|
NC EMERGE MONORAIL 4.5 X 20MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 4.5 X 20MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 4.5 X 8MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 4.5 X 8MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 12MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 12MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 15MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 15MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 8MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.0 X 8MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.5 X 12MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.5 X 12MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.5 X 8MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NC EMERGE MONORAIL 5.5 X 8MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
51715
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$189.49
|
| Rate for Payer: Beech Street Commercial |
$1,197.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: First Choice Health Commercial |
$1,134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.49
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$161.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,197.00
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$189.49
|
| Rate for Payer: United Healthcare Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare Medicare |
$189.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,071.00
|
|
|
NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$5,260.00
|
|
|
Service Code
|
HCPCS 29848 50
|
| Hospital Charge Code |
29848
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,154.80
|
| Rate for Payer: Aetna of WY Medicare |
$502.92
|
| Rate for Payer: Beech Street Commercial |
$4,997.00
|
| Rate for Payer: Cash Price |
$3,682.00
|
| Rate for Payer: Cash Price |
$3,682.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,102.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,154.80
|
| Rate for Payer: First Choice Health Commercial |
$4,734.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,997.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$502.92
|
| Rate for Payer: HealthUtah PPO |
$5,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,102.20
|
| Rate for Payer: Multiplan Medicare/VA |
$427.48
|
| Rate for Payer: One Health Plan of WY PPO |
$5,154.80
|
| Rate for Payer: PacificSource Commercial |
$4,734.00
|
| Rate for Payer: PHCS PPO |
$4,997.00
|
| Rate for Payer: Three Rivers PPO |
$3,945.00
|
| Rate for Payer: TriWest Veterans Administration |
$502.92
|
| Rate for Payer: United Healthcare Commercial |
$4,576.20
|
| Rate for Payer: United Healthcare Medicare |
$502.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4,471.00
|
|
|
NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$2,630.00
|
|
|
Service Code
|
HCPCS 29848
|
| Hospital Charge Code |
29848
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$2,630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,577.40
|
| Rate for Payer: Aetna of WY Medicare |
$502.92
|
| Rate for Payer: Beech Street Commercial |
$2,498.50
|
| Rate for Payer: Cash Price |
$1,841.00
|
| Rate for Payer: Cash Price |
$1,841.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,551.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,577.40
|
| Rate for Payer: First Choice Health Commercial |
$2,367.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,498.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$502.92
|
| Rate for Payer: HealthUtah PPO |
$2,630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,551.10
|
| Rate for Payer: Multiplan Medicare/VA |
$427.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,577.40
|
| Rate for Payer: PacificSource Commercial |
$2,367.00
|
| Rate for Payer: PHCS PPO |
$2,498.50
|
| Rate for Payer: Three Rivers PPO |
$1,972.50
|
| Rate for Payer: TriWest Veterans Administration |
$502.92
|
| Rate for Payer: United Healthcare Commercial |
$2,288.10
|
| Rate for Payer: United Healthcare Medicare |
$502.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,235.50
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 4354752603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.89
|
| Rate for Payer: Altius Commercial |
$0.89
|
| Rate for Payer: Beech Street Commercial |
$0.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.90
|
| Rate for Payer: Cigna of WY Commercial |
$0.91
|
| Rate for Payer: Entrust Commercial |
$0.88
|
| Rate for Payer: First Choice Health Commercial |
$0.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.61
|
| Rate for Payer: HealthUtah PPO |
$0.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.90
|
| Rate for Payer: Multiplan Medicare/VA |
$0.58
|
| Rate for Payer: One Health Plan of WY PPO |
$0.91
|
| Rate for Payer: PacificSource Commercial |
$0.84
|
| Rate for Payer: PHCS PPO |
$0.91
|
| Rate for Payer: Three Rivers PPO |
$0.70
|
| Rate for Payer: TriWest Veterans Administration |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.61
|
| Rate for Payer: WINHealth Partners Commercial |
$0.88
|
| Rate for Payer: Wise Provider Network Commercial |
$0.88
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
IP
|
$21.33
|
|
|
Service Code
|
NDC 0456141030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.48
|
| Rate for Payer: Altius Commercial |
$20.48
|
| Rate for Payer: Beech Street Commercial |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.51
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.69
|
| Rate for Payer: Cigna of WY Commercial |
$20.90
|
| Rate for Payer: Entrust Commercial |
$20.26
|
| Rate for Payer: First Choice Health Commercial |
$20.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.08
|
| Rate for Payer: HealthUtah PPO |
$21.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.69
|
| Rate for Payer: Multiplan Medicare/VA |
$13.37
|
| Rate for Payer: One Health Plan of WY PPO |
$20.90
|
| Rate for Payer: PacificSource Commercial |
$19.20
|
| Rate for Payer: PHCS PPO |
$20.90
|
| Rate for Payer: Three Rivers PPO |
$16.00
|
| Rate for Payer: TriWest Veterans Administration |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$18.56
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
| Rate for Payer: WINHealth Partners Commercial |
$20.26
|
| Rate for Payer: Wise Provider Network Commercial |
$20.26
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
IP
|
$13.12
|
|
|
Service Code
|
NDC 6068765211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$12.46
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
OP
|
$13.12
|
|
|
Service Code
|
NDC 6068765211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Aetna of WY Medicare |
$8.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.61
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$7.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$7.61
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$7.61
|
| Rate for Payer: WINHealth Partners Commercial |
$12.86
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 4354752603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.91
|
| Rate for Payer: Aetna of WY Medicare |
$0.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.89
|
| Rate for Payer: Altius Commercial |
$0.89
|
| Rate for Payer: Beech Street Commercial |
$0.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.90
|
| Rate for Payer: Cigna of WY Commercial |
$0.91
|
| Rate for Payer: Entrust Commercial |
$0.88
|
| Rate for Payer: First Choice Health Commercial |
$0.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.54
|
| Rate for Payer: HealthUtah PPO |
$0.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.90
|
| Rate for Payer: Multiplan Medicare/VA |
$0.51
|
| Rate for Payer: One Health Plan of WY PPO |
$0.91
|
| Rate for Payer: PacificSource Commercial |
$0.84
|
| Rate for Payer: PHCS PPO |
$0.91
|
| Rate for Payer: Three Rivers PPO |
$0.70
|
| Rate for Payer: TriWest Veterans Administration |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
| Rate for Payer: WINHealth Partners Commercial |
$0.91
|
| Rate for Payer: Wise Provider Network Commercial |
$0.88
|
|
|
NEBIVOLOL 10 MG TABLET [46020]
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
NDC 0456141030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.90
|
| Rate for Payer: Aetna of WY Medicare |
$14.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.48
|
| Rate for Payer: Altius Commercial |
$20.48
|
| Rate for Payer: Beech Street Commercial |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.51
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.69
|
| Rate for Payer: Cigna of WY Commercial |
$20.90
|
| Rate for Payer: Entrust Commercial |
$20.26
|
| Rate for Payer: First Choice Health Commercial |
$20.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.37
|
| Rate for Payer: HealthUtah PPO |
$21.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.69
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$20.90
|
| Rate for Payer: PacificSource Commercial |
$19.20
|
| Rate for Payer: PHCS PPO |
$20.90
|
| Rate for Payer: Three Rivers PPO |
$16.00
|
| Rate for Payer: TriWest Veterans Administration |
$12.37
|
| Rate for Payer: United Healthcare Commercial |
$18.56
|
| Rate for Payer: United Healthcare Medicare |
$12.37
|
| Rate for Payer: WINHealth Partners Commercial |
$20.90
|
| Rate for Payer: Wise Provider Network Commercial |
$20.26
|
|
|
NEBULIZER PEDI-NEB 0383
|
Facility
|
IP
|
$14.80
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.21
|
| Rate for Payer: Altius Commercial |
$14.21
|
| Rate for Payer: Beech Street Commercial |
$14.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.36
|
| Rate for Payer: Cigna of WY Commercial |
$14.50
|
| Rate for Payer: Entrust Commercial |
$14.06
|
| Rate for Payer: First Choice Health Commercial |
$14.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.77
|
| Rate for Payer: HealthUtah PPO |
$14.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.36
|
| Rate for Payer: Multiplan Medicare/VA |
$9.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.50
|
| Rate for Payer: PacificSource Commercial |
$13.32
|
| Rate for Payer: PHCS PPO |
$14.50
|
| Rate for Payer: Three Rivers PPO |
$11.10
|
| Rate for Payer: TriWest Veterans Administration |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$12.88
|
| Rate for Payer: United Healthcare Medicare |
$9.77
|
| Rate for Payer: WINHealth Partners Commercial |
$14.06
|
| Rate for Payer: Wise Provider Network Commercial |
$14.06
|
|
|
NEBULIZER PEDI-NEB 0383
|
Facility
|
OP
|
$14.80
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.50
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.21
|
| Rate for Payer: Altius Commercial |
$14.21
|
| Rate for Payer: Beech Street Commercial |
$14.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.36
|
| Rate for Payer: Cigna of WY Commercial |
$14.50
|
| Rate for Payer: Entrust Commercial |
$14.06
|
| Rate for Payer: First Choice Health Commercial |
$14.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.58
|
| Rate for Payer: HealthUtah PPO |
$14.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.36
|
| Rate for Payer: Multiplan Medicare/VA |
$8.15
|
| Rate for Payer: One Health Plan of WY PPO |
$14.50
|
| Rate for Payer: PacificSource Commercial |
$13.32
|
| Rate for Payer: PHCS PPO |
$14.50
|
| Rate for Payer: Three Rivers PPO |
$11.10
|
| Rate for Payer: TriWest Veterans Administration |
$8.58
|
| Rate for Payer: United Healthcare Commercial |
$12.88
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: WINHealth Partners Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.06
|
|
