|
CEMENT BONE REFOBACIN R 1X40
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
3003527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$367.36
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.14
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$332.63
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.14
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$350.14
|
| Rate for Payer: WINHealth Partners Commercial |
$545.30
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
CEMENT BONE REFOBACIN R 1X40
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
3003527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.82 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$378.84
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.18
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$310.82
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$327.18
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$327.18
|
| Rate for Payer: WINHealth Partners Commercial |
$562.52
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
CEMENT BOWL W/SPATULA
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
2650826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.99
|
| Rate for Payer: Aetna of WY Medicare |
$21.54
|
| Rate for Payer: Altius Commercial |
$31.33
|
| Rate for Payer: Beech Street Commercial |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.66
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.66
|
| Rate for Payer: Cigna of WY Commercial |
$31.99
|
| Rate for Payer: Entrust Commercial |
$31.01
|
| Rate for Payer: First Choice Health Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.60
|
| Rate for Payer: HealthUtah PPO |
$32.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.66
|
| Rate for Payer: Multiplan Medicare/VA |
$17.67
|
| Rate for Payer: One Health Plan of WY PPO |
$31.99
|
| Rate for Payer: PacificSource Commercial |
$29.38
|
| Rate for Payer: PHCS PPO |
$31.99
|
| Rate for Payer: Three Rivers PPO |
$24.48
|
| Rate for Payer: TriWest Veterans Administration |
$18.60
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
| Rate for Payer: United Healthcare Medicare |
$18.60
|
| Rate for Payer: WINHealth Partners Commercial |
$31.99
|
| Rate for Payer: Wise Provider Network Commercial |
$31.01
|
|
|
CEMENT BOWL W/SPATULA
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
2650826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.99
|
| Rate for Payer: Aetna of WY Medicare |
$20.89
|
| Rate for Payer: Altius Commercial |
$31.33
|
| Rate for Payer: Beech Street Commercial |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.66
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.66
|
| Rate for Payer: Cigna of WY Commercial |
$31.99
|
| Rate for Payer: Entrust Commercial |
$31.01
|
| Rate for Payer: First Choice Health Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.91
|
| Rate for Payer: HealthUtah PPO |
$32.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.66
|
| Rate for Payer: Multiplan Medicare/VA |
$18.91
|
| Rate for Payer: One Health Plan of WY PPO |
$31.99
|
| Rate for Payer: PacificSource Commercial |
$29.38
|
| Rate for Payer: PHCS PPO |
$31.99
|
| Rate for Payer: Three Rivers PPO |
$24.48
|
| Rate for Payer: TriWest Veterans Administration |
$19.91
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
| Rate for Payer: United Healthcare Medicare |
$19.91
|
| Rate for Payer: WINHealth Partners Commercial |
$31.01
|
| Rate for Payer: Wise Provider Network Commercial |
$31.01
|
|
|
CEMENT KIT DR BECK
|
Facility
|
OP
|
$8,732.50
|
|
| Hospital Charge Code |
2800204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,728.65 |
| Max. Negotiated Rate |
$8,732.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,557.85
|
| Rate for Payer: Aetna of WY Medicare |
$5,763.45
|
| Rate for Payer: Altius Commercial |
$8,383.20
|
| Rate for Payer: Beech Street Commercial |
$8,557.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,470.52
|
| Rate for Payer: Cash Price |
$6,112.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,470.52
|
| Rate for Payer: Cigna of WY Commercial |
$8,557.85
|
| Rate for Payer: Entrust Commercial |
$8,295.88
|
| Rate for Payer: First Choice Health Commercial |
$8,295.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,295.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,977.52
|
| Rate for Payer: HealthUtah PPO |
$8,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,470.52
|
| Rate for Payer: Multiplan Medicare/VA |
$4,728.65
|
| Rate for Payer: One Health Plan of WY PPO |
$8,557.85
|
| Rate for Payer: PacificSource Commercial |
$7,859.25
|
| Rate for Payer: PHCS PPO |
$8,557.85
|
| Rate for Payer: Three Rivers PPO |
$6,549.38
|
| Rate for Payer: TriWest Veterans Administration |
$4,977.52
|
| Rate for Payer: United Healthcare Commercial |
$8,339.54
|
| Rate for Payer: United Healthcare Medicare |
$4,977.52
|
| Rate for Payer: WINHealth Partners Commercial |
$8,557.85
|
| Rate for Payer: Wise Provider Network Commercial |
$8,295.88
|
|
|
CEMENT KIT DR BECK
|
Facility
|
IP
|
$8,732.50
|
|
| Hospital Charge Code |
2800204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.48 |
| Max. Negotiated Rate |
$8,732.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,557.85
|
| Rate for Payer: Aetna of WY Medicare |
$5,588.80
|
| Rate for Payer: Altius Commercial |
$8,383.20
|
| Rate for Payer: Beech Street Commercial |
$8,557.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,470.52
|
| Rate for Payer: Cash Price |
$6,112.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,470.52
|
| Rate for Payer: Cigna of WY Commercial |
$8,557.85
|
| Rate for Payer: Entrust Commercial |
$8,295.88
|
| Rate for Payer: First Choice Health Commercial |
$8,295.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,295.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,326.82
|
| Rate for Payer: HealthUtah PPO |
$8,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,470.52
|
| Rate for Payer: Multiplan Medicare/VA |
$5,060.48
|
| Rate for Payer: One Health Plan of WY PPO |
$8,557.85
|
| Rate for Payer: PacificSource Commercial |
$7,859.25
|
| Rate for Payer: PHCS PPO |
$8,557.85
|
| Rate for Payer: Three Rivers PPO |
$6,549.38
|
| Rate for Payer: TriWest Veterans Administration |
$5,326.82
|
| Rate for Payer: United Healthcare Commercial |
$8,339.54
|
| Rate for Payer: United Healthcare Medicare |
$5,326.82
|
| Rate for Payer: WINHealth Partners Commercial |
$8,295.88
|
| Rate for Payer: Wise Provider Network Commercial |
$8,295.88
|
|
|
CEMENT MIXER CLEARMIX DOUBLE
|
Facility
|
IP
|
$390.32
|
|
| Hospital Charge Code |
2650997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$390.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.51
|
| Rate for Payer: Aetna of WY Medicare |
$249.80
|
| Rate for Payer: Altius Commercial |
$374.71
|
| Rate for Payer: Beech Street Commercial |
$382.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$378.61
|
| Rate for Payer: Cash Price |
$273.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.61
|
| Rate for Payer: Cigna of WY Commercial |
$382.51
|
| Rate for Payer: Entrust Commercial |
$370.80
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$238.10
|
| Rate for Payer: HealthUtah PPO |
$390.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.61
|
| Rate for Payer: Multiplan Medicare/VA |
$226.19
|
| Rate for Payer: One Health Plan of WY PPO |
$382.51
|
| Rate for Payer: PacificSource Commercial |
$351.29
|
| Rate for Payer: PHCS PPO |
$382.51
|
| Rate for Payer: Three Rivers PPO |
$292.74
|
| Rate for Payer: TriWest Veterans Administration |
$238.10
|
| Rate for Payer: United Healthcare Commercial |
$372.76
|
| Rate for Payer: United Healthcare Medicare |
$238.10
|
| Rate for Payer: WINHealth Partners Commercial |
$370.80
|
| Rate for Payer: Wise Provider Network Commercial |
$370.80
|
|
|
CEMENT MIXER CLEARMIX DOUBLE
|
Facility
|
OP
|
$390.32
|
|
| Hospital Charge Code |
2650997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$390.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.51
|
| Rate for Payer: Aetna of WY Medicare |
$257.61
|
| Rate for Payer: Altius Commercial |
$374.71
|
| Rate for Payer: Beech Street Commercial |
$382.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$378.61
|
| Rate for Payer: Cash Price |
$273.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.61
|
| Rate for Payer: Cigna of WY Commercial |
$382.51
|
| Rate for Payer: Entrust Commercial |
$370.80
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.48
|
| Rate for Payer: HealthUtah PPO |
$390.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.61
|
| Rate for Payer: Multiplan Medicare/VA |
$211.36
|
| Rate for Payer: One Health Plan of WY PPO |
$382.51
|
| Rate for Payer: PacificSource Commercial |
$351.29
|
| Rate for Payer: PHCS PPO |
$382.51
|
| Rate for Payer: Three Rivers PPO |
$292.74
|
| Rate for Payer: TriWest Veterans Administration |
$222.48
|
| Rate for Payer: United Healthcare Commercial |
$372.76
|
| Rate for Payer: United Healthcare Medicare |
$222.48
|
| Rate for Payer: WINHealth Partners Commercial |
$382.51
|
| Rate for Payer: Wise Provider Network Commercial |
$370.80
|
|
|
CEMENT PLUG REPAIR KIT ZI
|
Facility
|
OP
|
$1,155.00
|
|
| Hospital Charge Code |
3003732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$762.30
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$658.35
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$625.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$658.35
|
| Rate for Payer: United Healthcare Commercial |
$1,103.02
|
| Rate for Payer: United Healthcare Medicare |
$658.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,131.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
CEMENT PLUG REPAIR KIT ZI
|
Facility
|
IP
|
$1,155.00
|
|
| Hospital Charge Code |
3003732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.32 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.55
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$669.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$704.55
|
| Rate for Payer: United Healthcare Commercial |
$1,103.02
|
| Rate for Payer: United Healthcare Medicare |
$704.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
CEMENT RESTRICTOR 8-13MM
|
Facility
|
OP
|
$323.75
|
|
| Hospital Charge Code |
3004370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.31 |
| Max. Negotiated Rate |
$323.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$317.28
|
| Rate for Payer: Aetna of WY Medicare |
$213.68
|
| Rate for Payer: Altius Commercial |
$310.80
|
| Rate for Payer: Beech Street Commercial |
$317.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.04
|
| Rate for Payer: Cash Price |
$226.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$314.04
|
| Rate for Payer: Cigna of WY Commercial |
$317.28
|
| Rate for Payer: Entrust Commercial |
$307.56
|
| Rate for Payer: First Choice Health Commercial |
$307.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$307.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.54
|
| Rate for Payer: HealthUtah PPO |
$323.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$314.04
|
| Rate for Payer: Multiplan Medicare/VA |
$175.31
|
| Rate for Payer: One Health Plan of WY PPO |
$317.28
|
| Rate for Payer: PacificSource Commercial |
$291.38
|
| Rate for Payer: PHCS PPO |
$317.28
|
| Rate for Payer: Three Rivers PPO |
$242.81
|
| Rate for Payer: TriWest Veterans Administration |
$184.54
|
| Rate for Payer: United Healthcare Commercial |
$309.18
|
| Rate for Payer: United Healthcare Medicare |
$184.54
|
| Rate for Payer: WINHealth Partners Commercial |
$317.28
|
| Rate for Payer: Wise Provider Network Commercial |
$307.56
|
|
|
CEMENT RESTRICTOR 8-13MM
|
Facility
|
IP
|
$323.75
|
|
| Hospital Charge Code |
3004370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.61 |
| Max. Negotiated Rate |
$323.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$317.28
|
| Rate for Payer: Aetna of WY Medicare |
$207.20
|
| Rate for Payer: Altius Commercial |
$310.80
|
| Rate for Payer: Beech Street Commercial |
$317.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.04
|
| Rate for Payer: Cash Price |
$226.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$314.04
|
| Rate for Payer: Cigna of WY Commercial |
$317.28
|
| Rate for Payer: Entrust Commercial |
$307.56
|
| Rate for Payer: First Choice Health Commercial |
$307.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$307.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.49
|
| Rate for Payer: HealthUtah PPO |
$323.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$314.04
|
| Rate for Payer: Multiplan Medicare/VA |
$187.61
|
| Rate for Payer: One Health Plan of WY PPO |
$317.28
|
| Rate for Payer: PacificSource Commercial |
$291.38
|
| Rate for Payer: PHCS PPO |
$317.28
|
| Rate for Payer: Three Rivers PPO |
$242.81
|
| Rate for Payer: TriWest Veterans Administration |
$197.49
|
| Rate for Payer: United Healthcare Commercial |
$309.18
|
| Rate for Payer: United Healthcare Medicare |
$197.49
|
| Rate for Payer: WINHealth Partners Commercial |
$307.56
|
| Rate for Payer: Wise Provider Network Commercial |
$307.56
|
|
|
CEMENT RESTRICTOR DIAM .13MM
|
Facility
|
OP
|
$1,140.30
|
|
| Hospital Charge Code |
3004701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.47 |
| Max. Negotiated Rate |
$1,140.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.49
|
| Rate for Payer: Aetna of WY Medicare |
$752.60
|
| Rate for Payer: Altius Commercial |
$1,094.69
|
| Rate for Payer: Beech Street Commercial |
$1,117.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,106.09
|
| Rate for Payer: Cash Price |
$798.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,106.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.49
|
| Rate for Payer: Entrust Commercial |
$1,083.28
|
| Rate for Payer: First Choice Health Commercial |
$1,083.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.97
|
| Rate for Payer: HealthUtah PPO |
$1,140.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,106.09
|
| Rate for Payer: Multiplan Medicare/VA |
$617.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.49
|
| Rate for Payer: PacificSource Commercial |
$1,026.27
|
| Rate for Payer: PHCS PPO |
$1,117.49
|
| Rate for Payer: Three Rivers PPO |
$855.22
|
| Rate for Payer: TriWest Veterans Administration |
$649.97
|
| Rate for Payer: United Healthcare Commercial |
$1,088.99
|
| Rate for Payer: United Healthcare Medicare |
$649.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,117.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.28
|
|
|
CEMENT RESTRICTOR DIAM .13MM
|
Facility
|
IP
|
$1,140.30
|
|
| Hospital Charge Code |
3004701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$1,140.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.49
|
| Rate for Payer: Aetna of WY Medicare |
$729.79
|
| Rate for Payer: Altius Commercial |
$1,094.69
|
| Rate for Payer: Beech Street Commercial |
$1,117.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,106.09
|
| Rate for Payer: Cash Price |
$798.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,106.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.49
|
| Rate for Payer: Entrust Commercial |
$1,083.28
|
| Rate for Payer: First Choice Health Commercial |
$1,083.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.58
|
| Rate for Payer: HealthUtah PPO |
$1,140.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,106.09
|
| Rate for Payer: Multiplan Medicare/VA |
$660.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.49
|
| Rate for Payer: PacificSource Commercial |
$1,026.27
|
| Rate for Payer: PHCS PPO |
$1,117.49
|
| Rate for Payer: Three Rivers PPO |
$855.22
|
| Rate for Payer: TriWest Veterans Administration |
$695.58
|
| Rate for Payer: United Healthcare Commercial |
$1,088.99
|
| Rate for Payer: United Healthcare Medicare |
$695.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,083.28
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.28
|
|
|
CEMENT RESTRICTOR DIAM .24MM
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
3004700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.64 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$685.44
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.31
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$620.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$653.31
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$653.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,017.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
CEMENT RESTRICTOR DIAM .24MM
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
3004700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.95 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$706.86
|
| Rate for Payer: Altius Commercial |
$1,028.16
|
| Rate for Payer: Beech Street Commercial |
$1,049.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.87
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: Entrust Commercial |
$1,017.45
|
| Rate for Payer: First Choice Health Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.47
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$579.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,049.58
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$610.47
|
| Rate for Payer: United Healthcare Commercial |
$1,022.80
|
| Rate for Payer: United Healthcare Medicare |
$610.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.58
|
| Rate for Payer: Wise Provider Network Commercial |
$1,017.45
|
|
|
CEMENT VIVORTE FORTERA 3CC
|
Facility
|
IP
|
$5,915.00
|
|
| Hospital Charge Code |
3004198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.74 |
| Max. Negotiated Rate |
$5,915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,796.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,785.60
|
| Rate for Payer: Altius Commercial |
$5,678.40
|
| Rate for Payer: Beech Street Commercial |
$5,796.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,737.55
|
| Rate for Payer: Cash Price |
$4,140.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,737.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,796.70
|
| Rate for Payer: Entrust Commercial |
$5,619.25
|
| Rate for Payer: First Choice Health Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,608.15
|
| Rate for Payer: HealthUtah PPO |
$5,915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,737.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,427.74
|
| Rate for Payer: One Health Plan of WY PPO |
$5,796.70
|
| Rate for Payer: PacificSource Commercial |
$5,323.50
|
| Rate for Payer: PHCS PPO |
$5,796.70
|
| Rate for Payer: Three Rivers PPO |
$4,436.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,608.15
|
| Rate for Payer: United Healthcare Commercial |
$5,648.82
|
| Rate for Payer: United Healthcare Medicare |
$3,608.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,619.25
|
| Rate for Payer: Wise Provider Network Commercial |
$5,619.25
|
|
|
CEMENT VIVORTE FORTERA 3CC
|
Facility
|
OP
|
$5,915.00
|
|
| Hospital Charge Code |
3004198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,202.97 |
| Max. Negotiated Rate |
$5,915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,796.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,903.90
|
| Rate for Payer: Altius Commercial |
$5,678.40
|
| Rate for Payer: Beech Street Commercial |
$5,796.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,737.55
|
| Rate for Payer: Cash Price |
$4,140.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,737.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,796.70
|
| Rate for Payer: Entrust Commercial |
$5,619.25
|
| Rate for Payer: First Choice Health Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,371.55
|
| Rate for Payer: HealthUtah PPO |
$5,915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,737.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,202.97
|
| Rate for Payer: One Health Plan of WY PPO |
$5,796.70
|
| Rate for Payer: PacificSource Commercial |
$5,323.50
|
| Rate for Payer: PHCS PPO |
$5,796.70
|
| Rate for Payer: Three Rivers PPO |
$4,436.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,371.55
|
| Rate for Payer: United Healthcare Commercial |
$5,648.82
|
| Rate for Payer: United Healthcare Medicare |
$3,371.55
|
| Rate for Payer: WINHealth Partners Commercial |
$5,796.70
|
| Rate for Payer: Wise Provider Network Commercial |
$5,619.25
|
|
|
CEM MIX COMPAC VAC 2 DOSE
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
2650084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.28 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$259.84
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$393.82
|
| 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: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.66
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$235.28
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$247.66
|
| Rate for Payer: United Healthcare Commercial |
$387.73
|
| Rate for Payer: United Healthcare Medicare |
$247.66
|
| Rate for Payer: WINHealth Partners Commercial |
$385.70
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
|
CEM MIX COMPAC VAC 2 DOSE
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
2650084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$267.96
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$393.82
|
| 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: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.42
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$219.85
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$231.42
|
| Rate for Payer: United Healthcare Commercial |
$387.73
|
| Rate for Payer: United Healthcare Medicare |
$231.42
|
| Rate for Payer: WINHealth Partners Commercial |
$397.88
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
|
CEM MIXING BOWL PALABOWL
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
3003177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.81 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.80
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$75.81
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$133.70
|
| Rate for Payer: United Healthcare Medicare |
$79.80
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
CEM MIXING BOWL PALABOWL
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
3003177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.13 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$89.60
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.80
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$81.13
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.40
|
| Rate for Payer: United Healthcare Commercial |
$133.70
|
| Rate for Payer: United Healthcare Medicare |
$85.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
CEM MIX PALACOS PRO R+G 80G
|
Facility
|
OP
|
$1,603.00
|
|
| Hospital Charge Code |
2650955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.02 |
| Max. Negotiated Rate |
$1,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,570.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,057.98
|
| Rate for Payer: Altius Commercial |
$1,538.88
|
| Rate for Payer: Beech Street Commercial |
$1,570.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,554.91
|
| Rate for Payer: Cash Price |
$1,122.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,554.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,570.94
|
| Rate for Payer: Entrust Commercial |
$1,522.85
|
| Rate for Payer: First Choice Health Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.71
|
| Rate for Payer: HealthUtah PPO |
$1,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,554.91
|
| Rate for Payer: Multiplan Medicare/VA |
$868.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,570.94
|
| Rate for Payer: PacificSource Commercial |
$1,442.70
|
| Rate for Payer: PHCS PPO |
$1,570.94
|
| Rate for Payer: Three Rivers PPO |
$1,202.25
|
| Rate for Payer: TriWest Veterans Administration |
$913.71
|
| Rate for Payer: United Healthcare Commercial |
$1,530.86
|
| Rate for Payer: United Healthcare Medicare |
$913.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,570.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1,522.85
|
|
|
CEM MIX PALACOS PRO R+G 80G
|
Facility
|
IP
|
$1,603.00
|
|
| Hospital Charge Code |
2650955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.94 |
| Max. Negotiated Rate |
$1,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,570.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,025.92
|
| Rate for Payer: Altius Commercial |
$1,538.88
|
| Rate for Payer: Beech Street Commercial |
$1,570.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,554.91
|
| Rate for Payer: Cash Price |
$1,122.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,554.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,570.94
|
| Rate for Payer: Entrust Commercial |
$1,522.85
|
| Rate for Payer: First Choice Health Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.83
|
| Rate for Payer: HealthUtah PPO |
$1,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,554.91
|
| Rate for Payer: Multiplan Medicare/VA |
$928.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,570.94
|
| Rate for Payer: PacificSource Commercial |
$1,442.70
|
| Rate for Payer: PHCS PPO |
$1,570.94
|
| Rate for Payer: Three Rivers PPO |
$1,202.25
|
| Rate for Payer: TriWest Veterans Administration |
$977.83
|
| Rate for Payer: United Healthcare Commercial |
$1,530.86
|
| Rate for Payer: United Healthcare Medicare |
$977.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,522.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,522.85
|
|
|
CEM PALACOS LV+G 1X40 W/GENT
|
Facility
|
IP
|
$681.48
|
|
| Hospital Charge Code |
3003176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.92 |
| Max. Negotiated Rate |
$681.48 |
| Rate for Payer: United Healthcare Commercial |
$650.81
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$667.85
|
| Rate for Payer: Aetna of WY Medicare |
$436.15
|
| Rate for Payer: Altius Commercial |
$654.22
|
| Rate for Payer: Beech Street Commercial |
$667.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$661.04
|
| Rate for Payer: Cash Price |
$477.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.04
|
| Rate for Payer: Cigna of WY Commercial |
$667.85
|
| Rate for Payer: Entrust Commercial |
$647.41
|
| Rate for Payer: First Choice Health Commercial |
$647.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.70
|
| Rate for Payer: HealthUtah PPO |
$681.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.04
|
| Rate for Payer: Multiplan Medicare/VA |
$394.92
|
| Rate for Payer: One Health Plan of WY PPO |
$667.85
|
| Rate for Payer: PacificSource Commercial |
$613.33
|
| Rate for Payer: PHCS PPO |
$667.85
|
| Rate for Payer: Three Rivers PPO |
$511.11
|
| Rate for Payer: TriWest Veterans Administration |
$415.70
|
| Rate for Payer: United Healthcare Medicare |
$415.70
|
| Rate for Payer: WINHealth Partners Commercial |
$647.41
|
| Rate for Payer: Wise Provider Network Commercial |
$647.41
|
|
