|
DAVINCI DRAPE INSTRUMENT ARM
|
Facility
|
OP
|
$191.10
|
|
| Hospital Charge Code |
2850011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$191.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.28
|
| Rate for Payer: Aetna of WY Medicare |
$126.13
|
| Rate for Payer: Altius Commercial |
$183.46
|
| Rate for Payer: Beech Street Commercial |
$187.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.37
|
| Rate for Payer: Cash Price |
$133.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.37
|
| Rate for Payer: Cigna of WY Commercial |
$187.28
|
| Rate for Payer: Entrust Commercial |
$181.54
|
| Rate for Payer: First Choice Health Commercial |
$181.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.93
|
| Rate for Payer: HealthUtah PPO |
$191.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.37
|
| Rate for Payer: Multiplan Medicare/VA |
$103.48
|
| Rate for Payer: One Health Plan of WY PPO |
$187.28
|
| Rate for Payer: PacificSource Commercial |
$171.99
|
| Rate for Payer: PHCS PPO |
$187.28
|
| Rate for Payer: Three Rivers PPO |
$143.32
|
| Rate for Payer: TriWest Veterans Administration |
$108.93
|
| Rate for Payer: United Healthcare Commercial |
$182.50
|
| Rate for Payer: United Healthcare Medicare |
$108.93
|
| Rate for Payer: WINHealth Partners Commercial |
$187.28
|
| Rate for Payer: Wise Provider Network Commercial |
$181.54
|
|
|
DAVINCI ENDOWRIST SUCTION
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2850009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$341.88
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.26
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$280.50
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.26
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$295.26
|
| Rate for Payer: WINHealth Partners Commercial |
$507.64
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
DAVINCI ENDOWRIST SUCTION
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2850009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$331.52
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.98
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$300.18
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$315.98
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$315.98
|
| Rate for Payer: WINHealth Partners Commercial |
$492.10
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
DAVINCI HEMOLOK M/L GREEN LIGATING CLIP
|
Facility
|
OP
|
$103.85
|
|
| Hospital Charge Code |
2850013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$103.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.77
|
| Rate for Payer: Aetna of WY Medicare |
$68.54
|
| Rate for Payer: Altius Commercial |
$99.70
|
| Rate for Payer: Beech Street Commercial |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.73
|
| Rate for Payer: Cash Price |
$72.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.73
|
| Rate for Payer: Cigna of WY Commercial |
$101.77
|
| Rate for Payer: Entrust Commercial |
$98.66
|
| Rate for Payer: First Choice Health Commercial |
$98.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.19
|
| Rate for Payer: HealthUtah PPO |
$103.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.73
|
| Rate for Payer: Multiplan Medicare/VA |
$56.23
|
| Rate for Payer: One Health Plan of WY PPO |
$101.77
|
| Rate for Payer: PacificSource Commercial |
$93.46
|
| Rate for Payer: PHCS PPO |
$101.77
|
| Rate for Payer: Three Rivers PPO |
$77.89
|
| Rate for Payer: TriWest Veterans Administration |
$59.19
|
| Rate for Payer: United Healthcare Commercial |
$99.18
|
| Rate for Payer: United Healthcare Medicare |
$59.19
|
| Rate for Payer: WINHealth Partners Commercial |
$101.77
|
| Rate for Payer: Wise Provider Network Commercial |
$98.66
|
|
|
DAVINCI HEMOLOK M/L GREEN LIGATING CLIP
|
Facility
|
IP
|
$103.85
|
|
| Hospital Charge Code |
2850013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$103.85 |
| Rate for Payer: United Healthcare Commercial |
$99.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.77
|
| Rate for Payer: Aetna of WY Medicare |
$66.46
|
| Rate for Payer: Altius Commercial |
$99.70
|
| Rate for Payer: Beech Street Commercial |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.73
|
| Rate for Payer: Cash Price |
$72.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.73
|
| Rate for Payer: Cigna of WY Commercial |
$101.77
|
| Rate for Payer: Entrust Commercial |
$98.66
|
| Rate for Payer: First Choice Health Commercial |
$98.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.35
|
| Rate for Payer: HealthUtah PPO |
$103.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.18
|
| Rate for Payer: One Health Plan of WY PPO |
$101.77
|
| Rate for Payer: PacificSource Commercial |
$93.46
|
| Rate for Payer: PHCS PPO |
$101.77
|
| Rate for Payer: Three Rivers PPO |
$77.89
|
| Rate for Payer: TriWest Veterans Administration |
$63.35
|
| Rate for Payer: United Healthcare Medicare |
$63.35
|
| Rate for Payer: WINHealth Partners Commercial |
$98.66
|
| Rate for Payer: Wise Provider Network Commercial |
$98.66
|
|
|
DAVINCI RELOAD 2.5 WHITE
|
Facility
|
IP
|
$845.25
|
|
| Hospital Charge Code |
2850001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.82 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$540.96
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$515.60
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$489.82
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$515.60
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$515.60
|
| Rate for Payer: WINHealth Partners Commercial |
$802.99
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI RELOAD 2.5 WHITE
|
Facility
|
OP
|
$845.25
|
|
| Hospital Charge Code |
2850001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.70 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$557.86
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.79
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$457.70
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$481.79
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$481.79
|
| Rate for Payer: WINHealth Partners Commercial |
$828.34
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI RELOAD 3.5 BLUE
|
Facility
|
OP
|
$845.25
|
|
| Hospital Charge Code |
2850002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.70 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$557.86
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.79
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$457.70
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$481.79
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$481.79
|
| Rate for Payer: WINHealth Partners Commercial |
$828.34
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI RELOAD 3.5 BLUE
|
Facility
|
IP
|
$845.25
|
|
| Hospital Charge Code |
2850002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.82 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$540.96
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$515.60
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$489.82
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$515.60
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$515.60
|
| Rate for Payer: WINHealth Partners Commercial |
$802.99
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI RELOAD 4.3 GREEN
|
Facility
|
OP
|
$845.25
|
|
| Hospital Charge Code |
2850003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.70 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$557.86
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.79
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$457.70
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$481.79
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$481.79
|
| Rate for Payer: WINHealth Partners Commercial |
$828.34
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI RELOAD 4.3 GREEN
|
Facility
|
IP
|
$845.25
|
|
| Hospital Charge Code |
2850003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.82 |
| Max. Negotiated Rate |
$845.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.34
|
| Rate for Payer: Aetna of WY Medicare |
$540.96
|
| Rate for Payer: Altius Commercial |
$811.44
|
| Rate for Payer: Beech Street Commercial |
$828.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$819.89
|
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.89
|
| Rate for Payer: Cigna of WY Commercial |
$828.34
|
| Rate for Payer: Entrust Commercial |
$802.99
|
| Rate for Payer: First Choice Health Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$515.60
|
| Rate for Payer: HealthUtah PPO |
$845.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.89
|
| Rate for Payer: Multiplan Medicare/VA |
$489.82
|
| Rate for Payer: One Health Plan of WY PPO |
$828.34
|
| Rate for Payer: PacificSource Commercial |
$760.72
|
| Rate for Payer: PHCS PPO |
$828.34
|
| Rate for Payer: Three Rivers PPO |
$633.94
|
| Rate for Payer: TriWest Veterans Administration |
$515.60
|
| Rate for Payer: United Healthcare Commercial |
$807.21
|
| Rate for Payer: United Healthcare Medicare |
$515.60
|
| Rate for Payer: WINHealth Partners Commercial |
$802.99
|
| Rate for Payer: Wise Provider Network Commercial |
$802.99
|
|
|
DAVINCI SEE SHARP SCOPE WARMER
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
2850016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$100.80
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.08
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$91.27
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$96.08
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$96.08
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
DAVINCI SEE SHARP SCOPE WARMER
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
2850016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.29 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.78
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$85.29
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$89.78
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$89.78
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
DAVINCI STAPLER SUREFORM
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
2850008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$758.10 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Aetna of WY Medicare |
$924.00
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,358.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$798.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Multiplan Medicare/VA |
$758.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$798.00
|
| Rate for Payer: United Healthcare Commercial |
$1,337.00
|
| Rate for Payer: United Healthcare Medicare |
$798.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,372.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
|
|
DAVINCI STAPLER SUREFORM
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
2850008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.30 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Aetna of WY Medicare |
$896.00
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,358.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$854.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Multiplan Medicare/VA |
$811.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$854.00
|
| Rate for Payer: United Healthcare Commercial |
$1,337.00
|
| Rate for Payer: United Healthcare Medicare |
$854.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,330.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
|
|
DAVINCI TIP COVER ACCESSORY
|
Facility
|
OP
|
$73.50
|
|
| Hospital Charge Code |
2850004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.03
|
| Rate for Payer: Aetna of WY Medicare |
$48.51
|
| Rate for Payer: Altius Commercial |
$70.56
|
| Rate for Payer: Beech Street Commercial |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.30
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.30
|
| Rate for Payer: Cigna of WY Commercial |
$72.03
|
| Rate for Payer: Entrust Commercial |
$69.82
|
| Rate for Payer: First Choice Health Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.90
|
| Rate for Payer: HealthUtah PPO |
$73.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.30
|
| Rate for Payer: Multiplan Medicare/VA |
$39.80
|
| Rate for Payer: One Health Plan of WY PPO |
$72.03
|
| Rate for Payer: PacificSource Commercial |
$66.15
|
| Rate for Payer: PHCS PPO |
$72.03
|
| Rate for Payer: Three Rivers PPO |
$55.12
|
| Rate for Payer: TriWest Veterans Administration |
$41.90
|
| Rate for Payer: United Healthcare Commercial |
$70.19
|
| Rate for Payer: United Healthcare Medicare |
$41.90
|
| Rate for Payer: WINHealth Partners Commercial |
$72.03
|
| Rate for Payer: Wise Provider Network Commercial |
$69.82
|
|
|
DAVINCI TIP COVER ACCESSORY
|
Facility
|
IP
|
$73.50
|
|
| Hospital Charge Code |
2850004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.03
|
| Rate for Payer: Aetna of WY Medicare |
$47.04
|
| Rate for Payer: Altius Commercial |
$70.56
|
| Rate for Payer: Beech Street Commercial |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.30
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.30
|
| Rate for Payer: Cigna of WY Commercial |
$72.03
|
| Rate for Payer: Entrust Commercial |
$69.82
|
| Rate for Payer: First Choice Health Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.84
|
| Rate for Payer: HealthUtah PPO |
$73.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.30
|
| Rate for Payer: Multiplan Medicare/VA |
$42.59
|
| Rate for Payer: One Health Plan of WY PPO |
$72.03
|
| Rate for Payer: PacificSource Commercial |
$66.15
|
| Rate for Payer: PHCS PPO |
$72.03
|
| Rate for Payer: Three Rivers PPO |
$55.12
|
| Rate for Payer: TriWest Veterans Administration |
$44.84
|
| Rate for Payer: United Healthcare Commercial |
$70.19
|
| Rate for Payer: United Healthcare Medicare |
$44.84
|
| Rate for Payer: WINHealth Partners Commercial |
$69.82
|
| Rate for Payer: Wise Provider Network Commercial |
$69.82
|
|
|
DAVINCI VESSEL SEALER EXTEND
|
Facility
|
OP
|
$1,396.50
|
|
| Hospital Charge Code |
2850007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.20 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,368.57
|
| Rate for Payer: Aetna of WY Medicare |
$921.69
|
| Rate for Payer: Altius Commercial |
$1,340.64
|
| Rate for Payer: Beech Street Commercial |
$1,368.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,354.60
|
| Rate for Payer: Cash Price |
$977.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,354.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,368.57
|
| Rate for Payer: Entrust Commercial |
$1,326.68
|
| Rate for Payer: First Choice Health Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$796.00
|
| Rate for Payer: HealthUtah PPO |
$1,396.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,354.60
|
| Rate for Payer: Multiplan Medicare/VA |
$756.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,368.57
|
| Rate for Payer: PacificSource Commercial |
$1,256.85
|
| Rate for Payer: PHCS PPO |
$1,368.57
|
| Rate for Payer: Three Rivers PPO |
$1,047.38
|
| Rate for Payer: TriWest Veterans Administration |
$796.00
|
| Rate for Payer: United Healthcare Commercial |
$1,333.66
|
| Rate for Payer: United Healthcare Medicare |
$796.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,368.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1,326.68
|
|
|
DAVINCI VESSEL SEALER EXTEND
|
Facility
|
IP
|
$1,396.50
|
|
| Hospital Charge Code |
2850007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$809.27 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,368.57
|
| Rate for Payer: Aetna of WY Medicare |
$893.76
|
| Rate for Payer: Altius Commercial |
$1,340.64
|
| Rate for Payer: Beech Street Commercial |
$1,368.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,354.60
|
| Rate for Payer: Cash Price |
$977.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,354.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,368.57
|
| Rate for Payer: Entrust Commercial |
$1,326.68
|
| Rate for Payer: First Choice Health Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$851.86
|
| Rate for Payer: HealthUtah PPO |
$1,396.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,354.60
|
| Rate for Payer: Multiplan Medicare/VA |
$809.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,368.57
|
| Rate for Payer: PacificSource Commercial |
$1,256.85
|
| Rate for Payer: PHCS PPO |
$1,368.57
|
| Rate for Payer: Three Rivers PPO |
$1,047.38
|
| Rate for Payer: TriWest Veterans Administration |
$851.86
|
| Rate for Payer: United Healthcare Commercial |
$1,333.66
|
| Rate for Payer: United Healthcare Medicare |
$851.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1,326.68
|
|
|
DBM 10CC PUTTY STRYKER
|
Facility
|
IP
|
$4,200.00
|
|
| Hospital Charge Code |
3350076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.90 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,562.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,433.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,562.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,990.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
DBM 10CC PUTTY STRYKER
|
Facility
|
OP
|
$4,200.00
|
|
| Hospital Charge Code |
3350076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.30 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,772.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,394.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,274.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,394.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,394.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,116.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
DBM 2.5 PUTTY STRYKER
|
Facility
|
OP
|
$2,033.50
|
|
| Hospital Charge Code |
3350073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.14 |
| Max. Negotiated Rate |
$2,033.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,992.83
|
| Rate for Payer: Aetna of WY Medicare |
$1,342.11
|
| Rate for Payer: Altius Commercial |
$1,952.16
|
| Rate for Payer: Beech Street Commercial |
$1,992.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,972.50
|
| Rate for Payer: Cash Price |
$1,423.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,972.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,992.83
|
| Rate for Payer: Entrust Commercial |
$1,931.82
|
| Rate for Payer: First Choice Health Commercial |
$1,931.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,931.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,159.10
|
| Rate for Payer: HealthUtah PPO |
$2,033.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,972.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,101.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,992.83
|
| Rate for Payer: PacificSource Commercial |
$1,830.15
|
| Rate for Payer: PHCS PPO |
$1,992.83
|
| Rate for Payer: Three Rivers PPO |
$1,525.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,159.10
|
| Rate for Payer: United Healthcare Commercial |
$1,941.99
|
| Rate for Payer: United Healthcare Medicare |
$1,159.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,992.83
|
| Rate for Payer: Wise Provider Network Commercial |
$1,931.82
|
|
|
DBM 2.5 PUTTY STRYKER
|
Facility
|
IP
|
$2,033.50
|
|
| Hospital Charge Code |
3350073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,178.41 |
| Max. Negotiated Rate |
$2,033.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,992.83
|
| Rate for Payer: Aetna of WY Medicare |
$1,301.44
|
| Rate for Payer: Altius Commercial |
$1,952.16
|
| Rate for Payer: Beech Street Commercial |
$1,992.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,972.50
|
| Rate for Payer: Cash Price |
$1,423.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,972.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,992.83
|
| Rate for Payer: Entrust Commercial |
$1,931.82
|
| Rate for Payer: First Choice Health Commercial |
$1,931.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,931.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,240.44
|
| Rate for Payer: HealthUtah PPO |
$2,033.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,972.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,178.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,992.83
|
| Rate for Payer: PacificSource Commercial |
$1,830.15
|
| Rate for Payer: PHCS PPO |
$1,992.83
|
| Rate for Payer: Three Rivers PPO |
$1,525.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,240.44
|
| Rate for Payer: United Healthcare Commercial |
$1,941.99
|
| Rate for Payer: United Healthcare Medicare |
$1,240.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,931.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,931.82
|
|
|
DBM 5CC + PUTTY STRYKER
|
Facility
|
IP
|
$6,905.50
|
|
| Hospital Charge Code |
3350075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,001.74 |
| Max. Negotiated Rate |
$6,905.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,767.39
|
| Rate for Payer: Aetna of WY Medicare |
$4,419.52
|
| Rate for Payer: Altius Commercial |
$6,629.28
|
| Rate for Payer: Beech Street Commercial |
$6,767.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,698.34
|
| Rate for Payer: Cash Price |
$4,833.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,698.34
|
| Rate for Payer: Cigna of WY Commercial |
$6,767.39
|
| Rate for Payer: Entrust Commercial |
$6,560.22
|
| Rate for Payer: First Choice Health Commercial |
$6,560.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,560.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,212.36
|
| Rate for Payer: HealthUtah PPO |
$6,905.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,698.34
|
| Rate for Payer: Multiplan Medicare/VA |
$4,001.74
|
| Rate for Payer: One Health Plan of WY PPO |
$6,767.39
|
| Rate for Payer: PacificSource Commercial |
$6,214.95
|
| Rate for Payer: PHCS PPO |
$6,767.39
|
| Rate for Payer: Three Rivers PPO |
$5,179.12
|
| Rate for Payer: TriWest Veterans Administration |
$4,212.36
|
| Rate for Payer: United Healthcare Commercial |
$6,594.75
|
| Rate for Payer: United Healthcare Medicare |
$4,212.36
|
| Rate for Payer: WINHealth Partners Commercial |
$6,560.22
|
| Rate for Payer: Wise Provider Network Commercial |
$6,560.22
|
|
|
DBM 5CC + PUTTY STRYKER
|
Facility
|
OP
|
$6,905.50
|
|
| Hospital Charge Code |
3350075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,739.33 |
| Max. Negotiated Rate |
$6,905.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,767.39
|
| Rate for Payer: Aetna of WY Medicare |
$4,557.63
|
| Rate for Payer: Altius Commercial |
$6,629.28
|
| Rate for Payer: Beech Street Commercial |
$6,767.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,698.34
|
| Rate for Payer: Cash Price |
$4,833.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,698.34
|
| Rate for Payer: Cigna of WY Commercial |
$6,767.39
|
| Rate for Payer: Entrust Commercial |
$6,560.22
|
| Rate for Payer: First Choice Health Commercial |
$6,560.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,560.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,936.14
|
| Rate for Payer: HealthUtah PPO |
$6,905.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,698.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3,739.33
|
| Rate for Payer: One Health Plan of WY PPO |
$6,767.39
|
| Rate for Payer: PacificSource Commercial |
$6,214.95
|
| Rate for Payer: PHCS PPO |
$6,767.39
|
| Rate for Payer: Three Rivers PPO |
$5,179.12
|
| Rate for Payer: TriWest Veterans Administration |
$3,936.14
|
| Rate for Payer: United Healthcare Commercial |
$6,594.75
|
| Rate for Payer: United Healthcare Medicare |
$3,936.14
|
| Rate for Payer: WINHealth Partners Commercial |
$6,767.39
|
| Rate for Payer: Wise Provider Network Commercial |
$6,560.22
|
|
