|
CERCLAGE 1.5MM SUPERCABLE
|
Facility
|
OP
|
$2,485.00
|
|
| Hospital Charge Code |
3004492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.63 |
| Max. Negotiated Rate |
$2,485.00 |
| Rate for Payer: United Healthcare Commercial |
$2,373.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,435.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,640.10
|
| Rate for Payer: Altius Commercial |
$2,385.60
|
| Rate for Payer: Beech Street Commercial |
$2,435.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,410.45
|
| Rate for Payer: Cash Price |
$1,739.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,410.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,435.30
|
| Rate for Payer: Entrust Commercial |
$2,360.75
|
| Rate for Payer: First Choice Health Commercial |
$2,360.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,360.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,416.45
|
| Rate for Payer: HealthUtah PPO |
$2,485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,410.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,345.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,435.30
|
| Rate for Payer: PacificSource Commercial |
$2,236.50
|
| Rate for Payer: PHCS PPO |
$2,435.30
|
| Rate for Payer: Three Rivers PPO |
$1,863.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,416.45
|
| Rate for Payer: United Healthcare Medicare |
$1,416.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2,435.30
|
| Rate for Payer: Wise Provider Network Commercial |
$2,360.75
|
|
|
CERCLAGE 1.5MM SUPERCABLE
|
Facility
|
IP
|
$2,485.00
|
|
| Hospital Charge Code |
3004492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.06 |
| Max. Negotiated Rate |
$2,485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,435.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,590.40
|
| Rate for Payer: Altius Commercial |
$2,385.60
|
| Rate for Payer: Beech Street Commercial |
$2,435.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,410.45
|
| Rate for Payer: Cash Price |
$1,739.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,410.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,435.30
|
| Rate for Payer: Entrust Commercial |
$2,360.75
|
| Rate for Payer: First Choice Health Commercial |
$2,360.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,360.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,515.85
|
| Rate for Payer: HealthUtah PPO |
$2,485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,410.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,440.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,435.30
|
| Rate for Payer: PacificSource Commercial |
$2,236.50
|
| Rate for Payer: PHCS PPO |
$2,435.30
|
| Rate for Payer: Three Rivers PPO |
$1,863.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,515.85
|
| Rate for Payer: United Healthcare Commercial |
$2,373.18
|
| Rate for Payer: United Healthcare Medicare |
$1,515.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,360.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,360.75
|
|
|
CERCLAGE CERVIX PREGNANCY ABDOMINAL
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 59325
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$489.02
|
| Rate for Payer: Aetna of WY Medicare |
$226.14
|
| Rate for Payer: Beech Street Commercial |
$474.05
|
| Rate for Payer: Cash Price |
$349.30
|
| Rate for Payer: Cash Price |
$349.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$484.03
|
| Rate for Payer: Cigna of WY Commercial |
$489.02
|
| Rate for Payer: First Choice Health Commercial |
$449.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$474.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.14
|
| Rate for Payer: HealthUtah PPO |
$499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$484.03
|
| Rate for Payer: Multiplan Medicare/VA |
$192.22
|
| Rate for Payer: One Health Plan of WY PPO |
$489.02
|
| Rate for Payer: PacificSource Commercial |
$449.10
|
| Rate for Payer: PHCS PPO |
$474.05
|
| Rate for Payer: Three Rivers PPO |
$374.25
|
| Rate for Payer: TriWest Veterans Administration |
$226.14
|
| Rate for Payer: United Healthcare Commercial |
$474.05
|
| Rate for Payer: WINHealth Partners Commercial |
$424.15
|
|
|
CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$121.46 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.76
|
| Rate for Payer: Aetna of WY Medicare |
$142.90
|
| Rate for Payer: Beech Street Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.64
|
| Rate for Payer: Cigna of WY Commercial |
$305.76
|
| Rate for Payer: First Choice Health Commercial |
$280.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.90
|
| Rate for Payer: HealthUtah PPO |
$312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.64
|
| Rate for Payer: Multiplan Medicare/VA |
$121.46
|
| Rate for Payer: One Health Plan of WY PPO |
$305.76
|
| Rate for Payer: PacificSource Commercial |
$280.80
|
| Rate for Payer: PHCS PPO |
$296.40
|
| Rate for Payer: Three Rivers PPO |
$234.00
|
| Rate for Payer: TriWest Veterans Administration |
$142.90
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
| Rate for Payer: WINHealth Partners Commercial |
$265.20
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [86986]
|
Facility
|
IP
|
$5,734.19
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,322.96 |
| Max. Negotiated Rate |
$5,734.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,619.51
|
| Rate for Payer: Aetna of WY Medicare |
$3,669.88
|
| Rate for Payer: Altius Commercial |
$5,504.82
|
| Rate for Payer: Beech Street Commercial |
$5,619.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,562.16
|
| Rate for Payer: Cash Price |
$4,013.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,562.16
|
| Rate for Payer: Cigna of WY Commercial |
$5,619.51
|
| Rate for Payer: Entrust Commercial |
$5,447.48
|
| Rate for Payer: First Choice Health Commercial |
$5,447.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,447.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,497.86
|
| Rate for Payer: HealthUtah PPO |
$5,734.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,562.16
|
| Rate for Payer: Multiplan Medicare/VA |
$3,322.96
|
| Rate for Payer: One Health Plan of WY PPO |
$5,619.51
|
| Rate for Payer: PacificSource Commercial |
$5,160.77
|
| Rate for Payer: PHCS PPO |
$5,619.51
|
| Rate for Payer: Three Rivers PPO |
$4,300.64
|
| Rate for Payer: TriWest Veterans Administration |
$3,497.86
|
| Rate for Payer: United Healthcare Commercial |
$5,476.15
|
| Rate for Payer: United Healthcare Medicare |
$3,497.86
|
| Rate for Payer: WINHealth Partners Commercial |
$5,447.48
|
| Rate for Payer: Wise Provider Network Commercial |
$5,447.48
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [86986]
|
Facility
|
OP
|
$5,734.19
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,105.06 |
| Max. Negotiated Rate |
$5,734.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,619.51
|
| Rate for Payer: Aetna of WY Medicare |
$3,784.57
|
| Rate for Payer: Altius Commercial |
$5,504.82
|
| Rate for Payer: Beech Street Commercial |
$5,619.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,562.16
|
| Rate for Payer: Cash Price |
$4,013.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,562.16
|
| Rate for Payer: Cigna of WY Commercial |
$5,619.51
|
| Rate for Payer: Entrust Commercial |
$5,447.48
|
| Rate for Payer: First Choice Health Commercial |
$5,447.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,447.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,268.49
|
| Rate for Payer: HealthUtah PPO |
$5,734.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,562.16
|
| Rate for Payer: Multiplan Medicare/VA |
$3,105.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5,619.51
|
| Rate for Payer: PacificSource Commercial |
$5,160.77
|
| Rate for Payer: PHCS PPO |
$5,619.51
|
| Rate for Payer: Three Rivers PPO |
$4,300.64
|
| Rate for Payer: TriWest Veterans Administration |
$3,268.49
|
| Rate for Payer: United Healthcare Commercial |
$5,476.15
|
| Rate for Payer: United Healthcare Medicare |
$3,268.49
|
| Rate for Payer: WINHealth Partners Commercial |
$5,619.51
|
| Rate for Payer: Wise Provider Network Commercial |
$5,447.48
|
|
|
CERV BALLOON W/ STYLET G198191
|
Facility
|
IP
|
$183.47
|
|
| Hospital Charge Code |
2450111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$183.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.80
|
| Rate for Payer: Aetna of WY Medicare |
$117.42
|
| Rate for Payer: Altius Commercial |
$176.13
|
| Rate for Payer: Beech Street Commercial |
$179.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.97
|
| Rate for Payer: Cash Price |
$128.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.97
|
| Rate for Payer: Cigna of WY Commercial |
$179.80
|
| Rate for Payer: Entrust Commercial |
$174.30
|
| Rate for Payer: First Choice Health Commercial |
$174.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.92
|
| Rate for Payer: HealthUtah PPO |
$183.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.97
|
| Rate for Payer: Multiplan Medicare/VA |
$106.32
|
| Rate for Payer: One Health Plan of WY PPO |
$179.80
|
| Rate for Payer: PacificSource Commercial |
$165.12
|
| Rate for Payer: PHCS PPO |
$179.80
|
| Rate for Payer: Three Rivers PPO |
$137.60
|
| Rate for Payer: TriWest Veterans Administration |
$111.92
|
| Rate for Payer: United Healthcare Commercial |
$175.21
|
| Rate for Payer: United Healthcare Medicare |
$111.92
|
| Rate for Payer: WINHealth Partners Commercial |
$174.30
|
| Rate for Payer: Wise Provider Network Commercial |
$174.30
|
|
|
CERV BALLOON W/ STYLET G198191
|
Facility
|
OP
|
$183.47
|
|
| Hospital Charge Code |
2450111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.35 |
| Max. Negotiated Rate |
$183.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.80
|
| Rate for Payer: Aetna of WY Medicare |
$121.09
|
| Rate for Payer: Altius Commercial |
$176.13
|
| Rate for Payer: Beech Street Commercial |
$179.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.97
|
| Rate for Payer: Cash Price |
$128.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.97
|
| Rate for Payer: Cigna of WY Commercial |
$179.80
|
| Rate for Payer: Entrust Commercial |
$174.30
|
| Rate for Payer: First Choice Health Commercial |
$174.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.58
|
| Rate for Payer: HealthUtah PPO |
$183.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.97
|
| Rate for Payer: Multiplan Medicare/VA |
$99.35
|
| Rate for Payer: One Health Plan of WY PPO |
$179.80
|
| Rate for Payer: PacificSource Commercial |
$165.12
|
| Rate for Payer: PHCS PPO |
$179.80
|
| Rate for Payer: Three Rivers PPO |
$137.60
|
| Rate for Payer: TriWest Veterans Administration |
$104.58
|
| Rate for Payer: United Healthcare Commercial |
$175.21
|
| Rate for Payer: United Healthcare Medicare |
$104.58
|
| Rate for Payer: WINHealth Partners Commercial |
$179.80
|
| Rate for Payer: Wise Provider Network Commercial |
$174.30
|
|
|
CERV COLLAR ADJ. ADLT 79-83131
|
Facility
|
OP
|
$18.06
|
|
| Hospital Charge Code |
2200089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.92
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.52
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.29
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.78
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.29
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$10.29
|
| Rate for Payer: WINHealth Partners Commercial |
$17.70
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. ADLT 79-83131
|
Facility
|
IP
|
$18.06
|
|
| Hospital Charge Code |
2200089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.56
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.52
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$17.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. PED 79-83130
|
Facility
|
OP
|
$18.06
|
|
| Hospital Charge Code |
2200090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.92
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.52
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.29
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.78
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.29
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$10.29
|
| Rate for Payer: WINHealth Partners Commercial |
$17.70
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. PED 79-83130
|
Facility
|
IP
|
$18.06
|
|
| Hospital Charge Code |
2200090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.56
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.52
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$17.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR MINI PERFIT ACE
|
Facility
|
OP
|
$15.75
|
|
| Hospital Charge Code |
2200435
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Commercial |
$15.12
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.96
|
| Rate for Payer: First Choice Health Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.81
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.96
|
|
|
CERV COLLAR MINI PERFIT ACE
|
Facility
|
IP
|
$15.75
|
|
| Hospital Charge Code |
2200435
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Commercial |
$15.12
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.96
|
| Rate for Payer: First Choice Health Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.61
|
| Rate for Payer: HealthUtah PPO |
$15.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.81
|
| Rate for Payer: TriWest Veterans Administration |
$9.61
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$9.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.96
|
|
|
CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS L0120
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
|
|
CERVICAL ALLOGRAFT SPACER 09MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
CERVICAL ALLOGRAFT SPACER 09MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
CERVICAL DISK MOBI C 13X15X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,750.55 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$14,322.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,369.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$11,750.55
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$12,369.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$12,369.00
|
| Rate for Payer: WINHealth Partners Commercial |
$21,266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 13X15X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,575.15 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,888.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13,237.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12,575.15
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$13,237.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$13,237.00
|
| Rate for Payer: WINHealth Partners Commercial |
$20,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 13X17X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,575.15 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,888.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13,237.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12,575.15
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$13,237.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$13,237.00
|
| Rate for Payer: WINHealth Partners Commercial |
$20,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 13X17X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,750.55 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$14,322.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,369.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$11,750.55
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$12,369.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$12,369.00
|
| Rate for Payer: WINHealth Partners Commercial |
$21,266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 15X15X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,575.15 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,888.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13,237.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12,575.15
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$13,237.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$13,237.00
|
| Rate for Payer: WINHealth Partners Commercial |
$20,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 15X15X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,750.55 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$14,322.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,369.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$11,750.55
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$12,369.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$12,369.00
|
| Rate for Payer: WINHealth Partners Commercial |
$21,266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 15X15X6MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,575.15 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,888.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13,237.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12,575.15
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$13,237.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$13,237.00
|
| Rate for Payer: WINHealth Partners Commercial |
$20,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
|
CERVICAL DISK MOBI C 15X15X6MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,750.55 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21,266.00
|
| Rate for Payer: Aetna of WY Medicare |
$14,322.00
|
| Rate for Payer: Altius Commercial |
$20,832.00
|
| Rate for Payer: Beech Street Commercial |
$21,266.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,049.00
|
| Rate for Payer: Cash Price |
$15,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$21,049.00
|
| Rate for Payer: Cigna of WY Commercial |
$21,266.00
|
| Rate for Payer: Entrust Commercial |
$20,615.00
|
| Rate for Payer: First Choice Health Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,369.00
|
| Rate for Payer: HealthUtah PPO |
$21,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21,049.00
|
| Rate for Payer: Multiplan Medicare/VA |
$11,750.55
|
| Rate for Payer: One Health Plan of WY PPO |
$21,266.00
|
| Rate for Payer: PacificSource Commercial |
$19,530.00
|
| Rate for Payer: PHCS PPO |
$21,266.00
|
| Rate for Payer: Three Rivers PPO |
$16,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$12,369.00
|
| Rate for Payer: United Healthcare Commercial |
$20,723.50
|
| Rate for Payer: United Healthcare Medicare |
$12,369.00
|
| Rate for Payer: WINHealth Partners Commercial |
$21,266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$20,615.00
|
|
