|
ACTIVE CORD DISP 12BX
|
Facility
|
OP
|
$50.40
|
|
| Hospital Charge Code |
2650032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.39
|
| Rate for Payer: Aetna of WY Medicare |
$33.26
|
| Rate for Payer: Altius Commercial |
$48.38
|
| Rate for Payer: Beech Street Commercial |
$49.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.89
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.89
|
| Rate for Payer: Cigna of WY Commercial |
$49.39
|
| Rate for Payer: Entrust Commercial |
$47.88
|
| Rate for Payer: First Choice Health Commercial |
$47.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.73
|
| Rate for Payer: HealthUtah PPO |
$50.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.89
|
| Rate for Payer: Multiplan Medicare/VA |
$27.29
|
| Rate for Payer: One Health Plan of WY PPO |
$49.39
|
| Rate for Payer: PacificSource Commercial |
$45.36
|
| Rate for Payer: PHCS PPO |
$49.39
|
| Rate for Payer: Three Rivers PPO |
$37.80
|
| Rate for Payer: TriWest Veterans Administration |
$28.73
|
| Rate for Payer: United Healthcare Commercial |
$48.13
|
| Rate for Payer: United Healthcare Medicare |
$28.73
|
| Rate for Payer: WINHealth Partners Commercial |
$49.39
|
| Rate for Payer: Wise Provider Network Commercial |
$47.88
|
|
|
ACU-SINCH KIT ACUMED
|
Facility
|
OP
|
$5,372.50
|
|
| Hospital Charge Code |
3003637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,909.21 |
| Max. Negotiated Rate |
$5,372.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,265.05
|
| Rate for Payer: Aetna of WY Medicare |
$3,545.85
|
| Rate for Payer: Altius Commercial |
$5,157.60
|
| Rate for Payer: Beech Street Commercial |
$5,265.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,211.32
|
| Rate for Payer: Cash Price |
$3,760.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,211.32
|
| Rate for Payer: Cigna of WY Commercial |
$5,265.05
|
| Rate for Payer: Entrust Commercial |
$5,103.88
|
| Rate for Payer: First Choice Health Commercial |
$5,103.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,103.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,062.32
|
| Rate for Payer: HealthUtah PPO |
$5,372.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,211.32
|
| Rate for Payer: Multiplan Medicare/VA |
$2,909.21
|
| Rate for Payer: One Health Plan of WY PPO |
$5,265.05
|
| Rate for Payer: PacificSource Commercial |
$4,835.25
|
| Rate for Payer: PHCS PPO |
$5,265.05
|
| Rate for Payer: Three Rivers PPO |
$4,029.38
|
| Rate for Payer: TriWest Veterans Administration |
$3,062.32
|
| Rate for Payer: United Healthcare Commercial |
$5,130.74
|
| Rate for Payer: United Healthcare Medicare |
$3,062.32
|
| Rate for Payer: WINHealth Partners Commercial |
$5,265.05
|
| Rate for Payer: Wise Provider Network Commercial |
$5,103.88
|
|
|
ACU-SINCH KIT ACUMED
|
Facility
|
IP
|
$5,372.50
|
|
| Hospital Charge Code |
3003637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,113.36 |
| Max. Negotiated Rate |
$5,372.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,265.05
|
| Rate for Payer: Aetna of WY Medicare |
$3,438.40
|
| Rate for Payer: Altius Commercial |
$5,157.60
|
| Rate for Payer: Beech Street Commercial |
$5,265.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,211.32
|
| Rate for Payer: Cash Price |
$3,760.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,211.32
|
| Rate for Payer: Cigna of WY Commercial |
$5,265.05
|
| Rate for Payer: Entrust Commercial |
$5,103.88
|
| Rate for Payer: First Choice Health Commercial |
$5,103.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,103.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,277.22
|
| Rate for Payer: HealthUtah PPO |
$5,372.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,211.32
|
| Rate for Payer: Multiplan Medicare/VA |
$3,113.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5,265.05
|
| Rate for Payer: PacificSource Commercial |
$4,835.25
|
| Rate for Payer: PHCS PPO |
$5,265.05
|
| Rate for Payer: Three Rivers PPO |
$4,029.38
|
| Rate for Payer: TriWest Veterans Administration |
$3,277.22
|
| Rate for Payer: United Healthcare Commercial |
$5,130.74
|
| Rate for Payer: United Healthcare Medicare |
$3,277.22
|
| Rate for Payer: WINHealth Partners Commercial |
$5,103.88
|
| Rate for Payer: Wise Provider Network Commercial |
$5,103.88
|
|
|
ACUSINCH KNOTLESS 3.5MM KIT
|
Facility
|
OP
|
$5,936.00
|
|
| Hospital Charge Code |
3004311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,214.34 |
| Max. Negotiated Rate |
$5,936.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,817.28
|
| Rate for Payer: Aetna of WY Medicare |
$3,917.76
|
| Rate for Payer: Altius Commercial |
$5,698.56
|
| Rate for Payer: Beech Street Commercial |
$5,817.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,757.92
|
| Rate for Payer: Cash Price |
$4,155.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,757.92
|
| Rate for Payer: Cigna of WY Commercial |
$5,817.28
|
| Rate for Payer: Entrust Commercial |
$5,639.20
|
| Rate for Payer: First Choice Health Commercial |
$5,639.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,639.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,383.52
|
| Rate for Payer: HealthUtah PPO |
$5,936.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,757.92
|
| Rate for Payer: Multiplan Medicare/VA |
$3,214.34
|
| Rate for Payer: One Health Plan of WY PPO |
$5,817.28
|
| Rate for Payer: PacificSource Commercial |
$5,342.40
|
| Rate for Payer: PHCS PPO |
$5,817.28
|
| Rate for Payer: Three Rivers PPO |
$4,452.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,383.52
|
| Rate for Payer: United Healthcare Commercial |
$5,668.88
|
| Rate for Payer: United Healthcare Medicare |
$3,383.52
|
| Rate for Payer: WINHealth Partners Commercial |
$5,817.28
|
| Rate for Payer: Wise Provider Network Commercial |
$5,639.20
|
|
|
ACUSINCH KNOTLESS 3.5MM KIT
|
Facility
|
IP
|
$5,936.00
|
|
| Hospital Charge Code |
3004311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.91 |
| Max. Negotiated Rate |
$5,936.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,817.28
|
| Rate for Payer: Aetna of WY Medicare |
$3,799.04
|
| Rate for Payer: Altius Commercial |
$5,698.56
|
| Rate for Payer: Beech Street Commercial |
$5,817.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,757.92
|
| Rate for Payer: Cash Price |
$4,155.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,757.92
|
| Rate for Payer: Cigna of WY Commercial |
$5,817.28
|
| Rate for Payer: Entrust Commercial |
$5,639.20
|
| Rate for Payer: First Choice Health Commercial |
$5,639.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,639.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,620.96
|
| Rate for Payer: HealthUtah PPO |
$5,936.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,757.92
|
| Rate for Payer: Multiplan Medicare/VA |
$3,439.91
|
| Rate for Payer: One Health Plan of WY PPO |
$5,817.28
|
| Rate for Payer: PacificSource Commercial |
$5,342.40
|
| Rate for Payer: PHCS PPO |
$5,817.28
|
| Rate for Payer: Three Rivers PPO |
$4,452.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,620.96
|
| Rate for Payer: United Healthcare Commercial |
$5,668.88
|
| Rate for Payer: United Healthcare Medicare |
$3,620.96
|
| Rate for Payer: WINHealth Partners Commercial |
$5,639.20
|
| Rate for Payer: Wise Provider Network Commercial |
$5,639.20
|
|
|
ACU-SINCH KNOTLESS SYSTEM 3.5
|
Facility
|
OP
|
$6,919.50
|
|
| Hospital Charge Code |
3001029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,746.91 |
| Max. Negotiated Rate |
$6,919.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,781.11
|
| Rate for Payer: Aetna of WY Medicare |
$4,566.87
|
| Rate for Payer: Altius Commercial |
$6,642.72
|
| Rate for Payer: Beech Street Commercial |
$6,781.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,711.92
|
| Rate for Payer: Cash Price |
$4,843.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,711.92
|
| Rate for Payer: Cigna of WY Commercial |
$6,781.11
|
| Rate for Payer: Entrust Commercial |
$6,573.52
|
| Rate for Payer: First Choice Health Commercial |
$6,573.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,573.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,944.12
|
| Rate for Payer: HealthUtah PPO |
$6,919.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,711.92
|
| Rate for Payer: Multiplan Medicare/VA |
$3,746.91
|
| Rate for Payer: One Health Plan of WY PPO |
$6,781.11
|
| Rate for Payer: PacificSource Commercial |
$6,227.55
|
| Rate for Payer: PHCS PPO |
$6,781.11
|
| Rate for Payer: Three Rivers PPO |
$5,189.62
|
| Rate for Payer: TriWest Veterans Administration |
$3,944.12
|
| Rate for Payer: United Healthcare Commercial |
$6,608.12
|
| Rate for Payer: United Healthcare Medicare |
$3,944.12
|
| Rate for Payer: WINHealth Partners Commercial |
$6,781.11
|
| Rate for Payer: Wise Provider Network Commercial |
$6,573.52
|
|
|
ACU-SINCH KNOTLESS SYSTEM 3.5
|
Facility
|
IP
|
$6,919.50
|
|
| Hospital Charge Code |
3001029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.85 |
| Max. Negotiated Rate |
$6,919.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,781.11
|
| Rate for Payer: Aetna of WY Medicare |
$4,428.48
|
| Rate for Payer: Altius Commercial |
$6,642.72
|
| Rate for Payer: Beech Street Commercial |
$6,781.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,711.92
|
| Rate for Payer: Cash Price |
$4,843.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,711.92
|
| Rate for Payer: Cigna of WY Commercial |
$6,781.11
|
| Rate for Payer: Entrust Commercial |
$6,573.52
|
| Rate for Payer: First Choice Health Commercial |
$6,573.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,573.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,220.90
|
| Rate for Payer: HealthUtah PPO |
$6,919.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,711.92
|
| Rate for Payer: Multiplan Medicare/VA |
$4,009.85
|
| Rate for Payer: One Health Plan of WY PPO |
$6,781.11
|
| Rate for Payer: PacificSource Commercial |
$6,227.55
|
| Rate for Payer: PHCS PPO |
$6,781.11
|
| Rate for Payer: Three Rivers PPO |
$5,189.62
|
| Rate for Payer: TriWest Veterans Administration |
$4,220.90
|
| Rate for Payer: United Healthcare Commercial |
$6,608.12
|
| Rate for Payer: United Healthcare Medicare |
$4,220.90
|
| Rate for Payer: WINHealth Partners Commercial |
$6,573.52
|
| Rate for Payer: Wise Provider Network Commercial |
$6,573.52
|
|
|
ACU-SINCH KNOTLESS SYSTEM 3.5 KIT
|
Facility
|
IP
|
$7,283.50
|
|
| Hospital Charge Code |
3001028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,220.79 |
| Max. Negotiated Rate |
$7,283.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,137.83
|
| Rate for Payer: Aetna of WY Medicare |
$4,661.44
|
| Rate for Payer: Altius Commercial |
$6,992.16
|
| Rate for Payer: Beech Street Commercial |
$7,137.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,065.00
|
| Rate for Payer: Cash Price |
$5,098.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,065.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,137.83
|
| Rate for Payer: Entrust Commercial |
$6,919.32
|
| Rate for Payer: First Choice Health Commercial |
$6,919.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,919.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,442.94
|
| Rate for Payer: HealthUtah PPO |
$7,283.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,065.00
|
| Rate for Payer: Multiplan Medicare/VA |
$4,220.79
|
| Rate for Payer: One Health Plan of WY PPO |
$7,137.83
|
| Rate for Payer: PacificSource Commercial |
$6,555.15
|
| Rate for Payer: PHCS PPO |
$7,137.83
|
| Rate for Payer: Three Rivers PPO |
$5,462.62
|
| Rate for Payer: TriWest Veterans Administration |
$4,442.94
|
| Rate for Payer: United Healthcare Commercial |
$6,955.74
|
| Rate for Payer: United Healthcare Medicare |
$4,442.94
|
| Rate for Payer: WINHealth Partners Commercial |
$6,919.32
|
| Rate for Payer: Wise Provider Network Commercial |
$6,919.32
|
|
|
ACU-SINCH KNOTLESS SYSTEM 3.5 KIT
|
Facility
|
OP
|
$7,283.50
|
|
| Hospital Charge Code |
3001028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,944.02 |
| Max. Negotiated Rate |
$7,283.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,137.83
|
| Rate for Payer: Aetna of WY Medicare |
$4,807.11
|
| Rate for Payer: Altius Commercial |
$6,992.16
|
| Rate for Payer: Beech Street Commercial |
$7,137.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,065.00
|
| Rate for Payer: Cash Price |
$5,098.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,065.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,137.83
|
| Rate for Payer: Entrust Commercial |
$6,919.32
|
| Rate for Payer: First Choice Health Commercial |
$6,919.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,919.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,151.60
|
| Rate for Payer: HealthUtah PPO |
$7,283.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,065.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,944.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7,137.83
|
| Rate for Payer: PacificSource Commercial |
$6,555.15
|
| Rate for Payer: PHCS PPO |
$7,137.83
|
| Rate for Payer: Three Rivers PPO |
$5,462.62
|
| Rate for Payer: TriWest Veterans Administration |
$4,151.60
|
| Rate for Payer: United Healthcare Commercial |
$6,955.74
|
| Rate for Payer: United Healthcare Medicare |
$4,151.60
|
| Rate for Payer: WINHealth Partners Commercial |
$7,137.83
|
| Rate for Payer: Wise Provider Network Commercial |
$6,919.32
|
|
|
ACUTRAK FUSION DEVICE 22MM
|
Facility
|
IP
|
$1,435.00
|
|
| Hospital Charge Code |
3002904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$831.58 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$918.40
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.35
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$831.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$875.35
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$875.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,363.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
ACUTRAK FUSION DEVICE 22MM
|
Facility
|
OP
|
$1,435.00
|
|
| Hospital Charge Code |
3002904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.05 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$947.10
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.95
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$777.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$817.95
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$817.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,406.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
ACUTRAK FUSION DEVICE 32MM
|
Facility
|
OP
|
$1,435.00
|
|
| Hospital Charge Code |
3002925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.05 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$947.10
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.95
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$777.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$817.95
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$817.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,406.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
ACUTRAK FUSION DEVICE 32MM
|
Facility
|
IP
|
$1,435.00
|
|
| Hospital Charge Code |
3002925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$831.58 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$918.40
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.35
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$831.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$875.35
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$875.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,363.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
ACUTRAK FUSION DRILL 24MM
|
Facility
|
IP
|
$577.50
|
|
| Hospital Charge Code |
3002906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.66 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$565.95
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Commercial |
$554.40
|
| Rate for Payer: Beech Street Commercial |
$565.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.18
|
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$560.18
|
| Rate for Payer: Cigna of WY Commercial |
$565.95
|
| Rate for Payer: Entrust Commercial |
$548.62
|
| Rate for Payer: First Choice Health Commercial |
$548.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$548.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.28
|
| Rate for Payer: HealthUtah PPO |
$577.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$560.18
|
| Rate for Payer: Multiplan Medicare/VA |
$334.66
|
| Rate for Payer: One Health Plan of WY PPO |
$565.95
|
| Rate for Payer: PacificSource Commercial |
$519.75
|
| Rate for Payer: PHCS PPO |
$565.95
|
| Rate for Payer: Three Rivers PPO |
$433.12
|
| Rate for Payer: TriWest Veterans Administration |
$352.28
|
| Rate for Payer: United Healthcare Commercial |
$551.51
|
| Rate for Payer: United Healthcare Medicare |
$352.28
|
| Rate for Payer: WINHealth Partners Commercial |
$548.62
|
| Rate for Payer: Wise Provider Network Commercial |
$548.62
|
|
|
ACUTRAK FUSION DRILL 24MM
|
Facility
|
OP
|
$577.50
|
|
| Hospital Charge Code |
3002906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.72 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$565.95
|
| Rate for Payer: Aetna of WY Medicare |
$381.15
|
| Rate for Payer: Altius Commercial |
$554.40
|
| Rate for Payer: Beech Street Commercial |
$565.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.18
|
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$560.18
|
| Rate for Payer: Cigna of WY Commercial |
$565.95
|
| Rate for Payer: Entrust Commercial |
$548.62
|
| Rate for Payer: First Choice Health Commercial |
$548.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$548.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.18
|
| Rate for Payer: HealthUtah PPO |
$577.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$560.18
|
| Rate for Payer: Multiplan Medicare/VA |
$312.72
|
| Rate for Payer: One Health Plan of WY PPO |
$565.95
|
| Rate for Payer: PacificSource Commercial |
$519.75
|
| Rate for Payer: PHCS PPO |
$565.95
|
| Rate for Payer: Three Rivers PPO |
$433.12
|
| Rate for Payer: TriWest Veterans Administration |
$329.18
|
| Rate for Payer: United Healthcare Commercial |
$551.51
|
| Rate for Payer: United Healthcare Medicare |
$329.18
|
| Rate for Payer: WINHealth Partners Commercial |
$565.95
|
| Rate for Payer: Wise Provider Network Commercial |
$548.62
|
|
|
ACUTRAK FUSION DRILL 32MM
|
Facility
|
OP
|
$668.50
|
|
| Hospital Charge Code |
3003235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.99 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$655.13
|
| Rate for Payer: Aetna of WY Medicare |
$441.21
|
| Rate for Payer: Altius Commercial |
$641.76
|
| Rate for Payer: Beech Street Commercial |
$655.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$648.44
|
| Rate for Payer: Cash Price |
$467.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$648.44
|
| Rate for Payer: Cigna of WY Commercial |
$655.13
|
| Rate for Payer: Entrust Commercial |
$635.08
|
| Rate for Payer: First Choice Health Commercial |
$635.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$635.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.04
|
| Rate for Payer: HealthUtah PPO |
$668.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$648.44
|
| Rate for Payer: Multiplan Medicare/VA |
$361.99
|
| Rate for Payer: One Health Plan of WY PPO |
$655.13
|
| Rate for Payer: PacificSource Commercial |
$601.65
|
| Rate for Payer: PHCS PPO |
$655.13
|
| Rate for Payer: Three Rivers PPO |
$501.38
|
| Rate for Payer: TriWest Veterans Administration |
$381.04
|
| Rate for Payer: United Healthcare Commercial |
$638.42
|
| Rate for Payer: United Healthcare Medicare |
$381.04
|
| Rate for Payer: WINHealth Partners Commercial |
$655.13
|
| Rate for Payer: Wise Provider Network Commercial |
$635.08
|
|
|
ACUTRAK FUSION DRILL 32MM
|
Facility
|
IP
|
$668.50
|
|
| Hospital Charge Code |
3003235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$655.13
|
| Rate for Payer: Aetna of WY Medicare |
$427.84
|
| Rate for Payer: Altius Commercial |
$641.76
|
| Rate for Payer: Beech Street Commercial |
$655.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$648.44
|
| Rate for Payer: Cash Price |
$467.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$648.44
|
| Rate for Payer: Cigna of WY Commercial |
$655.13
|
| Rate for Payer: Entrust Commercial |
$635.08
|
| Rate for Payer: First Choice Health Commercial |
$635.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$635.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.78
|
| Rate for Payer: HealthUtah PPO |
$668.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$648.44
|
| Rate for Payer: Multiplan Medicare/VA |
$387.40
|
| Rate for Payer: One Health Plan of WY PPO |
$655.13
|
| Rate for Payer: PacificSource Commercial |
$601.65
|
| Rate for Payer: PHCS PPO |
$655.13
|
| Rate for Payer: Three Rivers PPO |
$501.38
|
| Rate for Payer: TriWest Veterans Administration |
$407.78
|
| Rate for Payer: United Healthcare Commercial |
$638.42
|
| Rate for Payer: United Healthcare Medicare |
$407.78
|
| Rate for Payer: WINHealth Partners Commercial |
$635.08
|
| Rate for Payer: Wise Provider Network Commercial |
$635.08
|
|
|
ACYCLOVIR 400 MG TABLET [7394]
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
NDC 5026806111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.36
|
| Rate for Payer: Altius Commercial |
$15.53
|
| Rate for Payer: Beech Street Commercial |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.69
|
| Rate for Payer: Cigna of WY Commercial |
$15.86
|
| Rate for Payer: Entrust Commercial |
$15.37
|
| Rate for Payer: First Choice Health Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.87
|
| Rate for Payer: HealthUtah PPO |
$16.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.69
|
| Rate for Payer: Multiplan Medicare/VA |
$9.38
|
| Rate for Payer: One Health Plan of WY PPO |
$15.86
|
| Rate for Payer: PacificSource Commercial |
$14.56
|
| Rate for Payer: PHCS PPO |
$15.86
|
| Rate for Payer: Three Rivers PPO |
$12.14
|
| Rate for Payer: TriWest Veterans Administration |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Medicare |
$9.87
|
| Rate for Payer: WINHealth Partners Commercial |
$15.37
|
| Rate for Payer: Wise Provider Network Commercial |
$15.37
|
|
|
ACYCLOVIR 400 MG TABLET [7394]
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
NDC 5026806115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.36
|
| Rate for Payer: Altius Commercial |
$15.53
|
| Rate for Payer: Beech Street Commercial |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.69
|
| Rate for Payer: Cigna of WY Commercial |
$15.86
|
| Rate for Payer: Entrust Commercial |
$15.37
|
| Rate for Payer: First Choice Health Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.87
|
| Rate for Payer: HealthUtah PPO |
$16.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.69
|
| Rate for Payer: Multiplan Medicare/VA |
$9.38
|
| Rate for Payer: One Health Plan of WY PPO |
$15.86
|
| Rate for Payer: PacificSource Commercial |
$14.56
|
| Rate for Payer: PHCS PPO |
$15.86
|
| Rate for Payer: Three Rivers PPO |
$12.14
|
| Rate for Payer: TriWest Veterans Administration |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Medicare |
$9.87
|
| Rate for Payer: WINHealth Partners Commercial |
$15.37
|
| Rate for Payer: Wise Provider Network Commercial |
$15.37
|
|
|
ACYCLOVIR 400 MG TABLET [7394]
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
NDC 5026806111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.68
|
| Rate for Payer: Altius Commercial |
$15.53
|
| Rate for Payer: Beech Street Commercial |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.69
|
| Rate for Payer: Cigna of WY Commercial |
$15.86
|
| Rate for Payer: Entrust Commercial |
$15.37
|
| Rate for Payer: First Choice Health Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.22
|
| Rate for Payer: HealthUtah PPO |
$16.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.76
|
| Rate for Payer: One Health Plan of WY PPO |
$15.86
|
| Rate for Payer: PacificSource Commercial |
$14.56
|
| Rate for Payer: PHCS PPO |
$15.86
|
| Rate for Payer: Three Rivers PPO |
$12.14
|
| Rate for Payer: TriWest Veterans Administration |
$9.22
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Medicare |
$9.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.86
|
| Rate for Payer: Wise Provider Network Commercial |
$15.37
|
|
|
ACYCLOVIR 400 MG TABLET [7394]
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
NDC 5026806115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.68
|
| Rate for Payer: Altius Commercial |
$15.53
|
| Rate for Payer: Beech Street Commercial |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.69
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.69
|
| Rate for Payer: Cigna of WY Commercial |
$15.86
|
| Rate for Payer: Entrust Commercial |
$15.37
|
| Rate for Payer: First Choice Health Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.22
|
| Rate for Payer: HealthUtah PPO |
$16.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.76
|
| Rate for Payer: One Health Plan of WY PPO |
$15.86
|
| Rate for Payer: PacificSource Commercial |
$14.56
|
| Rate for Payer: PHCS PPO |
$15.86
|
| Rate for Payer: Three Rivers PPO |
$12.14
|
| Rate for Payer: TriWest Veterans Administration |
$9.22
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Medicare |
$9.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.86
|
| Rate for Payer: Wise Provider Network Commercial |
$15.37
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [4235]
|
Facility
|
IP
|
$19.20
|
|
|
Service Code
|
HCPCS J0133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Aetna of WY Medicare |
$12.29
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.71
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Multiplan Medicare/VA |
$11.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: TriWest Veterans Administration |
$11.71
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Medicare |
$11.71
|
| Rate for Payer: WINHealth Partners Commercial |
$18.24
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [4235]
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
HCPCS J0133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Aetna of WY Medicare |
$12.67
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Multiplan Medicare/VA |
$10.40
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.82
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
|
ADAPTIC DRESSING 3"X3" 2012
|
Facility
|
IP
|
$0.85
|
|
| Hospital Charge Code |
2000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.83
|
| Rate for Payer: Aetna of WY Medicare |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.82
|
| Rate for Payer: Cigna of WY Commercial |
$0.83
|
| Rate for Payer: Entrust Commercial |
$0.81
|
| Rate for Payer: First Choice Health Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.52
|
| Rate for Payer: HealthUtah PPO |
$0.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.82
|
| Rate for Payer: Multiplan Medicare/VA |
$0.49
|
| Rate for Payer: One Health Plan of WY PPO |
$0.83
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PHCS PPO |
$0.83
|
| Rate for Payer: Three Rivers PPO |
$0.64
|
| Rate for Payer: TriWest Veterans Administration |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
| Rate for Payer: WINHealth Partners Commercial |
$0.81
|
| Rate for Payer: Wise Provider Network Commercial |
$0.81
|
|
|
ADAPTIC DRESSING 3"X3" 2012
|
Facility
|
OP
|
$0.85
|
|
| Hospital Charge Code |
2000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.83
|
| Rate for Payer: Aetna of WY Medicare |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.82
|
| Rate for Payer: Cigna of WY Commercial |
$0.83
|
| Rate for Payer: Entrust Commercial |
$0.81
|
| Rate for Payer: First Choice Health Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.82
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.83
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PHCS PPO |
$0.83
|
| Rate for Payer: Three Rivers PPO |
$0.64
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.83
|
| Rate for Payer: Wise Provider Network Commercial |
$0.81
|
|
