|
CAGE INNOVASIS 10X09X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X09X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X10X28MM 10°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X10X28MM 10°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X10X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X10X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X11X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X11X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X12X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X12X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X13X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X13X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X14X28MM 12°
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
3004446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,301.70 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,064.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,686.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,301.70
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,686.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,686.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11,970.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE INNOVASIS 10X14X28MM 12°
|
Facility
|
OP
|
$12,600.00
|
|
| Hospital Charge Code |
3004446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,822.90 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,348.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,316.00
|
| Rate for Payer: Altius Commercial |
$12,096.00
|
| Rate for Payer: Beech Street Commercial |
$12,348.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,222.00
|
| Rate for Payer: Cash Price |
$8,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,222.00
|
| Rate for Payer: Cigna of WY Commercial |
$12,348.00
|
| Rate for Payer: Entrust Commercial |
$11,970.00
|
| Rate for Payer: First Choice Health Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,970.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,182.00
|
| Rate for Payer: HealthUtah PPO |
$12,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,222.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6,822.90
|
| Rate for Payer: One Health Plan of WY PPO |
$12,348.00
|
| Rate for Payer: PacificSource Commercial |
$11,340.00
|
| Rate for Payer: PHCS PPO |
$12,348.00
|
| Rate for Payer: Three Rivers PPO |
$9,450.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,182.00
|
| Rate for Payer: United Healthcare Commercial |
$12,033.00
|
| Rate for Payer: United Healthcare Medicare |
$7,182.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,348.00
|
| Rate for Payer: Wise Provider Network Commercial |
$11,970.00
|
|
|
CAGE LUCENT XP 12X32X10MM 15°
|
Facility
|
OP
|
$14,000.00
|
|
| Hospital Charge Code |
3004551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,581.00 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,720.00
|
| Rate for Payer: Aetna of WY Medicare |
$9,240.00
|
| Rate for Payer: Altius Commercial |
$13,440.00
|
| Rate for Payer: Beech Street Commercial |
$13,720.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,580.00
|
| Rate for Payer: Cash Price |
$9,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,580.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,720.00
|
| Rate for Payer: Entrust Commercial |
$13,300.00
|
| Rate for Payer: First Choice Health Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,980.00
|
| Rate for Payer: HealthUtah PPO |
$14,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,580.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,581.00
|
| Rate for Payer: One Health Plan of WY PPO |
$13,720.00
|
| Rate for Payer: PacificSource Commercial |
$12,600.00
|
| Rate for Payer: PHCS PPO |
$13,720.00
|
| Rate for Payer: Three Rivers PPO |
$10,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,980.00
|
| Rate for Payer: United Healthcare Commercial |
$13,370.00
|
| Rate for Payer: United Healthcare Medicare |
$7,980.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,720.00
|
| Rate for Payer: Wise Provider Network Commercial |
$13,300.00
|
|
|
CAGE LUCENT XP 12X32X10MM 15°
|
Facility
|
IP
|
$14,000.00
|
|
| Hospital Charge Code |
3004551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,113.00 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,720.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,960.00
|
| Rate for Payer: Altius Commercial |
$13,440.00
|
| Rate for Payer: Beech Street Commercial |
$13,720.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,580.00
|
| Rate for Payer: Cash Price |
$9,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,580.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,720.00
|
| Rate for Payer: Entrust Commercial |
$13,300.00
|
| Rate for Payer: First Choice Health Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,540.00
|
| Rate for Payer: HealthUtah PPO |
$14,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,580.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8,113.00
|
| Rate for Payer: One Health Plan of WY PPO |
$13,720.00
|
| Rate for Payer: PacificSource Commercial |
$12,600.00
|
| Rate for Payer: PHCS PPO |
$13,720.00
|
| Rate for Payer: Three Rivers PPO |
$10,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$8,540.00
|
| Rate for Payer: United Healthcare Commercial |
$13,370.00
|
| Rate for Payer: United Healthcare Medicare |
$8,540.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,300.00
|
| Rate for Payer: Wise Provider Network Commercial |
$13,300.00
|
|
|
CAGE SPINE ARCADIUS 4° 13X16X5MM
|
Facility
|
IP
|
$6,650.00
|
|
| Hospital Charge Code |
3004651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,853.68 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,256.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,056.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,056.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$4,056.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,317.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE SPINE ARCADIUS 4° 13X16X5MM
|
Facility
|
OP
|
$6,650.00
|
|
| Hospital Charge Code |
3004651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,600.98 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,389.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,790.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.98
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,790.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$3,790.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,517.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE SPINE ARCADIUS 4° 15X17X6MM
|
Facility
|
OP
|
$6,650.00
|
|
| Hospital Charge Code |
3004478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,600.98 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,389.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,790.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.98
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,790.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$3,790.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,517.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE SPINE ARCADIUS 4° 15X17X6MM
|
Facility
|
IP
|
$6,650.00
|
|
| Hospital Charge Code |
3004478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,853.68 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,256.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,056.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,056.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$4,056.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,317.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE SPINE ARCADIUS 4° 15X17X7MM
|
Facility
|
OP
|
$6,650.00
|
|
| Hospital Charge Code |
3004682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,600.98 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,389.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,790.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.98
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,790.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$3,790.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,517.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE SPINE ARCADIUS 4° 15X17X7MM
|
Facility
|
IP
|
$6,650.00
|
|
| Hospital Charge Code |
3004682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,853.68 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,256.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,056.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,056.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$4,056.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,317.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
CAGE XP ARC 12X32X8MM 15°
|
Facility
|
OP
|
$14,000.00
|
|
| Hospital Charge Code |
3004621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,581.00 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,720.00
|
| Rate for Payer: Aetna of WY Medicare |
$9,240.00
|
| Rate for Payer: Altius Commercial |
$13,440.00
|
| Rate for Payer: Beech Street Commercial |
$13,720.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,580.00
|
| Rate for Payer: Cash Price |
$9,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,580.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,720.00
|
| Rate for Payer: Entrust Commercial |
$13,300.00
|
| Rate for Payer: First Choice Health Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,980.00
|
| Rate for Payer: HealthUtah PPO |
$14,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,580.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,581.00
|
| Rate for Payer: One Health Plan of WY PPO |
$13,720.00
|
| Rate for Payer: PacificSource Commercial |
$12,600.00
|
| Rate for Payer: PHCS PPO |
$13,720.00
|
| Rate for Payer: Three Rivers PPO |
$10,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,980.00
|
| Rate for Payer: United Healthcare Commercial |
$13,370.00
|
| Rate for Payer: United Healthcare Medicare |
$7,980.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,720.00
|
| Rate for Payer: Wise Provider Network Commercial |
$13,300.00
|
|
|
CAGE XP ARC 12X32X8MM 15°
|
Facility
|
IP
|
$14,000.00
|
|
| Hospital Charge Code |
3004621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,113.00 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,720.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,960.00
|
| Rate for Payer: Altius Commercial |
$13,440.00
|
| Rate for Payer: Beech Street Commercial |
$13,720.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,580.00
|
| Rate for Payer: Cash Price |
$9,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,580.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,720.00
|
| Rate for Payer: Entrust Commercial |
$13,300.00
|
| Rate for Payer: First Choice Health Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,540.00
|
| Rate for Payer: HealthUtah PPO |
$14,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,580.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8,113.00
|
| Rate for Payer: One Health Plan of WY PPO |
$13,720.00
|
| Rate for Payer: PacificSource Commercial |
$12,600.00
|
| Rate for Payer: PHCS PPO |
$13,720.00
|
| Rate for Payer: Three Rivers PPO |
$10,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$8,540.00
|
| Rate for Payer: United Healthcare Commercial |
$13,370.00
|
| Rate for Payer: United Healthcare Medicare |
$8,540.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,300.00
|
| Rate for Payer: Wise Provider Network Commercial |
$13,300.00
|
|
|
CAGE XP ARC 12X32X9MM 15°
|
Facility
|
OP
|
$14,000.00
|
|
| Hospital Charge Code |
3004640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,581.00 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,720.00
|
| Rate for Payer: Aetna of WY Medicare |
$9,240.00
|
| Rate for Payer: Altius Commercial |
$13,440.00
|
| Rate for Payer: Beech Street Commercial |
$13,720.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,580.00
|
| Rate for Payer: Cash Price |
$9,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,580.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,720.00
|
| Rate for Payer: Entrust Commercial |
$13,300.00
|
| Rate for Payer: First Choice Health Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,300.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,980.00
|
| Rate for Payer: HealthUtah PPO |
$14,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,580.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,581.00
|
| Rate for Payer: One Health Plan of WY PPO |
$13,720.00
|
| Rate for Payer: PacificSource Commercial |
$12,600.00
|
| Rate for Payer: PHCS PPO |
$13,720.00
|
| Rate for Payer: Three Rivers PPO |
$10,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,980.00
|
| Rate for Payer: United Healthcare Commercial |
$13,370.00
|
| Rate for Payer: United Healthcare Medicare |
$7,980.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,720.00
|
| Rate for Payer: Wise Provider Network Commercial |
$13,300.00
|
|
