|
BONE GRAFT GENEXDS 980-005
|
Facility
|
IP
|
$5,075.00
|
|
| Hospital Charge Code |
3100685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,940.96 |
| 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 |
$3,248.00
|
| 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 |
$3,095.75
|
| Rate for Payer: HealthUtah PPO |
$5,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,922.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,940.96
|
| 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 |
$3,095.75
|
| Rate for Payer: United Healthcare Commercial |
$4,846.62
|
| Rate for Payer: United Healthcare Medicare |
$3,095.75
|
| Rate for Payer: WINHealth Partners Commercial |
$4,821.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,821.25
|
|
|
BONE LENGTH STUDIES
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 77073
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.16
|
| Rate for Payer: Aetna of WY Medicare |
$44.28
|
| Rate for Payer: Beech Street Commercial |
$419.90
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.74
|
| Rate for Payer: Cigna of WY Commercial |
$433.16
|
| Rate for Payer: First Choice Health Commercial |
$397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$419.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.28
|
| Rate for Payer: HealthUtah PPO |
$442.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.74
|
| Rate for Payer: Multiplan Medicare/VA |
$37.64
|
| Rate for Payer: One Health Plan of WY PPO |
$433.16
|
| Rate for Payer: PacificSource Commercial |
$397.80
|
| Rate for Payer: PHCS PPO |
$419.90
|
| Rate for Payer: Three Rivers PPO |
$331.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.28
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: WINHealth Partners Commercial |
$419.90
|
|
|
BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 20939
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$65.20
|
| Rate for Payer: Beech Street Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: First Choice Health Commercial |
$247.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.20
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$55.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$261.25
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$261.25
|
| Rate for Payer: WINHealth Partners Commercial |
$233.75
|
|
|
BONE MARROW ASPIRATION KIT
|
Facility
|
IP
|
$829.50
|
|
| Hospital Charge Code |
2650944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.70 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$812.91
|
| Rate for Payer: Aetna of WY Medicare |
$530.88
|
| Rate for Payer: Altius Commercial |
$796.32
|
| Rate for Payer: Beech Street Commercial |
$812.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.62
|
| Rate for Payer: Cash Price |
$580.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$804.62
|
| Rate for Payer: Cigna of WY Commercial |
$812.91
|
| Rate for Payer: Entrust Commercial |
$788.02
|
| Rate for Payer: First Choice Health Commercial |
$788.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$506.00
|
| Rate for Payer: HealthUtah PPO |
$829.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$804.62
|
| Rate for Payer: Multiplan Medicare/VA |
$480.70
|
| Rate for Payer: One Health Plan of WY PPO |
$812.91
|
| Rate for Payer: PacificSource Commercial |
$746.55
|
| Rate for Payer: PHCS PPO |
$812.91
|
| Rate for Payer: Three Rivers PPO |
$622.12
|
| Rate for Payer: TriWest Veterans Administration |
$506.00
|
| Rate for Payer: United Healthcare Commercial |
$792.17
|
| Rate for Payer: United Healthcare Medicare |
$506.00
|
| Rate for Payer: WINHealth Partners Commercial |
$788.02
|
| Rate for Payer: Wise Provider Network Commercial |
$788.02
|
|
|
BONE MARROW ASPIRATION KIT
|
Facility
|
OP
|
$829.50
|
|
| Hospital Charge Code |
2650944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.17 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$812.91
|
| Rate for Payer: Aetna of WY Medicare |
$547.47
|
| Rate for Payer: Altius Commercial |
$796.32
|
| Rate for Payer: Beech Street Commercial |
$812.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.62
|
| Rate for Payer: Cash Price |
$580.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$804.62
|
| Rate for Payer: Cigna of WY Commercial |
$812.91
|
| Rate for Payer: Entrust Commercial |
$788.02
|
| Rate for Payer: First Choice Health Commercial |
$788.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.82
|
| Rate for Payer: HealthUtah PPO |
$829.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$804.62
|
| Rate for Payer: Multiplan Medicare/VA |
$449.17
|
| Rate for Payer: One Health Plan of WY PPO |
$812.91
|
| Rate for Payer: PacificSource Commercial |
$746.55
|
| Rate for Payer: PHCS PPO |
$812.91
|
| Rate for Payer: Three Rivers PPO |
$622.12
|
| Rate for Payer: TriWest Veterans Administration |
$472.82
|
| Rate for Payer: United Healthcare Commercial |
$792.17
|
| Rate for Payer: United Healthcare Medicare |
$472.82
|
| Rate for Payer: WINHealth Partners Commercial |
$812.91
|
| Rate for Payer: Wise Provider Network Commercial |
$788.02
|
|
|
BONE MARROW NDL 6 IN 6 PORT
|
Facility
|
IP
|
$692.68
|
|
| Hospital Charge Code |
2800121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.41 |
| Max. Negotiated Rate |
$692.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$678.83
|
| Rate for Payer: Aetna of WY Medicare |
$443.32
|
| Rate for Payer: Altius Commercial |
$664.97
|
| Rate for Payer: Beech Street Commercial |
$678.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$671.90
|
| Rate for Payer: Cash Price |
$484.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$671.90
|
| Rate for Payer: Cigna of WY Commercial |
$678.83
|
| Rate for Payer: Entrust Commercial |
$658.05
|
| Rate for Payer: First Choice Health Commercial |
$658.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$658.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.53
|
| Rate for Payer: HealthUtah PPO |
$692.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$671.90
|
| Rate for Payer: Multiplan Medicare/VA |
$401.41
|
| Rate for Payer: One Health Plan of WY PPO |
$678.83
|
| Rate for Payer: PacificSource Commercial |
$623.41
|
| Rate for Payer: PHCS PPO |
$678.83
|
| Rate for Payer: Three Rivers PPO |
$519.51
|
| Rate for Payer: TriWest Veterans Administration |
$422.53
|
| Rate for Payer: United Healthcare Commercial |
$661.51
|
| Rate for Payer: United Healthcare Medicare |
$422.53
|
| Rate for Payer: WINHealth Partners Commercial |
$658.05
|
| Rate for Payer: Wise Provider Network Commercial |
$658.05
|
|
|
BONE MARROW NDL 6 IN 6 PORT
|
Facility
|
OP
|
$692.68
|
|
| Hospital Charge Code |
2800121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.09 |
| Max. Negotiated Rate |
$692.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$678.83
|
| Rate for Payer: Aetna of WY Medicare |
$457.17
|
| Rate for Payer: Altius Commercial |
$664.97
|
| Rate for Payer: Beech Street Commercial |
$678.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$671.90
|
| Rate for Payer: Cash Price |
$484.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$671.90
|
| Rate for Payer: Cigna of WY Commercial |
$678.83
|
| Rate for Payer: Entrust Commercial |
$658.05
|
| Rate for Payer: First Choice Health Commercial |
$658.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$658.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.83
|
| Rate for Payer: HealthUtah PPO |
$692.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$671.90
|
| Rate for Payer: Multiplan Medicare/VA |
$375.09
|
| Rate for Payer: One Health Plan of WY PPO |
$678.83
|
| Rate for Payer: PacificSource Commercial |
$623.41
|
| Rate for Payer: PHCS PPO |
$678.83
|
| Rate for Payer: Three Rivers PPO |
$519.51
|
| Rate for Payer: TriWest Veterans Administration |
$394.83
|
| Rate for Payer: United Healthcare Commercial |
$661.51
|
| Rate for Payer: United Healthcare Medicare |
$394.83
|
| Rate for Payer: WINHealth Partners Commercial |
$678.83
|
| Rate for Payer: Wise Provider Network Commercial |
$658.05
|
|
|
BONE MARROW NEEDLE VORTEX 13G CLOSED
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
2650999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.02 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$588.67
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$561.08
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$533.02
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$561.08
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$561.08
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 13G CLOSED
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
2650999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.07 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.29
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$498.07
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$524.29
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$524.29
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G CLOSED
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
2650998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.07 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.29
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$498.07
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$524.29
|
| Rate for Payer: United Healthcare Medicare |
$524.29
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G CLOSED
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
2650998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.02 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$588.67
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$561.08
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$533.02
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$561.08
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$561.08
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G OPEN
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
2650985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.07 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.29
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$498.07
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$524.29
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$524.29
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G OPEN
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
2650985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.02 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$588.67
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$561.08
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$533.02
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$561.08
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$561.08
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MILL BOWL ASSY BM210
|
Facility
|
IP
|
$706.86
|
|
| Hospital Charge Code |
2800114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.63 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.72
|
| Rate for Payer: Aetna of WY Medicare |
$452.39
|
| Rate for Payer: Altius Commercial |
$678.59
|
| Rate for Payer: Beech Street Commercial |
$692.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$685.65
|
| Rate for Payer: Cash Price |
$494.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.65
|
| Rate for Payer: Cigna of WY Commercial |
$692.72
|
| Rate for Payer: Entrust Commercial |
$671.52
|
| Rate for Payer: First Choice Health Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.18
|
| Rate for Payer: HealthUtah PPO |
$706.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.65
|
| Rate for Payer: Multiplan Medicare/VA |
$409.63
|
| Rate for Payer: One Health Plan of WY PPO |
$692.72
|
| Rate for Payer: PacificSource Commercial |
$636.17
|
| Rate for Payer: PHCS PPO |
$692.72
|
| Rate for Payer: Three Rivers PPO |
$530.14
|
| Rate for Payer: TriWest Veterans Administration |
$431.18
|
| Rate for Payer: United Healthcare Commercial |
$675.05
|
| Rate for Payer: United Healthcare Medicare |
$431.18
|
| Rate for Payer: WINHealth Partners Commercial |
$671.52
|
| Rate for Payer: Wise Provider Network Commercial |
$671.52
|
|
|
BONE MILL BOWL ASSY BM210
|
Facility
|
OP
|
$706.86
|
|
| Hospital Charge Code |
2800114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.76 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.72
|
| Rate for Payer: Aetna of WY Medicare |
$466.53
|
| Rate for Payer: Altius Commercial |
$678.59
|
| Rate for Payer: Beech Street Commercial |
$692.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$685.65
|
| Rate for Payer: Cash Price |
$494.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.65
|
| Rate for Payer: Cigna of WY Commercial |
$692.72
|
| Rate for Payer: Entrust Commercial |
$671.52
|
| Rate for Payer: First Choice Health Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$402.91
|
| Rate for Payer: HealthUtah PPO |
$706.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.65
|
| Rate for Payer: Multiplan Medicare/VA |
$382.76
|
| Rate for Payer: One Health Plan of WY PPO |
$692.72
|
| Rate for Payer: PacificSource Commercial |
$636.17
|
| Rate for Payer: PHCS PPO |
$692.72
|
| Rate for Payer: Three Rivers PPO |
$530.14
|
| Rate for Payer: TriWest Veterans Administration |
$402.91
|
| Rate for Payer: United Healthcare Commercial |
$675.05
|
| Rate for Payer: United Healthcare Medicare |
$402.91
|
| Rate for Payer: WINHealth Partners Commercial |
$692.72
|
| Rate for Payer: Wise Provider Network Commercial |
$671.52
|
|
|
BONE PLUG OSTEOCHONDRAL RFP10
|
Facility
|
OP
|
$8,312.50
|
|
| Hospital Charge Code |
3005571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,501.22 |
| Max. Negotiated Rate |
$8,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,146.25
|
| Rate for Payer: Aetna of WY Medicare |
$5,486.25
|
| Rate for Payer: Altius Commercial |
$7,980.00
|
| Rate for Payer: Beech Street Commercial |
$8,146.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,063.12
|
| Rate for Payer: Cash Price |
$5,818.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,063.12
|
| Rate for Payer: Cigna of WY Commercial |
$8,146.25
|
| Rate for Payer: Entrust Commercial |
$7,896.88
|
| Rate for Payer: First Choice Health Commercial |
$7,896.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,896.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,738.12
|
| Rate for Payer: HealthUtah PPO |
$8,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,063.12
|
| Rate for Payer: Multiplan Medicare/VA |
$4,501.22
|
| Rate for Payer: One Health Plan of WY PPO |
$8,146.25
|
| Rate for Payer: PacificSource Commercial |
$7,481.25
|
| Rate for Payer: PHCS PPO |
$8,146.25
|
| Rate for Payer: Three Rivers PPO |
$6,234.38
|
| Rate for Payer: TriWest Veterans Administration |
$4,738.12
|
| Rate for Payer: United Healthcare Commercial |
$7,938.44
|
| Rate for Payer: United Healthcare Medicare |
$4,738.12
|
| Rate for Payer: WINHealth Partners Commercial |
$8,146.25
|
| Rate for Payer: Wise Provider Network Commercial |
$7,896.88
|
|
|
BONE PLUG OSTEOCHONDRAL RFP10
|
Facility
|
IP
|
$8,312.50
|
|
| Hospital Charge Code |
3005571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.09 |
| Max. Negotiated Rate |
$8,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,146.25
|
| Rate for Payer: Aetna of WY Medicare |
$5,320.00
|
| Rate for Payer: Altius Commercial |
$7,980.00
|
| Rate for Payer: Beech Street Commercial |
$8,146.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,063.12
|
| Rate for Payer: Cash Price |
$5,818.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,063.12
|
| Rate for Payer: Cigna of WY Commercial |
$8,146.25
|
| Rate for Payer: Entrust Commercial |
$7,896.88
|
| Rate for Payer: First Choice Health Commercial |
$7,896.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,896.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,070.62
|
| Rate for Payer: HealthUtah PPO |
$8,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,063.12
|
| Rate for Payer: Multiplan Medicare/VA |
$4,817.09
|
| Rate for Payer: One Health Plan of WY PPO |
$8,146.25
|
| Rate for Payer: PacificSource Commercial |
$7,481.25
|
| Rate for Payer: PHCS PPO |
$8,146.25
|
| Rate for Payer: Three Rivers PPO |
$6,234.38
|
| Rate for Payer: TriWest Veterans Administration |
$5,070.62
|
| Rate for Payer: United Healthcare Commercial |
$7,938.44
|
| Rate for Payer: United Healthcare Medicare |
$5,070.62
|
| Rate for Payer: WINHealth Partners Commercial |
$7,896.88
|
| Rate for Payer: Wise Provider Network Commercial |
$7,896.88
|
|
|
BONE PLUG OSTEOCHONDRAL RFP16
|
Facility
|
IP
|
$15,295.00
|
|
| Hospital Charge Code |
3005572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,863.45 |
| Max. Negotiated Rate |
$15,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,989.10
|
| Rate for Payer: Aetna of WY Medicare |
$9,788.80
|
| Rate for Payer: Altius Commercial |
$14,683.20
|
| Rate for Payer: Beech Street Commercial |
$14,989.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14,836.15
|
| Rate for Payer: Cash Price |
$10,706.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,836.15
|
| Rate for Payer: Cigna of WY Commercial |
$14,989.10
|
| Rate for Payer: Entrust Commercial |
$14,530.25
|
| Rate for Payer: First Choice Health Commercial |
$14,530.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,530.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,329.95
|
| Rate for Payer: HealthUtah PPO |
$15,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,836.15
|
| Rate for Payer: Multiplan Medicare/VA |
$8,863.45
|
| Rate for Payer: One Health Plan of WY PPO |
$14,989.10
|
| Rate for Payer: PacificSource Commercial |
$13,765.50
|
| Rate for Payer: PHCS PPO |
$14,989.10
|
| Rate for Payer: Three Rivers PPO |
$11,471.25
|
| Rate for Payer: TriWest Veterans Administration |
$9,329.95
|
| Rate for Payer: United Healthcare Commercial |
$14,606.72
|
| Rate for Payer: United Healthcare Medicare |
$9,329.95
|
| Rate for Payer: WINHealth Partners Commercial |
$14,530.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14,530.25
|
|
|
BONE PLUG OSTEOCHONDRAL RFP16
|
Facility
|
OP
|
$15,295.00
|
|
| Hospital Charge Code |
3005572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,282.24 |
| Max. Negotiated Rate |
$15,295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,989.10
|
| Rate for Payer: Aetna of WY Medicare |
$10,094.70
|
| Rate for Payer: Altius Commercial |
$14,683.20
|
| Rate for Payer: Beech Street Commercial |
$14,989.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14,836.15
|
| Rate for Payer: Cash Price |
$10,706.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,836.15
|
| Rate for Payer: Cigna of WY Commercial |
$14,989.10
|
| Rate for Payer: Entrust Commercial |
$14,530.25
|
| Rate for Payer: First Choice Health Commercial |
$14,530.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,530.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,718.15
|
| Rate for Payer: HealthUtah PPO |
$15,295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,836.15
|
| Rate for Payer: Multiplan Medicare/VA |
$8,282.24
|
| Rate for Payer: One Health Plan of WY PPO |
$14,989.10
|
| Rate for Payer: PacificSource Commercial |
$13,765.50
|
| Rate for Payer: PHCS PPO |
$14,989.10
|
| Rate for Payer: Three Rivers PPO |
$11,471.25
|
| Rate for Payer: TriWest Veterans Administration |
$8,718.15
|
| Rate for Payer: United Healthcare Commercial |
$14,606.72
|
| Rate for Payer: United Healthcare Medicare |
$8,718.15
|
| Rate for Payer: WINHealth Partners Commercial |
$14,989.10
|
| Rate for Payer: Wise Provider Network Commercial |
$14,530.25
|
|
|
BONE PLUG VERTIGRAFT 11MM
|
Facility
|
IP
|
$1,202.22
|
|
| Hospital Charge Code |
3005570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.69 |
| Max. Negotiated Rate |
$1,202.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,178.18
|
| Rate for Payer: Aetna of WY Medicare |
$769.42
|
| Rate for Payer: Altius Commercial |
$1,154.13
|
| Rate for Payer: Beech Street Commercial |
$1,178.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,166.15
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,166.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,178.18
|
| Rate for Payer: Entrust Commercial |
$1,142.11
|
| Rate for Payer: First Choice Health Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.35
|
| Rate for Payer: HealthUtah PPO |
$1,202.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,166.15
|
| Rate for Payer: Multiplan Medicare/VA |
$696.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,178.18
|
| Rate for Payer: PacificSource Commercial |
$1,082.00
|
| Rate for Payer: PHCS PPO |
$1,178.18
|
| Rate for Payer: Three Rivers PPO |
$901.66
|
| Rate for Payer: TriWest Veterans Administration |
$733.35
|
| Rate for Payer: United Healthcare Commercial |
$1,148.12
|
| Rate for Payer: United Healthcare Medicare |
$733.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,142.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1,142.11
|
|
|
BONE PLUG VERTIGRAFT 11MM
|
Facility
|
OP
|
$1,202.22
|
|
| Hospital Charge Code |
3005570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$1,202.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,178.18
|
| Rate for Payer: Aetna of WY Medicare |
$793.47
|
| Rate for Payer: Altius Commercial |
$1,154.13
|
| Rate for Payer: Beech Street Commercial |
$1,178.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,166.15
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,166.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,178.18
|
| Rate for Payer: Entrust Commercial |
$1,142.11
|
| Rate for Payer: First Choice Health Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$685.27
|
| Rate for Payer: HealthUtah PPO |
$1,202.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,166.15
|
| Rate for Payer: Multiplan Medicare/VA |
$651.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,178.18
|
| Rate for Payer: PacificSource Commercial |
$1,082.00
|
| Rate for Payer: PHCS PPO |
$1,178.18
|
| Rate for Payer: Three Rivers PPO |
$901.66
|
| Rate for Payer: TriWest Veterans Administration |
$685.27
|
| Rate for Payer: United Healthcare Commercial |
$1,148.12
|
| Rate for Payer: United Healthcare Medicare |
$685.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,178.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,142.11
|
|
|
BONE PLUG VERTIGRAFT 8MM
|
Facility
|
OP
|
$1,202.22
|
|
| Hospital Charge Code |
3004201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$1,202.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,178.18
|
| Rate for Payer: Aetna of WY Medicare |
$793.47
|
| Rate for Payer: Altius Commercial |
$1,154.13
|
| Rate for Payer: Beech Street Commercial |
$1,178.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,166.15
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,166.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,178.18
|
| Rate for Payer: Entrust Commercial |
$1,142.11
|
| Rate for Payer: First Choice Health Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$685.27
|
| Rate for Payer: HealthUtah PPO |
$1,202.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,166.15
|
| Rate for Payer: Multiplan Medicare/VA |
$651.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,178.18
|
| Rate for Payer: PacificSource Commercial |
$1,082.00
|
| Rate for Payer: PHCS PPO |
$1,178.18
|
| Rate for Payer: Three Rivers PPO |
$901.66
|
| Rate for Payer: TriWest Veterans Administration |
$685.27
|
| Rate for Payer: United Healthcare Commercial |
$1,148.12
|
| Rate for Payer: United Healthcare Medicare |
$685.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,178.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,142.11
|
|
|
BONE PLUG VERTIGRAFT 8MM
|
Facility
|
IP
|
$1,202.22
|
|
| Hospital Charge Code |
3004201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.69 |
| Max. Negotiated Rate |
$1,202.22 |
| Rate for Payer: United Healthcare Commercial |
$1,148.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,178.18
|
| Rate for Payer: Aetna of WY Medicare |
$769.42
|
| Rate for Payer: Altius Commercial |
$1,154.13
|
| Rate for Payer: Beech Street Commercial |
$1,178.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,166.15
|
| Rate for Payer: Cash Price |
$841.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,166.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,178.18
|
| Rate for Payer: Entrust Commercial |
$1,142.11
|
| Rate for Payer: First Choice Health Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,142.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.35
|
| Rate for Payer: HealthUtah PPO |
$1,202.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,166.15
|
| Rate for Payer: Multiplan Medicare/VA |
$696.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,178.18
|
| Rate for Payer: PacificSource Commercial |
$1,082.00
|
| Rate for Payer: PHCS PPO |
$1,178.18
|
| Rate for Payer: Three Rivers PPO |
$901.66
|
| Rate for Payer: TriWest Veterans Administration |
$733.35
|
| Rate for Payer: United Healthcare Medicare |
$733.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,142.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1,142.11
|
|
|
BONE STRIP BECK
|
Facility
|
OP
|
$5,915.00
|
|
| Hospital Charge Code |
2800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,202.97 |
| Max. Negotiated Rate |
$5,915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,796.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,903.90
|
| Rate for Payer: Altius Commercial |
$5,678.40
|
| Rate for Payer: Beech Street Commercial |
$5,796.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,737.55
|
| Rate for Payer: Cash Price |
$4,140.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,737.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,796.70
|
| Rate for Payer: Entrust Commercial |
$5,619.25
|
| Rate for Payer: First Choice Health Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,371.55
|
| Rate for Payer: HealthUtah PPO |
$5,915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,737.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,202.97
|
| Rate for Payer: One Health Plan of WY PPO |
$5,796.70
|
| Rate for Payer: PacificSource Commercial |
$5,323.50
|
| Rate for Payer: PHCS PPO |
$5,796.70
|
| Rate for Payer: Three Rivers PPO |
$4,436.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,371.55
|
| Rate for Payer: United Healthcare Commercial |
$5,648.82
|
| Rate for Payer: United Healthcare Medicare |
$3,371.55
|
| Rate for Payer: WINHealth Partners Commercial |
$5,796.70
|
| Rate for Payer: Wise Provider Network Commercial |
$5,619.25
|
|
|
BONE STRIP BECK
|
Facility
|
IP
|
$5,915.00
|
|
| Hospital Charge Code |
2800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.74 |
| Max. Negotiated Rate |
$5,915.00 |
| Rate for Payer: WINHealth Partners Commercial |
$5,619.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,796.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,785.60
|
| Rate for Payer: Altius Commercial |
$5,678.40
|
| Rate for Payer: Beech Street Commercial |
$5,796.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,737.55
|
| Rate for Payer: Cash Price |
$4,140.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,737.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,796.70
|
| Rate for Payer: Entrust Commercial |
$5,619.25
|
| Rate for Payer: First Choice Health Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,619.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,608.15
|
| Rate for Payer: HealthUtah PPO |
$5,915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,737.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,427.74
|
| Rate for Payer: One Health Plan of WY PPO |
$5,796.70
|
| Rate for Payer: PacificSource Commercial |
$5,323.50
|
| Rate for Payer: PHCS PPO |
$5,796.70
|
| Rate for Payer: Three Rivers PPO |
$4,436.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,608.15
|
| Rate for Payer: United Healthcare Commercial |
$5,648.82
|
| Rate for Payer: United Healthcare Medicare |
$3,608.15
|
| Rate for Payer: Wise Provider Network Commercial |
$5,619.25
|
|
