|
CAGE 4 X 28 X 10 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 28 X 10 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 28 X 11 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 28 X 11 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 28 X 9 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 28 X 9 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 09 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 09 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 10 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 10 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 11 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 11 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 12 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 31 X 12 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE CERVICAL 14.5X12.5X10 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X10 MM
|
Facility
|
OP
|
$10,992.45
|
|
| Hospital Charge Code |
3003069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,952.41 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,255.02
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,265.70
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5,952.41
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,265.70
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,265.70
|
| Rate for Payer: WINHealth Partners Commercial |
$10,772.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X5 MM
|
Facility
|
OP
|
$10,992.45
|
|
| Hospital Charge Code |
3003064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,952.41 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,255.02
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,265.70
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5,952.41
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,265.70
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,265.70
|
| Rate for Payer: WINHealth Partners Commercial |
$10,772.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X5 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X6 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X6 MM
|
Facility
|
OP
|
$10,992.45
|
|
| Hospital Charge Code |
3003065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,952.41 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,255.02
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,265.70
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5,952.41
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,265.70
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,265.70
|
| Rate for Payer: WINHealth Partners Commercial |
$10,772.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X7 MM
|
Facility
|
OP
|
$10,992.45
|
|
| Hospital Charge Code |
3003066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,952.41 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,255.02
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,265.70
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5,952.41
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,265.70
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,265.70
|
| Rate for Payer: WINHealth Partners Commercial |
$10,772.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X7 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X8 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X8 MM
|
Facility
|
OP
|
$10,992.45
|
|
| Hospital Charge Code |
3003067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,952.41 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,255.02
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,265.70
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5,952.41
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,265.70
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,265.70
|
| Rate for Payer: WINHealth Partners Commercial |
$10,772.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
|
CAGE CERVICAL 14.5X12.5X9 MM
|
Facility
|
IP
|
$10,992.45
|
|
| Hospital Charge Code |
3003068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,370.12 |
| Max. Negotiated Rate |
$10,992.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,772.60
|
| Rate for Payer: Aetna of WY Medicare |
$7,035.17
|
| Rate for Payer: Altius Commercial |
$10,552.75
|
| Rate for Payer: Beech Street Commercial |
$10,772.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,662.68
|
| Rate for Payer: Cash Price |
$7,694.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,662.68
|
| Rate for Payer: Cigna of WY Commercial |
$10,772.60
|
| Rate for Payer: Entrust Commercial |
$10,442.83
|
| Rate for Payer: First Choice Health Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10,442.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,705.39
|
| Rate for Payer: HealthUtah PPO |
$10,992.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,662.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6,370.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10,772.60
|
| Rate for Payer: PacificSource Commercial |
$9,893.20
|
| Rate for Payer: PHCS PPO |
$10,772.60
|
| Rate for Payer: Three Rivers PPO |
$8,244.34
|
| Rate for Payer: TriWest Veterans Administration |
$6,705.39
|
| Rate for Payer: United Healthcare Commercial |
$10,497.79
|
| Rate for Payer: United Healthcare Medicare |
$6,705.39
|
| Rate for Payer: WINHealth Partners Commercial |
$10,442.83
|
| Rate for Payer: Wise Provider Network Commercial |
$10,442.83
|
|
