|
PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
48140
|
| Min. Negotiated Rate |
$1,260.07 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,151.68
|
| Rate for Payer: Aetna of WY Medicare |
$1,482.43
|
| Rate for Payer: Beech Street Commercial |
$3,055.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,119.52
|
| Rate for Payer: Cigna of WY Commercial |
$3,151.68
|
| Rate for Payer: First Choice Health Commercial |
$2,894.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,055.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,482.43
|
| Rate for Payer: HealthUtah PPO |
$3,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,119.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,260.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,151.68
|
| Rate for Payer: PacificSource Commercial |
$2,894.40
|
| Rate for Payer: PHCS PPO |
$3,055.20
|
| Rate for Payer: Three Rivers PPO |
$2,412.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,482.43
|
| Rate for Payer: United Healthcare Commercial |
$2,797.92
|
| Rate for Payer: United Healthcare Medicare |
$1,482.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,733.60
|
|
|
PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 48140 AS
|
| Hospital Charge Code |
48140
|
| Min. Negotiated Rate |
$1,260.07 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,151.68
|
| Rate for Payer: Aetna of WY Medicare |
$1,482.43
|
| Rate for Payer: Beech Street Commercial |
$3,055.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,119.52
|
| Rate for Payer: Cigna of WY Commercial |
$3,151.68
|
| Rate for Payer: First Choice Health Commercial |
$2,894.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,055.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,482.43
|
| Rate for Payer: HealthUtah PPO |
$3,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,119.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,260.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,151.68
|
| Rate for Payer: PacificSource Commercial |
$2,894.40
|
| Rate for Payer: PHCS PPO |
$3,055.20
|
| Rate for Payer: Three Rivers PPO |
$2,412.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,482.43
|
| Rate for Payer: United Healthcare Commercial |
$2,797.92
|
| Rate for Payer: United Healthcare Medicare |
$1,482.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,733.60
|
|
|
PNEUMAT WALKING BOOT PRE CST
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS L4360
|
| Hospital Charge Code |
L4360
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$328.73
|
| Rate for Payer: Beech Street Commercial |
$223.25
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: First Choice Health Commercial |
$211.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.73
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$279.42
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$223.25
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$328.73
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$328.73
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [89136]
|
Facility
|
OP
|
$466.36
|
|
|
Service Code
|
HCPCS 90670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.96 |
| Max. Negotiated Rate |
$466.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.03
|
| Rate for Payer: Aetna of WY Medicare |
$307.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$447.71
|
| Rate for Payer: Altius Commercial |
$447.71
|
| Rate for Payer: Beech Street Commercial |
$457.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$382.88
|
| Rate for Payer: Cash Price |
$326.45
|
| Rate for Payer: Cash Price |
$326.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.37
|
| Rate for Payer: Cigna of WY Commercial |
$457.03
|
| Rate for Payer: Entrust Commercial |
$443.04
|
| Rate for Payer: First Choice Health Commercial |
$443.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.49
|
| Rate for Payer: HealthUtah PPO |
$466.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.37
|
| Rate for Payer: Multiplan Medicare/VA |
$256.96
|
| Rate for Payer: One Health Plan of WY PPO |
$457.03
|
| Rate for Payer: PacificSource Commercial |
$419.72
|
| Rate for Payer: PHCS PPO |
$457.03
|
| Rate for Payer: Three Rivers PPO |
$349.77
|
| Rate for Payer: TriWest Veterans Administration |
$270.49
|
| Rate for Payer: United Healthcare Commercial |
$405.73
|
| Rate for Payer: United Healthcare Medicare |
$257.99
|
| Rate for Payer: WINHealth Partners Commercial |
$457.03
|
| Rate for Payer: Wise Provider Network Commercial |
$443.04
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [89136]
|
Facility
|
IP
|
$466.36
|
|
|
Service Code
|
HCPCS 90670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$292.41 |
| Max. Negotiated Rate |
$466.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$447.71
|
| Rate for Payer: Altius Commercial |
$447.71
|
| Rate for Payer: Beech Street Commercial |
$457.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$382.88
|
| Rate for Payer: Cash Price |
$326.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.37
|
| Rate for Payer: Cigna of WY Commercial |
$457.03
|
| Rate for Payer: Entrust Commercial |
$443.04
|
| Rate for Payer: First Choice Health Commercial |
$443.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.80
|
| Rate for Payer: HealthUtah PPO |
$466.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.37
|
| Rate for Payer: Multiplan Medicare/VA |
$292.41
|
| Rate for Payer: One Health Plan of WY PPO |
$457.03
|
| Rate for Payer: PacificSource Commercial |
$419.72
|
| Rate for Payer: PHCS PPO |
$457.03
|
| Rate for Payer: Three Rivers PPO |
$349.77
|
| Rate for Payer: TriWest Veterans Administration |
$307.80
|
| Rate for Payer: United Healthcare Commercial |
$405.73
|
| Rate for Payer: United Healthcare Medicare |
$307.80
|
| Rate for Payer: WINHealth Partners Commercial |
$443.04
|
| Rate for Payer: Wise Provider Network Commercial |
$443.04
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [162590]
|
Facility
|
IP
|
$579.92
|
|
|
Service Code
|
HCPCS 90677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$363.61 |
| Max. Negotiated Rate |
$579.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.72
|
| Rate for Payer: Altius Commercial |
$556.72
|
| Rate for Payer: Beech Street Commercial |
$568.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.11
|
| Rate for Payer: Cash Price |
$405.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.52
|
| Rate for Payer: Cigna of WY Commercial |
$568.32
|
| Rate for Payer: Entrust Commercial |
$550.92
|
| Rate for Payer: First Choice Health Commercial |
$550.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$550.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.75
|
| Rate for Payer: HealthUtah PPO |
$579.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.52
|
| Rate for Payer: Multiplan Medicare/VA |
$363.61
|
| Rate for Payer: One Health Plan of WY PPO |
$568.32
|
| Rate for Payer: PacificSource Commercial |
$521.93
|
| Rate for Payer: PHCS PPO |
$568.32
|
| Rate for Payer: Three Rivers PPO |
$434.94
|
| Rate for Payer: TriWest Veterans Administration |
$382.75
|
| Rate for Payer: United Healthcare Commercial |
$504.53
|
| Rate for Payer: United Healthcare Medicare |
$382.75
|
| Rate for Payer: WINHealth Partners Commercial |
$550.92
|
| Rate for Payer: Wise Provider Network Commercial |
$550.92
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [162590]
|
Facility
|
OP
|
$579.92
|
|
|
Service Code
|
HCPCS 90677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.04 |
| Max. Negotiated Rate |
$579.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.32
|
| Rate for Payer: Aetna of WY Medicare |
$382.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.72
|
| Rate for Payer: Altius Commercial |
$556.72
|
| Rate for Payer: Beech Street Commercial |
$568.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.11
|
| Rate for Payer: Cash Price |
$405.94
|
| Rate for Payer: Cash Price |
$405.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.52
|
| Rate for Payer: Cigna of WY Commercial |
$568.32
|
| Rate for Payer: Entrust Commercial |
$550.92
|
| Rate for Payer: First Choice Health Commercial |
$550.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$550.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.35
|
| Rate for Payer: HealthUtah PPO |
$579.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.52
|
| Rate for Payer: Multiplan Medicare/VA |
$319.54
|
| Rate for Payer: One Health Plan of WY PPO |
$568.32
|
| Rate for Payer: PacificSource Commercial |
$521.93
|
| Rate for Payer: PHCS PPO |
$568.32
|
| Rate for Payer: Three Rivers PPO |
$434.94
|
| Rate for Payer: TriWest Veterans Administration |
$336.35
|
| Rate for Payer: United Healthcare Commercial |
$504.53
|
| Rate for Payer: United Healthcare Medicare |
$298.04
|
| Rate for Payer: WINHealth Partners Commercial |
$568.32
|
| Rate for Payer: Wise Provider Network Commercial |
$550.92
|
|
|
PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [187244]
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 90684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.54 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$577.22
|
| Rate for Payer: Aetna of WY Medicare |
$388.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$565.44
|
| Rate for Payer: Altius Commercial |
$565.44
|
| Rate for Payer: Beech Street Commercial |
$577.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$483.57
|
| Rate for Payer: Cash Price |
$412.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$571.33
|
| Rate for Payer: Cigna of WY Commercial |
$577.22
|
| Rate for Payer: Entrust Commercial |
$559.55
|
| Rate for Payer: First Choice Health Commercial |
$559.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$559.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.62
|
| Rate for Payer: HealthUtah PPO |
$589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$571.33
|
| Rate for Payer: Multiplan Medicare/VA |
$324.54
|
| Rate for Payer: One Health Plan of WY PPO |
$577.22
|
| Rate for Payer: PacificSource Commercial |
$530.10
|
| Rate for Payer: PHCS PPO |
$577.22
|
| Rate for Payer: Three Rivers PPO |
$441.75
|
| Rate for Payer: TriWest Veterans Administration |
$341.62
|
| Rate for Payer: United Healthcare Commercial |
$512.43
|
| Rate for Payer: United Healthcare Medicare |
$341.62
|
| Rate for Payer: WINHealth Partners Commercial |
$577.22
|
| Rate for Payer: Wise Provider Network Commercial |
$559.55
|
|
|
PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE [187244]
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 90684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.30 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$577.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$565.44
|
| Rate for Payer: Altius Commercial |
$565.44
|
| Rate for Payer: Beech Street Commercial |
$577.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$483.57
|
| Rate for Payer: Cash Price |
$412.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$571.33
|
| Rate for Payer: Cigna of WY Commercial |
$577.22
|
| Rate for Payer: Entrust Commercial |
$559.55
|
| Rate for Payer: First Choice Health Commercial |
$559.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$559.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$388.74
|
| Rate for Payer: HealthUtah PPO |
$589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$571.33
|
| Rate for Payer: Multiplan Medicare/VA |
$369.30
|
| Rate for Payer: One Health Plan of WY PPO |
$577.22
|
| Rate for Payer: PacificSource Commercial |
$530.10
|
| Rate for Payer: PHCS PPO |
$577.22
|
| Rate for Payer: Three Rivers PPO |
$441.75
|
| Rate for Payer: TriWest Veterans Administration |
$388.74
|
| Rate for Payer: United Healthcare Commercial |
$512.43
|
| Rate for Payer: United Healthcare Medicare |
$388.74
|
| Rate for Payer: WINHealth Partners Commercial |
$559.55
|
| Rate for Payer: Wise Provider Network Commercial |
$559.55
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [25272]
|
Facility
|
OP
|
$307.70
|
|
|
Service Code
|
HCPCS 90732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.55
|
| Rate for Payer: Aetna of WY Medicare |
$203.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$295.39
|
| Rate for Payer: Altius Commercial |
$295.39
|
| Rate for Payer: Beech Street Commercial |
$301.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.62
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.47
|
| Rate for Payer: Cigna of WY Commercial |
$301.55
|
| Rate for Payer: Entrust Commercial |
$292.32
|
| Rate for Payer: First Choice Health Commercial |
$292.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.47
|
| Rate for Payer: HealthUtah PPO |
$307.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.47
|
| Rate for Payer: Multiplan Medicare/VA |
$169.54
|
| Rate for Payer: One Health Plan of WY PPO |
$301.55
|
| Rate for Payer: PacificSource Commercial |
$276.93
|
| Rate for Payer: PHCS PPO |
$301.55
|
| Rate for Payer: Three Rivers PPO |
$230.78
|
| Rate for Payer: TriWest Veterans Administration |
$178.47
|
| Rate for Payer: United Healthcare Commercial |
$267.70
|
| Rate for Payer: United Healthcare Medicare |
$133.47
|
| Rate for Payer: WINHealth Partners Commercial |
$301.55
|
| Rate for Payer: Wise Provider Network Commercial |
$292.32
|
|
|
PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE [25272]
|
Facility
|
IP
|
$307.70
|
|
|
Service Code
|
HCPCS 90732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.93 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$295.39
|
| Rate for Payer: Altius Commercial |
$295.39
|
| Rate for Payer: Beech Street Commercial |
$301.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.62
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.47
|
| Rate for Payer: Cigna of WY Commercial |
$301.55
|
| Rate for Payer: Entrust Commercial |
$292.32
|
| Rate for Payer: First Choice Health Commercial |
$292.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.08
|
| Rate for Payer: HealthUtah PPO |
$307.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.47
|
| Rate for Payer: Multiplan Medicare/VA |
$192.93
|
| Rate for Payer: One Health Plan of WY PPO |
$301.55
|
| Rate for Payer: PacificSource Commercial |
$276.93
|
| Rate for Payer: PHCS PPO |
$301.55
|
| Rate for Payer: Three Rivers PPO |
$230.78
|
| Rate for Payer: TriWest Veterans Administration |
$203.08
|
| Rate for Payer: United Healthcare Commercial |
$267.70
|
| Rate for Payer: United Healthcare Medicare |
$203.08
|
| Rate for Payer: WINHealth Partners Commercial |
$292.32
|
| Rate for Payer: Wise Provider Network Commercial |
$292.32
|
|
|
POLAR CARE ANKLE PAD 04730
|
Facility
|
IP
|
$83.19
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$83.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.86
|
| Rate for Payer: Altius Commercial |
$79.86
|
| Rate for Payer: Beech Street Commercial |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.30
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.69
|
| Rate for Payer: Cigna of WY Commercial |
$81.53
|
| Rate for Payer: Entrust Commercial |
$79.03
|
| Rate for Payer: First Choice Health Commercial |
$79.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.91
|
| Rate for Payer: HealthUtah PPO |
$83.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.69
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$81.53
|
| Rate for Payer: PacificSource Commercial |
$74.87
|
| Rate for Payer: PHCS PPO |
$81.53
|
| Rate for Payer: Three Rivers PPO |
$62.39
|
| Rate for Payer: TriWest Veterans Administration |
$54.91
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
| Rate for Payer: United Healthcare Medicare |
$54.91
|
| Rate for Payer: WINHealth Partners Commercial |
$79.03
|
| Rate for Payer: Wise Provider Network Commercial |
$79.03
|
|
|
POLAR CARE ANKLE PAD 04730
|
Facility
|
OP
|
$83.19
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$83.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.53
|
| Rate for Payer: Aetna of WY Medicare |
$54.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.86
|
| Rate for Payer: Altius Commercial |
$79.86
|
| Rate for Payer: Beech Street Commercial |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.30
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.69
|
| Rate for Payer: Cigna of WY Commercial |
$81.53
|
| Rate for Payer: Entrust Commercial |
$79.03
|
| Rate for Payer: First Choice Health Commercial |
$79.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.25
|
| Rate for Payer: HealthUtah PPO |
$83.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.69
|
| Rate for Payer: Multiplan Medicare/VA |
$45.84
|
| Rate for Payer: One Health Plan of WY PPO |
$81.53
|
| Rate for Payer: PacificSource Commercial |
$74.87
|
| Rate for Payer: PHCS PPO |
$81.53
|
| Rate for Payer: Three Rivers PPO |
$62.39
|
| Rate for Payer: TriWest Veterans Administration |
$48.25
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
| Rate for Payer: United Healthcare Medicare |
$48.25
|
| Rate for Payer: WINHealth Partners Commercial |
$81.53
|
| Rate for Payer: Wise Provider Network Commercial |
$79.03
|
|
|
POLAR CARE CUBE 10701
|
Facility
|
OP
|
$195.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.73 |
| Max. Negotiated Rate |
$195.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.60
|
| Rate for Payer: Aetna of WY Medicare |
$129.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.69
|
| Rate for Payer: Altius Commercial |
$187.69
|
| Rate for Payer: Beech Street Commercial |
$191.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.51
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.64
|
| Rate for Payer: Cigna of WY Commercial |
$191.60
|
| Rate for Payer: Entrust Commercial |
$185.73
|
| Rate for Payer: First Choice Health Commercial |
$185.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.40
|
| Rate for Payer: HealthUtah PPO |
$195.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.64
|
| Rate for Payer: Multiplan Medicare/VA |
$107.73
|
| Rate for Payer: One Health Plan of WY PPO |
$191.60
|
| Rate for Payer: PacificSource Commercial |
$175.96
|
| Rate for Payer: PHCS PPO |
$191.60
|
| Rate for Payer: Three Rivers PPO |
$146.63
|
| Rate for Payer: TriWest Veterans Administration |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$170.09
|
| Rate for Payer: United Healthcare Medicare |
$113.40
|
| Rate for Payer: WINHealth Partners Commercial |
$191.60
|
| Rate for Payer: Wise Provider Network Commercial |
$185.73
|
|
|
POLAR CARE CUBE 10701
|
Facility
|
IP
|
$195.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.58 |
| Max. Negotiated Rate |
$195.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.69
|
| Rate for Payer: Altius Commercial |
$187.69
|
| Rate for Payer: Beech Street Commercial |
$191.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.51
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.64
|
| Rate for Payer: Cigna of WY Commercial |
$191.60
|
| Rate for Payer: Entrust Commercial |
$185.73
|
| Rate for Payer: First Choice Health Commercial |
$185.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.04
|
| Rate for Payer: HealthUtah PPO |
$195.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.64
|
| Rate for Payer: Multiplan Medicare/VA |
$122.58
|
| Rate for Payer: One Health Plan of WY PPO |
$191.60
|
| Rate for Payer: PacificSource Commercial |
$175.96
|
| Rate for Payer: PHCS PPO |
$191.60
|
| Rate for Payer: Three Rivers PPO |
$146.63
|
| Rate for Payer: TriWest Veterans Administration |
$129.04
|
| Rate for Payer: United Healthcare Commercial |
$170.09
|
| Rate for Payer: United Healthcare Medicare |
$129.04
|
| Rate for Payer: WINHealth Partners Commercial |
$185.73
|
| Rate for Payer: Wise Provider Network Commercial |
$185.73
|
|
|
POLAR CARE HIP PAD 04750
|
Facility
|
OP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Aetna of WY Medicare |
$56.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.61
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$49.61
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$49.61
|
| Rate for Payer: WINHealth Partners Commercial |
$83.83
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE HIP PAD 04750
|
Facility
|
IP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.63
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.26
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE KNEE PAD LG 04703
|
Facility
|
OP
|
$84.88
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$84.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.18
|
| Rate for Payer: Aetna of WY Medicare |
$56.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.48
|
| Rate for Payer: Altius Commercial |
$81.48
|
| Rate for Payer: Beech Street Commercial |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.69
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.33
|
| Rate for Payer: Cigna of WY Commercial |
$83.18
|
| Rate for Payer: Entrust Commercial |
$80.64
|
| Rate for Payer: First Choice Health Commercial |
$80.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.23
|
| Rate for Payer: HealthUtah PPO |
$84.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.33
|
| Rate for Payer: Multiplan Medicare/VA |
$46.77
|
| Rate for Payer: One Health Plan of WY PPO |
$83.18
|
| Rate for Payer: PacificSource Commercial |
$76.39
|
| Rate for Payer: PHCS PPO |
$83.18
|
| Rate for Payer: Three Rivers PPO |
$63.66
|
| Rate for Payer: TriWest Veterans Administration |
$49.23
|
| Rate for Payer: United Healthcare Commercial |
$73.85
|
| Rate for Payer: United Healthcare Medicare |
$49.23
|
| Rate for Payer: WINHealth Partners Commercial |
$83.18
|
| Rate for Payer: Wise Provider Network Commercial |
$80.64
|
|
|
POLAR CARE KNEE PAD LG 04703
|
Facility
|
IP
|
$84.88
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$84.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.48
|
| Rate for Payer: Altius Commercial |
$81.48
|
| Rate for Payer: Beech Street Commercial |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.69
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.33
|
| Rate for Payer: Cigna of WY Commercial |
$83.18
|
| Rate for Payer: Entrust Commercial |
$80.64
|
| Rate for Payer: First Choice Health Commercial |
$80.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.02
|
| Rate for Payer: HealthUtah PPO |
$84.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.33
|
| Rate for Payer: Multiplan Medicare/VA |
$53.22
|
| Rate for Payer: One Health Plan of WY PPO |
$83.18
|
| Rate for Payer: PacificSource Commercial |
$76.39
|
| Rate for Payer: PHCS PPO |
$83.18
|
| Rate for Payer: Three Rivers PPO |
$63.66
|
| Rate for Payer: TriWest Veterans Administration |
$56.02
|
| Rate for Payer: United Healthcare Commercial |
$73.85
|
| Rate for Payer: United Healthcare Medicare |
$56.02
|
| Rate for Payer: WINHealth Partners Commercial |
$80.64
|
| Rate for Payer: Wise Provider Network Commercial |
$80.64
|
|
|
POLAR CARE KNEE PAD XL 04705
|
Facility
|
IP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.63
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.26
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE KNEE PAD XL 04705
|
Facility
|
OP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Aetna of WY Medicare |
$56.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.61
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$49.61
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$49.61
|
| Rate for Payer: WINHealth Partners Commercial |
$83.83
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE SHOULDER LG 04900
|
Facility
|
OP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Aetna of WY Medicare |
$56.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.61
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$49.61
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$49.61
|
| Rate for Payer: WINHealth Partners Commercial |
$83.83
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE SHOULDER LG 04900
|
Facility
|
IP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.63
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.26
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE SHOULDER XL 04905
|
Facility
|
IP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.63
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.26
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
POLAR CARE SHOULDER XL 04905
|
Facility
|
OP
|
$85.54
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Aetna of WY Medicare |
$56.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.61
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$49.61
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$49.61
|
| Rate for Payer: WINHealth Partners Commercial |
$83.83
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
