|
BONE AGE STUDIES
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 77072
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.52
|
| Rate for Payer: Aetna of WY Medicare |
$25.37
|
| Rate for Payer: Beech Street Commercial |
$355.30
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$362.78
|
| Rate for Payer: Cigna of WY Commercial |
$366.52
|
| Rate for Payer: First Choice Health Commercial |
$336.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.37
|
| Rate for Payer: HealthUtah PPO |
$374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$362.78
|
| Rate for Payer: Multiplan Medicare/VA |
$21.56
|
| Rate for Payer: One Health Plan of WY PPO |
$366.52
|
| Rate for Payer: PacificSource Commercial |
$336.60
|
| Rate for Payer: PHCS PPO |
$355.30
|
| Rate for Payer: Three Rivers PPO |
$280.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.37
|
| Rate for Payer: United Healthcare Commercial |
$355.30
|
| Rate for Payer: WINHealth Partners Commercial |
$355.30
|
|
|
BONE DOWEL 10MM REVISION KIT
|
Facility
|
OP
|
$2,003.12
|
|
| Hospital Charge Code |
3004511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.69 |
| Max. Negotiated Rate |
$2,003.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,963.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,322.06
|
| Rate for Payer: Altius Commercial |
$1,923.00
|
| Rate for Payer: Beech Street Commercial |
$1,963.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,943.03
|
| Rate for Payer: Cash Price |
$1,402.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,943.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,963.06
|
| Rate for Payer: Entrust Commercial |
$1,902.96
|
| Rate for Payer: First Choice Health Commercial |
$1,902.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,902.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,141.78
|
| Rate for Payer: HealthUtah PPO |
$2,003.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,943.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,084.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,963.06
|
| Rate for Payer: PacificSource Commercial |
$1,802.81
|
| Rate for Payer: PHCS PPO |
$1,963.06
|
| Rate for Payer: Three Rivers PPO |
$1,502.34
|
| Rate for Payer: TriWest Veterans Administration |
$1,141.78
|
| Rate for Payer: United Healthcare Commercial |
$1,912.98
|
| Rate for Payer: United Healthcare Medicare |
$1,141.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,963.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,902.96
|
|
|
BONE DOWEL 10MM REVISION KIT
|
Facility
|
IP
|
$2,003.12
|
|
| Hospital Charge Code |
3004511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.81 |
| Max. Negotiated Rate |
$2,003.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,963.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,282.00
|
| Rate for Payer: Altius Commercial |
$1,923.00
|
| Rate for Payer: Beech Street Commercial |
$1,963.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,943.03
|
| Rate for Payer: Cash Price |
$1,402.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,943.03
|
| Rate for Payer: Cigna of WY Commercial |
$1,963.06
|
| Rate for Payer: Entrust Commercial |
$1,902.96
|
| Rate for Payer: First Choice Health Commercial |
$1,902.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,902.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,221.90
|
| Rate for Payer: HealthUtah PPO |
$2,003.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,943.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,160.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,963.06
|
| Rate for Payer: PacificSource Commercial |
$1,802.81
|
| Rate for Payer: PHCS PPO |
$1,963.06
|
| Rate for Payer: Three Rivers PPO |
$1,502.34
|
| Rate for Payer: TriWest Veterans Administration |
$1,221.90
|
| Rate for Payer: United Healthcare Commercial |
$1,912.98
|
| Rate for Payer: United Healthcare Medicare |
$1,221.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,902.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1,902.96
|
|
|
BONE DOWEL 12MM REVISION KIT
|
Facility
|
IP
|
$1,715.00
|
|
| Hospital Charge Code |
3004147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.84 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: United Healthcare Commercial |
$1,637.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,097.60
|
| Rate for Payer: Altius Commercial |
$1,646.40
|
| Rate for Payer: Beech Street Commercial |
$1,680.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,663.55
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: Entrust Commercial |
$1,629.25
|
| Rate for Payer: First Choice Health Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,046.15
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$993.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,680.70
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,046.15
|
| Rate for Payer: United Healthcare Medicare |
$1,046.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,629.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,629.25
|
|
|
BONE DOWEL 12MM REVISION KIT
|
Facility
|
OP
|
$1,715.00
|
|
| Hospital Charge Code |
3004147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.67 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,131.90
|
| Rate for Payer: Altius Commercial |
$1,646.40
|
| Rate for Payer: Beech Street Commercial |
$1,680.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,663.55
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: Entrust Commercial |
$1,629.25
|
| Rate for Payer: First Choice Health Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.55
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$928.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,680.70
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$977.55
|
| Rate for Payer: United Healthcare Commercial |
$1,637.82
|
| Rate for Payer: United Healthcare Medicare |
$977.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,680.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,629.25
|
|
|
BONE DOWEL 13MM REVISION KIT
|
Facility
|
IP
|
$2,044.00
|
|
| Hospital Charge Code |
3004148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.50 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,308.16
|
| Rate for Payer: Altius Commercial |
$1,962.24
|
| Rate for Payer: Beech Street Commercial |
$2,003.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,982.68
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.12
|
| Rate for Payer: Entrust Commercial |
$1,941.80
|
| Rate for Payer: First Choice Health Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,246.84
|
| Rate for Payer: HealthUtah PPO |
$2,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,184.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.12
|
| Rate for Payer: PacificSource Commercial |
$1,839.60
|
| Rate for Payer: PHCS PPO |
$2,003.12
|
| Rate for Payer: Three Rivers PPO |
$1,533.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,246.84
|
| Rate for Payer: United Healthcare Commercial |
$1,952.02
|
| Rate for Payer: United Healthcare Medicare |
$1,246.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,941.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.80
|
|
|
BONE DOWEL 13MM REVISION KIT
|
Facility
|
OP
|
$2,044.00
|
|
| Hospital Charge Code |
3004148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,106.83 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,349.04
|
| Rate for Payer: Altius Commercial |
$1,962.24
|
| Rate for Payer: Beech Street Commercial |
$2,003.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,982.68
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.12
|
| Rate for Payer: Entrust Commercial |
$1,941.80
|
| Rate for Payer: First Choice Health Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,165.08
|
| Rate for Payer: HealthUtah PPO |
$2,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,106.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.12
|
| Rate for Payer: PacificSource Commercial |
$1,839.60
|
| Rate for Payer: PHCS PPO |
$2,003.12
|
| Rate for Payer: Three Rivers PPO |
$1,533.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,165.08
|
| Rate for Payer: United Healthcare Commercial |
$1,952.02
|
| Rate for Payer: United Healthcare Medicare |
$1,165.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,003.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.80
|
|
|
BONE DOWEL 14MM REVISION KIT
|
Facility
|
OP
|
$2,044.00
|
|
| Hospital Charge Code |
3004512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,106.83 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,349.04
|
| Rate for Payer: Altius Commercial |
$1,962.24
|
| Rate for Payer: Beech Street Commercial |
$2,003.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,982.68
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.12
|
| Rate for Payer: Entrust Commercial |
$1,941.80
|
| Rate for Payer: First Choice Health Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,165.08
|
| Rate for Payer: HealthUtah PPO |
$2,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,106.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.12
|
| Rate for Payer: PacificSource Commercial |
$1,839.60
|
| Rate for Payer: PHCS PPO |
$2,003.12
|
| Rate for Payer: Three Rivers PPO |
$1,533.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,165.08
|
| Rate for Payer: United Healthcare Commercial |
$1,952.02
|
| Rate for Payer: United Healthcare Medicare |
$1,165.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,003.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.80
|
|
|
BONE DOWEL 14MM REVISION KIT
|
Facility
|
IP
|
$2,044.00
|
|
| Hospital Charge Code |
3004512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.50 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,308.16
|
| Rate for Payer: Altius Commercial |
$1,962.24
|
| Rate for Payer: Beech Street Commercial |
$2,003.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,982.68
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.12
|
| Rate for Payer: Entrust Commercial |
$1,941.80
|
| Rate for Payer: First Choice Health Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,246.84
|
| Rate for Payer: HealthUtah PPO |
$2,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,184.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.12
|
| Rate for Payer: PacificSource Commercial |
$1,839.60
|
| Rate for Payer: PHCS PPO |
$2,003.12
|
| Rate for Payer: Three Rivers PPO |
$1,533.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,246.84
|
| Rate for Payer: United Healthcare Commercial |
$1,952.02
|
| Rate for Payer: United Healthcare Medicare |
$1,246.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,941.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.80
|
|
|
BONE DOWEL 16MM REVISION KIT
|
Facility
|
OP
|
$2,248.40
|
|
| Hospital Charge Code |
3004513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,217.51 |
| Max. Negotiated Rate |
$2,248.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,203.43
|
| Rate for Payer: Aetna of WY Medicare |
$1,483.94
|
| Rate for Payer: Altius Commercial |
$2,158.46
|
| Rate for Payer: Beech Street Commercial |
$2,203.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,180.95
|
| Rate for Payer: Cash Price |
$1,573.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,180.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,203.43
|
| Rate for Payer: Entrust Commercial |
$2,135.98
|
| Rate for Payer: First Choice Health Commercial |
$2,135.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,135.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,281.59
|
| Rate for Payer: HealthUtah PPO |
$2,248.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,180.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,217.51
|
| Rate for Payer: One Health Plan of WY PPO |
$2,203.43
|
| Rate for Payer: PacificSource Commercial |
$2,023.56
|
| Rate for Payer: PHCS PPO |
$2,203.43
|
| Rate for Payer: Three Rivers PPO |
$1,686.30
|
| Rate for Payer: TriWest Veterans Administration |
$1,281.59
|
| Rate for Payer: United Healthcare Commercial |
$2,147.22
|
| Rate for Payer: United Healthcare Medicare |
$1,281.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2,203.43
|
| Rate for Payer: Wise Provider Network Commercial |
$2,135.98
|
|
|
BONE DOWEL 16MM REVISION KIT
|
Facility
|
IP
|
$2,248.40
|
|
| Hospital Charge Code |
3004513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,302.95 |
| Max. Negotiated Rate |
$2,248.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,203.43
|
| Rate for Payer: Aetna of WY Medicare |
$1,438.98
|
| Rate for Payer: Altius Commercial |
$2,158.46
|
| Rate for Payer: Beech Street Commercial |
$2,203.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,180.95
|
| Rate for Payer: Cash Price |
$1,573.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,180.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,203.43
|
| Rate for Payer: Entrust Commercial |
$2,135.98
|
| Rate for Payer: First Choice Health Commercial |
$2,135.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,135.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,371.52
|
| Rate for Payer: HealthUtah PPO |
$2,248.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,180.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,302.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,203.43
|
| Rate for Payer: PacificSource Commercial |
$2,023.56
|
| Rate for Payer: PHCS PPO |
$2,203.43
|
| Rate for Payer: Three Rivers PPO |
$1,686.30
|
| Rate for Payer: TriWest Veterans Administration |
$1,371.52
|
| Rate for Payer: United Healthcare Commercial |
$2,147.22
|
| Rate for Payer: United Healthcare Medicare |
$1,371.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,135.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2,135.98
|
|
|
BONE DOWEL GRAFT 10MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,852.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,258.02
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,950.11
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,852.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$1,950.11
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$1,950.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 10MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,189.60
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,086.96
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,982.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$2,086.96
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$2,086.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 10MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.80 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,650.72
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,289.26
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,174.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,289.26
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,289.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3,935.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 10MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.42 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,570.40
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,449.91
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,327.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,449.91
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,449.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,815.44
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 11MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,852.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,258.02
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,950.11
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,852.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$1,950.11
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$1,950.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 11MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,189.60
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,086.96
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,982.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$2,086.96
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$2,086.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 11MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.42 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,570.40
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,449.91
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,327.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,449.91
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,449.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,815.44
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 11MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.80 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,650.72
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,289.26
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,174.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,289.26
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,289.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3,935.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 12MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,852.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,258.02
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,950.11
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,852.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$1,950.11
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$1,950.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 12MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,189.60
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,086.96
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,982.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$2,086.96
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$2,086.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 12MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.80 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,650.72
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,289.26
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,174.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,289.26
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,289.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3,935.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 12MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.42 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,935.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,570.40
|
| Rate for Payer: Altius Commercial |
$3,855.60
|
| Rate for Payer: Beech Street Commercial |
$3,935.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,895.76
|
| Rate for Payer: Cash Price |
$2,811.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,895.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,935.92
|
| Rate for Payer: Entrust Commercial |
$3,815.44
|
| Rate for Payer: First Choice Health Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,815.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,449.91
|
| Rate for Payer: HealthUtah PPO |
$4,016.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,895.76
|
| Rate for Payer: Multiplan Medicare/VA |
$2,327.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,935.92
|
| Rate for Payer: PacificSource Commercial |
$3,614.62
|
| Rate for Payer: PHCS PPO |
$3,935.92
|
| Rate for Payer: Three Rivers PPO |
$3,012.19
|
| Rate for Payer: TriWest Veterans Administration |
$2,449.91
|
| Rate for Payer: United Healthcare Commercial |
$3,835.52
|
| Rate for Payer: United Healthcare Medicare |
$2,449.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,815.44
|
| Rate for Payer: Wise Provider Network Commercial |
$3,815.44
|
|
|
BONE DOWEL GRAFT 13MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,189.60
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,086.96
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,982.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$2,086.96
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$2,086.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,250.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
|
BONE DOWEL GRAFT 13MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,852.61 |
| Max. Negotiated Rate |
$3,421.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,352.82
|
| Rate for Payer: Aetna of WY Medicare |
$2,258.02
|
| Rate for Payer: Altius Commercial |
$3,284.40
|
| Rate for Payer: Beech Street Commercial |
$3,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,318.61
|
| Rate for Payer: Cash Price |
$2,394.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,318.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,352.82
|
| Rate for Payer: Entrust Commercial |
$3,250.19
|
| Rate for Payer: First Choice Health Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,250.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,950.11
|
| Rate for Payer: HealthUtah PPO |
$3,421.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,318.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,852.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,352.82
|
| Rate for Payer: PacificSource Commercial |
$3,079.12
|
| Rate for Payer: PHCS PPO |
$3,352.82
|
| Rate for Payer: Three Rivers PPO |
$2,565.94
|
| Rate for Payer: TriWest Veterans Administration |
$1,950.11
|
| Rate for Payer: United Healthcare Commercial |
$3,267.29
|
| Rate for Payer: United Healthcare Medicare |
$1,950.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3,352.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3,250.19
|
|
