|
OSELTAMIVIR 75 MG CAPSULE [12331]
|
Facility
|
OP
|
$9.75
|
|
|
Service Code
|
NDC 6818067711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.56
|
| Rate for Payer: Aetna of WY Medicare |
$6.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.36
|
| Rate for Payer: Altius Commercial |
$9.36
|
| Rate for Payer: Beech Street Commercial |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.46
|
| Rate for Payer: Cigna of WY Commercial |
$9.56
|
| Rate for Payer: Entrust Commercial |
$9.26
|
| Rate for Payer: First Choice Health Commercial |
$9.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.66
|
| Rate for Payer: HealthUtah PPO |
$9.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.46
|
| Rate for Payer: Multiplan Medicare/VA |
$5.37
|
| Rate for Payer: One Health Plan of WY PPO |
$9.56
|
| Rate for Payer: PacificSource Commercial |
$8.78
|
| Rate for Payer: PHCS PPO |
$9.56
|
| Rate for Payer: Three Rivers PPO |
$7.31
|
| Rate for Payer: TriWest Veterans Administration |
$5.66
|
| Rate for Payer: United Healthcare Commercial |
$8.48
|
| Rate for Payer: United Healthcare Medicare |
$5.66
|
| Rate for Payer: WINHealth Partners Commercial |
$9.56
|
| Rate for Payer: Wise Provider Network Commercial |
$9.26
|
|
|
OS LOCATOR MX11
|
Facility
|
IP
|
$16.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.79
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.51
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.86
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$10.31
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$10.86
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare |
$10.86
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
OS LOCATOR MX11
|
Facility
|
OP
|
$16.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.79
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.51
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.54
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$9.06
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28288
|
| Hospital Charge Code |
28288
|
| Min. Negotiated Rate |
$362.87 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,196.18
|
| Rate for Payer: Aetna of WY Medicare |
$426.91
|
| Rate for Payer: Beech Street Commercial |
$2,128.95
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,173.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,196.18
|
| Rate for Payer: First Choice Health Commercial |
$2,016.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.91
|
| Rate for Payer: HealthUtah PPO |
$2,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,173.77
|
| Rate for Payer: Multiplan Medicare/VA |
$362.87
|
| Rate for Payer: One Health Plan of WY PPO |
$2,196.18
|
| Rate for Payer: PacificSource Commercial |
$2,016.90
|
| Rate for Payer: PHCS PPO |
$2,128.95
|
| Rate for Payer: Three Rivers PPO |
$1,680.75
|
| Rate for Payer: TriWest Veterans Administration |
$426.91
|
| Rate for Payer: United Healthcare Commercial |
$1,949.67
|
| Rate for Payer: United Healthcare Medicare |
$426.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,904.85
|
|
|
OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
28119
|
| Min. Negotiated Rate |
$303.41 |
| Max. Negotiated Rate |
$1,867.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,829.66
|
| Rate for Payer: Aetna of WY Medicare |
$356.95
|
| Rate for Payer: Beech Street Commercial |
$1,773.65
|
| Rate for Payer: Cash Price |
$1,306.90
|
| Rate for Payer: Cash Price |
$1,306.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,810.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,829.66
|
| Rate for Payer: First Choice Health Commercial |
$1,680.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,773.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.95
|
| Rate for Payer: HealthUtah PPO |
$1,867.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,810.99
|
| Rate for Payer: Multiplan Medicare/VA |
$303.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,829.66
|
| Rate for Payer: PacificSource Commercial |
$1,680.30
|
| Rate for Payer: PHCS PPO |
$1,773.65
|
| Rate for Payer: Three Rivers PPO |
$1,400.25
|
| Rate for Payer: TriWest Veterans Administration |
$356.95
|
| Rate for Payer: United Healthcare Commercial |
$1,624.29
|
| Rate for Payer: United Healthcare Medicare |
$356.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,586.95
|
|
|
OSTECTOMY PRTL 5TH METAR HEAD SPX
|
Professional
|
Both
|
$5,848.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
28110
|
| Min. Negotiated Rate |
$244.79 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,731.04
|
| Rate for Payer: Aetna of WY Medicare |
$287.99
|
| Rate for Payer: Beech Street Commercial |
$5,555.60
|
| Rate for Payer: Cash Price |
$4,093.60
|
| Rate for Payer: Cash Price |
$4,093.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,672.56
|
| Rate for Payer: Cigna of WY Commercial |
$5,731.04
|
| Rate for Payer: First Choice Health Commercial |
$5,263.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,555.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.99
|
| Rate for Payer: HealthUtah PPO |
$5,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,672.56
|
| Rate for Payer: Multiplan Medicare/VA |
$244.79
|
| Rate for Payer: One Health Plan of WY PPO |
$5,731.04
|
| Rate for Payer: PacificSource Commercial |
$5,263.20
|
| Rate for Payer: PHCS PPO |
$5,555.60
|
| Rate for Payer: Three Rivers PPO |
$4,386.00
|
| Rate for Payer: TriWest Veterans Administration |
$287.99
|
| Rate for Payer: United Healthcare Commercial |
$5,087.76
|
| Rate for Payer: United Healthcare Medicare |
$287.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,970.80
|
|
|
OSTECTOMY TARSAL COALITION
|
Professional
|
Both
|
$2,984.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
28116
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,924.32
|
| Rate for Payer: Aetna of WY Medicare |
$566.47
|
| Rate for Payer: Beech Street Commercial |
$2,834.80
|
| Rate for Payer: Cash Price |
$2,088.80
|
| Rate for Payer: Cash Price |
$2,088.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,894.48
|
| Rate for Payer: Cigna of WY Commercial |
$2,924.32
|
| Rate for Payer: First Choice Health Commercial |
$2,685.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,834.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.47
|
| Rate for Payer: HealthUtah PPO |
$2,984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,894.48
|
| Rate for Payer: Multiplan Medicare/VA |
$481.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,924.32
|
| Rate for Payer: PacificSource Commercial |
$2,685.60
|
| Rate for Payer: PHCS PPO |
$2,834.80
|
| Rate for Payer: Three Rivers PPO |
$2,238.00
|
| Rate for Payer: TriWest Veterans Administration |
$566.47
|
| Rate for Payer: United Healthcare Commercial |
$2,596.08
|
| Rate for Payer: United Healthcare Medicare |
$566.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,536.40
|
|
|
OSTECTOMY TARSAL COALITION
|
Professional
|
Both
|
$2,984.00
|
|
|
Service Code
|
HCPCS 28116 80
|
| Hospital Charge Code |
28116
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,924.32
|
| Rate for Payer: Aetna of WY Medicare |
$566.47
|
| Rate for Payer: Beech Street Commercial |
$2,834.80
|
| Rate for Payer: Cash Price |
$2,088.80
|
| Rate for Payer: Cash Price |
$2,088.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,894.48
|
| Rate for Payer: Cigna of WY Commercial |
$2,924.32
|
| Rate for Payer: First Choice Health Commercial |
$2,685.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,834.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$566.47
|
| Rate for Payer: HealthUtah PPO |
$2,984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,894.48
|
| Rate for Payer: Multiplan Medicare/VA |
$481.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,924.32
|
| Rate for Payer: PacificSource Commercial |
$2,685.60
|
| Rate for Payer: PHCS PPO |
$2,834.80
|
| Rate for Payer: Three Rivers PPO |
$2,238.00
|
| Rate for Payer: TriWest Veterans Administration |
$566.47
|
| Rate for Payer: United Healthcare Commercial |
$2,596.08
|
| Rate for Payer: United Healthcare Medicare |
$566.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,536.40
|
|
|
OSTEOCHONDRAL ALLOGRAFT KNEE OPEN
|
Professional
|
Both
|
$4,712.00
|
|
|
Service Code
|
HCPCS 27415 AS
|
| Hospital Charge Code |
27415
|
| Min. Negotiated Rate |
$1,122.26 |
| Max. Negotiated Rate |
$4,712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,617.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.31
|
| Rate for Payer: Beech Street Commercial |
$4,476.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,570.64
|
| Rate for Payer: Cigna of WY Commercial |
$4,617.76
|
| Rate for Payer: First Choice Health Commercial |
$4,240.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,476.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.31
|
| Rate for Payer: HealthUtah PPO |
$4,712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,570.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$4,617.76
|
| Rate for Payer: PacificSource Commercial |
$4,240.80
|
| Rate for Payer: PHCS PPO |
$4,476.40
|
| Rate for Payer: Three Rivers PPO |
$3,534.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.31
|
| Rate for Payer: United Healthcare Commercial |
$4,099.44
|
| Rate for Payer: United Healthcare Medicare |
$1,320.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4,005.20
|
|
|
OSTEOCHONDRAL ALLOGRAFT KNEE OPEN
|
Professional
|
Both
|
$4,712.00
|
|
|
Service Code
|
HCPCS 27415
|
| Hospital Charge Code |
27415
|
| Min. Negotiated Rate |
$1,122.26 |
| Max. Negotiated Rate |
$4,712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,617.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.31
|
| Rate for Payer: Beech Street Commercial |
$4,476.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,570.64
|
| Rate for Payer: Cigna of WY Commercial |
$4,617.76
|
| Rate for Payer: First Choice Health Commercial |
$4,240.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,476.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.31
|
| Rate for Payer: HealthUtah PPO |
$4,712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,570.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$4,617.76
|
| Rate for Payer: PacificSource Commercial |
$4,240.80
|
| Rate for Payer: PHCS PPO |
$4,476.40
|
| Rate for Payer: Three Rivers PPO |
$3,534.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.31
|
| Rate for Payer: United Healthcare Commercial |
$4,099.44
|
| Rate for Payer: United Healthcare Medicare |
$1,320.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4,005.20
|
|
|
OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY
|
Professional
|
Both
|
$4,603.00
|
|
|
Service Code
|
HCPCS 27416
|
| Hospital Charge Code |
27416
|
| Min. Negotiated Rate |
$804.10 |
| Max. Negotiated Rate |
$4,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,510.94
|
| Rate for Payer: Aetna of WY Medicare |
$946.00
|
| Rate for Payer: Beech Street Commercial |
$4,372.85
|
| Rate for Payer: Cash Price |
$3,222.10
|
| Rate for Payer: Cash Price |
$3,222.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,464.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,510.94
|
| Rate for Payer: First Choice Health Commercial |
$4,142.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,372.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.00
|
| Rate for Payer: HealthUtah PPO |
$4,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,464.91
|
| Rate for Payer: Multiplan Medicare/VA |
$804.10
|
| Rate for Payer: One Health Plan of WY PPO |
$4,510.94
|
| Rate for Payer: PacificSource Commercial |
$4,142.70
|
| Rate for Payer: PHCS PPO |
$4,372.85
|
| Rate for Payer: Three Rivers PPO |
$3,452.25
|
| Rate for Payer: TriWest Veterans Administration |
$946.00
|
| Rate for Payer: United Healthcare Commercial |
$4,004.61
|
| Rate for Payer: United Healthcare Medicare |
$946.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,912.55
|
|
|
OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY
|
Professional
|
Both
|
$4,603.00
|
|
|
Service Code
|
HCPCS 27416 AS
|
| Hospital Charge Code |
27416
|
| Min. Negotiated Rate |
$804.10 |
| Max. Negotiated Rate |
$4,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,510.94
|
| Rate for Payer: Aetna of WY Medicare |
$946.00
|
| Rate for Payer: Beech Street Commercial |
$4,372.85
|
| Rate for Payer: Cash Price |
$3,222.10
|
| Rate for Payer: Cash Price |
$3,222.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,464.91
|
| Rate for Payer: Cigna of WY Commercial |
$4,510.94
|
| Rate for Payer: First Choice Health Commercial |
$4,142.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,372.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$946.00
|
| Rate for Payer: HealthUtah PPO |
$4,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,464.91
|
| Rate for Payer: Multiplan Medicare/VA |
$804.10
|
| Rate for Payer: One Health Plan of WY PPO |
$4,510.94
|
| Rate for Payer: PacificSource Commercial |
$4,142.70
|
| Rate for Payer: PHCS PPO |
$4,372.85
|
| Rate for Payer: Three Rivers PPO |
$3,452.25
|
| Rate for Payer: TriWest Veterans Administration |
$946.00
|
| Rate for Payer: United Healthcare Commercial |
$4,004.61
|
| Rate for Payer: United Healthcare Medicare |
$946.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,912.55
|
|
|
OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
98925
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$22.01
|
| Rate for Payer: Beech Street Commercial |
$119.70
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: First Choice Health Commercial |
$113.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.01
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$18.71
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$119.70
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.01
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Medicare |
$22.01
|
| Rate for Payer: WINHealth Partners Commercial |
$119.70
|
|
|
OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
98926
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$33.38
|
| Rate for Payer: Beech Street Commercial |
$130.15
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: First Choice Health Commercial |
$123.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.38
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$28.37
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$130.15
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.38
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: United Healthcare Medicare |
$33.38
|
| Rate for Payer: WINHealth Partners Commercial |
$130.15
|
|
|
OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
98927
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$44.43
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.43
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$37.77
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.43
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
|
|
OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
98928
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$56.05
|
| Rate for Payer: Beech Street Commercial |
$208.05
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: First Choice Health Commercial |
$197.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.05
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$47.64
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$208.05
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.05
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$56.05
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
|
|
OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
98929
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$67.10
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$57.04
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
|
|
OSTEOPLASTY CARPAL BONE SHORTENING
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 25394 80
|
| Hospital Charge Code |
25394
|
| Min. Negotiated Rate |
$647.89 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,472.94
|
| Rate for Payer: Aetna of WY Medicare |
$762.22
|
| Rate for Payer: Beech Street Commercial |
$1,427.85
|
| Rate for Payer: Cash Price |
$1,052.10
|
| Rate for Payer: Cash Price |
$1,052.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,457.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,472.94
|
| Rate for Payer: First Choice Health Commercial |
$1,352.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,427.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$762.22
|
| Rate for Payer: HealthUtah PPO |
$1,503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,457.91
|
| Rate for Payer: Multiplan Medicare/VA |
$647.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,472.94
|
| Rate for Payer: PacificSource Commercial |
$1,352.70
|
| Rate for Payer: PHCS PPO |
$1,427.85
|
| Rate for Payer: Three Rivers PPO |
$1,127.25
|
| Rate for Payer: TriWest Veterans Administration |
$762.22
|
| Rate for Payer: United Healthcare Commercial |
$1,307.61
|
| Rate for Payer: United Healthcare Medicare |
$762.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,277.55
|
|
|
OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
25390
|
| Min. Negotiated Rate |
$635.43 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$747.56
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.56
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$635.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$747.56
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$747.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 25390 AS
|
| Hospital Charge Code |
25390
|
| Min. Negotiated Rate |
$635.43 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$747.56
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.56
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$635.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$747.56
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$747.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 25390 80
|
| Hospital Charge Code |
25390
|
| Min. Negotiated Rate |
$635.43 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$747.56
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.56
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$635.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$747.56
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$747.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
|
OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,364.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
28300
|
| Min. Negotiated Rate |
$536.97 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,296.72
|
| Rate for Payer: Aetna of WY Medicare |
$631.73
|
| Rate for Payer: Beech Street Commercial |
$3,195.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,263.08
|
| Rate for Payer: Cigna of WY Commercial |
$3,296.72
|
| Rate for Payer: First Choice Health Commercial |
$3,027.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,195.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$631.73
|
| Rate for Payer: HealthUtah PPO |
$3,364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,263.08
|
| Rate for Payer: Multiplan Medicare/VA |
$536.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,296.72
|
| Rate for Payer: PacificSource Commercial |
$3,027.60
|
| Rate for Payer: PHCS PPO |
$3,195.80
|
| Rate for Payer: Three Rivers PPO |
$2,523.00
|
| Rate for Payer: TriWest Veterans Administration |
$631.73
|
| Rate for Payer: United Healthcare Commercial |
$2,926.68
|
| Rate for Payer: United Healthcare Medicare |
$631.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,859.40
|
|
|
OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,364.00
|
|
|
Service Code
|
HCPCS 28300 80
|
| Hospital Charge Code |
28300
|
| Min. Negotiated Rate |
$536.97 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,296.72
|
| Rate for Payer: Aetna of WY Medicare |
$631.73
|
| Rate for Payer: Beech Street Commercial |
$3,195.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,263.08
|
| Rate for Payer: Cigna of WY Commercial |
$3,296.72
|
| Rate for Payer: First Choice Health Commercial |
$3,027.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,195.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$631.73
|
| Rate for Payer: HealthUtah PPO |
$3,364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,263.08
|
| Rate for Payer: Multiplan Medicare/VA |
$536.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,296.72
|
| Rate for Payer: PacificSource Commercial |
$3,027.60
|
| Rate for Payer: PHCS PPO |
$3,195.80
|
| Rate for Payer: Three Rivers PPO |
$2,523.00
|
| Rate for Payer: TriWest Veterans Administration |
$631.73
|
| Rate for Payer: United Healthcare Commercial |
$2,926.68
|
| Rate for Payer: United Healthcare Medicare |
$631.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,859.40
|
|
|
OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,364.00
|
|
|
Service Code
|
HCPCS 28300 AS
|
| Hospital Charge Code |
28300
|
| Min. Negotiated Rate |
$536.97 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,296.72
|
| Rate for Payer: Aetna of WY Medicare |
$631.73
|
| Rate for Payer: Beech Street Commercial |
$3,195.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: Cash Price |
$2,354.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,263.08
|
| Rate for Payer: Cigna of WY Commercial |
$3,296.72
|
| Rate for Payer: First Choice Health Commercial |
$3,027.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,195.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$631.73
|
| Rate for Payer: HealthUtah PPO |
$3,364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,263.08
|
| Rate for Payer: Multiplan Medicare/VA |
$536.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,296.72
|
| Rate for Payer: PacificSource Commercial |
$3,027.60
|
| Rate for Payer: PHCS PPO |
$3,195.80
|
| Rate for Payer: Three Rivers PPO |
$2,523.00
|
| Rate for Payer: TriWest Veterans Administration |
$631.73
|
| Rate for Payer: United Healthcare Commercial |
$2,926.68
|
| Rate for Payer: United Healthcare Medicare |
$631.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,859.40
|
|
|
OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,868.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
23480
|
| Min. Negotiated Rate |
$675.54 |
| Max. Negotiated Rate |
$3,868.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,790.64
|
| Rate for Payer: Aetna of WY Medicare |
$794.75
|
| Rate for Payer: Beech Street Commercial |
$3,674.60
|
| Rate for Payer: Cash Price |
$2,707.60
|
| Rate for Payer: Cash Price |
$2,707.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,751.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,790.64
|
| Rate for Payer: First Choice Health Commercial |
$3,481.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,674.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.75
|
| Rate for Payer: HealthUtah PPO |
$3,868.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,751.96
|
| Rate for Payer: Multiplan Medicare/VA |
$675.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,790.64
|
| Rate for Payer: PacificSource Commercial |
$3,481.20
|
| Rate for Payer: PHCS PPO |
$3,674.60
|
| Rate for Payer: Three Rivers PPO |
$2,901.00
|
| Rate for Payer: TriWest Veterans Administration |
$794.75
|
| Rate for Payer: United Healthcare Commercial |
$3,365.16
|
| Rate for Payer: United Healthcare Medicare |
$794.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,287.80
|
|
