|
BONE DOWEL GRAFT 13MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003926
|
|
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 XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003926
|
|
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 14MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002494
|
|
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 14MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002494
|
|
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 14MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003927
|
|
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 14MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003927
|
|
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 16MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002495
|
|
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 16MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002495
|
|
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 16MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003928
|
|
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 16MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003928
|
|
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 18MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002496
|
|
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 18MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002496
|
|
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 18MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003929
|
|
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 18MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003929
|
|
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 9MM
|
Facility
|
OP
|
$3,421.25
|
|
| Hospital Charge Code |
3002489
|
|
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 9MM
|
Facility
|
IP
|
$3,421.25
|
|
| Hospital Charge Code |
3002489
|
|
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 9 MM XL
|
Facility
|
IP
|
$4,016.25
|
|
| Hospital Charge Code |
3003922
|
|
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 9 MM XL
|
Facility
|
OP
|
$4,016.25
|
|
| Hospital Charge Code |
3003922
|
|
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 FOAM ROLL
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
2200364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$100.80
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.08
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$91.27
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$96.08
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$96.08
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
BONE FOAM ROLL
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
2200364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.29 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.78
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$85.29
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$89.78
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$89.78
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$222.61 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,209.32
|
| Rate for Payer: Aetna of WY Medicare |
$261.89
|
| Rate for Payer: Beech Street Commercial |
$1,172.30
|
| Rate for Payer: Cash Price |
$863.80
|
| Rate for Payer: Cash Price |
$863.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,196.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,209.32
|
| Rate for Payer: First Choice Health Commercial |
$1,110.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,172.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.89
|
| Rate for Payer: HealthUtah PPO |
$1,234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,196.98
|
| Rate for Payer: Multiplan Medicare/VA |
$222.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,209.32
|
| Rate for Payer: PacificSource Commercial |
$1,110.60
|
| Rate for Payer: PHCS PPO |
$1,172.30
|
| Rate for Payer: Three Rivers PPO |
$925.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.89
|
| Rate for Payer: United Healthcare Commercial |
$1,172.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,048.90
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$807.00
|
|
|
Service Code
|
HCPCS 20900 80
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: United Healthcare Commercial |
$766.65
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$807.00
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Aetna of WY Medicare |
$172.22
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.22
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: Multiplan Medicare/VA |
$146.39
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.22
|
| Rate for Payer: United Healthcare Commercial |
$766.65
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$807.00
|
|
|
Service Code
|
HCPCS 20900 AS
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: United Healthcare Commercial |
$766.65
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
BONE GRAFT GENEXDS 980-005
|
Facility
|
OP
|
$5,075.00
|
|
| Hospital Charge Code |
3100685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,748.11 |
| Max. Negotiated Rate |
$5,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,973.50
|
| Rate for Payer: Aetna of WY Medicare |
$3,349.50
|
| Rate for Payer: Altius Commercial |
$4,872.00
|
| Rate for Payer: Beech Street Commercial |
$4,973.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,922.75
|
| Rate for Payer: Cash Price |
$3,552.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,922.75
|
| Rate for Payer: Cigna of WY Commercial |
$4,973.50
|
| Rate for Payer: Entrust Commercial |
$4,821.25
|
| Rate for Payer: First Choice Health Commercial |
$4,821.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,821.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,892.75
|
| Rate for Payer: HealthUtah PPO |
$5,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,922.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,748.11
|
| Rate for Payer: One Health Plan of WY PPO |
$4,973.50
|
| Rate for Payer: PacificSource Commercial |
$4,567.50
|
| Rate for Payer: PHCS PPO |
$4,973.50
|
| Rate for Payer: Three Rivers PPO |
$3,806.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,892.75
|
| Rate for Payer: United Healthcare Commercial |
$4,846.62
|
| Rate for Payer: United Healthcare Medicare |
$2,892.75
|
| Rate for Payer: WINHealth Partners Commercial |
$4,973.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,821.25
|
|
