|
DRAIN JACKSON PRATT BULB 100CC
|
Facility
|
IP
|
$27.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.46
|
| Rate for Payer: Altius Commercial |
$26.46
|
| Rate for Payer: Beech Street Commercial |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.63
|
| Rate for Payer: Cash Price |
$19.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.73
|
| Rate for Payer: Cigna of WY Commercial |
$27.01
|
| Rate for Payer: Entrust Commercial |
$26.18
|
| Rate for Payer: First Choice Health Commercial |
$26.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.19
|
| Rate for Payer: HealthUtah PPO |
$27.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.73
|
| Rate for Payer: Multiplan Medicare/VA |
$17.28
|
| Rate for Payer: One Health Plan of WY PPO |
$27.01
|
| Rate for Payer: PacificSource Commercial |
$24.80
|
| Rate for Payer: PHCS PPO |
$27.01
|
| Rate for Payer: Three Rivers PPO |
$20.67
|
| Rate for Payer: TriWest Veterans Administration |
$18.19
|
| Rate for Payer: United Healthcare Commercial |
$23.98
|
| Rate for Payer: United Healthcare Medicare |
$18.19
|
| Rate for Payer: WINHealth Partners Commercial |
$26.18
|
| Rate for Payer: Wise Provider Network Commercial |
$26.18
|
|
|
DRAIN JACKSON PRATT FLAT 7MM
|
Facility
|
IP
|
$33.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.22
|
| Rate for Payer: Altius Commercial |
$32.22
|
| Rate for Payer: Beech Street Commercial |
$32.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.55
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.55
|
| Rate for Payer: Cigna of WY Commercial |
$32.89
|
| Rate for Payer: Entrust Commercial |
$31.88
|
| Rate for Payer: First Choice Health Commercial |
$31.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.15
|
| Rate for Payer: HealthUtah PPO |
$33.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.55
|
| Rate for Payer: Multiplan Medicare/VA |
$21.04
|
| Rate for Payer: One Health Plan of WY PPO |
$32.89
|
| Rate for Payer: PacificSource Commercial |
$30.20
|
| Rate for Payer: PHCS PPO |
$32.89
|
| Rate for Payer: Three Rivers PPO |
$25.17
|
| Rate for Payer: TriWest Veterans Administration |
$22.15
|
| Rate for Payer: United Healthcare Commercial |
$29.20
|
| Rate for Payer: United Healthcare Medicare |
$22.15
|
| Rate for Payer: WINHealth Partners Commercial |
$31.88
|
| Rate for Payer: Wise Provider Network Commercial |
$31.88
|
|
|
DRAIN JACKSON PRATT FLAT 7MM
|
Facility
|
OP
|
$33.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$33.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.89
|
| Rate for Payer: Aetna of WY Medicare |
$22.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.22
|
| Rate for Payer: Altius Commercial |
$32.22
|
| Rate for Payer: Beech Street Commercial |
$32.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.55
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.55
|
| Rate for Payer: Cigna of WY Commercial |
$32.89
|
| Rate for Payer: Entrust Commercial |
$31.88
|
| Rate for Payer: First Choice Health Commercial |
$31.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.46
|
| Rate for Payer: HealthUtah PPO |
$33.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.55
|
| Rate for Payer: Multiplan Medicare/VA |
$18.49
|
| Rate for Payer: One Health Plan of WY PPO |
$32.89
|
| Rate for Payer: PacificSource Commercial |
$30.20
|
| Rate for Payer: PHCS PPO |
$32.89
|
| Rate for Payer: Three Rivers PPO |
$25.17
|
| Rate for Payer: TriWest Veterans Administration |
$19.46
|
| Rate for Payer: United Healthcare Commercial |
$29.20
|
| Rate for Payer: United Healthcare Medicare |
$19.46
|
| Rate for Payer: WINHealth Partners Commercial |
$32.89
|
| Rate for Payer: Wise Provider Network Commercial |
$31.88
|
|
|
DRAIN JACKSON PRATT SPRING RES
|
Facility
|
IP
|
$63.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$63.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.22
|
| Rate for Payer: Altius Commercial |
$61.22
|
| Rate for Payer: Beech Street Commercial |
$62.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.86
|
| Rate for Payer: Cigna of WY Commercial |
$62.49
|
| Rate for Payer: Entrust Commercial |
$60.58
|
| Rate for Payer: First Choice Health Commercial |
$60.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.09
|
| Rate for Payer: HealthUtah PPO |
$63.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.86
|
| Rate for Payer: Multiplan Medicare/VA |
$39.98
|
| Rate for Payer: One Health Plan of WY PPO |
$62.49
|
| Rate for Payer: PacificSource Commercial |
$57.39
|
| Rate for Payer: PHCS PPO |
$62.49
|
| Rate for Payer: Three Rivers PPO |
$47.83
|
| Rate for Payer: TriWest Veterans Administration |
$42.09
|
| Rate for Payer: United Healthcare Commercial |
$55.48
|
| Rate for Payer: United Healthcare Medicare |
$42.09
|
| Rate for Payer: WINHealth Partners Commercial |
$60.58
|
| Rate for Payer: Wise Provider Network Commercial |
$60.58
|
|
|
DRAIN JACKSON PRATT SPRING RES
|
Facility
|
OP
|
$63.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$63.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.49
|
| Rate for Payer: Aetna of WY Medicare |
$42.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.22
|
| Rate for Payer: Altius Commercial |
$61.22
|
| Rate for Payer: Beech Street Commercial |
$62.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.36
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.86
|
| Rate for Payer: Cigna of WY Commercial |
$62.49
|
| Rate for Payer: Entrust Commercial |
$60.58
|
| Rate for Payer: First Choice Health Commercial |
$60.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.99
|
| Rate for Payer: HealthUtah PPO |
$63.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.86
|
| Rate for Payer: Multiplan Medicare/VA |
$35.14
|
| Rate for Payer: One Health Plan of WY PPO |
$62.49
|
| Rate for Payer: PacificSource Commercial |
$57.39
|
| Rate for Payer: PHCS PPO |
$62.49
|
| Rate for Payer: Three Rivers PPO |
$47.83
|
| Rate for Payer: TriWest Veterans Administration |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$55.48
|
| Rate for Payer: United Healthcare Medicare |
$36.99
|
| Rate for Payer: WINHealth Partners Commercial |
$62.49
|
| Rate for Payer: Wise Provider Network Commercial |
$60.58
|
|
|
DRAPE 1/2 SHEET
|
Facility
|
IP
|
$3.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.18
|
| Rate for Payer: Altius Commercial |
$3.18
|
| Rate for Payer: Beech Street Commercial |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.21
|
| Rate for Payer: Cigna of WY Commercial |
$3.24
|
| Rate for Payer: Entrust Commercial |
$3.14
|
| Rate for Payer: First Choice Health Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.18
|
| Rate for Payer: HealthUtah PPO |
$3.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.21
|
| Rate for Payer: Multiplan Medicare/VA |
$2.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3.24
|
| Rate for Payer: PacificSource Commercial |
$2.98
|
| Rate for Payer: PHCS PPO |
$3.24
|
| Rate for Payer: Three Rivers PPO |
$2.48
|
| Rate for Payer: TriWest Veterans Administration |
$2.18
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
| Rate for Payer: United Healthcare Medicare |
$2.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3.14
|
| Rate for Payer: Wise Provider Network Commercial |
$3.14
|
|
|
DRAPE 1/2 SHEET
|
Facility
|
OP
|
$3.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.24
|
| Rate for Payer: Aetna of WY Medicare |
$2.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.18
|
| Rate for Payer: Altius Commercial |
$3.18
|
| Rate for Payer: Beech Street Commercial |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.21
|
| Rate for Payer: Cigna of WY Commercial |
$3.24
|
| Rate for Payer: Entrust Commercial |
$3.14
|
| Rate for Payer: First Choice Health Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.92
|
| Rate for Payer: HealthUtah PPO |
$3.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3.24
|
| Rate for Payer: PacificSource Commercial |
$2.98
|
| Rate for Payer: PHCS PPO |
$3.24
|
| Rate for Payer: Three Rivers PPO |
$2.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.92
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
| Rate for Payer: United Healthcare Medicare |
$1.92
|
| Rate for Payer: WINHealth Partners Commercial |
$3.24
|
| Rate for Payer: Wise Provider Network Commercial |
$3.14
|
|
|
DRAPE 3/4 SHEET
|
Facility
|
OP
|
$8.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.94
|
| Rate for Payer: Aetna of WY Medicare |
$5.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.78
|
| Rate for Payer: Altius Commercial |
$7.78
|
| Rate for Payer: Beech Street Commercial |
$7.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.86
|
| Rate for Payer: Cigna of WY Commercial |
$7.94
|
| Rate for Payer: Entrust Commercial |
$7.70
|
| Rate for Payer: First Choice Health Commercial |
$7.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.70
|
| Rate for Payer: HealthUtah PPO |
$8.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.86
|
| Rate for Payer: Multiplan Medicare/VA |
$4.46
|
| Rate for Payer: One Health Plan of WY PPO |
$7.94
|
| Rate for Payer: PacificSource Commercial |
$7.29
|
| Rate for Payer: PHCS PPO |
$7.94
|
| Rate for Payer: Three Rivers PPO |
$6.08
|
| Rate for Payer: TriWest Veterans Administration |
$4.70
|
| Rate for Payer: United Healthcare Commercial |
$7.05
|
| Rate for Payer: United Healthcare Medicare |
$4.70
|
| Rate for Payer: WINHealth Partners Commercial |
$7.94
|
| Rate for Payer: Wise Provider Network Commercial |
$7.70
|
|
|
DRAPE 3/4 SHEET
|
Facility
|
IP
|
$8.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.78
|
| Rate for Payer: Altius Commercial |
$7.78
|
| Rate for Payer: Beech Street Commercial |
$7.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.86
|
| Rate for Payer: Cigna of WY Commercial |
$7.94
|
| Rate for Payer: Entrust Commercial |
$7.70
|
| Rate for Payer: First Choice Health Commercial |
$7.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.35
|
| Rate for Payer: HealthUtah PPO |
$8.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.86
|
| Rate for Payer: Multiplan Medicare/VA |
$5.08
|
| Rate for Payer: One Health Plan of WY PPO |
$7.94
|
| Rate for Payer: PacificSource Commercial |
$7.29
|
| Rate for Payer: PHCS PPO |
$7.94
|
| Rate for Payer: Three Rivers PPO |
$6.08
|
| Rate for Payer: TriWest Veterans Administration |
$5.35
|
| Rate for Payer: United Healthcare Commercial |
$7.05
|
| Rate for Payer: United Healthcare Medicare |
$5.35
|
| Rate for Payer: WINHealth Partners Commercial |
$7.70
|
| Rate for Payer: Wise Provider Network Commercial |
$7.70
|
|
|
DRAPE ARTHROSCOPY ONLY
|
Facility
|
IP
|
$51.39
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.33
|
| Rate for Payer: Altius Commercial |
$49.33
|
| Rate for Payer: Beech Street Commercial |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.19
|
| Rate for Payer: Cash Price |
$35.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.85
|
| Rate for Payer: Cigna of WY Commercial |
$50.36
|
| Rate for Payer: Entrust Commercial |
$48.82
|
| Rate for Payer: First Choice Health Commercial |
$48.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$51.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.85
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$50.36
|
| Rate for Payer: PacificSource Commercial |
$46.25
|
| Rate for Payer: PHCS PPO |
$50.36
|
| Rate for Payer: Three Rivers PPO |
$38.54
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$44.71
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$48.82
|
| Rate for Payer: Wise Provider Network Commercial |
$48.82
|
|
|
DRAPE ARTHROSCOPY ONLY
|
Facility
|
OP
|
$51.39
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.36
|
| Rate for Payer: Aetna of WY Medicare |
$33.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.33
|
| Rate for Payer: Altius Commercial |
$49.33
|
| Rate for Payer: Beech Street Commercial |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.19
|
| Rate for Payer: Cash Price |
$35.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.85
|
| Rate for Payer: Cigna of WY Commercial |
$50.36
|
| Rate for Payer: Entrust Commercial |
$48.82
|
| Rate for Payer: First Choice Health Commercial |
$48.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.81
|
| Rate for Payer: HealthUtah PPO |
$51.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.85
|
| Rate for Payer: Multiplan Medicare/VA |
$28.32
|
| Rate for Payer: One Health Plan of WY PPO |
$50.36
|
| Rate for Payer: PacificSource Commercial |
$46.25
|
| Rate for Payer: PHCS PPO |
$50.36
|
| Rate for Payer: Three Rivers PPO |
$38.54
|
| Rate for Payer: TriWest Veterans Administration |
$29.81
|
| Rate for Payer: United Healthcare Commercial |
$44.71
|
| Rate for Payer: United Healthcare Medicare |
$29.81
|
| Rate for Payer: WINHealth Partners Commercial |
$50.36
|
| Rate for Payer: Wise Provider Network Commercial |
$48.82
|
|
|
DRAPE BI LIMB 76 X 124
|
Facility
|
OP
|
$27.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.33
|
| Rate for Payer: Aetna of WY Medicare |
$18.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.77
|
| Rate for Payer: Altius Commercial |
$26.77
|
| Rate for Payer: Beech Street Commercial |
$27.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.90
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.05
|
| Rate for Payer: Cigna of WY Commercial |
$27.33
|
| Rate for Payer: Entrust Commercial |
$26.50
|
| Rate for Payer: First Choice Health Commercial |
$26.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.18
|
| Rate for Payer: HealthUtah PPO |
$27.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.05
|
| Rate for Payer: Multiplan Medicare/VA |
$15.37
|
| Rate for Payer: One Health Plan of WY PPO |
$27.33
|
| Rate for Payer: PacificSource Commercial |
$25.10
|
| Rate for Payer: PHCS PPO |
$27.33
|
| Rate for Payer: Three Rivers PPO |
$20.92
|
| Rate for Payer: TriWest Veterans Administration |
$16.18
|
| Rate for Payer: United Healthcare Commercial |
$24.26
|
| Rate for Payer: United Healthcare Medicare |
$16.18
|
| Rate for Payer: WINHealth Partners Commercial |
$27.33
|
| Rate for Payer: Wise Provider Network Commercial |
$26.50
|
|
|
DRAPE BI LIMB 76 X 124
|
Facility
|
IP
|
$27.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.77
|
| Rate for Payer: Altius Commercial |
$26.77
|
| Rate for Payer: Beech Street Commercial |
$27.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.90
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.05
|
| Rate for Payer: Cigna of WY Commercial |
$27.33
|
| Rate for Payer: Entrust Commercial |
$26.50
|
| Rate for Payer: First Choice Health Commercial |
$26.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.41
|
| Rate for Payer: HealthUtah PPO |
$27.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.05
|
| Rate for Payer: Multiplan Medicare/VA |
$17.49
|
| Rate for Payer: One Health Plan of WY PPO |
$27.33
|
| Rate for Payer: PacificSource Commercial |
$25.10
|
| Rate for Payer: PHCS PPO |
$27.33
|
| Rate for Payer: Three Rivers PPO |
$20.92
|
| Rate for Payer: TriWest Veterans Administration |
$18.41
|
| Rate for Payer: United Healthcare Commercial |
$24.26
|
| Rate for Payer: United Healthcare Medicare |
$18.41
|
| Rate for Payer: WINHealth Partners Commercial |
$26.50
|
| Rate for Payer: Wise Provider Network Commercial |
$26.50
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY 38X44 STERILE
|
Facility
|
IP
|
$5.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.44
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.66
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.74
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.56
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$4.93
|
| Rate for Payer: United Healthcare Medicare |
$3.74
|
| Rate for Payer: WINHealth Partners Commercial |
$5.39
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY 38X44 STERILE
|
Facility
|
OP
|
$5.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.44
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.66
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.29
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.12
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.29
|
| Rate for Payer: United Healthcare Commercial |
$4.93
|
| Rate for Payer: United Healthcare Medicare |
$3.29
|
| Rate for Payer: WINHealth Partners Commercial |
$5.56
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
DRAPE C-ARM 42"X74" JENSEN
|
Facility
|
IP
|
$7.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$7.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.00
|
| Rate for Payer: Altius Commercial |
$7.00
|
| Rate for Payer: Beech Street Commercial |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.07
|
| Rate for Payer: Cigna of WY Commercial |
$7.14
|
| Rate for Payer: Entrust Commercial |
$6.93
|
| Rate for Payer: First Choice Health Commercial |
$6.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.81
|
| Rate for Payer: HealthUtah PPO |
$7.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.07
|
| Rate for Payer: Multiplan Medicare/VA |
$4.57
|
| Rate for Payer: One Health Plan of WY PPO |
$7.14
|
| Rate for Payer: PacificSource Commercial |
$6.56
|
| Rate for Payer: PHCS PPO |
$7.14
|
| Rate for Payer: Three Rivers PPO |
$5.47
|
| Rate for Payer: TriWest Veterans Administration |
$4.81
|
| Rate for Payer: United Healthcare Commercial |
$6.34
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WINHealth Partners Commercial |
$6.93
|
| Rate for Payer: Wise Provider Network Commercial |
$6.93
|
|
|
DRAPE C-ARM 42"X74" JENSEN
|
Facility
|
OP
|
$7.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.14
|
| Rate for Payer: Aetna of WY Medicare |
$4.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.00
|
| Rate for Payer: Altius Commercial |
$7.00
|
| Rate for Payer: Beech Street Commercial |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.07
|
| Rate for Payer: Cigna of WY Commercial |
$7.14
|
| Rate for Payer: Entrust Commercial |
$6.93
|
| Rate for Payer: First Choice Health Commercial |
$6.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.23
|
| Rate for Payer: HealthUtah PPO |
$7.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.07
|
| Rate for Payer: Multiplan Medicare/VA |
$4.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.14
|
| Rate for Payer: PacificSource Commercial |
$6.56
|
| Rate for Payer: PHCS PPO |
$7.14
|
| Rate for Payer: Three Rivers PPO |
$5.47
|
| Rate for Payer: TriWest Veterans Administration |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$6.34
|
| Rate for Payer: United Healthcare Medicare |
$4.23
|
| Rate for Payer: WINHealth Partners Commercial |
$7.14
|
| Rate for Payer: Wise Provider Network Commercial |
$6.93
|
|
|
DRAPE C-ARM DISP
|
Facility
|
OP
|
$5.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.03
|
| Rate for Payer: Aetna of WY Medicare |
$3.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.92
|
| Rate for Payer: Altius Commercial |
$4.92
|
| Rate for Payer: Beech Street Commercial |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.21
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.98
|
| Rate for Payer: Cigna of WY Commercial |
$5.03
|
| Rate for Payer: Entrust Commercial |
$4.87
|
| Rate for Payer: First Choice Health Commercial |
$4.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.98
|
| Rate for Payer: HealthUtah PPO |
$5.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.98
|
| Rate for Payer: Multiplan Medicare/VA |
$2.83
|
| Rate for Payer: One Health Plan of WY PPO |
$5.03
|
| Rate for Payer: PacificSource Commercial |
$4.62
|
| Rate for Payer: PHCS PPO |
$5.03
|
| Rate for Payer: Three Rivers PPO |
$3.85
|
| Rate for Payer: TriWest Veterans Administration |
$2.98
|
| Rate for Payer: United Healthcare Commercial |
$4.46
|
| Rate for Payer: United Healthcare Medicare |
$2.98
|
| Rate for Payer: WINHealth Partners Commercial |
$5.03
|
| Rate for Payer: Wise Provider Network Commercial |
$4.87
|
|
|
DRAPE C-ARM DISP
|
Facility
|
IP
|
$5.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.92
|
| Rate for Payer: Altius Commercial |
$4.92
|
| Rate for Payer: Beech Street Commercial |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.21
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.98
|
| Rate for Payer: Cigna of WY Commercial |
$5.03
|
| Rate for Payer: Entrust Commercial |
$4.87
|
| Rate for Payer: First Choice Health Commercial |
$4.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.39
|
| Rate for Payer: HealthUtah PPO |
$5.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.98
|
| Rate for Payer: Multiplan Medicare/VA |
$3.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5.03
|
| Rate for Payer: PacificSource Commercial |
$4.62
|
| Rate for Payer: PHCS PPO |
$5.03
|
| Rate for Payer: Three Rivers PPO |
$3.85
|
| Rate for Payer: TriWest Veterans Administration |
$3.39
|
| Rate for Payer: United Healthcare Commercial |
$4.46
|
| Rate for Payer: United Healthcare Medicare |
$3.39
|
| Rate for Payer: WINHealth Partners Commercial |
$4.87
|
| Rate for Payer: Wise Provider Network Commercial |
$4.87
|
|
|
DRAPE C-ARM LARGE
|
Facility
|
IP
|
$23.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.35
|
| Rate for Payer: Altius Commercial |
$22.35
|
| Rate for Payer: Beech Street Commercial |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.11
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.58
|
| Rate for Payer: Cigna of WY Commercial |
$22.81
|
| Rate for Payer: Entrust Commercial |
$22.12
|
| Rate for Payer: First Choice Health Commercial |
$22.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.36
|
| Rate for Payer: HealthUtah PPO |
$23.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.58
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$22.81
|
| Rate for Payer: PacificSource Commercial |
$20.95
|
| Rate for Payer: PHCS PPO |
$22.81
|
| Rate for Payer: Three Rivers PPO |
$17.46
|
| Rate for Payer: TriWest Veterans Administration |
$15.36
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Medicare |
$15.36
|
| Rate for Payer: WINHealth Partners Commercial |
$22.12
|
| Rate for Payer: Wise Provider Network Commercial |
$22.12
|
|
|
DRAPE C-ARM LARGE
|
Facility
|
OP
|
$23.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.81
|
| Rate for Payer: Aetna of WY Medicare |
$15.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.35
|
| Rate for Payer: Altius Commercial |
$22.35
|
| Rate for Payer: Beech Street Commercial |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.11
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.58
|
| Rate for Payer: Cigna of WY Commercial |
$22.81
|
| Rate for Payer: Entrust Commercial |
$22.12
|
| Rate for Payer: First Choice Health Commercial |
$22.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$23.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.58
|
| Rate for Payer: Multiplan Medicare/VA |
$12.83
|
| Rate for Payer: One Health Plan of WY PPO |
$22.81
|
| Rate for Payer: PacificSource Commercial |
$20.95
|
| Rate for Payer: PHCS PPO |
$22.81
|
| Rate for Payer: Three Rivers PPO |
$17.46
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$20.25
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$22.81
|
| Rate for Payer: Wise Provider Network Commercial |
$22.12
|
|
|
DRAPE C-ARM MINI
|
Facility
|
OP
|
$88.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.46
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$48.88
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$51.46
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$51.46
|
| Rate for Payer: WINHealth Partners Commercial |
$86.95
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
DRAPE C-ARM MINI
|
Facility
|
IP
|
$88.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.17
|
| Rate for Payer: Altius Commercial |
$85.17
|
| Rate for Payer: Beech Street Commercial |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.84
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.06
|
| Rate for Payer: Cigna of WY Commercial |
$86.95
|
| Rate for Payer: Entrust Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.56
|
| Rate for Payer: HealthUtah PPO |
$88.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.06
|
| Rate for Payer: Multiplan Medicare/VA |
$55.63
|
| Rate for Payer: One Health Plan of WY PPO |
$86.95
|
| Rate for Payer: PacificSource Commercial |
$79.85
|
| Rate for Payer: PHCS PPO |
$86.95
|
| Rate for Payer: Three Rivers PPO |
$66.54
|
| Rate for Payer: TriWest Veterans Administration |
$58.56
|
| Rate for Payer: United Healthcare Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare |
$58.56
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$84.28
|
|
|
DRAPE C-ARMOR STERILE 5600
|
Facility
|
OP
|
$123.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$123.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.48
|
| Rate for Payer: Aetna of WY Medicare |
$81.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.00
|
| Rate for Payer: Altius Commercial |
$119.00
|
| Rate for Payer: Beech Street Commercial |
$121.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.77
|
| Rate for Payer: Cash Price |
$86.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.24
|
| Rate for Payer: Cigna of WY Commercial |
$121.48
|
| Rate for Payer: Entrust Commercial |
$117.76
|
| Rate for Payer: First Choice Health Commercial |
$117.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.90
|
| Rate for Payer: HealthUtah PPO |
$123.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.24
|
| Rate for Payer: Multiplan Medicare/VA |
$68.30
|
| Rate for Payer: One Health Plan of WY PPO |
$121.48
|
| Rate for Payer: PacificSource Commercial |
$111.56
|
| Rate for Payer: PHCS PPO |
$121.48
|
| Rate for Payer: Three Rivers PPO |
$92.97
|
| Rate for Payer: TriWest Veterans Administration |
$71.90
|
| Rate for Payer: United Healthcare Commercial |
$107.85
|
| Rate for Payer: United Healthcare Medicare |
$71.90
|
| Rate for Payer: WINHealth Partners Commercial |
$121.48
|
| Rate for Payer: Wise Provider Network Commercial |
$117.76
|
|
|
DRAPE C-ARMOR STERILE 5600
|
Facility
|
IP
|
$123.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$123.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.00
|
| Rate for Payer: Altius Commercial |
$119.00
|
| Rate for Payer: Beech Street Commercial |
$121.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.77
|
| Rate for Payer: Cash Price |
$86.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.24
|
| Rate for Payer: Cigna of WY Commercial |
$121.48
|
| Rate for Payer: Entrust Commercial |
$117.76
|
| Rate for Payer: First Choice Health Commercial |
$117.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.81
|
| Rate for Payer: HealthUtah PPO |
$123.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.24
|
| Rate for Payer: Multiplan Medicare/VA |
$77.72
|
| Rate for Payer: One Health Plan of WY PPO |
$121.48
|
| Rate for Payer: PacificSource Commercial |
$111.56
|
| Rate for Payer: PHCS PPO |
$121.48
|
| Rate for Payer: Three Rivers PPO |
$92.97
|
| Rate for Payer: TriWest Veterans Administration |
$81.81
|
| Rate for Payer: United Healthcare Commercial |
$107.85
|
| Rate for Payer: United Healthcare Medicare |
$81.81
|
| Rate for Payer: WINHealth Partners Commercial |
$117.76
|
| Rate for Payer: Wise Provider Network Commercial |
$117.76
|
|
