|
BRACE KNEE TRIPANEL IMMOB 16"
|
Facility
|
IP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.56
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$55.63
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$58.56
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$58.56
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 16"
|
Facility
|
OP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.46
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$48.88
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$51.46
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
| Rate for Payer: WINHealth Partners Commercial |
$86.95
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 20"
|
Facility
|
OP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.46
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$48.88
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$51.46
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
| Rate for Payer: WINHealth Partners Commercial |
$86.95
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 20"
|
Facility
|
IP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.56
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$55.63
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$58.56
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$58.56
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 22"
|
Facility
|
IP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.56
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$55.63
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$58.56
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$58.56
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 22"
|
Facility
|
OP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.46
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$48.88
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$51.46
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
| Rate for Payer: WINHealth Partners Commercial |
$86.95
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 24"
|
Facility
|
OP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.46
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$48.88
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$51.46
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
| Rate for Payer: WINHealth Partners Commercial |
$86.95
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE TRIPANEL IMMOB 24"
|
Facility
|
IP
|
$88.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.56
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$55.63
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$58.56
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$58.56
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
BRACE KNEE T-SCOPE BREG 08814
|
Facility
|
OP
|
$172.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.31 |
| Max. Negotiated Rate |
$172.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.51
|
| Rate for Payer: Aetna of WY Medicare |
$114.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$166.05
|
| Rate for Payer: Altius Commercial |
$166.05
|
| Rate for Payer: Beech Street Commercial |
$169.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.01
|
| Rate for Payer: Cash Price |
$121.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.78
|
| Rate for Payer: Cigna of WY Commercial |
$169.51
|
| Rate for Payer: Entrust Commercial |
$164.32
|
| Rate for Payer: First Choice Health Commercial |
$164.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$172.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.78
|
| Rate for Payer: Multiplan Medicare/VA |
$95.31
|
| Rate for Payer: One Health Plan of WY PPO |
$169.51
|
| Rate for Payer: PacificSource Commercial |
$155.67
|
| Rate for Payer: PHCS PPO |
$169.51
|
| Rate for Payer: Three Rivers PPO |
$129.73
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$150.48
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$169.51
|
| Rate for Payer: Wise Provider Network Commercial |
$164.32
|
|
|
BRACE KNEE T-SCOPE BREG 08814
|
Facility
|
IP
|
$172.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$172.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$166.05
|
| Rate for Payer: Altius Commercial |
$166.05
|
| Rate for Payer: Beech Street Commercial |
$169.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.01
|
| Rate for Payer: Cash Price |
$121.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.78
|
| Rate for Payer: Cigna of WY Commercial |
$169.51
|
| Rate for Payer: Entrust Commercial |
$164.32
|
| Rate for Payer: First Choice Health Commercial |
$164.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.16
|
| Rate for Payer: HealthUtah PPO |
$172.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.78
|
| Rate for Payer: Multiplan Medicare/VA |
$108.45
|
| Rate for Payer: One Health Plan of WY PPO |
$169.51
|
| Rate for Payer: PacificSource Commercial |
$155.67
|
| Rate for Payer: PHCS PPO |
$169.51
|
| Rate for Payer: Three Rivers PPO |
$129.73
|
| Rate for Payer: TriWest Veterans Administration |
$114.16
|
| Rate for Payer: United Healthcare Commercial |
$150.48
|
| Rate for Payer: United Healthcare Medicare |
$114.16
|
| Rate for Payer: WINHealth Partners Commercial |
$164.32
|
| Rate for Payer: Wise Provider Network Commercial |
$164.32
|
|
|
BRACE KNEE T-SCOPE PEDIATRIC
|
Facility
|
IP
|
$361.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$361.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$354.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$347.25
|
| Rate for Payer: Altius Commercial |
$347.25
|
| Rate for Payer: Beech Street Commercial |
$354.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$296.97
|
| Rate for Payer: Cash Price |
$253.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$350.87
|
| Rate for Payer: Cigna of WY Commercial |
$354.49
|
| Rate for Payer: Entrust Commercial |
$343.63
|
| Rate for Payer: First Choice Health Commercial |
$343.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$343.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$238.74
|
| Rate for Payer: HealthUtah PPO |
$361.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$350.87
|
| Rate for Payer: Multiplan Medicare/VA |
$226.80
|
| Rate for Payer: One Health Plan of WY PPO |
$354.49
|
| Rate for Payer: PacificSource Commercial |
$325.55
|
| Rate for Payer: PHCS PPO |
$354.49
|
| Rate for Payer: Three Rivers PPO |
$271.29
|
| Rate for Payer: TriWest Veterans Administration |
$238.74
|
| Rate for Payer: United Healthcare Commercial |
$314.70
|
| Rate for Payer: United Healthcare Medicare |
$238.74
|
| Rate for Payer: WINHealth Partners Commercial |
$343.63
|
| Rate for Payer: Wise Provider Network Commercial |
$343.63
|
|
|
BRACE KNEE T-SCOPE PEDIATRIC
|
Facility
|
OP
|
$361.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.31 |
| Max. Negotiated Rate |
$361.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$354.49
|
| Rate for Payer: Aetna of WY Medicare |
$238.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$347.25
|
| Rate for Payer: Altius Commercial |
$347.25
|
| Rate for Payer: Beech Street Commercial |
$354.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$296.97
|
| Rate for Payer: Cash Price |
$253.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$350.87
|
| Rate for Payer: Cigna of WY Commercial |
$354.49
|
| Rate for Payer: Entrust Commercial |
$343.63
|
| Rate for Payer: First Choice Health Commercial |
$343.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$343.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.80
|
| Rate for Payer: HealthUtah PPO |
$361.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$350.87
|
| Rate for Payer: Multiplan Medicare/VA |
$199.31
|
| Rate for Payer: One Health Plan of WY PPO |
$354.49
|
| Rate for Payer: PacificSource Commercial |
$325.55
|
| Rate for Payer: PHCS PPO |
$354.49
|
| Rate for Payer: Three Rivers PPO |
$271.29
|
| Rate for Payer: TriWest Veterans Administration |
$209.80
|
| Rate for Payer: United Healthcare Commercial |
$314.70
|
| Rate for Payer: United Healthcare Medicare |
$209.80
|
| Rate for Payer: WINHealth Partners Commercial |
$354.49
|
| Rate for Payer: Wise Provider Network Commercial |
$343.63
|
|
|
BRACE PATELLA LG VP40125-040
|
Facility
|
OP
|
$22.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.16
|
| Rate for Payer: Aetna of WY Medicare |
$14.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.71
|
| Rate for Payer: Altius Commercial |
$21.71
|
| Rate for Payer: Beech Street Commercial |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$22.16
|
| Rate for Payer: Entrust Commercial |
$21.48
|
| Rate for Payer: First Choice Health Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.11
|
| Rate for Payer: HealthUtah PPO |
$22.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.93
|
| Rate for Payer: Multiplan Medicare/VA |
$12.46
|
| Rate for Payer: One Health Plan of WY PPO |
$22.16
|
| Rate for Payer: PacificSource Commercial |
$20.35
|
| Rate for Payer: PHCS PPO |
$22.16
|
| Rate for Payer: Three Rivers PPO |
$16.96
|
| Rate for Payer: TriWest Veterans Administration |
$13.11
|
| Rate for Payer: United Healthcare Commercial |
$19.67
|
| Rate for Payer: United Healthcare Medicare |
$13.11
|
| Rate for Payer: WINHealth Partners Commercial |
$22.16
|
| Rate for Payer: Wise Provider Network Commercial |
$21.48
|
|
|
BRACE PATELLA LG VP40125-040
|
Facility
|
IP
|
$22.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.71
|
| Rate for Payer: Altius Commercial |
$21.71
|
| Rate for Payer: Beech Street Commercial |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$22.16
|
| Rate for Payer: Entrust Commercial |
$21.48
|
| Rate for Payer: First Choice Health Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.92
|
| Rate for Payer: HealthUtah PPO |
$22.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.93
|
| Rate for Payer: Multiplan Medicare/VA |
$14.18
|
| Rate for Payer: One Health Plan of WY PPO |
$22.16
|
| Rate for Payer: PacificSource Commercial |
$20.35
|
| Rate for Payer: PHCS PPO |
$22.16
|
| Rate for Payer: Three Rivers PPO |
$16.96
|
| Rate for Payer: TriWest Veterans Administration |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$19.67
|
| Rate for Payer: United Healthcare Medicare |
$14.92
|
| Rate for Payer: WINHealth Partners Commercial |
$21.48
|
| Rate for Payer: Wise Provider Network Commercial |
$21.48
|
|
|
BRACE PATELLA SM VP40125-020
|
Facility
|
OP
|
$22.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.16
|
| Rate for Payer: Aetna of WY Medicare |
$14.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.71
|
| Rate for Payer: Altius Commercial |
$21.71
|
| Rate for Payer: Beech Street Commercial |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$22.16
|
| Rate for Payer: Entrust Commercial |
$21.48
|
| Rate for Payer: First Choice Health Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.11
|
| Rate for Payer: HealthUtah PPO |
$22.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.93
|
| Rate for Payer: Multiplan Medicare/VA |
$12.46
|
| Rate for Payer: One Health Plan of WY PPO |
$22.16
|
| Rate for Payer: PacificSource Commercial |
$20.35
|
| Rate for Payer: PHCS PPO |
$22.16
|
| Rate for Payer: Three Rivers PPO |
$16.96
|
| Rate for Payer: TriWest Veterans Administration |
$13.11
|
| Rate for Payer: United Healthcare Commercial |
$19.67
|
| Rate for Payer: United Healthcare Medicare |
$13.11
|
| Rate for Payer: WINHealth Partners Commercial |
$22.16
|
| Rate for Payer: Wise Provider Network Commercial |
$21.48
|
|
|
BRACE PATELLA SM VP40125-020
|
Facility
|
IP
|
$22.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$22.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.71
|
| Rate for Payer: Altius Commercial |
$21.71
|
| Rate for Payer: Beech Street Commercial |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$22.16
|
| Rate for Payer: Entrust Commercial |
$21.48
|
| Rate for Payer: First Choice Health Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.92
|
| Rate for Payer: HealthUtah PPO |
$22.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.93
|
| Rate for Payer: Multiplan Medicare/VA |
$14.18
|
| Rate for Payer: One Health Plan of WY PPO |
$22.16
|
| Rate for Payer: PacificSource Commercial |
$20.35
|
| Rate for Payer: PHCS PPO |
$22.16
|
| Rate for Payer: Three Rivers PPO |
$16.96
|
| Rate for Payer: TriWest Veterans Administration |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$19.67
|
| Rate for Payer: United Healthcare Medicare |
$14.92
|
| Rate for Payer: WINHealth Partners Commercial |
$21.48
|
| Rate for Payer: Wise Provider Network Commercial |
$21.48
|
|
|
BRACE PATELLA STAB LG LT 20154
|
Facility
|
IP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.06
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$59.91
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$63.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.77
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB LG LT 20154
|
Facility
|
OP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Aetna of WY Medicare |
$63.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.42
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$52.65
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$55.42
|
| Rate for Payer: WINHealth Partners Commercial |
$93.64
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB LG RT 20174
|
Facility
|
OP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Aetna of WY Medicare |
$63.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.42
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$52.65
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$55.42
|
| Rate for Payer: WINHealth Partners Commercial |
$93.64
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB LG RT 20174
|
Facility
|
IP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.06
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$59.91
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$63.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.77
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB SM LT 20152
|
Facility
|
OP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Aetna of WY Medicare |
$63.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.42
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$52.65
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$55.42
|
| Rate for Payer: WINHealth Partners Commercial |
$93.64
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB SM LT 20152
|
Facility
|
IP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.06
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$59.91
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$63.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.77
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB SM RT 20172
|
Facility
|
OP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Aetna of WY Medicare |
$63.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.42
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$52.65
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$55.42
|
| Rate for Payer: WINHealth Partners Commercial |
$93.64
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB SM RT 20172
|
Facility
|
IP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.06
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$59.91
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$63.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.77
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
|
BRACE PATELLA STAB XL LT 20155
|
Facility
|
IP
|
$95.55
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.73
|
| Rate for Payer: Altius Commercial |
$91.73
|
| Rate for Payer: Beech Street Commercial |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$66.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.68
|
| Rate for Payer: Cigna of WY Commercial |
$93.64
|
| Rate for Payer: Entrust Commercial |
$90.77
|
| Rate for Payer: First Choice Health Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.06
|
| Rate for Payer: HealthUtah PPO |
$95.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.68
|
| Rate for Payer: Multiplan Medicare/VA |
$59.91
|
| Rate for Payer: One Health Plan of WY PPO |
$93.64
|
| Rate for Payer: PacificSource Commercial |
$86.00
|
| Rate for Payer: PHCS PPO |
$93.64
|
| Rate for Payer: Three Rivers PPO |
$71.66
|
| Rate for Payer: TriWest Veterans Administration |
$63.06
|
| Rate for Payer: United Healthcare Commercial |
$83.13
|
| Rate for Payer: United Healthcare Medicare |
$63.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.77
|
| Rate for Payer: Wise Provider Network Commercial |
$90.77
|
|
