|
BONE TAP CAN 6.7MM AR-8946-12
|
Facility
|
IP
|
$1,155.00
|
|
| Hospital Charge Code |
3003300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.32 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.55
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$669.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$704.55
|
| Rate for Payer: United Healthcare Commercial |
$1,103.02
|
| Rate for Payer: United Healthcare Medicare |
$704.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
BONE TAP CAN 6.7MM AR-8946-12
|
Facility
|
OP
|
$1,155.00
|
|
| Hospital Charge Code |
3003300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$762.30
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$658.35
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$625.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$658.35
|
| Rate for Payer: United Healthcare Commercial |
$1,103.02
|
| Rate for Payer: United Healthcare Medicare |
$658.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,131.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
BONE TAP CANNULATED 4.0MM
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
3004183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.05 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$462.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$679.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$379.05
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare |
$399.00
|
| Rate for Payer: WINHealth Partners Commercial |
$686.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
BONE TAP CANNULATED 4.0MM
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
3004183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$448.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$679.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$405.65
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$427.00
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare |
$427.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
BONE TRICORTICOL BLK 8MM
|
Facility
|
OP
|
$1,888.25
|
|
| Hospital Charge Code |
2800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.49 |
| Max. Negotiated Rate |
$1,888.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,850.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,246.24
|
| Rate for Payer: Altius Commercial |
$1,812.72
|
| Rate for Payer: Beech Street Commercial |
$1,850.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,831.60
|
| Rate for Payer: Cash Price |
$1,321.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,831.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,850.48
|
| Rate for Payer: Entrust Commercial |
$1,793.84
|
| Rate for Payer: First Choice Health Commercial |
$1,793.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,793.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,076.30
|
| Rate for Payer: HealthUtah PPO |
$1,888.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,831.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,022.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,850.48
|
| Rate for Payer: PacificSource Commercial |
$1,699.42
|
| Rate for Payer: PHCS PPO |
$1,850.48
|
| Rate for Payer: Three Rivers PPO |
$1,416.19
|
| Rate for Payer: TriWest Veterans Administration |
$1,076.30
|
| Rate for Payer: United Healthcare Commercial |
$1,803.28
|
| Rate for Payer: United Healthcare Medicare |
$1,076.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,850.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1,793.84
|
|
|
BONE TRICORTICOL BLK 8MM
|
Facility
|
IP
|
$1,888.25
|
|
| Hospital Charge Code |
2800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.24 |
| Max. Negotiated Rate |
$1,888.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,850.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,208.48
|
| Rate for Payer: Altius Commercial |
$1,812.72
|
| Rate for Payer: Beech Street Commercial |
$1,850.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,831.60
|
| Rate for Payer: Cash Price |
$1,321.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,831.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,850.48
|
| Rate for Payer: Entrust Commercial |
$1,793.84
|
| Rate for Payer: First Choice Health Commercial |
$1,793.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,793.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,151.83
|
| Rate for Payer: HealthUtah PPO |
$1,888.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,831.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,094.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,850.48
|
| Rate for Payer: PacificSource Commercial |
$1,699.42
|
| Rate for Payer: PHCS PPO |
$1,850.48
|
| Rate for Payer: Three Rivers PPO |
$1,416.19
|
| Rate for Payer: TriWest Veterans Administration |
$1,151.83
|
| Rate for Payer: United Healthcare Commercial |
$1,803.28
|
| Rate for Payer: United Healthcare Medicare |
$1,151.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,793.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,793.84
|
|
|
BONE VOID FILLER 10CC
|
Facility
|
OP
|
$13,037.50
|
|
| Hospital Charge Code |
3001071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,059.81 |
| Max. Negotiated Rate |
$13,037.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,776.75
|
| Rate for Payer: Aetna of WY Medicare |
$8,604.75
|
| Rate for Payer: Altius Commercial |
$12,516.00
|
| Rate for Payer: Beech Street Commercial |
$12,776.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,646.38
|
| Rate for Payer: Cash Price |
$9,126.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,646.38
|
| Rate for Payer: Cigna of WY Commercial |
$12,776.75
|
| Rate for Payer: Entrust Commercial |
$12,385.62
|
| Rate for Payer: First Choice Health Commercial |
$12,385.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,385.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,431.38
|
| Rate for Payer: HealthUtah PPO |
$13,037.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,646.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7,059.81
|
| Rate for Payer: One Health Plan of WY PPO |
$12,776.75
|
| Rate for Payer: PacificSource Commercial |
$11,733.75
|
| Rate for Payer: PHCS PPO |
$12,776.75
|
| Rate for Payer: Three Rivers PPO |
$9,778.12
|
| Rate for Payer: TriWest Veterans Administration |
$7,431.38
|
| Rate for Payer: United Healthcare Commercial |
$12,450.81
|
| Rate for Payer: United Healthcare Medicare |
$7,431.38
|
| Rate for Payer: WINHealth Partners Commercial |
$12,776.75
|
| Rate for Payer: Wise Provider Network Commercial |
$12,385.62
|
|
|
BONE VOID FILLER 10CC
|
Facility
|
IP
|
$13,037.50
|
|
| Hospital Charge Code |
3001071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,555.23 |
| Max. Negotiated Rate |
$13,037.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,776.75
|
| Rate for Payer: Aetna of WY Medicare |
$8,344.00
|
| Rate for Payer: Altius Commercial |
$12,516.00
|
| Rate for Payer: Beech Street Commercial |
$12,776.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,646.38
|
| Rate for Payer: Cash Price |
$9,126.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,646.38
|
| Rate for Payer: Cigna of WY Commercial |
$12,776.75
|
| Rate for Payer: Entrust Commercial |
$12,385.62
|
| Rate for Payer: First Choice Health Commercial |
$12,385.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,385.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,952.88
|
| Rate for Payer: HealthUtah PPO |
$13,037.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,646.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7,555.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12,776.75
|
| Rate for Payer: PacificSource Commercial |
$11,733.75
|
| Rate for Payer: PHCS PPO |
$12,776.75
|
| Rate for Payer: Three Rivers PPO |
$9,778.12
|
| Rate for Payer: TriWest Veterans Administration |
$7,952.88
|
| Rate for Payer: United Healthcare Commercial |
$12,450.81
|
| Rate for Payer: United Healthcare Medicare |
$7,952.88
|
| Rate for Payer: WINHealth Partners Commercial |
$12,385.62
|
| Rate for Payer: Wise Provider Network Commercial |
$12,385.62
|
|
|
BONE WAX
|
Facility
|
OP
|
$13.01
|
|
| Hospital Charge Code |
2650040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.75
|
| Rate for Payer: Aetna of WY Medicare |
$8.59
|
| Rate for Payer: Altius Commercial |
$12.49
|
| Rate for Payer: Beech Street Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.62
|
| Rate for Payer: Cigna of WY Commercial |
$12.75
|
| Rate for Payer: Entrust Commercial |
$12.36
|
| Rate for Payer: First Choice Health Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.42
|
| Rate for Payer: HealthUtah PPO |
$13.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.62
|
| Rate for Payer: Multiplan Medicare/VA |
$7.04
|
| Rate for Payer: One Health Plan of WY PPO |
$12.75
|
| Rate for Payer: PacificSource Commercial |
$11.71
|
| Rate for Payer: PHCS PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$7.42
|
| Rate for Payer: United Healthcare Commercial |
$12.42
|
| Rate for Payer: United Healthcare Medicare |
$7.42
|
| Rate for Payer: WINHealth Partners Commercial |
$12.75
|
| Rate for Payer: Wise Provider Network Commercial |
$12.36
|
|
|
BONE WAX
|
Facility
|
IP
|
$13.01
|
|
| Hospital Charge Code |
2650040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.75
|
| Rate for Payer: Aetna of WY Medicare |
$8.33
|
| Rate for Payer: Altius Commercial |
$12.49
|
| Rate for Payer: Beech Street Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.62
|
| Rate for Payer: Cigna of WY Commercial |
$12.75
|
| Rate for Payer: Entrust Commercial |
$12.36
|
| Rate for Payer: First Choice Health Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.94
|
| Rate for Payer: HealthUtah PPO |
$13.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.62
|
| Rate for Payer: Multiplan Medicare/VA |
$7.54
|
| Rate for Payer: One Health Plan of WY PPO |
$12.75
|
| Rate for Payer: PacificSource Commercial |
$11.71
|
| Rate for Payer: PHCS PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$7.94
|
| Rate for Payer: United Healthcare Commercial |
$12.42
|
| Rate for Payer: United Healthcare Medicare |
$7.94
|
| Rate for Payer: WINHealth Partners Commercial |
$12.36
|
| Rate for Payer: Wise Provider Network Commercial |
$12.36
|
|
|
BOOT XCEL MED SHORT 100618-030
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED SHORT 100618-030
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED TALL 100617-030
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED TALL 100617-030
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM SHORT 100618-020
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM SHORT 100618-020
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM TALL 100617-020
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM TALL 100617-020
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG SHORT 100618-040
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG SHORT 100618-040
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG TALL 100617-040
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG TALL 100617-040
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL SHORT 100618-050
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
2200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL SHORT 100618-050
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL TALL 100617-050
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
