|
CERVICAL DISK MOBI C 15X17X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004384
|
|
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 15X17X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004384
|
|
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 15X17X6MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004477
|
|
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 15X17X6MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004477
|
|
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 15X19X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004530
|
|
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 15X19X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004530
|
|
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 17X17X5MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004486
|
|
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 17X17X5MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004486
|
|
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 17X17X6MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004553
|
|
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 17X17X6MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004553
|
|
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 17X19X6MM
|
Facility
|
IP
|
$21,700.00
|
|
| Hospital Charge Code |
3004554
|
|
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 17X19X6MM
|
Facility
|
OP
|
$21,700.00
|
|
| Hospital Charge Code |
3004554
|
|
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 IBD 7x16x13 PLANAR 6° .16CC
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004758
|
|
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 IBD 7x16x13 PLANAR 6° .16CC
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004758
|
|
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 IBD 8x18x14 PLANAR 6 DEG 0.19 C
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004722
|
|
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 IBD 8x18x14 PLANAR 6 DEG 0.19 C
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004722
|
|
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 IBD 9x16x13 PLANAR 6° .21CC
|
Facility
|
IP
|
$4,812.54
|
|
| Hospital Charge Code |
3004723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.87 |
| Max. Negotiated Rate |
$4,812.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.29
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.03
|
| Rate for Payer: Altius Commercial |
$4,620.04
|
| Rate for Payer: Beech Street Commercial |
$4,716.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.16
|
| Rate for Payer: Cash Price |
$3,368.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.16
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.29
|
| Rate for Payer: Entrust Commercial |
$4,571.91
|
| Rate for Payer: First Choice Health Commercial |
$4,571.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.65
|
| Rate for Payer: HealthUtah PPO |
$4,812.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.16
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.29
|
| Rate for Payer: PacificSource Commercial |
$4,331.29
|
| Rate for Payer: PHCS PPO |
$4,716.29
|
| Rate for Payer: Three Rivers PPO |
$3,609.40
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.65
|
| Rate for Payer: United Healthcare Commercial |
$4,595.98
|
| Rate for Payer: United Healthcare Medicare |
$2,935.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.91
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.91
|
|
|
CERVICAL IBD 9x16x13 PLANAR 6° .21CC
|
Facility
|
OP
|
$4,812.54
|
|
| Hospital Charge Code |
3004723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.99 |
| Max. Negotiated Rate |
$4,812.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.29
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.28
|
| Rate for Payer: Altius Commercial |
$4,620.04
|
| Rate for Payer: Beech Street Commercial |
$4,716.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.16
|
| Rate for Payer: Cash Price |
$3,368.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.16
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.29
|
| Rate for Payer: Entrust Commercial |
$4,571.91
|
| Rate for Payer: First Choice Health Commercial |
$4,571.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.15
|
| Rate for Payer: HealthUtah PPO |
$4,812.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.16
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.29
|
| Rate for Payer: PacificSource Commercial |
$4,331.29
|
| Rate for Payer: PHCS PPO |
$4,716.29
|
| Rate for Payer: Three Rivers PPO |
$3,609.40
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.15
|
| Rate for Payer: United Healthcare Commercial |
$4,595.98
|
| Rate for Payer: United Healthcare Medicare |
$2,743.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.29
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.91
|
|
|
CERVICAL LORD SPACER 7X12.5X15
|
Facility
|
OP
|
$3,150.00
|
|
| Hospital Charge Code |
3004385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.72 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,087.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,079.00
|
| Rate for Payer: Altius Commercial |
$3,024.00
|
| Rate for Payer: Beech Street Commercial |
$3,087.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,055.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,055.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,087.00
|
| Rate for Payer: Entrust Commercial |
$2,992.50
|
| Rate for Payer: First Choice Health Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,795.50
|
| Rate for Payer: HealthUtah PPO |
$3,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,055.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,705.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,087.00
|
| Rate for Payer: PacificSource Commercial |
$2,835.00
|
| Rate for Payer: PHCS PPO |
$3,087.00
|
| Rate for Payer: Three Rivers PPO |
$2,362.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,795.50
|
| Rate for Payer: United Healthcare Commercial |
$3,008.25
|
| Rate for Payer: United Healthcare Medicare |
$1,795.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,087.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,992.50
|
|
|
CERVICAL LORD SPACER 7X12.5X15
|
Facility
|
IP
|
$3,150.00
|
|
| Hospital Charge Code |
3004385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,825.42 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,087.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$3,024.00
|
| Rate for Payer: Beech Street Commercial |
$3,087.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,055.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,055.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,087.00
|
| Rate for Payer: Entrust Commercial |
$2,992.50
|
| Rate for Payer: First Choice Health Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,921.50
|
| Rate for Payer: HealthUtah PPO |
$3,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,055.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,825.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,087.00
|
| Rate for Payer: PacificSource Commercial |
$2,835.00
|
| Rate for Payer: PHCS PPO |
$3,087.00
|
| Rate for Payer: Three Rivers PPO |
$2,362.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,921.50
|
| Rate for Payer: United Healthcare Commercial |
$3,008.25
|
| Rate for Payer: United Healthcare Medicare |
$1,921.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,992.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,992.50
|
|
|
CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$6,357.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$1,186.40 |
| Max. Negotiated Rate |
$6,357.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,229.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,395.77
|
| Rate for Payer: Beech Street Commercial |
$6,039.15
|
| Rate for Payer: Cash Price |
$4,449.90
|
| Rate for Payer: Cash Price |
$4,449.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,166.29
|
| Rate for Payer: Cigna of WY Commercial |
$6,229.86
|
| Rate for Payer: First Choice Health Commercial |
$5,721.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,039.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,395.77
|
| Rate for Payer: HealthUtah PPO |
$6,357.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,166.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1,186.40
|
| Rate for Payer: One Health Plan of WY PPO |
$6,229.86
|
| Rate for Payer: PacificSource Commercial |
$5,721.30
|
| Rate for Payer: PHCS PPO |
$6,039.15
|
| Rate for Payer: Three Rivers PPO |
$4,767.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,395.77
|
| Rate for Payer: United Healthcare Commercial |
$6,039.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,403.45
|
|
|
CERVICAL MIAMI J MJ200-L STOUT
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
2200376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Aetna of WY Medicare |
$88.66
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.57
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$72.74
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.57
|
| Rate for Payer: United Healthcare Commercial |
$128.29
|
| Rate for Payer: United Healthcare Medicare |
$76.57
|
| Rate for Payer: WINHealth Partners Commercial |
$131.64
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
|
CERVICAL MIAMI J MJ200-L STOUT
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
2200376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.84 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Aetna of WY Medicare |
$85.97
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.94
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$77.84
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$128.29
|
| Rate for Payer: United Healthcare Medicare |
$81.94
|
| Rate for Payer: WINHealth Partners Commercial |
$127.61
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
|
CERVICAL MIAMI J MJ250 XS
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
2200375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Aetna of WY Medicare |
$88.66
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.57
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$72.74
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.57
|
| Rate for Payer: United Healthcare Commercial |
$128.29
|
| Rate for Payer: United Healthcare Medicare |
$76.57
|
| Rate for Payer: WINHealth Partners Commercial |
$131.64
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
|
CERVICAL MIAMI J MJ250 XS
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
2200375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.84 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Aetna of WY Medicare |
$85.97
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.30
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.94
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$77.84
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$128.29
|
| Rate for Payer: United Healthcare Medicare |
$81.94
|
| Rate for Payer: WINHealth Partners Commercial |
$127.61
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
