|
CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Professional
|
Both
|
$1,963.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
23575
|
| Min. Negotiated Rate |
$322.59 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,923.74
|
| Rate for Payer: Aetna of WY Medicare |
$379.52
|
| Rate for Payer: Beech Street Commercial |
$1,864.85
|
| Rate for Payer: Cash Price |
$1,374.10
|
| Rate for Payer: Cash Price |
$1,374.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,904.11
|
| Rate for Payer: Cigna of WY Commercial |
$1,923.74
|
| Rate for Payer: First Choice Health Commercial |
$1,766.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,864.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.52
|
| Rate for Payer: HealthUtah PPO |
$1,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,904.11
|
| Rate for Payer: Multiplan Medicare/VA |
$322.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,923.74
|
| Rate for Payer: PacificSource Commercial |
$1,766.70
|
| Rate for Payer: PHCS PPO |
$1,864.85
|
| Rate for Payer: Three Rivers PPO |
$1,472.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.52
|
| Rate for Payer: United Healthcare Commercial |
$1,707.81
|
| Rate for Payer: United Healthcare Medicare |
$379.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,668.55
|
|
|
CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
23665
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$1,973.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,933.54
|
| Rate for Payer: Aetna of WY Medicare |
$399.70
|
| Rate for Payer: Beech Street Commercial |
$1,874.35
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,913.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,933.54
|
| Rate for Payer: First Choice Health Commercial |
$1,775.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,874.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.70
|
| Rate for Payer: HealthUtah PPO |
$1,973.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,913.81
|
| Rate for Payer: Multiplan Medicare/VA |
$339.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,933.54
|
| Rate for Payer: PacificSource Commercial |
$1,775.70
|
| Rate for Payer: PHCS PPO |
$1,874.35
|
| Rate for Payer: Three Rivers PPO |
$1,479.75
|
| Rate for Payer: TriWest Veterans Administration |
$399.70
|
| Rate for Payer: United Healthcare Commercial |
$1,716.51
|
| Rate for Payer: United Healthcare Medicare |
$399.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,677.05
|
|
|
CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MNPJ
|
Professional
|
Both
|
$2,499.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
23675
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$497.25
|
| Rate for Payer: Beech Street Commercial |
$2,374.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: First Choice Health Commercial |
$2,249.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$497.25
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$422.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,374.05
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$2,174.13
|
| Rate for Payer: United Healthcare Medicare |
$497.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,124.15
|
|
|
CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Professional
|
Both
|
$2,925.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
24535
|
| Min. Negotiated Rate |
$481.47 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,866.50
|
| Rate for Payer: Aetna of WY Medicare |
$566.44
|
| Rate for Payer: Beech Street Commercial |
$2,778.75
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,837.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,866.50
|
| Rate for Payer: First Choice Health Commercial |
$2,632.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,778.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.44
|
| Rate for Payer: HealthUtah PPO |
$2,925.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,837.25
|
| Rate for Payer: Multiplan Medicare/VA |
$481.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,866.50
|
| Rate for Payer: PacificSource Commercial |
$2,632.50
|
| Rate for Payer: PHCS PPO |
$2,778.75
|
| Rate for Payer: Three Rivers PPO |
$2,193.75
|
| Rate for Payer: TriWest Veterans Administration |
$566.44
|
| Rate for Payer: United Healthcare Commercial |
$2,544.75
|
| Rate for Payer: United Healthcare Medicare |
$566.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.25
|
|
|
CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
24530
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,749.30
|
| Rate for Payer: Aetna of WY Medicare |
$353.53
|
| Rate for Payer: Beech Street Commercial |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,731.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,749.30
|
| Rate for Payer: First Choice Health Commercial |
$1,606.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,695.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.53
|
| Rate for Payer: HealthUtah PPO |
$1,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,731.45
|
| Rate for Payer: Multiplan Medicare/VA |
$300.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,749.30
|
| Rate for Payer: PacificSource Commercial |
$1,606.50
|
| Rate for Payer: PHCS PPO |
$1,695.75
|
| Rate for Payer: Three Rivers PPO |
$1,338.75
|
| Rate for Payer: TriWest Veterans Administration |
$353.53
|
| Rate for Payer: United Healthcare Commercial |
$1,552.95
|
| Rate for Payer: United Healthcare Medicare |
$353.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,517.25
|
|
|
CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$2,567.00
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
27501
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$2,567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,515.66
|
| Rate for Payer: Aetna of WY Medicare |
$488.15
|
| Rate for Payer: Beech Street Commercial |
$2,438.65
|
| Rate for Payer: Cash Price |
$1,796.90
|
| Rate for Payer: Cash Price |
$1,796.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,489.99
|
| Rate for Payer: Cigna of WY Commercial |
$2,515.66
|
| Rate for Payer: First Choice Health Commercial |
$2,310.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,438.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$488.15
|
| Rate for Payer: HealthUtah PPO |
$2,567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,489.99
|
| Rate for Payer: Multiplan Medicare/VA |
$414.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,515.66
|
| Rate for Payer: PacificSource Commercial |
$2,310.30
|
| Rate for Payer: PHCS PPO |
$2,438.65
|
| Rate for Payer: Three Rivers PPO |
$1,925.25
|
| Rate for Payer: TriWest Veterans Administration |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$2,233.29
|
| Rate for Payer: United Healthcare Medicare |
$488.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,181.95
|
|
|
CLTX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
27530
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,434.72
|
| Rate for Payer: Aetna of WY Medicare |
$292.22
|
| Rate for Payer: Beech Street Commercial |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: Cash Price |
$1,024.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,420.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,434.72
|
| Rate for Payer: First Choice Health Commercial |
$1,317.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,390.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.22
|
| Rate for Payer: HealthUtah PPO |
$1,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,420.08
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,434.72
|
| Rate for Payer: PacificSource Commercial |
$1,317.60
|
| Rate for Payer: PHCS PPO |
$1,390.80
|
| Rate for Payer: Three Rivers PPO |
$1,098.00
|
| Rate for Payer: TriWest Veterans Administration |
$292.22
|
| Rate for Payer: United Healthcare Commercial |
$1,273.68
|
| Rate for Payer: United Healthcare Medicare |
$292.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.40
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$2,539.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
27752
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$2,539.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,488.22
|
| Rate for Payer: Aetna of WY Medicare |
$483.41
|
| Rate for Payer: Beech Street Commercial |
$2,412.05
|
| Rate for Payer: Cash Price |
$1,777.30
|
| Rate for Payer: Cash Price |
$1,777.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,462.83
|
| Rate for Payer: Cigna of WY Commercial |
$2,488.22
|
| Rate for Payer: First Choice Health Commercial |
$2,285.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,412.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$483.41
|
| Rate for Payer: HealthUtah PPO |
$2,539.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,462.83
|
| Rate for Payer: Multiplan Medicare/VA |
$410.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,488.22
|
| Rate for Payer: PacificSource Commercial |
$2,285.10
|
| Rate for Payer: PHCS PPO |
$2,412.05
|
| Rate for Payer: Three Rivers PPO |
$1,904.25
|
| Rate for Payer: TriWest Veterans Administration |
$483.41
|
| Rate for Payer: United Healthcare Commercial |
$2,208.93
|
| Rate for Payer: United Healthcare Medicare |
$483.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,158.15
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$3,295.00
|
|
|
Service Code
|
HCPCS 27750 50
|
| Hospital Charge Code |
27750
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$3,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,229.10
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$3,130.25
|
| Rate for Payer: Cash Price |
$2,306.50
|
| Rate for Payer: Cash Price |
$2,306.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,196.15
|
| Rate for Payer: Cigna of WY Commercial |
$3,229.10
|
| Rate for Payer: First Choice Health Commercial |
$2,965.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,130.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$3,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,196.15
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,229.10
|
| Rate for Payer: PacificSource Commercial |
$2,965.50
|
| Rate for Payer: PHCS PPO |
$3,130.25
|
| Rate for Payer: Three Rivers PPO |
$2,471.25
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$2,866.65
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,800.75
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
27750
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,614.06
|
| Rate for Payer: Aetna of WY Medicare |
$324.99
|
| Rate for Payer: Beech Street Commercial |
$1,564.65
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,597.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,614.06
|
| Rate for Payer: First Choice Health Commercial |
$1,482.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,564.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.99
|
| Rate for Payer: HealthUtah PPO |
$1,647.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,597.59
|
| Rate for Payer: Multiplan Medicare/VA |
$276.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,614.06
|
| Rate for Payer: PacificSource Commercial |
$1,482.30
|
| Rate for Payer: PHCS PPO |
$1,564.65
|
| Rate for Payer: Three Rivers PPO |
$1,235.25
|
| Rate for Payer: TriWest Veterans Administration |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$1,432.89
|
| Rate for Payer: United Healthcare Medicare |
$324.99
|
| Rate for Payer: WINHealth Partners Commercial |
$1,399.95
|
|
|
CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MNPJ
|
Professional
|
Both
|
$2,705.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
25680
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$2,705.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,650.90
|
| Rate for Payer: Aetna of WY Medicare |
$525.08
|
| Rate for Payer: Beech Street Commercial |
$2,569.75
|
| Rate for Payer: Cash Price |
$1,893.50
|
| Rate for Payer: Cash Price |
$1,893.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,623.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,650.90
|
| Rate for Payer: First Choice Health Commercial |
$2,434.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,569.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$525.08
|
| Rate for Payer: HealthUtah PPO |
$2,705.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,623.85
|
| Rate for Payer: Multiplan Medicare/VA |
$446.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,650.90
|
| Rate for Payer: PacificSource Commercial |
$2,434.50
|
| Rate for Payer: PHCS PPO |
$2,569.75
|
| Rate for Payer: Three Rivers PPO |
$2,028.75
|
| Rate for Payer: TriWest Veterans Administration |
$525.08
|
| Rate for Payer: United Healthcare Commercial |
$2,353.35
|
| Rate for Payer: United Healthcare Medicare |
$525.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,299.25
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 27818 AS
|
| Hospital Charge Code |
27818
|
| Min. Negotiated Rate |
$370.86 |
| Max. Negotiated Rate |
$1,755.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,719.90
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Beech Street Commercial |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,702.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,719.90
|
| Rate for Payer: First Choice Health Commercial |
$1,579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,667.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: HealthUtah PPO |
$1,755.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,702.35
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,719.90
|
| Rate for Payer: PacificSource Commercial |
$1,579.50
|
| Rate for Payer: PHCS PPO |
$1,667.25
|
| Rate for Payer: Three Rivers PPO |
$1,316.25
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: United Healthcare Commercial |
$1,526.85
|
| Rate for Payer: United Healthcare Medicare |
$436.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,491.75
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
27818
|
| Min. Negotiated Rate |
$370.86 |
| Max. Negotiated Rate |
$1,755.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,719.90
|
| Rate for Payer: Aetna of WY Medicare |
$436.30
|
| Rate for Payer: Beech Street Commercial |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,702.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,719.90
|
| Rate for Payer: First Choice Health Commercial |
$1,579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,667.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.30
|
| Rate for Payer: HealthUtah PPO |
$1,755.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,702.35
|
| Rate for Payer: Multiplan Medicare/VA |
$370.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,719.90
|
| Rate for Payer: PacificSource Commercial |
$1,579.50
|
| Rate for Payer: PHCS PPO |
$1,667.25
|
| Rate for Payer: Three Rivers PPO |
$1,316.25
|
| Rate for Payer: TriWest Veterans Administration |
$436.30
|
| Rate for Payer: United Healthcare Commercial |
$1,526.85
|
| Rate for Payer: United Healthcare Medicare |
$436.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,491.75
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION
|
Professional
|
Both
|
$1,195.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
27816
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,171.10
|
| Rate for Payer: Aetna of WY Medicare |
$296.53
|
| Rate for Payer: Beech Street Commercial |
$1,135.25
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,159.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,171.10
|
| Rate for Payer: First Choice Health Commercial |
$1,075.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$296.53
|
| Rate for Payer: HealthUtah PPO |
$1,195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,159.15
|
| Rate for Payer: Multiplan Medicare/VA |
$252.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,171.10
|
| Rate for Payer: PacificSource Commercial |
$1,075.50
|
| Rate for Payer: PHCS PPO |
$1,135.25
|
| Rate for Payer: Three Rivers PPO |
$896.25
|
| Rate for Payer: TriWest Veterans Administration |
$296.53
|
| Rate for Payer: United Healthcare Commercial |
$1,039.65
|
| Rate for Payer: United Healthcare Medicare |
$296.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,015.75
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 22310 80
|
| Hospital Charge Code |
22310
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,469.02
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,424.05
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,454.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,469.02
|
| Rate for Payer: First Choice Health Commercial |
$1,349.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,424.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,454.03
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,469.02
|
| Rate for Payer: PacificSource Commercial |
$1,349.10
|
| Rate for Payer: PHCS PPO |
$1,424.05
|
| Rate for Payer: Three Rivers PPO |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,304.13
|
| Rate for Payer: United Healthcare Medicare |
$291.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.15
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 22310 AS
|
| Hospital Charge Code |
22310
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,469.02
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,424.05
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,454.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,469.02
|
| Rate for Payer: First Choice Health Commercial |
$1,349.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,424.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,454.03
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,469.02
|
| Rate for Payer: PacificSource Commercial |
$1,349.10
|
| Rate for Payer: PHCS PPO |
$1,424.05
|
| Rate for Payer: Three Rivers PPO |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,304.13
|
| Rate for Payer: United Healthcare Medicare |
$291.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.15
|
|
|
CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
22310
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$1,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,469.02
|
| Rate for Payer: Aetna of WY Medicare |
$291.39
|
| Rate for Payer: Beech Street Commercial |
$1,424.05
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: Cash Price |
$1,049.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,454.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,469.02
|
| Rate for Payer: First Choice Health Commercial |
$1,349.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,424.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.39
|
| Rate for Payer: HealthUtah PPO |
$1,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,454.03
|
| Rate for Payer: Multiplan Medicare/VA |
$247.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,469.02
|
| Rate for Payer: PacificSource Commercial |
$1,349.10
|
| Rate for Payer: PHCS PPO |
$1,424.05
|
| Rate for Payer: Three Rivers PPO |
$1,124.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.39
|
| Rate for Payer: United Healthcare Commercial |
$1,304.13
|
| Rate for Payer: United Healthcare Medicare |
$291.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.15
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$3,887.00
|
|
|
Service Code
|
HCPCS 57260
|
| Hospital Charge Code |
57260
|
| Min. Negotiated Rate |
$637.61 |
| Max. Negotiated Rate |
$3,887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,809.26
|
| Rate for Payer: Aetna of WY Medicare |
$750.13
|
| Rate for Payer: Beech Street Commercial |
$3,692.65
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,770.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,809.26
|
| Rate for Payer: First Choice Health Commercial |
$3,498.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,692.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$750.13
|
| Rate for Payer: HealthUtah PPO |
$3,887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,770.39
|
| Rate for Payer: Multiplan Medicare/VA |
$637.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,809.26
|
| Rate for Payer: PacificSource Commercial |
$3,498.30
|
| Rate for Payer: PHCS PPO |
$3,692.65
|
| Rate for Payer: Three Rivers PPO |
$2,915.25
|
| Rate for Payer: TriWest Veterans Administration |
$750.13
|
| Rate for Payer: United Healthcare Commercial |
$3,381.69
|
| Rate for Payer: United Healthcare Medicare |
$750.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3,303.95
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$3,887.00
|
|
|
Service Code
|
HCPCS 57260 80
|
| Hospital Charge Code |
57260
|
| Min. Negotiated Rate |
$637.61 |
| Max. Negotiated Rate |
$3,887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,809.26
|
| Rate for Payer: Aetna of WY Medicare |
$750.13
|
| Rate for Payer: Beech Street Commercial |
$3,692.65
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: Cash Price |
$2,720.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,770.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,809.26
|
| Rate for Payer: First Choice Health Commercial |
$3,498.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,692.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$750.13
|
| Rate for Payer: HealthUtah PPO |
$3,887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,770.39
|
| Rate for Payer: Multiplan Medicare/VA |
$637.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,809.26
|
| Rate for Payer: PacificSource Commercial |
$3,498.30
|
| Rate for Payer: PHCS PPO |
$3,692.65
|
| Rate for Payer: Three Rivers PPO |
$2,915.25
|
| Rate for Payer: TriWest Veterans Administration |
$750.13
|
| Rate for Payer: United Healthcare Commercial |
$3,381.69
|
| Rate for Payer: United Healthcare Medicare |
$750.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3,303.95
|
|
|
CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$5,269.00
|
|
|
Service Code
|
HCPCS 57265
|
| Hospital Charge Code |
57265
|
| Min. Negotiated Rate |
$712.53 |
| Max. Negotiated Rate |
$5,269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,163.62
|
| Rate for Payer: Aetna of WY Medicare |
$838.27
|
| Rate for Payer: Beech Street Commercial |
$5,005.55
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,110.93
|
| Rate for Payer: Cigna of WY Commercial |
$5,163.62
|
| Rate for Payer: First Choice Health Commercial |
$4,742.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,005.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$838.27
|
| Rate for Payer: HealthUtah PPO |
$5,269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,110.93
|
| Rate for Payer: Multiplan Medicare/VA |
$712.53
|
| Rate for Payer: One Health Plan of WY PPO |
$5,163.62
|
| Rate for Payer: PacificSource Commercial |
$4,742.10
|
| Rate for Payer: PHCS PPO |
$5,005.55
|
| Rate for Payer: Three Rivers PPO |
$3,951.75
|
| Rate for Payer: TriWest Veterans Administration |
$838.27
|
| Rate for Payer: United Healthcare Commercial |
$4,584.03
|
| Rate for Payer: United Healthcare Medicare |
$838.27
|
| Rate for Payer: WINHealth Partners Commercial |
$4,478.65
|
|
|
CNTRL 3 LUM CVC 7F 30CM ADAPT
|
Facility
|
IP
|
$127.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.09
|
| Rate for Payer: Altius Commercial |
$122.09
|
| Rate for Payer: Beech Street Commercial |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.41
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.36
|
| Rate for Payer: Cigna of WY Commercial |
$124.64
|
| Rate for Payer: Entrust Commercial |
$120.82
|
| Rate for Payer: First Choice Health Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.94
|
| Rate for Payer: HealthUtah PPO |
$127.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.36
|
| Rate for Payer: Multiplan Medicare/VA |
$79.74
|
| Rate for Payer: One Health Plan of WY PPO |
$124.64
|
| Rate for Payer: PacificSource Commercial |
$114.46
|
| Rate for Payer: PHCS PPO |
$124.64
|
| Rate for Payer: Three Rivers PPO |
$95.38
|
| Rate for Payer: TriWest Veterans Administration |
$83.94
|
| Rate for Payer: United Healthcare Commercial |
$110.65
|
| Rate for Payer: United Healthcare Medicare |
$83.94
|
| Rate for Payer: WINHealth Partners Commercial |
$120.82
|
| Rate for Payer: Wise Provider Network Commercial |
$120.82
|
|
|
CNTRL 3 LUM CVC 7F 30CM ADAPT
|
Facility
|
OP
|
$127.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.64
|
| Rate for Payer: Aetna of WY Medicare |
$83.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.09
|
| Rate for Payer: Altius Commercial |
$122.09
|
| Rate for Payer: Beech Street Commercial |
$124.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.41
|
| Rate for Payer: Cash Price |
$89.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.36
|
| Rate for Payer: Cigna of WY Commercial |
$124.64
|
| Rate for Payer: Entrust Commercial |
$120.82
|
| Rate for Payer: First Choice Health Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.76
|
| Rate for Payer: HealthUtah PPO |
$127.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.36
|
| Rate for Payer: Multiplan Medicare/VA |
$70.08
|
| Rate for Payer: One Health Plan of WY PPO |
$124.64
|
| Rate for Payer: PacificSource Commercial |
$114.46
|
| Rate for Payer: PHCS PPO |
$124.64
|
| Rate for Payer: Three Rivers PPO |
$95.38
|
| Rate for Payer: TriWest Veterans Administration |
$73.76
|
| Rate for Payer: United Healthcare Commercial |
$110.65
|
| Rate for Payer: United Healthcare Medicare |
$73.76
|
| Rate for Payer: WINHealth Partners Commercial |
$124.64
|
| Rate for Payer: Wise Provider Network Commercial |
$120.82
|
|
|
CNTRL VENOUS 3 LUMEN PRESSURE
|
Facility
|
OP
|
$446.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.08 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.67
|
| Rate for Payer: Aetna of WY Medicare |
$294.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$428.74
|
| Rate for Payer: Altius Commercial |
$428.74
|
| Rate for Payer: Beech Street Commercial |
$437.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$366.66
|
| Rate for Payer: Cash Price |
$312.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.20
|
| Rate for Payer: Cigna of WY Commercial |
$437.67
|
| Rate for Payer: Entrust Commercial |
$424.27
|
| Rate for Payer: First Choice Health Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.03
|
| Rate for Payer: HealthUtah PPO |
$446.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.20
|
| Rate for Payer: Multiplan Medicare/VA |
$246.08
|
| Rate for Payer: One Health Plan of WY PPO |
$437.67
|
| Rate for Payer: PacificSource Commercial |
$401.94
|
| Rate for Payer: PHCS PPO |
$437.67
|
| Rate for Payer: Three Rivers PPO |
$334.95
|
| Rate for Payer: TriWest Veterans Administration |
$259.03
|
| Rate for Payer: United Healthcare Commercial |
$388.54
|
| Rate for Payer: United Healthcare Medicare |
$259.03
|
| Rate for Payer: WINHealth Partners Commercial |
$437.67
|
| Rate for Payer: Wise Provider Network Commercial |
$424.27
|
|
|
CNTRL VENOUS 3 LUMEN PRESSURE
|
Facility
|
IP
|
$446.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.02 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$428.74
|
| Rate for Payer: Altius Commercial |
$428.74
|
| Rate for Payer: Beech Street Commercial |
$437.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$366.66
|
| Rate for Payer: Cash Price |
$312.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.20
|
| Rate for Payer: Cigna of WY Commercial |
$437.67
|
| Rate for Payer: Entrust Commercial |
$424.27
|
| Rate for Payer: First Choice Health Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.76
|
| Rate for Payer: HealthUtah PPO |
$446.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.20
|
| Rate for Payer: Multiplan Medicare/VA |
$280.02
|
| Rate for Payer: One Health Plan of WY PPO |
$437.67
|
| Rate for Payer: PacificSource Commercial |
$401.94
|
| Rate for Payer: PHCS PPO |
$437.67
|
| Rate for Payer: Three Rivers PPO |
$334.95
|
| Rate for Payer: TriWest Veterans Administration |
$294.76
|
| Rate for Payer: United Healthcare Commercial |
$388.54
|
| Rate for Payer: United Healthcare Medicare |
$294.76
|
| Rate for Payer: WINHealth Partners Commercial |
$424.27
|
| Rate for Payer: Wise Provider Network Commercial |
$424.27
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
OP
|
$96.47
|
|
|
Service Code
|
NDC 0527197174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.54
|
| Rate for Payer: Aetna of WY Medicare |
$63.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.61
|
| Rate for Payer: Altius Commercial |
$92.61
|
| Rate for Payer: Beech Street Commercial |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.20
|
| Rate for Payer: Cash Price |
$67.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.58
|
| Rate for Payer: Cigna of WY Commercial |
$94.54
|
| Rate for Payer: Entrust Commercial |
$91.65
|
| Rate for Payer: First Choice Health Commercial |
$91.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.95
|
| Rate for Payer: HealthUtah PPO |
$96.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.58
|
| Rate for Payer: Multiplan Medicare/VA |
$53.15
|
| Rate for Payer: One Health Plan of WY PPO |
$94.54
|
| Rate for Payer: PacificSource Commercial |
$86.82
|
| Rate for Payer: PHCS PPO |
$94.54
|
| Rate for Payer: Three Rivers PPO |
$72.35
|
| Rate for Payer: TriWest Veterans Administration |
$55.95
|
| Rate for Payer: United Healthcare Commercial |
$83.93
|
| Rate for Payer: United Healthcare Medicare |
$55.95
|
| Rate for Payer: WINHealth Partners Commercial |
$94.54
|
| Rate for Payer: Wise Provider Network Commercial |
$91.65
|
|
