|
BRACE PATELLA STAB XL LT 20155
|
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 XL RT 20175
|
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 RT 20175
|
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 XS VP40125-010
|
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 XS VP40125-010
|
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 PATELL BAND MED 79-80325
|
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 PATELL BAND MED 79-80325
|
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 PATELL STAB MED LT 20153
|
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 PATELL STAB MED LT 20153
|
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 PATELL STAB MED RT 20173
|
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 PATELL STAB MED RT 20173
|
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 TSCOPE ELBOW LEFT
|
Facility
|
OP
|
$182.52
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.57 |
| Max. Negotiated Rate |
$182.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.87
|
| Rate for Payer: Aetna of WY Medicare |
$120.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.22
|
| Rate for Payer: Altius Commercial |
$175.22
|
| Rate for Payer: Beech Street Commercial |
$178.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.85
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.04
|
| Rate for Payer: Cigna of WY Commercial |
$178.87
|
| Rate for Payer: Entrust Commercial |
$173.39
|
| Rate for Payer: First Choice Health Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.86
|
| Rate for Payer: HealthUtah PPO |
$182.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.04
|
| Rate for Payer: Multiplan Medicare/VA |
$100.57
|
| Rate for Payer: One Health Plan of WY PPO |
$178.87
|
| Rate for Payer: PacificSource Commercial |
$164.27
|
| Rate for Payer: PHCS PPO |
$178.87
|
| Rate for Payer: Three Rivers PPO |
$136.89
|
| Rate for Payer: TriWest Veterans Administration |
$105.86
|
| Rate for Payer: United Healthcare Commercial |
$158.79
|
| Rate for Payer: United Healthcare Medicare |
$105.86
|
| Rate for Payer: WINHealth Partners Commercial |
$178.87
|
| Rate for Payer: Wise Provider Network Commercial |
$173.39
|
|
|
BRACE TSCOPE ELBOW LEFT
|
Facility
|
IP
|
$182.52
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$182.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.22
|
| Rate for Payer: Altius Commercial |
$175.22
|
| Rate for Payer: Beech Street Commercial |
$178.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.85
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.04
|
| Rate for Payer: Cigna of WY Commercial |
$178.87
|
| Rate for Payer: Entrust Commercial |
$173.39
|
| Rate for Payer: First Choice Health Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.46
|
| Rate for Payer: HealthUtah PPO |
$182.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.04
|
| Rate for Payer: Multiplan Medicare/VA |
$114.44
|
| Rate for Payer: One Health Plan of WY PPO |
$178.87
|
| Rate for Payer: PacificSource Commercial |
$164.27
|
| Rate for Payer: PHCS PPO |
$178.87
|
| Rate for Payer: Three Rivers PPO |
$136.89
|
| Rate for Payer: TriWest Veterans Administration |
$120.46
|
| Rate for Payer: United Healthcare Commercial |
$158.79
|
| Rate for Payer: United Healthcare Medicare |
$120.46
|
| Rate for Payer: WINHealth Partners Commercial |
$173.39
|
| Rate for Payer: Wise Provider Network Commercial |
$173.39
|
|
|
BRACE TSCOPE ELBOW RIGHT
|
Facility
|
IP
|
$182.52
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$182.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.22
|
| Rate for Payer: Altius Commercial |
$175.22
|
| Rate for Payer: Beech Street Commercial |
$178.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.85
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.04
|
| Rate for Payer: Cigna of WY Commercial |
$178.87
|
| Rate for Payer: Entrust Commercial |
$173.39
|
| Rate for Payer: First Choice Health Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.46
|
| Rate for Payer: HealthUtah PPO |
$182.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.04
|
| Rate for Payer: Multiplan Medicare/VA |
$114.44
|
| Rate for Payer: One Health Plan of WY PPO |
$178.87
|
| Rate for Payer: PacificSource Commercial |
$164.27
|
| Rate for Payer: PHCS PPO |
$178.87
|
| Rate for Payer: Three Rivers PPO |
$136.89
|
| Rate for Payer: TriWest Veterans Administration |
$120.46
|
| Rate for Payer: United Healthcare Commercial |
$158.79
|
| Rate for Payer: United Healthcare Medicare |
$120.46
|
| Rate for Payer: WINHealth Partners Commercial |
$173.39
|
| Rate for Payer: Wise Provider Network Commercial |
$173.39
|
|
|
BRACE TSCOPE ELBOW RIGHT
|
Facility
|
OP
|
$182.52
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.57 |
| Max. Negotiated Rate |
$182.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.87
|
| Rate for Payer: Aetna of WY Medicare |
$120.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.22
|
| Rate for Payer: Altius Commercial |
$175.22
|
| Rate for Payer: Beech Street Commercial |
$178.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.85
|
| Rate for Payer: Cash Price |
$127.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.04
|
| Rate for Payer: Cigna of WY Commercial |
$178.87
|
| Rate for Payer: Entrust Commercial |
$173.39
|
| Rate for Payer: First Choice Health Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.86
|
| Rate for Payer: HealthUtah PPO |
$182.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.04
|
| Rate for Payer: Multiplan Medicare/VA |
$100.57
|
| Rate for Payer: One Health Plan of WY PPO |
$178.87
|
| Rate for Payer: PacificSource Commercial |
$164.27
|
| Rate for Payer: PHCS PPO |
$178.87
|
| Rate for Payer: Three Rivers PPO |
$136.89
|
| Rate for Payer: TriWest Veterans Administration |
$105.86
|
| Rate for Payer: United Healthcare Commercial |
$158.79
|
| Rate for Payer: United Healthcare Medicare |
$105.86
|
| Rate for Payer: WINHealth Partners Commercial |
$178.87
|
| Rate for Payer: Wise Provider Network Commercial |
$173.39
|
|
|
BRACE WRIST/THUMB L UNIV SZ
|
Facility
|
OP
|
$17.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.63
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$16.97
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB L UNIV SZ
|
Facility
|
IP
|
$17.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.63
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.43
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.86
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$11.43
|
| Rate for Payer: WINHealth Partners Commercial |
$16.45
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB R UNIV SZ
|
Facility
|
IP
|
$17.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.63
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.43
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.86
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$11.43
|
| Rate for Payer: WINHealth Partners Commercial |
$16.45
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB R UNIV SZ
|
Facility
|
OP
|
$17.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.63
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$16.97
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BREAST PUMP CONNECTOR 87076
|
Facility
|
OP
|
$3.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.44
|
| Rate for Payer: Aetna of WY Medicare |
$2.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.37
|
| Rate for Payer: Altius Commercial |
$3.37
|
| Rate for Payer: Beech Street Commercial |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.44
|
| Rate for Payer: Entrust Commercial |
$3.33
|
| Rate for Payer: First Choice Health Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.04
|
| Rate for Payer: HealthUtah PPO |
$3.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3.44
|
| Rate for Payer: PacificSource Commercial |
$3.16
|
| Rate for Payer: PHCS PPO |
$3.44
|
| Rate for Payer: Three Rivers PPO |
$2.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.04
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
| Rate for Payer: United Healthcare Medicare |
$2.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3.44
|
| Rate for Payer: Wise Provider Network Commercial |
$3.33
|
|
|
BREAST PUMP CONNECTOR 87076
|
Facility
|
IP
|
$3.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.37
|
| Rate for Payer: Altius Commercial |
$3.37
|
| Rate for Payer: Beech Street Commercial |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.44
|
| Rate for Payer: Entrust Commercial |
$3.33
|
| Rate for Payer: First Choice Health Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.32
|
| Rate for Payer: HealthUtah PPO |
$3.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$2.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3.44
|
| Rate for Payer: PacificSource Commercial |
$3.16
|
| Rate for Payer: PHCS PPO |
$3.44
|
| Rate for Payer: Three Rivers PPO |
$2.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$3.05
|
| Rate for Payer: United Healthcare Medicare |
$2.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3.33
|
| Rate for Payer: Wise Provider Network Commercial |
$3.33
|
|
|
BRIDLE NASAL TUBE SYS 16-18F
|
Facility
|
IP
|
$450.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.65 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.77
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.11
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.53
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$282.65
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$297.53
|
| Rate for Payer: United Healthcare Commercial |
$392.20
|
| Rate for Payer: United Healthcare Medicare |
$297.53
|
| Rate for Payer: WINHealth Partners Commercial |
$428.26
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 16-18F
|
Facility
|
OP
|
$450.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$297.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.77
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.11
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.46
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$261.46
|
| Rate for Payer: United Healthcare Commercial |
$392.20
|
| Rate for Payer: United Healthcare Medicare |
$261.46
|
| Rate for Payer: WINHealth Partners Commercial |
$441.78
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 8-10F
|
Facility
|
OP
|
$450.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$297.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.77
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.11
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.46
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$248.39
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$261.46
|
| Rate for Payer: United Healthcare Commercial |
$392.20
|
| Rate for Payer: United Healthcare Medicare |
$261.46
|
| Rate for Payer: WINHealth Partners Commercial |
$441.78
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 8-10F
|
Facility
|
IP
|
$450.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.65 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.77
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.11
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.53
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$282.65
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$297.53
|
| Rate for Payer: United Healthcare Commercial |
$392.20
|
| Rate for Payer: United Healthcare Medicare |
$297.53
|
| Rate for Payer: WINHealth Partners Commercial |
$428.26
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
