|
CORRECT BUNION, SIMPLE
|
Professional
|
Both
|
$2,354.00
|
|
|
Service Code
|
HCPCS 28290
|
| Min. Negotiated Rate |
$1,765.50 |
| Max. Negotiated Rate |
$2,354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,306.92
|
| Rate for Payer: Beech Street Commercial |
$2,236.30
|
| Rate for Payer: Cash Price |
$1,647.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,283.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,306.92
|
| Rate for Payer: First Choice Health Commercial |
$2,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,236.30
|
| Rate for Payer: HealthUtah PPO |
$2,354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,283.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,306.92
|
| Rate for Payer: PacificSource Commercial |
$2,118.60
|
| Rate for Payer: PHCS PPO |
$2,236.30
|
| Rate for Payer: Three Rivers PPO |
$1,765.50
|
| Rate for Payer: United Healthcare Commercial |
$2,236.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,000.90
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$7,694.00
|
|
|
Service Code
|
HCPCS 28285 50
|
| Min. Negotiated Rate |
$5,770.50 |
| Max. Negotiated Rate |
$7,694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,540.12
|
| Rate for Payer: Beech Street Commercial |
$7,309.30
|
| Rate for Payer: Cash Price |
$5,385.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,463.18
|
| Rate for Payer: Cigna of WY Commercial |
$7,540.12
|
| Rate for Payer: First Choice Health Commercial |
$6,924.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,309.30
|
| Rate for Payer: HealthUtah PPO |
$7,694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,463.18
|
| Rate for Payer: One Health Plan of WY PPO |
$7,540.12
|
| Rate for Payer: PacificSource Commercial |
$6,924.60
|
| Rate for Payer: PHCS PPO |
$7,309.30
|
| Rate for Payer: Three Rivers PPO |
$5,770.50
|
| Rate for Payer: United Healthcare Commercial |
$7,309.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,539.90
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$3,846.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$322.19 |
| Max. Negotiated Rate |
$3,846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,769.08
|
| Rate for Payer: Aetna of WY Medicare |
$379.05
|
| Rate for Payer: Beech Street Commercial |
$3,653.70
|
| Rate for Payer: Cash Price |
$2,692.20
|
| Rate for Payer: Cash Price |
$2,692.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,730.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,769.08
|
| Rate for Payer: First Choice Health Commercial |
$3,461.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,653.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.05
|
| Rate for Payer: HealthUtah PPO |
$3,846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,730.62
|
| Rate for Payer: Multiplan Medicare/VA |
$322.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,769.08
|
| Rate for Payer: PacificSource Commercial |
$3,461.40
|
| Rate for Payer: PHCS PPO |
$3,653.70
|
| Rate for Payer: Three Rivers PPO |
$2,884.50
|
| Rate for Payer: TriWest Veterans Administration |
$379.05
|
| Rate for Payer: United Healthcare Commercial |
$3,653.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,269.10
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 28285 80
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$617.40
|
| Rate for Payer: Beech Street Commercial |
$598.50
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$611.10
|
| Rate for Payer: Cigna of WY Commercial |
$617.40
|
| Rate for Payer: First Choice Health Commercial |
$567.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$598.50
|
| Rate for Payer: HealthUtah PPO |
$630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$611.10
|
| Rate for Payer: One Health Plan of WY PPO |
$617.40
|
| Rate for Payer: PacificSource Commercial |
$567.00
|
| Rate for Payer: PHCS PPO |
$598.50
|
| Rate for Payer: Three Rivers PPO |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$598.50
|
| Rate for Payer: WINHealth Partners Commercial |
$535.50
|
|
|
CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$4,659.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$426.65 |
| Max. Negotiated Rate |
$4,659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,565.82
|
| Rate for Payer: Aetna of WY Medicare |
$501.94
|
| Rate for Payer: Beech Street Commercial |
$4,426.05
|
| Rate for Payer: Cash Price |
$3,261.30
|
| Rate for Payer: Cash Price |
$3,261.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,519.23
|
| Rate for Payer: Cigna of WY Commercial |
$4,565.82
|
| Rate for Payer: First Choice Health Commercial |
$4,193.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,426.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.94
|
| Rate for Payer: HealthUtah PPO |
$4,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,519.23
|
| Rate for Payer: Multiplan Medicare/VA |
$426.65
|
| Rate for Payer: One Health Plan of WY PPO |
$4,565.82
|
| Rate for Payer: PacificSource Commercial |
$4,193.10
|
| Rate for Payer: PHCS PPO |
$4,426.05
|
| Rate for Payer: Three Rivers PPO |
$3,494.25
|
| Rate for Payer: TriWest Veterans Administration |
$501.94
|
| Rate for Payer: United Healthcare Commercial |
$4,426.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3,960.15
|
|
|
CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$4,659.00
|
|
|
Service Code
|
HCPCS 28296 AS
|
| Min. Negotiated Rate |
$426.65 |
| Max. Negotiated Rate |
$4,659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,565.82
|
| Rate for Payer: Beech Street Commercial |
$4,426.05
|
| Rate for Payer: Cash Price |
$3,261.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,519.23
|
| Rate for Payer: Cigna of WY Commercial |
$4,565.82
|
| Rate for Payer: First Choice Health Commercial |
$4,193.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,426.05
|
| Rate for Payer: HealthUtah PPO |
$4,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,519.23
|
| Rate for Payer: One Health Plan of WY PPO |
$4,565.82
|
| Rate for Payer: PacificSource Commercial |
$4,193.10
|
| Rate for Payer: PHCS PPO |
$4,426.05
|
| Rate for Payer: Three Rivers PPO |
$3,494.25
|
| Rate for Payer: United Healthcare Commercial |
$4,426.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3,960.15
|
|
|
CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 28296 80
|
| Min. Negotiated Rate |
$699.00 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$913.36
|
| Rate for Payer: Beech Street Commercial |
$885.40
|
| Rate for Payer: Cash Price |
$652.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$904.04
|
| Rate for Payer: Cigna of WY Commercial |
$913.36
|
| Rate for Payer: First Choice Health Commercial |
$838.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$885.40
|
| Rate for Payer: HealthUtah PPO |
$932.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$904.04
|
| Rate for Payer: One Health Plan of WY PPO |
$913.36
|
| Rate for Payer: PacificSource Commercial |
$838.80
|
| Rate for Payer: PHCS PPO |
$885.40
|
| Rate for Payer: Three Rivers PPO |
$699.00
|
| Rate for Payer: United Healthcare Commercial |
$885.40
|
| Rate for Payer: WINHealth Partners Commercial |
$792.20
|
|
|
CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 28292 AS
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$727.16
|
| Rate for Payer: Beech Street Commercial |
$704.90
|
| Rate for Payer: Cash Price |
$519.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$719.74
|
| Rate for Payer: Cigna of WY Commercial |
$727.16
|
| Rate for Payer: First Choice Health Commercial |
$667.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$704.90
|
| Rate for Payer: HealthUtah PPO |
$742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$719.74
|
| Rate for Payer: One Health Plan of WY PPO |
$727.16
|
| Rate for Payer: PacificSource Commercial |
$667.80
|
| Rate for Payer: PHCS PPO |
$704.90
|
| Rate for Payer: Three Rivers PPO |
$556.50
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
| Rate for Payer: WINHealth Partners Commercial |
$630.70
|
|
|
CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$3,697.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$404.32 |
| Max. Negotiated Rate |
$3,697.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,623.06
|
| Rate for Payer: Aetna of WY Medicare |
$475.67
|
| Rate for Payer: Beech Street Commercial |
$3,512.15
|
| Rate for Payer: Cash Price |
$2,587.90
|
| Rate for Payer: Cash Price |
$2,587.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,586.09
|
| Rate for Payer: Cigna of WY Commercial |
$3,623.06
|
| Rate for Payer: First Choice Health Commercial |
$3,327.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,512.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.67
|
| Rate for Payer: HealthUtah PPO |
$3,697.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,586.09
|
| Rate for Payer: Multiplan Medicare/VA |
$404.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,623.06
|
| Rate for Payer: PacificSource Commercial |
$3,327.30
|
| Rate for Payer: PHCS PPO |
$3,512.15
|
| Rate for Payer: Three Rivers PPO |
$2,772.75
|
| Rate for Payer: TriWest Veterans Administration |
$475.67
|
| Rate for Payer: United Healthcare Commercial |
$3,512.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3,142.45
|
|
|
CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 28292 80
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$727.16
|
| Rate for Payer: Beech Street Commercial |
$704.90
|
| Rate for Payer: Cash Price |
$519.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$719.74
|
| Rate for Payer: Cigna of WY Commercial |
$727.16
|
| Rate for Payer: First Choice Health Commercial |
$667.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$704.90
|
| Rate for Payer: HealthUtah PPO |
$742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$719.74
|
| Rate for Payer: One Health Plan of WY PPO |
$727.16
|
| Rate for Payer: PacificSource Commercial |
$667.80
|
| Rate for Payer: PHCS PPO |
$704.90
|
| Rate for Payer: Three Rivers PPO |
$556.50
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
| Rate for Payer: WINHealth Partners Commercial |
$630.70
|
|
|
CORTICAL FIBER 10 CC ALLOGRAFT
|
Facility
|
IP
|
$3,272.50
|
|
| Hospital Charge Code |
2800388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,896.41 |
| Max. Negotiated Rate |
$3,272.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,207.05
|
| Rate for Payer: Aetna of WY Medicare |
$2,094.40
|
| Rate for Payer: Altius Commercial |
$3,141.60
|
| Rate for Payer: Beech Street Commercial |
$3,207.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,174.32
|
| Rate for Payer: Cash Price |
$2,290.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,174.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,207.05
|
| Rate for Payer: Entrust Commercial |
$3,108.88
|
| Rate for Payer: First Choice Health Commercial |
$3,108.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,996.22
|
| Rate for Payer: HealthUtah PPO |
$3,272.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,174.32
|
| Rate for Payer: Multiplan Medicare/VA |
$1,896.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,207.05
|
| Rate for Payer: PacificSource Commercial |
$2,945.25
|
| Rate for Payer: PHCS PPO |
$3,207.05
|
| Rate for Payer: Three Rivers PPO |
$2,454.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,996.22
|
| Rate for Payer: United Healthcare Commercial |
$3,125.24
|
| Rate for Payer: United Healthcare Medicare |
$1,996.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3,108.88
|
| Rate for Payer: Wise Provider Network Commercial |
$3,108.88
|
|
|
CORTICAL FIBER 10 CC ALLOGRAFT
|
Facility
|
OP
|
$3,272.50
|
|
| Hospital Charge Code |
2800388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,772.06 |
| Max. Negotiated Rate |
$3,272.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,207.05
|
| Rate for Payer: Aetna of WY Medicare |
$2,159.85
|
| Rate for Payer: Altius Commercial |
$3,141.60
|
| Rate for Payer: Beech Street Commercial |
$3,207.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,174.32
|
| Rate for Payer: Cash Price |
$2,290.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,174.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,207.05
|
| Rate for Payer: Entrust Commercial |
$3,108.88
|
| Rate for Payer: First Choice Health Commercial |
$3,108.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,108.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,865.32
|
| Rate for Payer: HealthUtah PPO |
$3,272.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,174.32
|
| Rate for Payer: Multiplan Medicare/VA |
$1,772.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3,207.05
|
| Rate for Payer: PacificSource Commercial |
$2,945.25
|
| Rate for Payer: PHCS PPO |
$3,207.05
|
| Rate for Payer: Three Rivers PPO |
$2,454.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,865.32
|
| Rate for Payer: United Healthcare Commercial |
$3,125.24
|
| Rate for Payer: United Healthcare Medicare |
$1,865.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,207.05
|
| Rate for Payer: Wise Provider Network Commercial |
$3,108.88
|
|
|
CORTICAL FIBER 20 CC ALLOGRAFT
|
Facility
|
IP
|
$5,862.50
|
|
| Hospital Charge Code |
2800389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,397.32 |
| Max. Negotiated Rate |
$5,862.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,745.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,752.00
|
| Rate for Payer: Altius Commercial |
$5,628.00
|
| Rate for Payer: Beech Street Commercial |
$5,745.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,686.62
|
| Rate for Payer: Cash Price |
$4,103.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,686.62
|
| Rate for Payer: Cigna of WY Commercial |
$5,745.25
|
| Rate for Payer: Entrust Commercial |
$5,569.38
|
| Rate for Payer: First Choice Health Commercial |
$5,569.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,569.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,576.12
|
| Rate for Payer: HealthUtah PPO |
$5,862.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,686.62
|
| Rate for Payer: Multiplan Medicare/VA |
$3,397.32
|
| Rate for Payer: One Health Plan of WY PPO |
$5,745.25
|
| Rate for Payer: PacificSource Commercial |
$5,276.25
|
| Rate for Payer: PHCS PPO |
$5,745.25
|
| Rate for Payer: Three Rivers PPO |
$4,396.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,576.12
|
| Rate for Payer: United Healthcare Commercial |
$5,598.69
|
| Rate for Payer: United Healthcare Medicare |
$3,576.12
|
| Rate for Payer: WINHealth Partners Commercial |
$5,569.38
|
| Rate for Payer: Wise Provider Network Commercial |
$5,569.38
|
|
|
CORTICAL FIBER 20 CC ALLOGRAFT
|
Facility
|
OP
|
$5,862.50
|
|
| Hospital Charge Code |
2800389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$5,862.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,745.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,869.25
|
| Rate for Payer: Altius Commercial |
$5,628.00
|
| Rate for Payer: Beech Street Commercial |
$5,745.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,686.62
|
| Rate for Payer: Cash Price |
$4,103.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,686.62
|
| Rate for Payer: Cigna of WY Commercial |
$5,745.25
|
| Rate for Payer: Entrust Commercial |
$5,569.38
|
| Rate for Payer: First Choice Health Commercial |
$5,569.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,569.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,341.62
|
| Rate for Payer: HealthUtah PPO |
$5,862.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,686.62
|
| Rate for Payer: Multiplan Medicare/VA |
$3,174.54
|
| Rate for Payer: One Health Plan of WY PPO |
$5,745.25
|
| Rate for Payer: PacificSource Commercial |
$5,276.25
|
| Rate for Payer: PHCS PPO |
$5,745.25
|
| Rate for Payer: Three Rivers PPO |
$4,396.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,341.62
|
| Rate for Payer: United Healthcare Commercial |
$5,598.69
|
| Rate for Payer: United Healthcare Medicare |
$3,341.62
|
| Rate for Payer: WINHealth Partners Commercial |
$5,745.25
|
| Rate for Payer: Wise Provider Network Commercial |
$5,569.38
|
|
|
CORTICAL FIBER 2.5CC ALLOGRAFT
|
Facility
|
IP
|
$1,041.25
|
|
| Hospital Charge Code |
2800386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.40 |
| Max. Negotiated Rate |
$1,041.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,020.42
|
| Rate for Payer: Aetna of WY Medicare |
$666.40
|
| Rate for Payer: Altius Commercial |
$999.60
|
| Rate for Payer: Beech Street Commercial |
$1,020.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,010.01
|
| Rate for Payer: Cash Price |
$728.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,010.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,020.42
|
| Rate for Payer: Entrust Commercial |
$989.19
|
| Rate for Payer: First Choice Health Commercial |
$989.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$989.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.16
|
| Rate for Payer: HealthUtah PPO |
$1,041.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,010.01
|
| Rate for Payer: Multiplan Medicare/VA |
$603.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,020.42
|
| Rate for Payer: PacificSource Commercial |
$937.12
|
| Rate for Payer: PHCS PPO |
$1,020.42
|
| Rate for Payer: Three Rivers PPO |
$780.94
|
| Rate for Payer: TriWest Veterans Administration |
$635.16
|
| Rate for Payer: United Healthcare Commercial |
$994.39
|
| Rate for Payer: United Healthcare Medicare |
$635.16
|
| Rate for Payer: WINHealth Partners Commercial |
$989.19
|
| Rate for Payer: Wise Provider Network Commercial |
$989.19
|
|
|
CORTICAL FIBER 2.5CC ALLOGRAFT
|
Facility
|
OP
|
$1,041.25
|
|
| Hospital Charge Code |
2800386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.84 |
| Max. Negotiated Rate |
$1,041.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,020.42
|
| Rate for Payer: Aetna of WY Medicare |
$687.22
|
| Rate for Payer: Altius Commercial |
$999.60
|
| Rate for Payer: Beech Street Commercial |
$1,020.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,010.01
|
| Rate for Payer: Cash Price |
$728.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,010.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,020.42
|
| Rate for Payer: Entrust Commercial |
$989.19
|
| Rate for Payer: First Choice Health Commercial |
$989.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$989.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.51
|
| Rate for Payer: HealthUtah PPO |
$1,041.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,010.01
|
| Rate for Payer: Multiplan Medicare/VA |
$563.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,020.42
|
| Rate for Payer: PacificSource Commercial |
$937.12
|
| Rate for Payer: PHCS PPO |
$1,020.42
|
| Rate for Payer: Three Rivers PPO |
$780.94
|
| Rate for Payer: TriWest Veterans Administration |
$593.51
|
| Rate for Payer: United Healthcare Commercial |
$994.39
|
| Rate for Payer: United Healthcare Medicare |
$593.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,020.42
|
| Rate for Payer: Wise Provider Network Commercial |
$989.19
|
|
|
CORTICAL FIBER 5.0CC ALLOGRAFT
|
Facility
|
OP
|
$1,933.75
|
|
| Hospital Charge Code |
2800387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.13 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,895.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,276.28
|
| Rate for Payer: Altius Commercial |
$1,856.40
|
| Rate for Payer: Beech Street Commercial |
$1,895.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,875.74
|
| Rate for Payer: Cash Price |
$1,353.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,875.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,895.08
|
| Rate for Payer: Entrust Commercial |
$1,837.06
|
| Rate for Payer: First Choice Health Commercial |
$1,837.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,837.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.24
|
| Rate for Payer: HealthUtah PPO |
$1,933.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,875.74
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,895.08
|
| Rate for Payer: PacificSource Commercial |
$1,740.38
|
| Rate for Payer: PHCS PPO |
$1,895.08
|
| Rate for Payer: Three Rivers PPO |
$1,450.31
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.24
|
| Rate for Payer: United Healthcare Commercial |
$1,846.73
|
| Rate for Payer: United Healthcare Medicare |
$1,102.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1,895.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1,837.06
|
|
|
CORTICAL FIBER 5.0CC ALLOGRAFT
|
Facility
|
IP
|
$1,933.75
|
|
| Hospital Charge Code |
2800387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.61 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,895.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,237.60
|
| Rate for Payer: Altius Commercial |
$1,856.40
|
| Rate for Payer: Beech Street Commercial |
$1,895.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,875.74
|
| Rate for Payer: Cash Price |
$1,353.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,875.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,895.08
|
| Rate for Payer: Entrust Commercial |
$1,837.06
|
| Rate for Payer: First Choice Health Commercial |
$1,837.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,837.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,179.59
|
| Rate for Payer: HealthUtah PPO |
$1,933.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,875.74
|
| Rate for Payer: Multiplan Medicare/VA |
$1,120.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,895.08
|
| Rate for Payer: PacificSource Commercial |
$1,740.38
|
| Rate for Payer: PHCS PPO |
$1,895.08
|
| Rate for Payer: Three Rivers PPO |
$1,450.31
|
| Rate for Payer: TriWest Veterans Administration |
$1,179.59
|
| Rate for Payer: United Healthcare Commercial |
$1,846.73
|
| Rate for Payer: United Healthcare Medicare |
$1,179.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,837.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,837.06
|
|
|
CORTINA CAGE 4 X 28 X 10
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 10
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 11
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 11
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 11
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 11
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CORTINA CAGE 4 X 28 X 12
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
