|
| Rate for Payer: United Healthcare Medicare |
$310.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,343.85
|
|
|
CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
27762
|
| Min. Negotiated Rate |
$371.99 |
| Max. Negotiated Rate |
$2,236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,191.28
|
| Rate for Payer: Aetna of WY Medicare |
$437.63
|
| Rate for Payer: Beech Street Commercial |
$2,124.20
|
| Rate for Payer: Cash Price |
$1,565.20
|
| Rate for Payer: Cash Price |
$1,565.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,168.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,191.28
|
| Rate for Payer: First Choice Health Commercial |
$2,012.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,124.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.63
|
| Rate for Payer: HealthUtah PPO |
$2,236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,168.92
|
| Rate for Payer: Multiplan Medicare/VA |
$371.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,191.28
|
| Rate for Payer: PacificSource Commercial |
$2,012.40
|
| Rate for Payer: PHCS PPO |
$2,124.20
|
| Rate for Payer: Three Rivers PPO |
$1,677.00
|
| Rate for Payer: TriWest Veterans Administration |
$437.63
|
| Rate for Payer: United Healthcare Commercial |
$1,945.32
|
| Rate for Payer: United Healthcare Medicare |
$437.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.60
|
|
|
CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
26605
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,486.66
|
| Rate for Payer: Aetna of WY Medicare |
$299.81
|
| Rate for Payer: Beech Street Commercial |
$1,441.15
|
| Rate for Payer: Cash Price |
$1,061.90
|
| Rate for Payer: Cash Price |
$1,061.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,471.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,486.66
|
| Rate for Payer: First Choice Health Commercial |
$1,365.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,441.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.81
|
| Rate for Payer: HealthUtah PPO |
$1,517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,471.49
|
| Rate for Payer: Multiplan Medicare/VA |
$254.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,486.66
|
| Rate for Payer: PacificSource Commercial |
$1,365.30
|
| Rate for Payer: PHCS PPO |
$1,441.15
|
| Rate for Payer: Three Rivers PPO |
$1,137.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.81
|
| Rate for Payer: United Healthcare Commercial |
$1,319.79
|
| Rate for Payer: United Healthcare Medicare |
$299.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,289.45
|
|
|
CLTX METACARPAL FX W/O MANIPULATION EACH BONE
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
26600
|
| Min. Negotiated Rate |
$247.42 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.36
|
| Rate for Payer: Aetna of WY Medicare |
$291.08
|
| Rate for Payer: Beech Street Commercial |
$647.90
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.54
|
| Rate for Payer: Cigna of WY Commercial |
$668.36
|
| Rate for Payer: First Choice Health Commercial |
$613.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.08
|
| Rate for Payer: HealthUtah PPO |
$682.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.54
|
| Rate for Payer: Multiplan Medicare/VA |
$247.42
|
| Rate for Payer: One Health Plan of WY PPO |
$668.36
|
| Rate for Payer: PacificSource Commercial |
$613.80
|
| Rate for Payer: PHCS PPO |
$647.90
|
| Rate for Payer: Three Rivers PPO |
$511.50
|
| Rate for Payer: TriWest Veterans Administration |
$291.08
|
| Rate for Payer: United Healthcare Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare |
$291.08
|
| Rate for Payer: WINHealth Partners Commercial |
$579.70
|
|
|
CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
26700
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Aetna of WY Medicare |
$314.40
|
| Rate for Payer: Beech Street Commercial |
$1,159.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: First Choice Health Commercial |
$1,098.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.40
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,159.00
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$314.40
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$314.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,037.00
|
|
|
CLTX METAR FX W/MANJ
|
Professional
|
Both
|
$1,172.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
28475
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$1,172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,148.56
|
| Rate for Payer: Aetna of WY Medicare |
$228.67
|
| Rate for Payer: Beech Street Commercial |
$1,113.40
|
| Rate for Payer: Cash Price |
$820.40
|
| Rate for Payer: Cash Price |
$820.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,136.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,148.56
|
| Rate for Payer: First Choice Health Commercial |
$1,054.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,113.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.67
|
| Rate for Payer: HealthUtah PPO |
$1,172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,136.84
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,148.56
|
| Rate for Payer: PacificSource Commercial |
$1,054.80
|
| Rate for Payer: PHCS PPO |
$1,113.40
|
| Rate for Payer: Three Rivers PPO |
$879.00
|
| Rate for Payer: TriWest Veterans Administration |
$228.67
|
| Rate for Payer: United Healthcare Commercial |
$1,019.64
|
| Rate for Payer: United Healthcare Medicare |
$228.67
|
| Rate for Payer: WINHealth Partners Commercial |
$996.20
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
28630
|
| Min. Negotiated Rate |
$91.83 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$561.54
|
| Rate for Payer: Aetna of WY Medicare |
$108.04
|
| Rate for Payer: Beech Street Commercial |
$544.35
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.81
|
| Rate for Payer: Cigna of WY Commercial |
$561.54
|
| Rate for Payer: First Choice Health Commercial |
$515.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$544.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.04
|
| Rate for Payer: HealthUtah PPO |
$573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.81
|
| Rate for Payer: Multiplan Medicare/VA |
$91.83
|
| Rate for Payer: One Health Plan of WY PPO |
$561.54
|
| Rate for Payer: PacificSource Commercial |
$515.70
|
| Rate for Payer: PHCS PPO |
$544.35
|
| Rate for Payer: Three Rivers PPO |
$429.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.04
|
| Rate for Payer: United Healthcare Commercial |
$498.51
|
| Rate for Payer: United Healthcare Medicare |
$108.04
|
| Rate for Payer: WINHealth Partners Commercial |
$487.05
|
|
|
CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
26725
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,206.38
|
| Rate for Payer: Aetna of WY Medicare |
$306.16
|
| Rate for Payer: Beech Street Commercial |
$1,169.45
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,194.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,206.38
|
| Rate for Payer: First Choice Health Commercial |
$1,107.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,169.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.16
|
| Rate for Payer: HealthUtah PPO |
$1,231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,194.07
|
| Rate for Payer: Multiplan Medicare/VA |
$260.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,206.38
|
| Rate for Payer: PacificSource Commercial |
$1,107.90
|
| Rate for Payer: PHCS PPO |
$1,169.45
|
| Rate for Payer: Three Rivers PPO |
$923.25
|
| Rate for Payer: TriWest Veterans Administration |
$306.16
|
| Rate for Payer: United Healthcare Commercial |
$1,070.97
|
| Rate for Payer: United Healthcare Medicare |
$306.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,046.35
|
|
|
CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
26720
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.88
|
| Rate for Payer: Aetna of WY Medicare |
$192.49
|
| Rate for Payer: Beech Street Commercial |
$908.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: Cash Price |
$669.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$927.32
|
| Rate for Payer: Cigna of WY Commercial |
$936.88
|
| Rate for Payer: First Choice Health Commercial |
$860.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$908.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.49
|
| Rate for Payer: HealthUtah PPO |
$956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$927.32
|
| Rate for Payer: Multiplan Medicare/VA |
$163.62
|
| Rate for Payer: One Health Plan of WY PPO |
$936.88
|
| Rate for Payer: PacificSource Commercial |
$860.40
|
| Rate for Payer: PHCS PPO |
$908.20
|
| Rate for Payer: Three Rivers PPO |
$717.00
|
| Rate for Payer: TriWest Veterans Administration |
$192.49
|
| Rate for Payer: United Healthcare Commercial |
$831.72
|
| Rate for Payer: United Healthcare Medicare |
$192.49
|
| Rate for Payer: WINHealth Partners Commercial |
$812.60
|
|
|
CLTX POST HIP ARTHRP DISLC REQ ANES
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
27266
|
| Min. Negotiated Rate |
$483.59 |
| Max. Negotiated Rate |
$3,005.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,944.90
|
| Rate for Payer: Aetna of WY Medicare |
$568.93
|
| Rate for Payer: Beech Street Commercial |
$2,854.75
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: Cash Price |
$2,103.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,914.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,944.90
|
| Rate for Payer: First Choice Health Commercial |
$2,704.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,854.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.93
|
| Rate for Payer: HealthUtah PPO |
$3,005.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,914.85
|
| Rate for Payer: Multiplan Medicare/VA |
$483.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,944.90
|
| Rate for Payer: PacificSource Commercial |
$2,704.50
|
| Rate for Payer: PHCS PPO |
$2,854.75
|
| Rate for Payer: Three Rivers PPO |
$2,253.75
|
| Rate for Payer: TriWest Veterans Administration |
$568.93
|
| Rate for Payer: United Healthcare Commercial |
$2,614.35
|
| Rate for Payer: United Healthcare Medicare |
$568.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,554.25
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
27265
|
| Min. Negotiated Rate |
$350.97 |
| Max. Negotiated Rate |
$2,086.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,044.28
|
| Rate for Payer: Aetna of WY Medicare |
$412.91
|
| Rate for Payer: Beech Street Commercial |
$1,981.70
|
| Rate for Payer: Cash Price |
$1,460.20
|
| Rate for Payer: Cash Price |
$1,460.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,023.42
|
| Rate for Payer: Cigna of WY Commercial |
$2,044.28
|
| Rate for Payer: First Choice Health Commercial |
$1,877.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,981.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.91
|
| Rate for Payer: HealthUtah PPO |
$2,086.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,023.42
|
| Rate for Payer: Multiplan Medicare/VA |
$350.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,044.28
|
| Rate for Payer: PacificSource Commercial |
$1,877.40
|
| Rate for Payer: PHCS PPO |
$1,981.70
|
| Rate for Payer: Three Rivers PPO |
$1,564.50
|
| Rate for Payer: TriWest Veterans Administration |
$412.91
|
| Rate for Payer: United Healthcare Commercial |
$1,814.82
|
| Rate for Payer: United Healthcare Medicare |
$412.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,773.10
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$2,902.00
|
|
|
Service Code
|
HCPCS 27780 50
|
| Hospital Charge Code |
27780
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,843.96
|
| Rate for Payer: Aetna of WY Medicare |
$287.46
|
| Rate for Payer: Beech Street Commercial |
$2,756.90
|
| Rate for Payer: Cash Price |
$2,031.40
|
| Rate for Payer: Cash Price |
$2,031.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,814.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,843.96
|
| Rate for Payer: First Choice Health Commercial |
$2,611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.46
|
| Rate for Payer: HealthUtah PPO |
$2,902.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,814.94
|
| Rate for Payer: Multiplan Medicare/VA |
$244.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,843.96
|
| Rate for Payer: PacificSource Commercial |
$2,611.80
|
| Rate for Payer: PHCS PPO |
$2,756.90
|
| Rate for Payer: Three Rivers PPO |
$2,176.50
|
| Rate for Payer: TriWest Veterans Administration |
$287.46
|
| Rate for Payer: United Healthcare Commercial |
$2,524.74
|
| Rate for Payer: United Healthcare Medicare |
$287.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,466.70
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
27780
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Aetna of WY Medicare |
$287.46
|
| Rate for Payer: Beech Street Commercial |
$1,378.45
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: First Choice Health Commercial |
$1,305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.46
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$244.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PHCS PPO |
$1,378.45
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.46
|
| Rate for Payer: United Healthcare Commercial |
$1,262.37
|
| Rate for Payer: United Healthcare Medicare |
$287.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,233.35
|
|
|
CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$2,182.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
23605
|
| Min. Negotiated Rate |
$361.43 |
| Max. Negotiated Rate |
$2,182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,138.36
|
| Rate for Payer: Aetna of WY Medicare |
$425.21
|
| Rate for Payer: Beech Street Commercial |
$2,072.90
|
| Rate for Payer: Cash Price |
$1,527.40
|
| Rate for Payer: Cash Price |
$1,527.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,116.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,138.36
|
| Rate for Payer: First Choice Health Commercial |
$1,963.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,072.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.21
|
| Rate for Payer: HealthUtah PPO |
$2,182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,116.54
|
| Rate for Payer: Multiplan Medicare/VA |
$361.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,138.36
|
| Rate for Payer: PacificSource Commercial |
$1,963.80
|
| Rate for Payer: PHCS PPO |
$2,072.90
|
| Rate for Payer: Three Rivers PPO |
$1,636.50
|
| Rate for Payer: TriWest Veterans Administration |
$425.21
|
| Rate for Payer: United Healthcare Commercial |
$1,898.34
|
| Rate for Payer: United Healthcare Medicare |
$425.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,854.70
|
|
|
CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
23600
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,517.04
|
| Rate for Payer: Aetna of WY Medicare |
$319.45
|
| Rate for Payer: Beech Street Commercial |
$1,470.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,501.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,517.04
|
| Rate for Payer: First Choice Health Commercial |
$1,393.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,470.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.45
|
| Rate for Payer: HealthUtah PPO |
$1,548.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,501.56
|
| Rate for Payer: Multiplan Medicare/VA |
$271.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,517.04
|
| Rate for Payer: PacificSource Commercial |
$1,393.20
|
| Rate for Payer: PHCS PPO |
$1,470.60
|
| Rate for Payer: Three Rivers PPO |
$1,161.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.45
|
| Rate for Payer: United Healthcare Commercial |
$1,346.76
|
| Rate for Payer: United Healthcare Medicare |
$319.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,315.80
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
24640
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.47
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.47
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.70
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.47
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$78.47
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
|
|
CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Professional
|
Both
|
$2,907.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
25520
|
| Min. Negotiated Rate |
$458.97 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,848.86
|
| Rate for Payer: Aetna of WY Medicare |
$539.96
|
| Rate for Payer: Beech Street Commercial |
$2,761.65
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,819.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,848.86
|
| Rate for Payer: First Choice Health Commercial |
$2,616.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,761.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.96
|
| Rate for Payer: HealthUtah PPO |
$2,907.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,819.79
|
| Rate for Payer: Multiplan Medicare/VA |
$458.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,848.86
|
| Rate for Payer: PacificSource Commercial |
$2,616.30
|
| Rate for Payer: PHCS PPO |
$2,761.65
|
| Rate for Payer: Three Rivers PPO |
$2,180.25
|
| Rate for Payer: TriWest Veterans Administration |
$539.96
|
| Rate for Payer: United Healthcare Commercial |
$2,529.09
|
| Rate for Payer: United Healthcare Medicare |
$539.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.95
|
|
