|
ANATOMICAL NASAL PACK Q770406
|
Facility
|
IP
|
$14.98
|
|
| Hospital Charge Code |
2400248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.68
|
| Rate for Payer: Aetna of WY Medicare |
$9.59
|
| Rate for Payer: Altius Commercial |
$14.38
|
| Rate for Payer: Beech Street Commercial |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.53
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.53
|
| Rate for Payer: Cigna of WY Commercial |
$14.68
|
| Rate for Payer: Entrust Commercial |
$14.23
|
| Rate for Payer: First Choice Health Commercial |
$14.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.14
|
| Rate for Payer: HealthUtah PPO |
$14.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.53
|
| Rate for Payer: Multiplan Medicare/VA |
$8.68
|
| Rate for Payer: One Health Plan of WY PPO |
$14.68
|
| Rate for Payer: PacificSource Commercial |
$13.48
|
| Rate for Payer: PHCS PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$11.24
|
| Rate for Payer: TriWest Veterans Administration |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare |
$9.14
|
| Rate for Payer: WINHealth Partners Commercial |
$14.23
|
| Rate for Payer: Wise Provider Network Commercial |
$14.23
|
|
|
ANATOMICAL NASAL PACK Q770406
|
Facility
|
OP
|
$14.98
|
|
| Hospital Charge Code |
2400248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.68
|
| Rate for Payer: Aetna of WY Medicare |
$9.89
|
| Rate for Payer: Altius Commercial |
$14.38
|
| Rate for Payer: Beech Street Commercial |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.53
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.53
|
| Rate for Payer: Cigna of WY Commercial |
$14.68
|
| Rate for Payer: Entrust Commercial |
$14.23
|
| Rate for Payer: First Choice Health Commercial |
$14.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.54
|
| Rate for Payer: HealthUtah PPO |
$14.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.53
|
| Rate for Payer: Multiplan Medicare/VA |
$8.11
|
| Rate for Payer: One Health Plan of WY PPO |
$14.68
|
| Rate for Payer: PacificSource Commercial |
$13.48
|
| Rate for Payer: PHCS PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$11.24
|
| Rate for Payer: TriWest Veterans Administration |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare |
$8.54
|
| Rate for Payer: WINHealth Partners Commercial |
$14.68
|
| Rate for Payer: Wise Provider Network Commercial |
$14.23
|
|
|
ANCHOR BONE 3 ALL IN ONE TRAY
|
Facility
|
OP
|
$3,747.42
|
|
| Hospital Charge Code |
3003558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,029.23 |
| Max. Negotiated Rate |
$3,747.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,672.47
|
| Rate for Payer: Aetna of WY Medicare |
$2,473.30
|
| Rate for Payer: Altius Commercial |
$3,597.52
|
| Rate for Payer: Beech Street Commercial |
$3,672.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,635.00
|
| Rate for Payer: Cash Price |
$2,623.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,672.47
|
| Rate for Payer: Entrust Commercial |
$3,560.05
|
| Rate for Payer: First Choice Health Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,136.03
|
| Rate for Payer: HealthUtah PPO |
$3,747.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,029.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,672.47
|
| Rate for Payer: PacificSource Commercial |
$3,372.68
|
| Rate for Payer: PHCS PPO |
$3,672.47
|
| Rate for Payer: Three Rivers PPO |
$2,810.56
|
| Rate for Payer: TriWest Veterans Administration |
$2,136.03
|
| Rate for Payer: United Healthcare Commercial |
$3,578.79
|
| Rate for Payer: United Healthcare Medicare |
$2,136.03
|
| Rate for Payer: WINHealth Partners Commercial |
$3,672.47
|
| Rate for Payer: Wise Provider Network Commercial |
$3,560.05
|
|
|
ANCHOR BONE 3 ALL IN ONE TRAY
|
Facility
|
IP
|
$3,747.42
|
|
| Hospital Charge Code |
3003558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.63 |
| Max. Negotiated Rate |
$3,747.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,672.47
|
| Rate for Payer: Aetna of WY Medicare |
$2,398.35
|
| Rate for Payer: Altius Commercial |
$3,597.52
|
| Rate for Payer: Beech Street Commercial |
$3,672.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,635.00
|
| Rate for Payer: Cash Price |
$2,623.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,672.47
|
| Rate for Payer: Entrust Commercial |
$3,560.05
|
| Rate for Payer: First Choice Health Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,285.93
|
| Rate for Payer: HealthUtah PPO |
$3,747.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,171.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,672.47
|
| Rate for Payer: PacificSource Commercial |
$3,372.68
|
| Rate for Payer: PHCS PPO |
$3,672.47
|
| Rate for Payer: Three Rivers PPO |
$2,810.56
|
| Rate for Payer: TriWest Veterans Administration |
$2,285.93
|
| Rate for Payer: United Healthcare Commercial |
$3,578.79
|
| Rate for Payer: United Healthcare Medicare |
$2,285.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3,560.05
|
| Rate for Payer: Wise Provider Network Commercial |
$3,560.05
|
|
|
ANCHOR BONE SINGLE
|
Facility
|
IP
|
$2,294.46
|
|
| Hospital Charge Code |
3003777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.64 |
| Max. Negotiated Rate |
$2,294.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,248.57
|
| Rate for Payer: Aetna of WY Medicare |
$1,468.45
|
| Rate for Payer: Altius Commercial |
$2,202.68
|
| Rate for Payer: Beech Street Commercial |
$2,248.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,225.63
|
| Rate for Payer: Cash Price |
$1,606.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,225.63
|
| Rate for Payer: Cigna of WY Commercial |
$2,248.57
|
| Rate for Payer: Entrust Commercial |
$2,179.74
|
| Rate for Payer: First Choice Health Commercial |
$2,179.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,179.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,399.62
|
| Rate for Payer: HealthUtah PPO |
$2,294.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,225.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,329.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,248.57
|
| Rate for Payer: PacificSource Commercial |
$2,065.01
|
| Rate for Payer: PHCS PPO |
$2,248.57
|
| Rate for Payer: Three Rivers PPO |
$1,720.84
|
| Rate for Payer: TriWest Veterans Administration |
$1,399.62
|
| Rate for Payer: United Healthcare Commercial |
$2,191.21
|
| Rate for Payer: United Healthcare Medicare |
$1,399.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,179.74
|
| Rate for Payer: Wise Provider Network Commercial |
$2,179.74
|
|
|
ANCHOR BONE SINGLE
|
Facility
|
OP
|
$2,294.46
|
|
| Hospital Charge Code |
3003777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.45 |
| Max. Negotiated Rate |
$2,294.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,248.57
|
| Rate for Payer: Aetna of WY Medicare |
$1,514.34
|
| Rate for Payer: Altius Commercial |
$2,202.68
|
| Rate for Payer: Beech Street Commercial |
$2,248.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,225.63
|
| Rate for Payer: Cash Price |
$1,606.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,225.63
|
| Rate for Payer: Cigna of WY Commercial |
$2,248.57
|
| Rate for Payer: Entrust Commercial |
$2,179.74
|
| Rate for Payer: First Choice Health Commercial |
$2,179.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,179.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,307.84
|
| Rate for Payer: HealthUtah PPO |
$2,294.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,225.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,242.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2,248.57
|
| Rate for Payer: PacificSource Commercial |
$2,065.01
|
| Rate for Payer: PHCS PPO |
$2,248.57
|
| Rate for Payer: Three Rivers PPO |
$1,720.84
|
| Rate for Payer: TriWest Veterans Administration |
$1,307.84
|
| Rate for Payer: United Healthcare Commercial |
$2,191.21
|
| Rate for Payer: United Healthcare Medicare |
$1,307.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,248.57
|
| Rate for Payer: Wise Provider Network Commercial |
$2,179.74
|
|
|
ANCHOR FIBERTAK DX DISPOSABLES
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
3003425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.19 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.25
|
| Rate for Payer: Aetna of WY Medicare |
$635.25
|
| Rate for Payer: Altius Commercial |
$924.00
|
| Rate for Payer: Beech Street Commercial |
$943.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$933.62
|
| Rate for Payer: Cash Price |
$673.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$933.62
|
| Rate for Payer: Cigna of WY Commercial |
$943.25
|
| Rate for Payer: Entrust Commercial |
$914.38
|
| Rate for Payer: First Choice Health Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$548.62
|
| Rate for Payer: HealthUtah PPO |
$962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$933.62
|
| Rate for Payer: Multiplan Medicare/VA |
$521.19
|
| Rate for Payer: One Health Plan of WY PPO |
$943.25
|
| Rate for Payer: PacificSource Commercial |
$866.25
|
| Rate for Payer: PHCS PPO |
$943.25
|
| Rate for Payer: Three Rivers PPO |
$721.88
|
| Rate for Payer: TriWest Veterans Administration |
$548.62
|
| Rate for Payer: United Healthcare Commercial |
$919.19
|
| Rate for Payer: United Healthcare Medicare |
$548.62
|
| Rate for Payer: WINHealth Partners Commercial |
$943.25
|
| Rate for Payer: Wise Provider Network Commercial |
$914.38
|
|
|
ANCHOR FIBERTAK DX DISPOSABLES
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
3003425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.77 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.25
|
| Rate for Payer: Aetna of WY Medicare |
$616.00
|
| Rate for Payer: Altius Commercial |
$924.00
|
| Rate for Payer: Beech Street Commercial |
$943.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$933.62
|
| Rate for Payer: Cash Price |
$673.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$933.62
|
| Rate for Payer: Cigna of WY Commercial |
$943.25
|
| Rate for Payer: Entrust Commercial |
$914.38
|
| Rate for Payer: First Choice Health Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$587.12
|
| Rate for Payer: HealthUtah PPO |
$962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$933.62
|
| Rate for Payer: Multiplan Medicare/VA |
$557.77
|
| Rate for Payer: One Health Plan of WY PPO |
$943.25
|
| Rate for Payer: PacificSource Commercial |
$866.25
|
| Rate for Payer: PHCS PPO |
$943.25
|
| Rate for Payer: Three Rivers PPO |
$721.88
|
| Rate for Payer: TriWest Veterans Administration |
$587.12
|
| Rate for Payer: United Healthcare Commercial |
$919.19
|
| Rate for Payer: United Healthcare Medicare |
$587.12
|
| Rate for Payer: WINHealth Partners Commercial |
$914.38
|
| Rate for Payer: Wise Provider Network Commercial |
$914.38
|
|
|
ANCHOR FOOTPRINT ULTRA 4.5 SUT
|
Facility
|
IP
|
$1,164.80
|
|
| Hospital Charge Code |
3003260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.50
|
| Rate for Payer: Aetna of WY Medicare |
$745.47
|
| Rate for Payer: Altius Commercial |
$1,118.21
|
| Rate for Payer: Beech Street Commercial |
$1,141.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.86
|
| Rate for Payer: Cash Price |
$815.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.50
|
| Rate for Payer: Entrust Commercial |
$1,106.56
|
| Rate for Payer: First Choice Health Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$710.53
|
| Rate for Payer: HealthUtah PPO |
$1,164.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.86
|
| Rate for Payer: Multiplan Medicare/VA |
$675.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.50
|
| Rate for Payer: PacificSource Commercial |
$1,048.32
|
| Rate for Payer: PHCS PPO |
$1,141.50
|
| Rate for Payer: Three Rivers PPO |
$873.60
|
| Rate for Payer: TriWest Veterans Administration |
$710.53
|
| Rate for Payer: United Healthcare Commercial |
$1,112.38
|
| Rate for Payer: United Healthcare Medicare |
$710.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.56
|
|
|
ANCHOR FOOTPRINT ULTRA 4.5 SUT
|
Facility
|
OP
|
$1,164.80
|
|
| Hospital Charge Code |
3003260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.74 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: United Healthcare Commercial |
$1,112.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.50
|
| Rate for Payer: Aetna of WY Medicare |
$768.77
|
| Rate for Payer: Altius Commercial |
$1,118.21
|
| Rate for Payer: Beech Street Commercial |
$1,141.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.86
|
| Rate for Payer: Cash Price |
$815.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.50
|
| Rate for Payer: Entrust Commercial |
$1,106.56
|
| Rate for Payer: First Choice Health Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$663.94
|
| Rate for Payer: HealthUtah PPO |
$1,164.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.86
|
| Rate for Payer: Multiplan Medicare/VA |
$630.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.50
|
| Rate for Payer: PacificSource Commercial |
$1,048.32
|
| Rate for Payer: PHCS PPO |
$1,141.50
|
| Rate for Payer: Three Rivers PPO |
$873.60
|
| Rate for Payer: TriWest Veterans Administration |
$663.94
|
| Rate for Payer: United Healthcare Medicare |
$663.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.56
|
|
|
ANCHOR FOOTPRINT ULTRA 5.5 SUT
|
Facility
|
OP
|
$1,164.80
|
|
| Hospital Charge Code |
3003261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.74 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.50
|
| Rate for Payer: Aetna of WY Medicare |
$768.77
|
| Rate for Payer: Altius Commercial |
$1,118.21
|
| Rate for Payer: Beech Street Commercial |
$1,141.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.86
|
| Rate for Payer: Cash Price |
$815.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.50
|
| Rate for Payer: Entrust Commercial |
$1,106.56
|
| Rate for Payer: First Choice Health Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$663.94
|
| Rate for Payer: HealthUtah PPO |
$1,164.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.86
|
| Rate for Payer: Multiplan Medicare/VA |
$630.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.50
|
| Rate for Payer: PacificSource Commercial |
$1,048.32
|
| Rate for Payer: PHCS PPO |
$1,141.50
|
| Rate for Payer: Three Rivers PPO |
$873.60
|
| Rate for Payer: TriWest Veterans Administration |
$663.94
|
| Rate for Payer: United Healthcare Commercial |
$1,112.38
|
| Rate for Payer: United Healthcare Medicare |
$663.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.56
|
|
|
ANCHOR FOOTPRINT ULTRA 5.5 SUT
|
Facility
|
IP
|
$1,164.80
|
|
| Hospital Charge Code |
3003261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.50
|
| Rate for Payer: Aetna of WY Medicare |
$745.47
|
| Rate for Payer: Altius Commercial |
$1,118.21
|
| Rate for Payer: Beech Street Commercial |
$1,141.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.86
|
| Rate for Payer: Cash Price |
$815.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.50
|
| Rate for Payer: Entrust Commercial |
$1,106.56
|
| Rate for Payer: First Choice Health Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$710.53
|
| Rate for Payer: HealthUtah PPO |
$1,164.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.86
|
| Rate for Payer: Multiplan Medicare/VA |
$675.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.50
|
| Rate for Payer: PacificSource Commercial |
$1,048.32
|
| Rate for Payer: PHCS PPO |
$1,141.50
|
| Rate for Payer: Three Rivers PPO |
$873.60
|
| Rate for Payer: TriWest Veterans Administration |
$710.53
|
| Rate for Payer: United Healthcare Commercial |
$1,112.38
|
| Rate for Payer: United Healthcare Medicare |
$710.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.56
|
|
|
ANCHOR HEALICOIL 4.5MM SUT
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
3003262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.38 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Aetna of WY Medicare |
$785.40
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,154.30
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.30
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$644.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$678.30
|
| Rate for Payer: United Healthcare Commercial |
$1,136.45
|
| Rate for Payer: United Healthcare Medicare |
$678.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,166.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
ANCHOR HEALICOIL 4.5MM SUT
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
3003262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$689.60 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Aetna of WY Medicare |
$761.60
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,154.30
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$725.90
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$689.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$725.90
|
| Rate for Payer: United Healthcare Commercial |
$1,136.45
|
| Rate for Payer: United Healthcare Medicare |
$725.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
ANCHOR HEALICOIL 4.5 TAPE BLUE
|
Facility
|
OP
|
$1,207.50
|
|
| Hospital Charge Code |
3003432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.86 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$796.95
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.28
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$653.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$688.28
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$688.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ANCHOR HEALICOIL 4.5 TAPE BLUE
|
Facility
|
IP
|
$1,207.50
|
|
| Hospital Charge Code |
3003432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.75 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$772.80
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.58
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$699.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$736.58
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$736.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,147.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ANCHOR HEALICOIL 4.5 TAPE CBRD
|
Facility
|
OP
|
$1,207.50
|
|
| Hospital Charge Code |
3003437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.86 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$796.95
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.28
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$653.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$688.28
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$688.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ANCHOR HEALICOIL 4.5 TAPE CBRD
|
Facility
|
IP
|
$1,207.50
|
|
| Hospital Charge Code |
3003437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.75 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$772.80
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.58
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$699.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$736.58
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$736.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,147.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ANCHOR PEEK SWIVELOCK 4.75X19
|
Facility
|
OP
|
$2,963.80
|
|
| Hospital Charge Code |
3004524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.90 |
| Max. Negotiated Rate |
$2,963.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,904.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,956.11
|
| Rate for Payer: Altius Commercial |
$2,845.25
|
| Rate for Payer: Beech Street Commercial |
$2,904.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,874.89
|
| Rate for Payer: Cash Price |
$2,074.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,874.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,904.52
|
| Rate for Payer: Entrust Commercial |
$2,815.61
|
| Rate for Payer: First Choice Health Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,689.37
|
| Rate for Payer: HealthUtah PPO |
$2,963.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,874.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,604.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,904.52
|
| Rate for Payer: PacificSource Commercial |
$2,667.42
|
| Rate for Payer: PHCS PPO |
$2,904.52
|
| Rate for Payer: Three Rivers PPO |
$2,222.85
|
| Rate for Payer: TriWest Veterans Administration |
$1,689.37
|
| Rate for Payer: United Healthcare Commercial |
$2,830.43
|
| Rate for Payer: United Healthcare Medicare |
$1,689.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,904.52
|
| Rate for Payer: Wise Provider Network Commercial |
$2,815.61
|
|
|
ANCHOR PEEK SWIVELOCK 4.75X19
|
Facility
|
IP
|
$2,963.80
|
|
| Hospital Charge Code |
3004524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.52 |
| Max. Negotiated Rate |
$2,963.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,904.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,896.83
|
| Rate for Payer: Altius Commercial |
$2,845.25
|
| Rate for Payer: Beech Street Commercial |
$2,904.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,874.89
|
| Rate for Payer: Cash Price |
$2,074.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,874.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,904.52
|
| Rate for Payer: Entrust Commercial |
$2,815.61
|
| Rate for Payer: First Choice Health Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,807.92
|
| Rate for Payer: HealthUtah PPO |
$2,963.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,874.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,717.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,904.52
|
| Rate for Payer: PacificSource Commercial |
$2,667.42
|
| Rate for Payer: PHCS PPO |
$2,904.52
|
| Rate for Payer: Three Rivers PPO |
$2,222.85
|
| Rate for Payer: TriWest Veterans Administration |
$1,807.92
|
| Rate for Payer: United Healthcare Commercial |
$2,830.43
|
| Rate for Payer: United Healthcare Medicare |
$1,807.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,815.61
|
| Rate for Payer: Wise Provider Network Commercial |
$2,815.61
|
|
|
ANCHOR PUSHLOK 2.9X15.5 1923PS
|
Facility
|
OP
|
$1,471.68
|
|
| Hospital Charge Code |
3001490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$796.91 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.25
|
| Rate for Payer: Aetna of WY Medicare |
$971.31
|
| Rate for Payer: Altius Commercial |
$1,412.81
|
| Rate for Payer: Beech Street Commercial |
$1,442.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,427.53
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.25
|
| Rate for Payer: Entrust Commercial |
$1,398.10
|
| Rate for Payer: First Choice Health Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$838.86
|
| Rate for Payer: HealthUtah PPO |
$1,471.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.53
|
| Rate for Payer: Multiplan Medicare/VA |
$796.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.25
|
| Rate for Payer: PacificSource Commercial |
$1,324.51
|
| Rate for Payer: PHCS PPO |
$1,442.25
|
| Rate for Payer: Three Rivers PPO |
$1,103.76
|
| Rate for Payer: TriWest Veterans Administration |
$838.86
|
| Rate for Payer: United Healthcare Commercial |
$1,405.45
|
| Rate for Payer: United Healthcare Medicare |
$838.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,442.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.10
|
|
|
ANCHOR PUSHLOK 2.9X15.5 1923PS
|
Facility
|
IP
|
$1,471.68
|
|
| Hospital Charge Code |
3001490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.84 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.25
|
| Rate for Payer: Aetna of WY Medicare |
$941.88
|
| Rate for Payer: Altius Commercial |
$1,412.81
|
| Rate for Payer: Beech Street Commercial |
$1,442.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,427.53
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.25
|
| Rate for Payer: Entrust Commercial |
$1,398.10
|
| Rate for Payer: First Choice Health Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$897.72
|
| Rate for Payer: HealthUtah PPO |
$1,471.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.53
|
| Rate for Payer: Multiplan Medicare/VA |
$852.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.25
|
| Rate for Payer: PacificSource Commercial |
$1,324.51
|
| Rate for Payer: PHCS PPO |
$1,442.25
|
| Rate for Payer: Three Rivers PPO |
$1,103.76
|
| Rate for Payer: TriWest Veterans Administration |
$897.72
|
| Rate for Payer: United Healthcare Commercial |
$1,405.45
|
| Rate for Payer: United Healthcare Medicare |
$897.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.10
|
|
|
ANCHOR PUSHLOK 3.5X19.5 1926PS
|
Facility
|
OP
|
$1,260.00
|
|
| Hospital Charge Code |
3004120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.29 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$831.60
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$718.20
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$682.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$718.20
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$718.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
ANCHOR PUSHLOK 3.5X19.5 1926PS
|
Facility
|
IP
|
$1,260.00
|
|
| Hospital Charge Code |
3004120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.17 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$806.40
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.60
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$730.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$768.60
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$768.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
ANCHORS BONE 3 W/ DEL SYSTEM
|
Facility
|
IP
|
$3,325.00
|
|
| Hospital Charge Code |
3003002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,926.84 |
| Max. Negotiated Rate |
$3,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,258.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,128.00
|
| Rate for Payer: Altius Commercial |
$3,192.00
|
| Rate for Payer: Beech Street Commercial |
$3,258.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,225.25
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,225.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,258.50
|
| Rate for Payer: Entrust Commercial |
$3,158.75
|
| Rate for Payer: First Choice Health Commercial |
$3,158.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,158.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,028.25
|
| Rate for Payer: HealthUtah PPO |
$3,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,225.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,926.84
|
| Rate for Payer: One Health Plan of WY PPO |
$3,258.50
|
| Rate for Payer: PacificSource Commercial |
$2,992.50
|
| Rate for Payer: PHCS PPO |
$3,258.50
|
| Rate for Payer: Three Rivers PPO |
$2,493.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,028.25
|
| Rate for Payer: United Healthcare Commercial |
$3,175.38
|
| Rate for Payer: United Healthcare Medicare |
$2,028.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,158.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,158.75
|
|
