|
DRAPE CASSETTE 24X40
|
Facility
|
IP
|
$4.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.97
|
| Rate for Payer: Altius Commercial |
$3.97
|
| Rate for Payer: Beech Street Commercial |
$4.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.02
|
| Rate for Payer: Cigna of WY Commercial |
$4.06
|
| Rate for Payer: Entrust Commercial |
$3.93
|
| Rate for Payer: First Choice Health Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.73
|
| Rate for Payer: HealthUtah PPO |
$4.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.02
|
| Rate for Payer: Multiplan Medicare/VA |
$2.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4.06
|
| Rate for Payer: PacificSource Commercial |
$3.73
|
| Rate for Payer: PHCS PPO |
$4.06
|
| Rate for Payer: Three Rivers PPO |
$3.10
|
| Rate for Payer: TriWest Veterans Administration |
$2.73
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$2.73
|
| Rate for Payer: WINHealth Partners Commercial |
$3.93
|
| Rate for Payer: Wise Provider Network Commercial |
$3.93
|
|
|
DRAPE CASSETTE 24X40
|
Facility
|
OP
|
$4.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.06
|
| Rate for Payer: Aetna of WY Medicare |
$2.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.97
|
| Rate for Payer: Altius Commercial |
$3.97
|
| Rate for Payer: Beech Street Commercial |
$4.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.02
|
| Rate for Payer: Cigna of WY Commercial |
$4.06
|
| Rate for Payer: Entrust Commercial |
$3.93
|
| Rate for Payer: First Choice Health Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.40
|
| Rate for Payer: HealthUtah PPO |
$4.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.02
|
| Rate for Payer: Multiplan Medicare/VA |
$2.28
|
| Rate for Payer: One Health Plan of WY PPO |
$4.06
|
| Rate for Payer: PacificSource Commercial |
$3.73
|
| Rate for Payer: PHCS PPO |
$4.06
|
| Rate for Payer: Three Rivers PPO |
$3.10
|
| Rate for Payer: TriWest Veterans Administration |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4.06
|
| Rate for Payer: Wise Provider Network Commercial |
$3.93
|
|
|
DRAPE CESAREAN C-SECTION
|
Facility
|
OP
|
$64.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$64.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.62
|
| Rate for Payer: Aetna of WY Medicare |
$42.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.32
|
| Rate for Payer: Altius Commercial |
$62.32
|
| Rate for Payer: Beech Street Commercial |
$63.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.30
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.97
|
| Rate for Payer: Cigna of WY Commercial |
$63.62
|
| Rate for Payer: Entrust Commercial |
$61.67
|
| Rate for Payer: First Choice Health Commercial |
$61.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.65
|
| Rate for Payer: HealthUtah PPO |
$64.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.97
|
| Rate for Payer: Multiplan Medicare/VA |
$35.77
|
| Rate for Payer: One Health Plan of WY PPO |
$63.62
|
| Rate for Payer: PacificSource Commercial |
$58.43
|
| Rate for Payer: PHCS PPO |
$63.62
|
| Rate for Payer: Three Rivers PPO |
$48.69
|
| Rate for Payer: TriWest Veterans Administration |
$37.65
|
| Rate for Payer: United Healthcare Commercial |
$56.48
|
| Rate for Payer: United Healthcare Medicare |
$37.65
|
| Rate for Payer: WINHealth Partners Commercial |
$63.62
|
| Rate for Payer: Wise Provider Network Commercial |
$61.67
|
|
|
DRAPE CESAREAN C-SECTION
|
Facility
|
IP
|
$64.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$64.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.32
|
| Rate for Payer: Altius Commercial |
$62.32
|
| Rate for Payer: Beech Street Commercial |
$63.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.30
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.97
|
| Rate for Payer: Cigna of WY Commercial |
$63.62
|
| Rate for Payer: Entrust Commercial |
$61.67
|
| Rate for Payer: First Choice Health Commercial |
$61.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.85
|
| Rate for Payer: HealthUtah PPO |
$64.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.97
|
| Rate for Payer: Multiplan Medicare/VA |
$40.70
|
| Rate for Payer: One Health Plan of WY PPO |
$63.62
|
| Rate for Payer: PacificSource Commercial |
$58.43
|
| Rate for Payer: PHCS PPO |
$63.62
|
| Rate for Payer: Three Rivers PPO |
$48.69
|
| Rate for Payer: TriWest Veterans Administration |
$42.85
|
| Rate for Payer: United Healthcare Commercial |
$56.48
|
| Rate for Payer: United Healthcare Medicare |
$42.85
|
| Rate for Payer: WINHealth Partners Commercial |
$61.67
|
| Rate for Payer: Wise Provider Network Commercial |
$61.67
|
|
|
DRAPE CYSTOSCOPY
|
Facility
|
OP
|
$12.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.90
|
| Rate for Payer: Aetna of WY Medicare |
$8.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.65
|
| Rate for Payer: Altius Commercial |
$11.65
|
| Rate for Payer: Beech Street Commercial |
$11.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.97
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.78
|
| Rate for Payer: Cigna of WY Commercial |
$11.90
|
| Rate for Payer: Entrust Commercial |
$11.53
|
| Rate for Payer: First Choice Health Commercial |
$11.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.04
|
| Rate for Payer: HealthUtah PPO |
$12.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.78
|
| Rate for Payer: Multiplan Medicare/VA |
$6.69
|
| Rate for Payer: One Health Plan of WY PPO |
$11.90
|
| Rate for Payer: PacificSource Commercial |
$10.93
|
| Rate for Payer: PHCS PPO |
$11.90
|
| Rate for Payer: Three Rivers PPO |
$9.10
|
| Rate for Payer: TriWest Veterans Administration |
$7.04
|
| Rate for Payer: United Healthcare Commercial |
$10.56
|
| Rate for Payer: United Healthcare Medicare |
$7.04
|
| Rate for Payer: WINHealth Partners Commercial |
$11.90
|
| Rate for Payer: Wise Provider Network Commercial |
$11.53
|
|
|
DRAPE CYSTOSCOPY
|
Facility
|
IP
|
$12.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.65
|
| Rate for Payer: Altius Commercial |
$11.65
|
| Rate for Payer: Beech Street Commercial |
$11.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.97
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.78
|
| Rate for Payer: Cigna of WY Commercial |
$11.90
|
| Rate for Payer: Entrust Commercial |
$11.53
|
| Rate for Payer: First Choice Health Commercial |
$11.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.01
|
| Rate for Payer: HealthUtah PPO |
$12.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.78
|
| Rate for Payer: Multiplan Medicare/VA |
$7.61
|
| Rate for Payer: One Health Plan of WY PPO |
$11.90
|
| Rate for Payer: PacificSource Commercial |
$10.93
|
| Rate for Payer: PHCS PPO |
$11.90
|
| Rate for Payer: Three Rivers PPO |
$9.10
|
| Rate for Payer: TriWest Veterans Administration |
$8.01
|
| Rate for Payer: United Healthcare Commercial |
$10.56
|
| Rate for Payer: United Healthcare Medicare |
$8.01
|
| Rate for Payer: WINHealth Partners Commercial |
$11.53
|
| Rate for Payer: Wise Provider Network Commercial |
$11.53
|
|
|
DRAPE EXTREMITY (ONLY)
|
Facility
|
IP
|
$21.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.38
|
| Rate for Payer: Altius Commercial |
$20.38
|
| Rate for Payer: Beech Street Commercial |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.59
|
| Rate for Payer: Cigna of WY Commercial |
$20.81
|
| Rate for Payer: Entrust Commercial |
$20.17
|
| Rate for Payer: First Choice Health Commercial |
$20.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.01
|
| Rate for Payer: HealthUtah PPO |
$21.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.59
|
| Rate for Payer: Multiplan Medicare/VA |
$13.31
|
| Rate for Payer: One Health Plan of WY PPO |
$20.81
|
| Rate for Payer: PacificSource Commercial |
$19.11
|
| Rate for Payer: PHCS PPO |
$20.81
|
| Rate for Payer: Three Rivers PPO |
$15.92
|
| Rate for Payer: TriWest Veterans Administration |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$18.47
|
| Rate for Payer: United Healthcare Medicare |
$14.01
|
| Rate for Payer: WINHealth Partners Commercial |
$20.17
|
| Rate for Payer: Wise Provider Network Commercial |
$20.17
|
|
|
DRAPE EXTREMITY (ONLY)
|
Facility
|
OP
|
$21.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.81
|
| Rate for Payer: Aetna of WY Medicare |
$14.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.38
|
| Rate for Payer: Altius Commercial |
$20.38
|
| Rate for Payer: Beech Street Commercial |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.59
|
| Rate for Payer: Cigna of WY Commercial |
$20.81
|
| Rate for Payer: Entrust Commercial |
$20.17
|
| Rate for Payer: First Choice Health Commercial |
$20.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.31
|
| Rate for Payer: HealthUtah PPO |
$21.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.59
|
| Rate for Payer: Multiplan Medicare/VA |
$11.70
|
| Rate for Payer: One Health Plan of WY PPO |
$20.81
|
| Rate for Payer: PacificSource Commercial |
$19.11
|
| Rate for Payer: PHCS PPO |
$20.81
|
| Rate for Payer: Three Rivers PPO |
$15.92
|
| Rate for Payer: TriWest Veterans Administration |
$12.31
|
| Rate for Payer: United Healthcare Commercial |
$18.47
|
| Rate for Payer: United Healthcare Medicare |
$12.31
|
| Rate for Payer: WINHealth Partners Commercial |
$20.81
|
| Rate for Payer: Wise Provider Network Commercial |
$20.17
|
|
|
DRAPE FEMORAL ANGIOGRAPHY POUCH
|
Facility
|
OP
|
$36.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.90
|
| Rate for Payer: Aetna of WY Medicare |
$24.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.16
|
| Rate for Payer: Altius Commercial |
$35.16
|
| Rate for Payer: Beech Street Commercial |
$35.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.07
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.53
|
| Rate for Payer: Cigna of WY Commercial |
$35.90
|
| Rate for Payer: Entrust Commercial |
$34.80
|
| Rate for Payer: First Choice Health Commercial |
$34.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.25
|
| Rate for Payer: HealthUtah PPO |
$36.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.53
|
| Rate for Payer: Multiplan Medicare/VA |
$20.18
|
| Rate for Payer: One Health Plan of WY PPO |
$35.90
|
| Rate for Payer: PacificSource Commercial |
$32.97
|
| Rate for Payer: PHCS PPO |
$35.90
|
| Rate for Payer: Three Rivers PPO |
$27.47
|
| Rate for Payer: TriWest Veterans Administration |
$21.25
|
| Rate for Payer: United Healthcare Commercial |
$31.87
|
| Rate for Payer: United Healthcare Medicare |
$21.25
|
| Rate for Payer: WINHealth Partners Commercial |
$35.90
|
| Rate for Payer: Wise Provider Network Commercial |
$34.80
|
|
|
DRAPE FEMORAL ANGIOGRAPHY POUCH
|
Facility
|
IP
|
$36.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.16
|
| Rate for Payer: Altius Commercial |
$35.16
|
| Rate for Payer: Beech Street Commercial |
$35.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.07
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.53
|
| Rate for Payer: Cigna of WY Commercial |
$35.90
|
| Rate for Payer: Entrust Commercial |
$34.80
|
| Rate for Payer: First Choice Health Commercial |
$34.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.18
|
| Rate for Payer: HealthUtah PPO |
$36.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.53
|
| Rate for Payer: Multiplan Medicare/VA |
$22.97
|
| Rate for Payer: One Health Plan of WY PPO |
$35.90
|
| Rate for Payer: PacificSource Commercial |
$32.97
|
| Rate for Payer: PHCS PPO |
$35.90
|
| Rate for Payer: Three Rivers PPO |
$27.47
|
| Rate for Payer: TriWest Veterans Administration |
$24.18
|
| Rate for Payer: United Healthcare Commercial |
$31.87
|
| Rate for Payer: United Healthcare Medicare |
$24.18
|
| Rate for Payer: WINHealth Partners Commercial |
$34.80
|
| Rate for Payer: Wise Provider Network Commercial |
$34.80
|
|
|
DRAPE HAND TALLJOST
|
Facility
|
OP
|
$23.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$23.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.14
|
| Rate for Payer: Aetna of WY Medicare |
$15.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.67
|
| Rate for Payer: Altius Commercial |
$22.67
|
| Rate for Payer: Beech Street Commercial |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.90
|
| Rate for Payer: Cigna of WY Commercial |
$23.14
|
| Rate for Payer: Entrust Commercial |
$22.43
|
| Rate for Payer: First Choice Health Commercial |
$22.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.69
|
| Rate for Payer: HealthUtah PPO |
$23.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.90
|
| Rate for Payer: Multiplan Medicare/VA |
$13.01
|
| Rate for Payer: One Health Plan of WY PPO |
$23.14
|
| Rate for Payer: PacificSource Commercial |
$21.25
|
| Rate for Payer: PHCS PPO |
$23.14
|
| Rate for Payer: Three Rivers PPO |
$17.71
|
| Rate for Payer: TriWest Veterans Administration |
$13.69
|
| Rate for Payer: United Healthcare Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WINHealth Partners Commercial |
$23.14
|
| Rate for Payer: Wise Provider Network Commercial |
$22.43
|
|
|
DRAPE HAND TALLJOST
|
Facility
|
IP
|
$23.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$23.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.67
|
| Rate for Payer: Altius Commercial |
$22.67
|
| Rate for Payer: Beech Street Commercial |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.90
|
| Rate for Payer: Cigna of WY Commercial |
$23.14
|
| Rate for Payer: Entrust Commercial |
$22.43
|
| Rate for Payer: First Choice Health Commercial |
$22.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.58
|
| Rate for Payer: HealthUtah PPO |
$23.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.90
|
| Rate for Payer: Multiplan Medicare/VA |
$14.80
|
| Rate for Payer: One Health Plan of WY PPO |
$23.14
|
| Rate for Payer: PacificSource Commercial |
$21.25
|
| Rate for Payer: PHCS PPO |
$23.14
|
| Rate for Payer: Three Rivers PPO |
$17.71
|
| Rate for Payer: TriWest Veterans Administration |
$15.58
|
| Rate for Payer: United Healthcare Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare |
$15.58
|
| Rate for Payer: WINHealth Partners Commercial |
$22.43
|
| Rate for Payer: Wise Provider Network Commercial |
$22.43
|
|
|
DRAPE IMPERVIOUS U-DRAPE
|
Facility
|
OP
|
$6.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.24
|
| Rate for Payer: Aetna of WY Medicare |
$4.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.12
|
| Rate for Payer: Altius Commercial |
$6.12
|
| Rate for Payer: Beech Street Commercial |
$6.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.18
|
| Rate for Payer: Cigna of WY Commercial |
$6.24
|
| Rate for Payer: Entrust Commercial |
$6.05
|
| Rate for Payer: First Choice Health Commercial |
$6.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.69
|
| Rate for Payer: HealthUtah PPO |
$6.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.18
|
| Rate for Payer: Multiplan Medicare/VA |
$3.51
|
| Rate for Payer: One Health Plan of WY PPO |
$6.24
|
| Rate for Payer: PacificSource Commercial |
$5.73
|
| Rate for Payer: PHCS PPO |
$6.24
|
| Rate for Payer: Three Rivers PPO |
$4.78
|
| Rate for Payer: TriWest Veterans Administration |
$3.69
|
| Rate for Payer: United Healthcare Commercial |
$5.54
|
| Rate for Payer: United Healthcare Medicare |
$3.69
|
| Rate for Payer: WINHealth Partners Commercial |
$6.24
|
| Rate for Payer: Wise Provider Network Commercial |
$6.05
|
|
|
DRAPE IMPERVIOUS U-DRAPE
|
Facility
|
IP
|
$6.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.12
|
| Rate for Payer: Altius Commercial |
$6.12
|
| Rate for Payer: Beech Street Commercial |
$6.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.18
|
| Rate for Payer: Cigna of WY Commercial |
$6.24
|
| Rate for Payer: Entrust Commercial |
$6.05
|
| Rate for Payer: First Choice Health Commercial |
$6.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.20
|
| Rate for Payer: HealthUtah PPO |
$6.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.18
|
| Rate for Payer: Multiplan Medicare/VA |
$3.99
|
| Rate for Payer: One Health Plan of WY PPO |
$6.24
|
| Rate for Payer: PacificSource Commercial |
$5.73
|
| Rate for Payer: PHCS PPO |
$6.24
|
| Rate for Payer: Three Rivers PPO |
$4.78
|
| Rate for Payer: TriWest Veterans Administration |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$5.54
|
| Rate for Payer: United Healthcare Medicare |
$4.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6.05
|
| Rate for Payer: Wise Provider Network Commercial |
$6.05
|
|
|
DRAPE IOBAN
|
Facility
|
IP
|
$24.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.16
|
| Rate for Payer: Altius Commercial |
$23.16
|
| Rate for Payer: Beech Street Commercial |
$23.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.81
|
| Rate for Payer: Cash Price |
$16.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.41
|
| Rate for Payer: Cigna of WY Commercial |
$23.65
|
| Rate for Payer: Entrust Commercial |
$22.92
|
| Rate for Payer: First Choice Health Commercial |
$22.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.93
|
| Rate for Payer: HealthUtah PPO |
$24.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.41
|
| Rate for Payer: Multiplan Medicare/VA |
$15.13
|
| Rate for Payer: One Health Plan of WY PPO |
$23.65
|
| Rate for Payer: PacificSource Commercial |
$21.72
|
| Rate for Payer: PHCS PPO |
$23.65
|
| Rate for Payer: Three Rivers PPO |
$18.10
|
| Rate for Payer: TriWest Veterans Administration |
$15.93
|
| Rate for Payer: United Healthcare Commercial |
$20.99
|
| Rate for Payer: United Healthcare Medicare |
$15.93
|
| Rate for Payer: WINHealth Partners Commercial |
$22.92
|
| Rate for Payer: Wise Provider Network Commercial |
$22.92
|
|
|
DRAPE IOBAN
|
Facility
|
OP
|
$24.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.65
|
| Rate for Payer: Aetna of WY Medicare |
$15.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.16
|
| Rate for Payer: Altius Commercial |
$23.16
|
| Rate for Payer: Beech Street Commercial |
$23.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.81
|
| Rate for Payer: Cash Price |
$16.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.41
|
| Rate for Payer: Cigna of WY Commercial |
$23.65
|
| Rate for Payer: Entrust Commercial |
$22.92
|
| Rate for Payer: First Choice Health Commercial |
$22.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.00
|
| Rate for Payer: HealthUtah PPO |
$24.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.41
|
| Rate for Payer: Multiplan Medicare/VA |
$13.30
|
| Rate for Payer: One Health Plan of WY PPO |
$23.65
|
| Rate for Payer: PacificSource Commercial |
$21.72
|
| Rate for Payer: PHCS PPO |
$23.65
|
| Rate for Payer: Three Rivers PPO |
$18.10
|
| Rate for Payer: TriWest Veterans Administration |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$20.99
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
| Rate for Payer: WINHealth Partners Commercial |
$23.65
|
| Rate for Payer: Wise Provider Network Commercial |
$22.92
|
|
|
DRAPE LAPAROTOMY SHEET
|
Facility
|
IP
|
$16.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.59
|
| Rate for Payer: Altius Commercial |
$15.59
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.33
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.75
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.43
|
| Rate for Payer: First Choice Health Commercial |
$15.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.72
|
| Rate for Payer: HealthUtah PPO |
$16.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.75
|
| Rate for Payer: Multiplan Medicare/VA |
$10.18
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.72
|
| Rate for Payer: United Healthcare Commercial |
$14.13
|
| Rate for Payer: United Healthcare Medicare |
$10.72
|
| Rate for Payer: WINHealth Partners Commercial |
$15.43
|
| Rate for Payer: Wise Provider Network Commercial |
$15.43
|
|
|
DRAPE LAPAROTOMY SHEET
|
Facility
|
OP
|
$16.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.59
|
| Rate for Payer: Altius Commercial |
$15.59
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.33
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.75
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.43
|
| Rate for Payer: First Choice Health Commercial |
$15.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.42
|
| Rate for Payer: HealthUtah PPO |
$16.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.75
|
| Rate for Payer: Multiplan Medicare/VA |
$8.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.18
|
| Rate for Payer: TriWest Veterans Administration |
$9.42
|
| Rate for Payer: United Healthcare Commercial |
$14.13
|
| Rate for Payer: United Healthcare Medicare |
$9.42
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.43
|
|
|
DRAPE LEGGINGS 31X48" 6" CUFF
|
Facility
|
IP
|
$7.55
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.25
|
| Rate for Payer: Altius Commercial |
$7.25
|
| Rate for Payer: Beech Street Commercial |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.32
|
| Rate for Payer: Cigna of WY Commercial |
$7.40
|
| Rate for Payer: Entrust Commercial |
$7.17
|
| Rate for Payer: First Choice Health Commercial |
$7.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.98
|
| Rate for Payer: HealthUtah PPO |
$7.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.32
|
| Rate for Payer: Multiplan Medicare/VA |
$4.73
|
| Rate for Payer: One Health Plan of WY PPO |
$7.40
|
| Rate for Payer: PacificSource Commercial |
$6.80
|
| Rate for Payer: PHCS PPO |
$7.40
|
| Rate for Payer: Three Rivers PPO |
$5.66
|
| Rate for Payer: TriWest Veterans Administration |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
| Rate for Payer: WINHealth Partners Commercial |
$7.17
|
| Rate for Payer: Wise Provider Network Commercial |
$7.17
|
|
|
DRAPE LEGGINGS 31X48" 6" CUFF
|
Facility
|
OP
|
$7.55
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.40
|
| Rate for Payer: Aetna of WY Medicare |
$4.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.25
|
| Rate for Payer: Altius Commercial |
$7.25
|
| Rate for Payer: Beech Street Commercial |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.32
|
| Rate for Payer: Cigna of WY Commercial |
$7.40
|
| Rate for Payer: Entrust Commercial |
$7.17
|
| Rate for Payer: First Choice Health Commercial |
$7.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.38
|
| Rate for Payer: HealthUtah PPO |
$7.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.32
|
| Rate for Payer: Multiplan Medicare/VA |
$4.16
|
| Rate for Payer: One Health Plan of WY PPO |
$7.40
|
| Rate for Payer: PacificSource Commercial |
$6.80
|
| Rate for Payer: PHCS PPO |
$7.40
|
| Rate for Payer: Three Rivers PPO |
$5.66
|
| Rate for Payer: TriWest Veterans Administration |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare |
$4.38
|
| Rate for Payer: WINHealth Partners Commercial |
$7.40
|
| Rate for Payer: Wise Provider Network Commercial |
$7.17
|
|
|
DRAPE LITHOTOMY W/FLUID
|
Facility
|
OP
|
$32.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Aetna of WY Medicare |
$21.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.45
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Multiplan Medicare/VA |
$18.05
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: TriWest Veterans Administration |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$19.00
|
| Rate for Payer: WINHealth Partners Commercial |
$32.10
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
|
|
DRAPE LITHOTOMY W/FLUID
|
Facility
|
IP
|
$32.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.45
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.62
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Multiplan Medicare/VA |
$20.54
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: TriWest Veterans Administration |
$21.62
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$21.62
|
| Rate for Payer: WINHealth Partners Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
|
|
DRAPE MAYO STAND
|
Facility
|
IP
|
$3.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.92
|
| Rate for Payer: Altius Commercial |
$2.92
|
| Rate for Payer: Beech Street Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.95
|
| Rate for Payer: Cigna of WY Commercial |
$2.98
|
| Rate for Payer: Entrust Commercial |
$2.89
|
| Rate for Payer: First Choice Health Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.01
|
| Rate for Payer: HealthUtah PPO |
$3.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1.91
|
| Rate for Payer: One Health Plan of WY PPO |
$2.98
|
| Rate for Payer: PacificSource Commercial |
$2.74
|
| Rate for Payer: PHCS PPO |
$2.98
|
| Rate for Payer: Three Rivers PPO |
$2.28
|
| Rate for Payer: TriWest Veterans Administration |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$2.64
|
| Rate for Payer: United Healthcare Medicare |
$2.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2.89
|
| Rate for Payer: Wise Provider Network Commercial |
$2.89
|
|
|
DRAPE MAYO STAND
|
Facility
|
OP
|
$3.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.98
|
| Rate for Payer: Aetna of WY Medicare |
$2.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.92
|
| Rate for Payer: Altius Commercial |
$2.92
|
| Rate for Payer: Beech Street Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.95
|
| Rate for Payer: Cigna of WY Commercial |
$2.98
|
| Rate for Payer: Entrust Commercial |
$2.89
|
| Rate for Payer: First Choice Health Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.76
|
| Rate for Payer: HealthUtah PPO |
$3.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2.98
|
| Rate for Payer: PacificSource Commercial |
$2.74
|
| Rate for Payer: PHCS PPO |
$2.98
|
| Rate for Payer: Three Rivers PPO |
$2.28
|
| Rate for Payer: TriWest Veterans Administration |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$2.64
|
| Rate for Payer: United Healthcare Medicare |
$1.76
|
| Rate for Payer: WINHealth Partners Commercial |
$2.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2.89
|
|
|
DRAPE MICROSCOPE ZEISS TIVATO
|
Facility
|
OP
|
$135.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$135.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.40
|
| Rate for Payer: Aetna of WY Medicare |
$89.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.70
|
| Rate for Payer: Altius Commercial |
$129.70
|
| Rate for Payer: Beech Street Commercial |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.92
|
| Rate for Payer: Cash Price |
$94.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.05
|
| Rate for Payer: Cigna of WY Commercial |
$132.40
|
| Rate for Payer: Entrust Commercial |
$128.34
|
| Rate for Payer: First Choice Health Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.36
|
| Rate for Payer: HealthUtah PPO |
$135.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.05
|
| Rate for Payer: Multiplan Medicare/VA |
$74.44
|
| Rate for Payer: One Health Plan of WY PPO |
$132.40
|
| Rate for Payer: PacificSource Commercial |
$121.59
|
| Rate for Payer: PHCS PPO |
$132.40
|
| Rate for Payer: Three Rivers PPO |
$101.32
|
| Rate for Payer: TriWest Veterans Administration |
$78.36
|
| Rate for Payer: United Healthcare Commercial |
$117.54
|
| Rate for Payer: United Healthcare Medicare |
$78.36
|
| Rate for Payer: WINHealth Partners Commercial |
$132.40
|
| Rate for Payer: Wise Provider Network Commercial |
$128.34
|
|
