|
DRILL 2.7MM CMP FT CALIBRATED
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
3002481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.57 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$450.45
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$662.02
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.02
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$369.57
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$389.02
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
| Rate for Payer: WINHealth Partners Commercial |
$668.85
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
DRILL 2.7MM STANDARD
|
Facility
|
IP
|
$450.80
|
|
| Hospital Charge Code |
3002902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.24 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$288.51
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.99
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$261.24
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$274.99
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$274.99
|
| Rate for Payer: WINHealth Partners Commercial |
$428.26
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
DRILL 2.7MM STANDARD
|
Facility
|
OP
|
$450.80
|
|
| Hospital Charge Code |
3002902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.11 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$297.53
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.96
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$244.11
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$256.96
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$256.96
|
| Rate for Payer: WINHealth Partners Commercial |
$441.78
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
DRILL 3.0MM 80-1088
|
Facility
|
OP
|
$707.00
|
|
| Hospital Charge Code |
3003767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.84 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Aetna of WY Medicare |
$466.62
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$685.79
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$402.99
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$382.84
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$402.99
|
| Rate for Payer: United Healthcare Commercial |
$675.18
|
| Rate for Payer: United Healthcare Medicare |
$402.99
|
| Rate for Payer: WINHealth Partners Commercial |
$692.86
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
DRILL 3.0MM 80-1088
|
Facility
|
IP
|
$707.00
|
|
| Hospital Charge Code |
3003767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.71 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Aetna of WY Medicare |
$452.48
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$685.79
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.27
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$409.71
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$431.27
|
| Rate for Payer: United Healthcare Commercial |
$675.18
|
| Rate for Payer: United Healthcare Medicare |
$431.27
|
| Rate for Payer: WINHealth Partners Commercial |
$671.65
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
DRILL 3.5MM QUICK LAG
|
Facility
|
IP
|
$1,169.00
|
|
| Hospital Charge Code |
3003518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.44 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,145.62
|
| Rate for Payer: Aetna of WY Medicare |
$748.16
|
| Rate for Payer: Altius Commercial |
$1,122.24
|
| Rate for Payer: Beech Street Commercial |
$1,145.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,133.93
|
| Rate for Payer: Cash Price |
$818.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,133.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,145.62
|
| Rate for Payer: Entrust Commercial |
$1,110.55
|
| Rate for Payer: First Choice Health Commercial |
$1,110.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,110.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$713.09
|
| Rate for Payer: HealthUtah PPO |
$1,169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,133.93
|
| Rate for Payer: Multiplan Medicare/VA |
$677.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,145.62
|
| Rate for Payer: PacificSource Commercial |
$1,052.10
|
| Rate for Payer: PHCS PPO |
$1,145.62
|
| Rate for Payer: Three Rivers PPO |
$876.75
|
| Rate for Payer: TriWest Veterans Administration |
$713.09
|
| Rate for Payer: United Healthcare Commercial |
$1,116.40
|
| Rate for Payer: United Healthcare Medicare |
$713.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,110.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,110.55
|
|
|
DRILL 3.5MM QUICK LAG
|
Facility
|
OP
|
$1,169.00
|
|
| Hospital Charge Code |
3003518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.01 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,145.62
|
| Rate for Payer: Aetna of WY Medicare |
$771.54
|
| Rate for Payer: Altius Commercial |
$1,122.24
|
| Rate for Payer: Beech Street Commercial |
$1,145.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,133.93
|
| Rate for Payer: Cash Price |
$818.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,133.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,145.62
|
| Rate for Payer: Entrust Commercial |
$1,110.55
|
| Rate for Payer: First Choice Health Commercial |
$1,110.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,110.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$666.33
|
| Rate for Payer: HealthUtah PPO |
$1,169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,133.93
|
| Rate for Payer: Multiplan Medicare/VA |
$633.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,145.62
|
| Rate for Payer: PacificSource Commercial |
$1,052.10
|
| Rate for Payer: PHCS PPO |
$1,145.62
|
| Rate for Payer: Three Rivers PPO |
$876.75
|
| Rate for Payer: TriWest Veterans Administration |
$666.33
|
| Rate for Payer: United Healthcare Commercial |
$1,116.40
|
| Rate for Payer: United Healthcare Medicare |
$666.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,110.55
|
|
|
DRILL 4.0MM CANNULATED CB040
|
Facility
|
IP
|
$533.75
|
|
| Hospital Charge Code |
3100680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.31 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$341.60
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.59
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$309.31
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$325.59
|
| Rate for Payer: WINHealth Partners Commercial |
$507.06
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 4.0MM CANNULATED CB040
|
Facility
|
OP
|
$533.75
|
|
| Hospital Charge Code |
3100680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$352.28
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.24
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$289.03
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$304.24
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$304.24
|
| Rate for Payer: WINHealth Partners Commercial |
$523.08
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 4.5MM CANNULATED CB045
|
Facility
|
OP
|
$533.75
|
|
| Hospital Charge Code |
3100681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$352.28
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.24
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$289.03
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$304.24
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$304.24
|
| Rate for Payer: WINHealth Partners Commercial |
$523.08
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 4.5MM CANNULATED CB045
|
Facility
|
IP
|
$533.75
|
|
| Hospital Charge Code |
3100681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.31 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$341.60
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.59
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$309.31
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$325.59
|
| Rate for Payer: WINHealth Partners Commercial |
$507.06
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 4.7 LONG ACUTRAK 2
|
Facility
|
OP
|
$2,093.00
|
|
| Hospital Charge Code |
3003497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,133.36 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,051.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,381.38
|
| Rate for Payer: Altius Commercial |
$2,009.28
|
| Rate for Payer: Beech Street Commercial |
$2,051.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,030.21
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,030.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,051.14
|
| Rate for Payer: Entrust Commercial |
$1,988.35
|
| Rate for Payer: First Choice Health Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,193.01
|
| Rate for Payer: HealthUtah PPO |
$2,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,030.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,133.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,051.14
|
| Rate for Payer: PacificSource Commercial |
$1,883.70
|
| Rate for Payer: PHCS PPO |
$2,051.14
|
| Rate for Payer: Three Rivers PPO |
$1,569.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,193.01
|
| Rate for Payer: United Healthcare Commercial |
$1,998.82
|
| Rate for Payer: United Healthcare Medicare |
$1,193.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,051.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,988.35
|
|
|
DRILL 4.7 LONG ACUTRAK 2
|
Facility
|
IP
|
$2,093.00
|
|
| Hospital Charge Code |
3003497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,212.89 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,051.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,339.52
|
| Rate for Payer: Altius Commercial |
$2,009.28
|
| Rate for Payer: Beech Street Commercial |
$2,051.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,030.21
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,030.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,051.14
|
| Rate for Payer: Entrust Commercial |
$1,988.35
|
| Rate for Payer: First Choice Health Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,276.73
|
| Rate for Payer: HealthUtah PPO |
$2,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,030.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,212.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,051.14
|
| Rate for Payer: PacificSource Commercial |
$1,883.70
|
| Rate for Payer: PHCS PPO |
$2,051.14
|
| Rate for Payer: Three Rivers PPO |
$1,569.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,276.73
|
| Rate for Payer: United Healthcare Commercial |
$1,998.82
|
| Rate for Payer: United Healthcare Medicare |
$1,276.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,988.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,988.35
|
|
|
DRILL 4.7 PROFILE ACUTRAK 2
|
Facility
|
IP
|
$2,093.00
|
|
| Hospital Charge Code |
3003496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,212.89 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,051.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,339.52
|
| Rate for Payer: Altius Commercial |
$2,009.28
|
| Rate for Payer: Beech Street Commercial |
$2,051.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,030.21
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,030.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,051.14
|
| Rate for Payer: Entrust Commercial |
$1,988.35
|
| Rate for Payer: First Choice Health Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,276.73
|
| Rate for Payer: HealthUtah PPO |
$2,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,030.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,212.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,051.14
|
| Rate for Payer: PacificSource Commercial |
$1,883.70
|
| Rate for Payer: PHCS PPO |
$2,051.14
|
| Rate for Payer: Three Rivers PPO |
$1,569.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,276.73
|
| Rate for Payer: United Healthcare Commercial |
$1,998.82
|
| Rate for Payer: United Healthcare Medicare |
$1,276.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,988.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,988.35
|
|
|
DRILL 4.7 PROFILE ACUTRAK 2
|
Facility
|
OP
|
$2,093.00
|
|
| Hospital Charge Code |
3003496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,133.36 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,051.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,381.38
|
| Rate for Payer: Altius Commercial |
$2,009.28
|
| Rate for Payer: Beech Street Commercial |
$2,051.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,030.21
|
| Rate for Payer: Cash Price |
$1,465.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,030.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,051.14
|
| Rate for Payer: Entrust Commercial |
$1,988.35
|
| Rate for Payer: First Choice Health Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,988.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,193.01
|
| Rate for Payer: HealthUtah PPO |
$2,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,030.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,133.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,051.14
|
| Rate for Payer: PacificSource Commercial |
$1,883.70
|
| Rate for Payer: PHCS PPO |
$2,051.14
|
| Rate for Payer: Three Rivers PPO |
$1,569.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,193.01
|
| Rate for Payer: United Healthcare Commercial |
$1,998.82
|
| Rate for Payer: United Healthcare Medicare |
$1,193.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,051.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,988.35
|
|
|
DRILL 4MM AR-1204D
|
Facility
|
IP
|
$402.50
|
|
| Hospital Charge Code |
3003295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$394.45
|
| Rate for Payer: Aetna of WY Medicare |
$257.60
|
| Rate for Payer: Altius Commercial |
$386.40
|
| Rate for Payer: Beech Street Commercial |
$394.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$390.42
|
| Rate for Payer: Cash Price |
$281.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$390.42
|
| Rate for Payer: Cigna of WY Commercial |
$394.45
|
| Rate for Payer: Entrust Commercial |
$382.38
|
| Rate for Payer: First Choice Health Commercial |
$382.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$382.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.52
|
| Rate for Payer: HealthUtah PPO |
$402.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$390.42
|
| Rate for Payer: Multiplan Medicare/VA |
$233.25
|
| Rate for Payer: One Health Plan of WY PPO |
$394.45
|
| Rate for Payer: PacificSource Commercial |
$362.25
|
| Rate for Payer: PHCS PPO |
$394.45
|
| Rate for Payer: Three Rivers PPO |
$301.88
|
| Rate for Payer: TriWest Veterans Administration |
$245.52
|
| Rate for Payer: United Healthcare Commercial |
$384.39
|
| Rate for Payer: United Healthcare Medicare |
$245.52
|
| Rate for Payer: WINHealth Partners Commercial |
$382.38
|
| Rate for Payer: Wise Provider Network Commercial |
$382.38
|
|
|
DRILL 4MM AR-1204D
|
Facility
|
OP
|
$402.50
|
|
| Hospital Charge Code |
3003295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$394.45
|
| Rate for Payer: Aetna of WY Medicare |
$265.65
|
| Rate for Payer: Altius Commercial |
$386.40
|
| Rate for Payer: Beech Street Commercial |
$394.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$390.42
|
| Rate for Payer: Cash Price |
$281.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$390.42
|
| Rate for Payer: Cigna of WY Commercial |
$394.45
|
| Rate for Payer: Entrust Commercial |
$382.38
|
| Rate for Payer: First Choice Health Commercial |
$382.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$382.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.42
|
| Rate for Payer: HealthUtah PPO |
$402.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$390.42
|
| Rate for Payer: Multiplan Medicare/VA |
$217.95
|
| Rate for Payer: One Health Plan of WY PPO |
$394.45
|
| Rate for Payer: PacificSource Commercial |
$362.25
|
| Rate for Payer: PHCS PPO |
$394.45
|
| Rate for Payer: Three Rivers PPO |
$301.88
|
| Rate for Payer: TriWest Veterans Administration |
$229.42
|
| Rate for Payer: United Healthcare Commercial |
$384.39
|
| Rate for Payer: United Healthcare Medicare |
$229.42
|
| Rate for Payer: WINHealth Partners Commercial |
$394.45
|
| Rate for Payer: Wise Provider Network Commercial |
$382.38
|
|
|
DRILL 5.0MM CANNULATED CB050
|
Facility
|
OP
|
$533.75
|
|
| Hospital Charge Code |
3100682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$352.28
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.24
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$289.03
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$304.24
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$304.24
|
| Rate for Payer: WINHealth Partners Commercial |
$523.08
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 5.0MM CANNULATED CB050
|
Facility
|
IP
|
$533.75
|
|
| Hospital Charge Code |
3100682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.31 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$341.60
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.59
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$309.31
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$325.59
|
| Rate for Payer: WINHealth Partners Commercial |
$507.06
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 5.0MM CANNULATED Q/C
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
3003549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,064.83 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,800.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,176.00
|
| Rate for Payer: Altius Commercial |
$1,764.00
|
| Rate for Payer: Beech Street Commercial |
$1,800.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,782.38
|
| Rate for Payer: Cash Price |
$1,286.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,782.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,800.75
|
| Rate for Payer: Entrust Commercial |
$1,745.62
|
| Rate for Payer: First Choice Health Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,120.88
|
| Rate for Payer: HealthUtah PPO |
$1,837.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,782.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,064.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,800.75
|
| Rate for Payer: PacificSource Commercial |
$1,653.75
|
| Rate for Payer: PHCS PPO |
$1,800.75
|
| Rate for Payer: Three Rivers PPO |
$1,378.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,120.88
|
| Rate for Payer: United Healthcare Commercial |
$1,754.81
|
| Rate for Payer: United Healthcare Medicare |
$1,120.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,745.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,745.62
|
|
|
DRILL 5.0MM CANNULATED Q/C
|
Facility
|
OP
|
$1,837.50
|
|
| Hospital Charge Code |
3003549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.01 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,800.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,212.75
|
| Rate for Payer: Altius Commercial |
$1,764.00
|
| Rate for Payer: Beech Street Commercial |
$1,800.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,782.38
|
| Rate for Payer: Cash Price |
$1,286.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,782.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,800.75
|
| Rate for Payer: Entrust Commercial |
$1,745.62
|
| Rate for Payer: First Choice Health Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,047.38
|
| Rate for Payer: HealthUtah PPO |
$1,837.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,782.38
|
| Rate for Payer: Multiplan Medicare/VA |
$995.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,800.75
|
| Rate for Payer: PacificSource Commercial |
$1,653.75
|
| Rate for Payer: PHCS PPO |
$1,800.75
|
| Rate for Payer: Three Rivers PPO |
$1,378.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,047.38
|
| Rate for Payer: United Healthcare Commercial |
$1,754.81
|
| Rate for Payer: United Healthcare Medicare |
$1,047.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,800.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,745.62
|
|
|
DRILL 6.0MM CANNULATED CB060
|
Facility
|
IP
|
$533.75
|
|
| Hospital Charge Code |
3100683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.31 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$341.60
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.59
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$309.31
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$325.59
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$325.59
|
| Rate for Payer: WINHealth Partners Commercial |
$507.06
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 6.0MM CANNULATED CB060
|
Facility
|
OP
|
$533.75
|
|
| Hospital Charge Code |
3100683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.03 |
| Max. Negotiated Rate |
$533.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.08
|
| Rate for Payer: Aetna of WY Medicare |
$352.28
|
| Rate for Payer: Altius Commercial |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$523.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$373.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.74
|
| Rate for Payer: Cigna of WY Commercial |
$523.08
|
| Rate for Payer: Entrust Commercial |
$507.06
|
| Rate for Payer: First Choice Health Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.24
|
| Rate for Payer: HealthUtah PPO |
$533.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.74
|
| Rate for Payer: Multiplan Medicare/VA |
$289.03
|
| Rate for Payer: One Health Plan of WY PPO |
$523.08
|
| Rate for Payer: PacificSource Commercial |
$480.38
|
| Rate for Payer: PHCS PPO |
$523.08
|
| Rate for Payer: Three Rivers PPO |
$400.31
|
| Rate for Payer: TriWest Veterans Administration |
$304.24
|
| Rate for Payer: United Healthcare Commercial |
$509.73
|
| Rate for Payer: United Healthcare Medicare |
$304.24
|
| Rate for Payer: WINHealth Partners Commercial |
$523.08
|
| Rate for Payer: Wise Provider Network Commercial |
$507.06
|
|
|
DRILL 6.5MM ASNIS CANNULATED
|
Facility
|
OP
|
$1,115.87
|
|
| Hospital Charge Code |
3000459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.24 |
| Max. Negotiated Rate |
$1,115.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,093.55
|
| Rate for Payer: Aetna of WY Medicare |
$736.47
|
| Rate for Payer: Altius Commercial |
$1,071.24
|
| Rate for Payer: Beech Street Commercial |
$1,093.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,082.39
|
| Rate for Payer: Cash Price |
$781.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,082.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,093.55
|
| Rate for Payer: Entrust Commercial |
$1,060.08
|
| Rate for Payer: First Choice Health Commercial |
$1,060.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,060.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$636.05
|
| Rate for Payer: HealthUtah PPO |
$1,115.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,082.39
|
| Rate for Payer: Multiplan Medicare/VA |
$604.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,093.55
|
| Rate for Payer: PacificSource Commercial |
$1,004.28
|
| Rate for Payer: PHCS PPO |
$1,093.55
|
| Rate for Payer: Three Rivers PPO |
$836.90
|
| Rate for Payer: TriWest Veterans Administration |
$636.05
|
| Rate for Payer: United Healthcare Commercial |
$1,065.66
|
| Rate for Payer: United Healthcare Medicare |
$636.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,093.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,060.08
|
|
|
DRILL 6.5MM ASNIS CANNULATED
|
Facility
|
IP
|
$1,115.87
|
|
| Hospital Charge Code |
3000459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.65 |
| Max. Negotiated Rate |
$1,115.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,093.55
|
| Rate for Payer: Aetna of WY Medicare |
$714.16
|
| Rate for Payer: Altius Commercial |
$1,071.24
|
| Rate for Payer: Beech Street Commercial |
$1,093.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,082.39
|
| Rate for Payer: Cash Price |
$781.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,082.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,093.55
|
| Rate for Payer: Entrust Commercial |
$1,060.08
|
| Rate for Payer: First Choice Health Commercial |
$1,060.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,060.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$680.68
|
| Rate for Payer: HealthUtah PPO |
$1,115.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,082.39
|
| Rate for Payer: Multiplan Medicare/VA |
$646.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,093.55
|
| Rate for Payer: PacificSource Commercial |
$1,004.28
|
| Rate for Payer: PHCS PPO |
$1,093.55
|
| Rate for Payer: Three Rivers PPO |
$836.90
|
| Rate for Payer: TriWest Veterans Administration |
$680.68
|
| Rate for Payer: United Healthcare Commercial |
$1,065.66
|
| Rate for Payer: United Healthcare Medicare |
$680.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,060.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1,060.08
|
|
