|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [17765]
|
Facility
|
IP
|
$30.88
|
|
|
Service Code
|
NDC 4580258001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$30.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.64
|
| Rate for Payer: Altius Commercial |
$29.64
|
| Rate for Payer: Beech Street Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.95
|
| Rate for Payer: Cigna of WY Commercial |
$30.26
|
| Rate for Payer: Entrust Commercial |
$29.34
|
| Rate for Payer: First Choice Health Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.38
|
| Rate for Payer: HealthUtah PPO |
$30.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.26
|
| Rate for Payer: PacificSource Commercial |
$27.79
|
| Rate for Payer: PHCS PPO |
$30.26
|
| Rate for Payer: Three Rivers PPO |
$23.16
|
| Rate for Payer: TriWest Veterans Administration |
$20.38
|
| Rate for Payer: United Healthcare Commercial |
$26.87
|
| Rate for Payer: United Healthcare Medicare |
$20.38
|
| Rate for Payer: WINHealth Partners Commercial |
$29.34
|
| Rate for Payer: Wise Provider Network Commercial |
$29.34
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [17765]
|
Facility
|
OP
|
$30.88
|
|
|
Service Code
|
NDC 4580258046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$30.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.26
|
| Rate for Payer: Aetna of WY Medicare |
$20.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.64
|
| Rate for Payer: Altius Commercial |
$29.64
|
| Rate for Payer: Beech Street Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.95
|
| Rate for Payer: Cigna of WY Commercial |
$30.26
|
| Rate for Payer: Entrust Commercial |
$29.34
|
| Rate for Payer: First Choice Health Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.91
|
| Rate for Payer: HealthUtah PPO |
$30.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.95
|
| Rate for Payer: Multiplan Medicare/VA |
$17.01
|
| Rate for Payer: One Health Plan of WY PPO |
$30.26
|
| Rate for Payer: PacificSource Commercial |
$27.79
|
| Rate for Payer: PHCS PPO |
$30.26
|
| Rate for Payer: Three Rivers PPO |
$23.16
|
| Rate for Payer: TriWest Veterans Administration |
$17.91
|
| Rate for Payer: United Healthcare Commercial |
$26.87
|
| Rate for Payer: United Healthcare Medicare |
$17.91
|
| Rate for Payer: WINHealth Partners Commercial |
$30.26
|
| Rate for Payer: Wise Provider Network Commercial |
$29.34
|
|
|
SCORPION NEEDLE AR-13991N
|
Facility
|
IP
|
$572.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.84 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$549.43
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$469.87
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$377.73
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$358.84
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$377.73
|
| Rate for Payer: United Healthcare Commercial |
$497.92
|
| Rate for Payer: United Healthcare Medicare |
$377.73
|
| Rate for Payer: WINHealth Partners Commercial |
$543.70
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
SCORPION NEEDLE AR-13991N
|
Facility
|
OP
|
$572.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.35 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Aetna of WY Medicare |
$377.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$549.43
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$469.87
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.95
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$315.35
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$331.95
|
| Rate for Payer: United Healthcare Commercial |
$497.92
|
| Rate for Payer: United Healthcare Medicare |
$331.95
|
| Rate for Payer: WINHealth Partners Commercial |
$560.87
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
SCREW TENO VENT 4X10 AR-1540PS
|
Facility
|
IP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$849.90
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$807.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$849.90
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$849.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,223.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCREW TENO VENT 4X10 AR-1540PS
|
Facility
|
OP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.53 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Aetna of WY Medicare |
$849.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$746.88
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$709.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$746.88
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$746.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,261.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCREW TENO VENT 5.5X15 1555PS
|
Facility
|
IP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$849.90
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$807.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$849.90
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$849.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,223.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCREW TENO VENT 5.5X15 1555PS
|
Facility
|
OP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.53 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Aetna of WY Medicare |
$849.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$746.88
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$709.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$746.88
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$746.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,261.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCREW TENO VENT 6.25X15 1562PS
|
Facility
|
OP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.53 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Aetna of WY Medicare |
$849.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$746.88
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$709.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$746.88
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$746.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,261.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCREW TENO VENT 6.25X15 1562PS
|
Facility
|
IP
|
$1,287.72
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$807.40 |
| Max. Negotiated Rate |
$1,287.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,261.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,236.21
|
| Rate for Payer: Altius Commercial |
$1,236.21
|
| Rate for Payer: Beech Street Commercial |
$1,261.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,057.22
|
| Rate for Payer: Cash Price |
$901.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,249.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,261.97
|
| Rate for Payer: Entrust Commercial |
$1,223.33
|
| Rate for Payer: First Choice Health Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,223.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$849.90
|
| Rate for Payer: HealthUtah PPO |
$1,287.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,249.09
|
| Rate for Payer: Multiplan Medicare/VA |
$807.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,261.97
|
| Rate for Payer: PacificSource Commercial |
$1,158.95
|
| Rate for Payer: PHCS PPO |
$1,261.97
|
| Rate for Payer: Three Rivers PPO |
$965.79
|
| Rate for Payer: TriWest Veterans Administration |
$849.90
|
| Rate for Payer: United Healthcare Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare Medicare |
$849.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,223.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1,223.33
|
|
|
SCR INTERFERENC 10X20 4020P-10
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.93
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$756.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$795.93
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$795.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENC 10X20 4020P-10
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.46
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$664.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$699.46
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$699.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENC 10X30 4030P-10
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENC 10X30 4030P-10
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENC 11X30 4030P-11
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.93
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$756.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$795.93
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$795.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENC 11X30 4030P-11
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.46
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$664.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$699.46
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$699.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENC 12X30 4030P-12
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENC 12X30 4030P-12
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 7X20 4020P-07
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.93
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$756.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$795.93
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$795.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENCE 7X20 4020P-07
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.46
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$664.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$699.46
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$699.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENCE 7X30 4030P-07
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.93
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$756.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$795.93
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$795.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENCE 7X30 4030P-07
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.46
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$664.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$699.46
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$699.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
SCR INTERFERENCE 8X20 4020P-08
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 8X20 4020P-08
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 8X30 4030P-08
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
