|
4K LAPAROSCOPE 0* 5.5 X 300 MM
|
Facility
|
OP
|
$3,024.00
|
|
| Hospital Charge Code |
3003537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,963.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,995.84
|
| Rate for Payer: Altius Commercial |
$2,903.04
|
| Rate for Payer: Beech Street Commercial |
$2,963.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,933.28
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,933.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,963.52
|
| Rate for Payer: Entrust Commercial |
$2,872.80
|
| Rate for Payer: First Choice Health Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,723.68
|
| Rate for Payer: HealthUtah PPO |
$3,024.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,933.28
|
| Rate for Payer: Multiplan Medicare/VA |
$1,637.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,963.52
|
| Rate for Payer: PacificSource Commercial |
$2,721.60
|
| Rate for Payer: PHCS PPO |
$2,963.52
|
| Rate for Payer: Three Rivers PPO |
$2,268.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,723.68
|
| Rate for Payer: United Healthcare Commercial |
$2,887.92
|
| Rate for Payer: United Healthcare Medicare |
$1,723.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,963.52
|
| Rate for Payer: Wise Provider Network Commercial |
$2,872.80
|
|
|
4K LAPAROSCOPE 0° 10X455MM
|
Facility
|
OP
|
$7,962.50
|
|
| Hospital Charge Code |
3004116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,311.69 |
| Max. Negotiated Rate |
$7,962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,803.25
|
| Rate for Payer: Aetna of WY Medicare |
$5,255.25
|
| Rate for Payer: Altius Commercial |
$7,644.00
|
| Rate for Payer: Beech Street Commercial |
$7,803.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,723.62
|
| Rate for Payer: Cash Price |
$5,573.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,723.62
|
| Rate for Payer: Cigna of WY Commercial |
$7,803.25
|
| Rate for Payer: Entrust Commercial |
$7,564.38
|
| Rate for Payer: First Choice Health Commercial |
$7,564.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,564.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,538.62
|
| Rate for Payer: HealthUtah PPO |
$7,962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,723.62
|
| Rate for Payer: Multiplan Medicare/VA |
$4,311.69
|
| Rate for Payer: One Health Plan of WY PPO |
$7,803.25
|
| Rate for Payer: PacificSource Commercial |
$7,166.25
|
| Rate for Payer: PHCS PPO |
$7,803.25
|
| Rate for Payer: Three Rivers PPO |
$5,971.88
|
| Rate for Payer: TriWest Veterans Administration |
$4,538.62
|
| Rate for Payer: United Healthcare Commercial |
$7,604.19
|
| Rate for Payer: United Healthcare Medicare |
$4,538.62
|
| Rate for Payer: WINHealth Partners Commercial |
$7,803.25
|
| Rate for Payer: Wise Provider Network Commercial |
$7,564.38
|
|
|
4K LAPAROSCOPE 0° 10X455MM
|
Facility
|
IP
|
$7,962.50
|
|
| Hospital Charge Code |
3004116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,614.27 |
| Max. Negotiated Rate |
$7,962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,803.25
|
| Rate for Payer: Aetna of WY Medicare |
$5,096.00
|
| Rate for Payer: Altius Commercial |
$7,644.00
|
| Rate for Payer: Beech Street Commercial |
$7,803.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,723.62
|
| Rate for Payer: Cash Price |
$5,573.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,723.62
|
| Rate for Payer: Cigna of WY Commercial |
$7,803.25
|
| Rate for Payer: Entrust Commercial |
$7,564.38
|
| Rate for Payer: First Choice Health Commercial |
$7,564.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,564.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,857.12
|
| Rate for Payer: HealthUtah PPO |
$7,962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,723.62
|
| Rate for Payer: Multiplan Medicare/VA |
$4,614.27
|
| Rate for Payer: One Health Plan of WY PPO |
$7,803.25
|
| Rate for Payer: PacificSource Commercial |
$7,166.25
|
| Rate for Payer: PHCS PPO |
$7,803.25
|
| Rate for Payer: Three Rivers PPO |
$5,971.88
|
| Rate for Payer: TriWest Veterans Administration |
$4,857.12
|
| Rate for Payer: United Healthcare Commercial |
$7,604.19
|
| Rate for Payer: United Healthcare Medicare |
$4,857.12
|
| Rate for Payer: WINHealth Partners Commercial |
$7,564.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7,564.38
|
|
|
4K LAPAROSCOPE 30* 5.5 X 300MM
|
Facility
|
OP
|
$9,555.00
|
|
| Hospital Charge Code |
3003538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,174.03 |
| Max. Negotiated Rate |
$9,555.00 |
| Rate for Payer: United Healthcare Commercial |
$9,125.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,363.90
|
| Rate for Payer: Aetna of WY Medicare |
$6,306.30
|
| Rate for Payer: Altius Commercial |
$9,172.80
|
| Rate for Payer: Beech Street Commercial |
$9,363.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,268.35
|
| Rate for Payer: Cash Price |
$6,688.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,268.35
|
| Rate for Payer: Cigna of WY Commercial |
$9,363.90
|
| Rate for Payer: Entrust Commercial |
$9,077.25
|
| Rate for Payer: First Choice Health Commercial |
$9,077.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,077.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,446.35
|
| Rate for Payer: HealthUtah PPO |
$9,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,268.35
|
| Rate for Payer: Multiplan Medicare/VA |
$5,174.03
|
| Rate for Payer: One Health Plan of WY PPO |
$9,363.90
|
| Rate for Payer: PacificSource Commercial |
$8,599.50
|
| Rate for Payer: PHCS PPO |
$9,363.90
|
| Rate for Payer: Three Rivers PPO |
$7,166.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,446.35
|
| Rate for Payer: United Healthcare Medicare |
$5,446.35
|
| Rate for Payer: WINHealth Partners Commercial |
$9,363.90
|
| Rate for Payer: Wise Provider Network Commercial |
$9,077.25
|
|
|
4K LAPAROSCOPE 30* 5.5 X 300MM
|
Facility
|
IP
|
$9,555.00
|
|
| Hospital Charge Code |
3003538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,537.12 |
| Max. Negotiated Rate |
$9,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,363.90
|
| Rate for Payer: Aetna of WY Medicare |
$6,115.20
|
| Rate for Payer: Altius Commercial |
$9,172.80
|
| Rate for Payer: Beech Street Commercial |
$9,363.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,268.35
|
| Rate for Payer: Cash Price |
$6,688.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,268.35
|
| Rate for Payer: Cigna of WY Commercial |
$9,363.90
|
| Rate for Payer: Entrust Commercial |
$9,077.25
|
| Rate for Payer: First Choice Health Commercial |
$9,077.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,077.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,828.55
|
| Rate for Payer: HealthUtah PPO |
$9,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,268.35
|
| Rate for Payer: Multiplan Medicare/VA |
$5,537.12
|
| Rate for Payer: One Health Plan of WY PPO |
$9,363.90
|
| Rate for Payer: PacificSource Commercial |
$8,599.50
|
| Rate for Payer: PHCS PPO |
$9,363.90
|
| Rate for Payer: Three Rivers PPO |
$7,166.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,828.55
|
| Rate for Payer: United Healthcare Commercial |
$9,125.02
|
| Rate for Payer: United Healthcare Medicare |
$5,828.55
|
| Rate for Payer: WINHealth Partners Commercial |
$9,077.25
|
| Rate for Payer: Wise Provider Network Commercial |
$9,077.25
|
|
|
4 PORT MANIFOLD
|
Facility
|
OP
|
$51.14
|
|
| Hospital Charge Code |
2650696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$51.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.12
|
| Rate for Payer: Aetna of WY Medicare |
$33.75
|
| Rate for Payer: Altius Commercial |
$49.09
|
| Rate for Payer: Beech Street Commercial |
$50.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.61
|
| Rate for Payer: Cash Price |
$35.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.61
|
| Rate for Payer: Cigna of WY Commercial |
$50.12
|
| Rate for Payer: Entrust Commercial |
$48.58
|
| Rate for Payer: First Choice Health Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.15
|
| Rate for Payer: HealthUtah PPO |
$51.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.61
|
| Rate for Payer: Multiplan Medicare/VA |
$27.69
|
| Rate for Payer: One Health Plan of WY PPO |
$50.12
|
| Rate for Payer: PacificSource Commercial |
$46.03
|
| Rate for Payer: PHCS PPO |
$50.12
|
| Rate for Payer: Three Rivers PPO |
$38.36
|
| Rate for Payer: TriWest Veterans Administration |
$29.15
|
| Rate for Payer: United Healthcare Commercial |
$48.84
|
| Rate for Payer: United Healthcare Medicare |
$29.15
|
| Rate for Payer: WINHealth Partners Commercial |
$50.12
|
| Rate for Payer: Wise Provider Network Commercial |
$48.58
|
|
|
4 PORT MANIFOLD
|
Facility
|
IP
|
$51.14
|
|
| Hospital Charge Code |
2650696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$51.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.12
|
| Rate for Payer: Aetna of WY Medicare |
$32.73
|
| Rate for Payer: Altius Commercial |
$49.09
|
| Rate for Payer: Beech Street Commercial |
$50.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.61
|
| Rate for Payer: Cash Price |
$35.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.61
|
| Rate for Payer: Cigna of WY Commercial |
$50.12
|
| Rate for Payer: Entrust Commercial |
$48.58
|
| Rate for Payer: First Choice Health Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.20
|
| Rate for Payer: HealthUtah PPO |
$51.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.61
|
| Rate for Payer: Multiplan Medicare/VA |
$29.64
|
| Rate for Payer: One Health Plan of WY PPO |
$50.12
|
| Rate for Payer: PacificSource Commercial |
$46.03
|
| Rate for Payer: PHCS PPO |
$50.12
|
| Rate for Payer: Three Rivers PPO |
$38.36
|
| Rate for Payer: TriWest Veterans Administration |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$48.84
|
| Rate for Payer: United Healthcare Medicare |
$31.20
|
| Rate for Payer: WINHealth Partners Commercial |
$48.58
|
| Rate for Payer: Wise Provider Network Commercial |
$48.58
|
|
|
4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$189.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$247.94
|
| Rate for Payer: Beech Street Commercial |
$240.35
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$245.41
|
| Rate for Payer: Cigna of WY Commercial |
$247.94
|
| Rate for Payer: First Choice Health Commercial |
$227.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$240.35
|
| Rate for Payer: HealthUtah PPO |
$253.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$245.41
|
| Rate for Payer: One Health Plan of WY PPO |
$247.94
|
| Rate for Payer: PacificSource Commercial |
$227.70
|
| Rate for Payer: PHCS PPO |
$240.35
|
| Rate for Payer: Three Rivers PPO |
$189.75
|
| Rate for Payer: United Healthcare Commercial |
$240.35
|
| Rate for Payer: WINHealth Partners Commercial |
$253.00
|
|
|
50 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
50 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
55CM 8 CONTACT EXTENSION KIT
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
2800424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.19 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,601.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,521.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,601.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,601.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,493.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
55CM 8 CONTACT EXTENSION KIT
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
2800424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.44 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,732.50
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,496.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,572.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
55 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
55 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
5/6 TRANSFIXING PIN HOFFMAN
|
Facility
|
OP
|
$345.80
|
|
| Hospital Charge Code |
3100403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.88
|
| Rate for Payer: Aetna of WY Medicare |
$228.23
|
| Rate for Payer: Altius Commercial |
$331.97
|
| Rate for Payer: Beech Street Commercial |
$338.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$335.43
|
| Rate for Payer: Cash Price |
$242.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.43
|
| Rate for Payer: Cigna of WY Commercial |
$338.88
|
| Rate for Payer: Entrust Commercial |
$328.51
|
| Rate for Payer: First Choice Health Commercial |
$328.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.11
|
| Rate for Payer: HealthUtah PPO |
$345.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.43
|
| Rate for Payer: Multiplan Medicare/VA |
$187.25
|
| Rate for Payer: One Health Plan of WY PPO |
$338.88
|
| Rate for Payer: PacificSource Commercial |
$311.22
|
| Rate for Payer: PHCS PPO |
$338.88
|
| Rate for Payer: Three Rivers PPO |
$259.35
|
| Rate for Payer: TriWest Veterans Administration |
$197.11
|
| Rate for Payer: United Healthcare Commercial |
$330.24
|
| Rate for Payer: United Healthcare Medicare |
$197.11
|
| Rate for Payer: WINHealth Partners Commercial |
$338.88
|
| Rate for Payer: Wise Provider Network Commercial |
$328.51
|
|
|
5/6 TRANSFIXING PIN HOFFMAN
|
Facility
|
IP
|
$345.80
|
|
| Hospital Charge Code |
3100403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.39 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.88
|
| Rate for Payer: Aetna of WY Medicare |
$221.31
|
| Rate for Payer: Altius Commercial |
$331.97
|
| Rate for Payer: Beech Street Commercial |
$338.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$335.43
|
| Rate for Payer: Cash Price |
$242.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.43
|
| Rate for Payer: Cigna of WY Commercial |
$338.88
|
| Rate for Payer: Entrust Commercial |
$328.51
|
| Rate for Payer: First Choice Health Commercial |
$328.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$210.94
|
| Rate for Payer: HealthUtah PPO |
$345.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.43
|
| Rate for Payer: Multiplan Medicare/VA |
$200.39
|
| Rate for Payer: One Health Plan of WY PPO |
$338.88
|
| Rate for Payer: PacificSource Commercial |
$311.22
|
| Rate for Payer: PHCS PPO |
$338.88
|
| Rate for Payer: Three Rivers PPO |
$259.35
|
| Rate for Payer: TriWest Veterans Administration |
$210.94
|
| Rate for Payer: United Healthcare Commercial |
$330.24
|
| Rate for Payer: United Healthcare Medicare |
$210.94
|
| Rate for Payer: WINHealth Partners Commercial |
$328.51
|
| Rate for Payer: Wise Provider Network Commercial |
$328.51
|
|
|
5-HOLE CLAMP W/ 30 DEG POSTS
|
Facility
|
IP
|
$2,734.41
|
|
| Hospital Charge Code |
3100551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,584.59 |
| Max. Negotiated Rate |
$2,734.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,679.72
|
| Rate for Payer: Aetna of WY Medicare |
$1,750.02
|
| Rate for Payer: Altius Commercial |
$2,625.03
|
| Rate for Payer: Beech Street Commercial |
$2,679.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,652.38
|
| Rate for Payer: Cash Price |
$1,914.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,652.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,679.72
|
| Rate for Payer: Entrust Commercial |
$2,597.69
|
| Rate for Payer: First Choice Health Commercial |
$2,597.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,597.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,667.99
|
| Rate for Payer: HealthUtah PPO |
$2,734.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,652.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,584.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,679.72
|
| Rate for Payer: PacificSource Commercial |
$2,460.97
|
| Rate for Payer: PHCS PPO |
$2,679.72
|
| Rate for Payer: Three Rivers PPO |
$2,050.81
|
| Rate for Payer: TriWest Veterans Administration |
$1,667.99
|
| Rate for Payer: United Healthcare Commercial |
$2,611.36
|
| Rate for Payer: United Healthcare Medicare |
$1,667.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,597.69
|
| Rate for Payer: Wise Provider Network Commercial |
$2,597.69
|
|
|
5-HOLE CLAMP W/ 30 DEG POSTS
|
Facility
|
OP
|
$2,734.41
|
|
| Hospital Charge Code |
3100551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,480.68 |
| Max. Negotiated Rate |
$2,734.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,679.72
|
| Rate for Payer: Aetna of WY Medicare |
$1,804.71
|
| Rate for Payer: Altius Commercial |
$2,625.03
|
| Rate for Payer: Beech Street Commercial |
$2,679.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,652.38
|
| Rate for Payer: Cash Price |
$1,914.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,652.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,679.72
|
| Rate for Payer: Entrust Commercial |
$2,597.69
|
| Rate for Payer: First Choice Health Commercial |
$2,597.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,597.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,558.61
|
| Rate for Payer: HealthUtah PPO |
$2,734.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,652.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,480.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,679.72
|
| Rate for Payer: PacificSource Commercial |
$2,460.97
|
| Rate for Payer: PHCS PPO |
$2,679.72
|
| Rate for Payer: Three Rivers PPO |
$2,050.81
|
| Rate for Payer: TriWest Veterans Administration |
$1,558.61
|
| Rate for Payer: United Healthcare Commercial |
$2,611.36
|
| Rate for Payer: United Healthcare Medicare |
$1,558.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,679.72
|
| Rate for Payer: Wise Provider Network Commercial |
$2,597.69
|
|
|
5-HOLE MULTI-PIN CLAMP HOFFMAN
|
Facility
|
OP
|
$2,474.57
|
|
| Hospital Charge Code |
3100406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.98 |
| Max. Negotiated Rate |
$2,474.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,633.22
|
| Rate for Payer: Altius Commercial |
$2,375.59
|
| Rate for Payer: Beech Street Commercial |
$2,425.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,400.33
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.08
|
| Rate for Payer: Entrust Commercial |
$2,350.84
|
| Rate for Payer: First Choice Health Commercial |
$2,350.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,350.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,410.50
|
| Rate for Payer: HealthUtah PPO |
$2,474.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,339.98
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.08
|
| Rate for Payer: PacificSource Commercial |
$2,227.11
|
| Rate for Payer: PHCS PPO |
$2,425.08
|
| Rate for Payer: Three Rivers PPO |
$1,855.93
|
| Rate for Payer: TriWest Veterans Administration |
$1,410.50
|
| Rate for Payer: United Healthcare Commercial |
$2,363.21
|
| Rate for Payer: United Healthcare Medicare |
$1,410.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,425.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2,350.84
|
|
|
5-HOLE MULTI-PIN CLAMP HOFFMAN
|
Facility
|
IP
|
$2,474.57
|
|
| Hospital Charge Code |
3100406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,474.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,583.72
|
| Rate for Payer: Altius Commercial |
$2,375.59
|
| Rate for Payer: Beech Street Commercial |
$2,425.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,400.33
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.08
|
| Rate for Payer: Entrust Commercial |
$2,350.84
|
| Rate for Payer: First Choice Health Commercial |
$2,350.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,350.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,509.49
|
| Rate for Payer: HealthUtah PPO |
$2,474.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,434.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.08
|
| Rate for Payer: PacificSource Commercial |
$2,227.11
|
| Rate for Payer: PHCS PPO |
$2,425.08
|
| Rate for Payer: Three Rivers PPO |
$1,855.93
|
| Rate for Payer: TriWest Veterans Administration |
$1,509.49
|
| Rate for Payer: United Healthcare Commercial |
$2,363.21
|
| Rate for Payer: United Healthcare Medicare |
$1,509.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,350.84
|
| Rate for Payer: Wise Provider Network Commercial |
$2,350.84
|
|
|
5X150X50MM APEX PIN HOFFMAN
|
Facility
|
OP
|
$379.68
|
|
| Hospital Charge Code |
3100404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$379.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.09
|
| Rate for Payer: Aetna of WY Medicare |
$250.59
|
| Rate for Payer: Altius Commercial |
$364.49
|
| Rate for Payer: Beech Street Commercial |
$372.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$368.29
|
| Rate for Payer: Cash Price |
$265.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.29
|
| Rate for Payer: Cigna of WY Commercial |
$372.09
|
| Rate for Payer: Entrust Commercial |
$360.70
|
| Rate for Payer: First Choice Health Commercial |
$360.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.42
|
| Rate for Payer: HealthUtah PPO |
$379.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.29
|
| Rate for Payer: Multiplan Medicare/VA |
$205.60
|
| Rate for Payer: One Health Plan of WY PPO |
$372.09
|
| Rate for Payer: PacificSource Commercial |
$341.71
|
| Rate for Payer: PHCS PPO |
$372.09
|
| Rate for Payer: Three Rivers PPO |
$284.76
|
| Rate for Payer: TriWest Veterans Administration |
$216.42
|
| Rate for Payer: United Healthcare Commercial |
$362.59
|
| Rate for Payer: United Healthcare Medicare |
$216.42
|
| Rate for Payer: WINHealth Partners Commercial |
$372.09
|
| Rate for Payer: Wise Provider Network Commercial |
$360.70
|
|
|
5X150X50MM APEX PIN HOFFMAN
|
Facility
|
IP
|
$379.68
|
|
| Hospital Charge Code |
3100404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.02 |
| Max. Negotiated Rate |
$379.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.09
|
| Rate for Payer: Aetna of WY Medicare |
$243.00
|
| Rate for Payer: Altius Commercial |
$364.49
|
| Rate for Payer: Beech Street Commercial |
$372.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$368.29
|
| Rate for Payer: Cash Price |
$265.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.29
|
| Rate for Payer: Cigna of WY Commercial |
$372.09
|
| Rate for Payer: Entrust Commercial |
$360.70
|
| Rate for Payer: First Choice Health Commercial |
$360.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.60
|
| Rate for Payer: HealthUtah PPO |
$379.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.29
|
| Rate for Payer: Multiplan Medicare/VA |
$220.02
|
| Rate for Payer: One Health Plan of WY PPO |
$372.09
|
| Rate for Payer: PacificSource Commercial |
$341.71
|
| Rate for Payer: PHCS PPO |
$372.09
|
| Rate for Payer: Three Rivers PPO |
$284.76
|
| Rate for Payer: TriWest Veterans Administration |
$231.60
|
| Rate for Payer: United Healthcare Commercial |
$362.59
|
| Rate for Payer: United Healthcare Medicare |
$231.60
|
| Rate for Payer: WINHealth Partners Commercial |
$360.70
|
| Rate for Payer: Wise Provider Network Commercial |
$360.70
|
|
|
5 X 20 MM LOW PROFILE SCREW
|
Facility
|
OP
|
$1,092.00
|
|
| Hospital Charge Code |
3002144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.32 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Medicare |
$720.72
|
| Rate for Payer: Altius Commercial |
$1,048.32
|
| Rate for Payer: Beech Street Commercial |
$1,070.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,059.24
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| Rate for Payer: Entrust Commercial |
$1,037.40
|
| Rate for Payer: First Choice Health Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$622.44
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$591.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PHCS PPO |
$1,070.16
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: TriWest Veterans Administration |
$622.44
|
| Rate for Payer: United Healthcare Commercial |
$1,042.86
|
| Rate for Payer: United Healthcare Medicare |
$622.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,070.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1,037.40
|
|
|
5 X 20 MM LOW PROFILE SCREW
|
Facility
|
IP
|
$1,092.00
|
|
| Hospital Charge Code |
3002144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.81 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Medicare |
$698.88
|
| Rate for Payer: Altius Commercial |
$1,048.32
|
| Rate for Payer: Beech Street Commercial |
$1,070.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,059.24
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| Rate for Payer: Entrust Commercial |
$1,037.40
|
| Rate for Payer: First Choice Health Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$666.12
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$632.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PHCS PPO |
$1,070.16
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: TriWest Veterans Administration |
$666.12
|
| Rate for Payer: United Healthcare Commercial |
$1,042.86
|
| Rate for Payer: United Healthcare Medicare |
$666.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,037.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,037.40
|
|
|
5 X 25 MM LOW PROFILE SCREW
|
Facility
|
OP
|
$1,092.00
|
|
| Hospital Charge Code |
3002142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.32 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.16
|
| Rate for Payer: Aetna of WY Medicare |
$720.72
|
| Rate for Payer: Altius Commercial |
$1,048.32
|
| Rate for Payer: Beech Street Commercial |
$1,070.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,059.24
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.16
|
| Rate for Payer: Entrust Commercial |
$1,037.40
|
| Rate for Payer: First Choice Health Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$622.44
|
| Rate for Payer: HealthUtah PPO |
$1,092.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.24
|
| Rate for Payer: Multiplan Medicare/VA |
$591.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.16
|
| Rate for Payer: PacificSource Commercial |
$982.80
|
| Rate for Payer: PHCS PPO |
$1,070.16
|
| Rate for Payer: Three Rivers PPO |
$819.00
|
| Rate for Payer: TriWest Veterans Administration |
$622.44
|
| Rate for Payer: United Healthcare Commercial |
$1,042.86
|
| Rate for Payer: United Healthcare Medicare |
$622.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,070.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1,037.40
|
|
