|
BRACE AFO DROP FOOT SMALL RT
|
Facility
|
OP
|
$68.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.74 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Aetna of WY Medicare |
$45.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.73
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$37.74
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$39.73
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$39.73
|
| Rate for Payer: WINHealth Partners Commercial |
$67.13
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
BRACE AFO DROP FOOT XLARGE LT
|
Facility
|
OP
|
$68.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.74 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Aetna of WY Medicare |
$45.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.73
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$37.74
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$39.73
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$39.73
|
| Rate for Payer: WINHealth Partners Commercial |
$67.13
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
BRACE AFO DROP FOOT XLARGE LT
|
Facility
|
IP
|
$68.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.21
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$42.95
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$45.21
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$45.21
|
| Rate for Payer: WINHealth Partners Commercial |
$65.08
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
BRACE AFO DROP FOOT XLARGE RT
|
Facility
|
OP
|
$68.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.74 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Aetna of WY Medicare |
$45.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.73
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$37.74
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$39.73
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$39.73
|
| Rate for Payer: WINHealth Partners Commercial |
$67.13
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
BRACE AFO DROP FOOT XLARGE RT
|
Facility
|
IP
|
$68.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.21
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$42.95
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$45.21
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$45.21
|
| Rate for Payer: WINHealth Partners Commercial |
$65.08
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
BRACE ANKLE LARGE SA702507
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE LARGE SA702507
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE MEDIUM SA702505
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE MEDIUM SA702505
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE SMALL SA702503
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE SMALL SA702503
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XLARGE SA702509
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XLARGE SA702509
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XSMALL SA702501
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XSMALL SA702501
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XXLARGE SA702511
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.04
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.64
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$28.04
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XXLARGE SA702511
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.41
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.69
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$30.31
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$42.06
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE KNEE HINGED LARGE
|
Facility
|
OP
|
$132.58
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.05 |
| Max. Negotiated Rate |
$132.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.93
|
| Rate for Payer: Aetna of WY Medicare |
$87.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.28
|
| Rate for Payer: Altius Commercial |
$127.28
|
| Rate for Payer: Beech Street Commercial |
$129.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.85
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.60
|
| Rate for Payer: Cigna of WY Commercial |
$129.93
|
| Rate for Payer: Entrust Commercial |
$125.95
|
| Rate for Payer: First Choice Health Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.90
|
| Rate for Payer: HealthUtah PPO |
$132.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.60
|
| Rate for Payer: Multiplan Medicare/VA |
$73.05
|
| Rate for Payer: One Health Plan of WY PPO |
$129.93
|
| Rate for Payer: PacificSource Commercial |
$119.32
|
| Rate for Payer: PHCS PPO |
$129.93
|
| Rate for Payer: Three Rivers PPO |
$99.44
|
| Rate for Payer: TriWest Veterans Administration |
$76.90
|
| Rate for Payer: United Healthcare Commercial |
$115.34
|
| Rate for Payer: United Healthcare Medicare |
$76.90
|
| Rate for Payer: WINHealth Partners Commercial |
$129.93
|
| Rate for Payer: Wise Provider Network Commercial |
$125.95
|
|
|
BRACE KNEE HINGED LARGE
|
Facility
|
IP
|
$132.58
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$132.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.28
|
| Rate for Payer: Altius Commercial |
$127.28
|
| Rate for Payer: Beech Street Commercial |
$129.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.85
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.60
|
| Rate for Payer: Cigna of WY Commercial |
$129.93
|
| Rate for Payer: Entrust Commercial |
$125.95
|
| Rate for Payer: First Choice Health Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.50
|
| Rate for Payer: HealthUtah PPO |
$132.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.60
|
| Rate for Payer: Multiplan Medicare/VA |
$83.13
|
| Rate for Payer: One Health Plan of WY PPO |
$129.93
|
| Rate for Payer: PacificSource Commercial |
$119.32
|
| Rate for Payer: PHCS PPO |
$129.93
|
| Rate for Payer: Three Rivers PPO |
$99.44
|
| Rate for Payer: TriWest Veterans Administration |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$115.34
|
| Rate for Payer: United Healthcare Medicare |
$87.50
|
| Rate for Payer: WINHealth Partners Commercial |
$125.95
|
| Rate for Payer: Wise Provider Network Commercial |
$125.95
|
|
|
BRACE KNEE HINGED MEDIUM
|
Facility
|
OP
|
$58.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.49
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.31
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.13
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$32.42
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$34.13
|
| Rate for Payer: United Healthcare Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare |
$34.13
|
| Rate for Payer: WINHealth Partners Commercial |
$57.66
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
BRACE KNEE HINGED MEDIUM
|
Facility
|
IP
|
$58.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.49
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.31
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.83
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$36.89
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$38.83
|
| Rate for Payer: United Healthcare Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare |
$38.83
|
| Rate for Payer: WINHealth Partners Commercial |
$55.90
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
BRACE KNEE HINGED SMALL
|
Facility
|
IP
|
$58.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.49
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.31
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.83
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$36.89
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$38.83
|
| Rate for Payer: United Healthcare Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare |
$38.83
|
| Rate for Payer: WINHealth Partners Commercial |
$55.90
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
BRACE KNEE HINGED SMALL
|
Facility
|
OP
|
$58.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.49
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.31
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.13
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$32.42
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$34.13
|
| Rate for Payer: United Healthcare Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare |
$34.13
|
| Rate for Payer: WINHealth Partners Commercial |
$57.66
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
BRACE KNEE IMMOB ADJ 222000C
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.48
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.72
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.54
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$34.71
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.54
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$36.54
|
| Rate for Payer: WINHealth Partners Commercial |
$61.74
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
BRACE KNEE IMMOB ADJ 222000C
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.48
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.72
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.58
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$39.50
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.58
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$41.58
|
| Rate for Payer: WINHealth Partners Commercial |
$59.85
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
