|
DRILL ACU MICRO EXTENDED LONG
|
Facility
|
IP
|
$1,708.00
|
|
| Hospital Charge Code |
3004018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$989.79 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,673.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,093.12
|
| Rate for Payer: Altius Commercial |
$1,639.68
|
| Rate for Payer: Beech Street Commercial |
$1,673.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,656.76
|
| Rate for Payer: Cash Price |
$1,195.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,656.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,673.84
|
| Rate for Payer: Entrust Commercial |
$1,622.60
|
| Rate for Payer: First Choice Health Commercial |
$1,622.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,622.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,041.88
|
| Rate for Payer: HealthUtah PPO |
$1,708.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,656.76
|
| Rate for Payer: Multiplan Medicare/VA |
$989.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1,673.84
|
| Rate for Payer: PacificSource Commercial |
$1,537.20
|
| Rate for Payer: PHCS PPO |
$1,673.84
|
| Rate for Payer: Three Rivers PPO |
$1,281.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,041.88
|
| Rate for Payer: United Healthcare Commercial |
$1,631.14
|
| Rate for Payer: United Healthcare Medicare |
$1,041.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,622.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,622.60
|
|
|
DRILL ACU MICRO EXTENDED LONG
|
Facility
|
OP
|
$1,708.00
|
|
| Hospital Charge Code |
3004018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$924.88 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,673.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,127.28
|
| Rate for Payer: Altius Commercial |
$1,639.68
|
| Rate for Payer: Beech Street Commercial |
$1,673.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,656.76
|
| Rate for Payer: Cash Price |
$1,195.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,656.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,673.84
|
| Rate for Payer: Entrust Commercial |
$1,622.60
|
| Rate for Payer: First Choice Health Commercial |
$1,622.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,622.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.56
|
| Rate for Payer: HealthUtah PPO |
$1,708.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,656.76
|
| Rate for Payer: Multiplan Medicare/VA |
$924.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,673.84
|
| Rate for Payer: PacificSource Commercial |
$1,537.20
|
| Rate for Payer: PHCS PPO |
$1,673.84
|
| Rate for Payer: Three Rivers PPO |
$1,281.00
|
| Rate for Payer: TriWest Veterans Administration |
$973.56
|
| Rate for Payer: United Healthcare Commercial |
$1,631.14
|
| Rate for Payer: United Healthcare Medicare |
$973.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,673.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,622.60
|
|
|
DRILL ACUTRAK 2 MICRO
|
Facility
|
OP
|
$1,533.00
|
|
| Hospital Charge Code |
3002534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$830.12 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,011.78
|
| Rate for Payer: Altius Commercial |
$1,471.68
|
| Rate for Payer: Beech Street Commercial |
$1,502.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,487.01
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: Entrust Commercial |
$1,456.35
|
| Rate for Payer: First Choice Health Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$873.81
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$830.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,502.34
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$873.81
|
| Rate for Payer: United Healthcare Commercial |
$1,464.02
|
| Rate for Payer: United Healthcare Medicare |
$873.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,502.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1,456.35
|
|
|
DRILL ACUTRAK 2 MICRO
|
Facility
|
IP
|
$1,533.00
|
|
| Hospital Charge Code |
3002534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.37 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Aetna of WY Medicare |
$981.12
|
| Rate for Payer: Altius Commercial |
$1,471.68
|
| Rate for Payer: Beech Street Commercial |
$1,502.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,487.01
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: Entrust Commercial |
$1,456.35
|
| Rate for Payer: First Choice Health Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$935.13
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$888.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,502.34
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$935.13
|
| Rate for Payer: United Healthcare Commercial |
$1,464.02
|
| Rate for Payer: United Healthcare Medicare |
$935.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,456.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,456.35
|
|
|
DRILL ACUTRAK 2 MICRO LONG
|
Facility
|
IP
|
$1,711.50
|
|
| Hospital Charge Code |
3002535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.81 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,677.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,095.36
|
| Rate for Payer: Altius Commercial |
$1,643.04
|
| Rate for Payer: Beech Street Commercial |
$1,677.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,660.16
|
| Rate for Payer: Cash Price |
$1,198.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,660.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,677.27
|
| Rate for Payer: Entrust Commercial |
$1,625.92
|
| Rate for Payer: First Choice Health Commercial |
$1,625.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,625.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.02
|
| Rate for Payer: HealthUtah PPO |
$1,711.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,660.16
|
| Rate for Payer: Multiplan Medicare/VA |
$991.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,677.27
|
| Rate for Payer: PacificSource Commercial |
$1,540.35
|
| Rate for Payer: PHCS PPO |
$1,677.27
|
| Rate for Payer: Three Rivers PPO |
$1,283.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.02
|
| Rate for Payer: United Healthcare Commercial |
$1,634.48
|
| Rate for Payer: United Healthcare Medicare |
$1,044.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,625.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1,625.92
|
|
|
DRILL ACUTRAK 2 MICRO LONG
|
Facility
|
OP
|
$1,711.50
|
|
| Hospital Charge Code |
3002535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.78 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,677.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,129.59
|
| Rate for Payer: Altius Commercial |
$1,643.04
|
| Rate for Payer: Beech Street Commercial |
$1,677.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,660.16
|
| Rate for Payer: Cash Price |
$1,198.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,660.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,677.27
|
| Rate for Payer: Entrust Commercial |
$1,625.92
|
| Rate for Payer: First Choice Health Commercial |
$1,625.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,625.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$975.56
|
| Rate for Payer: HealthUtah PPO |
$1,711.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,660.16
|
| Rate for Payer: Multiplan Medicare/VA |
$926.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,677.27
|
| Rate for Payer: PacificSource Commercial |
$1,540.35
|
| Rate for Payer: PHCS PPO |
$1,677.27
|
| Rate for Payer: Three Rivers PPO |
$1,283.62
|
| Rate for Payer: TriWest Veterans Administration |
$975.56
|
| Rate for Payer: United Healthcare Commercial |
$1,634.48
|
| Rate for Payer: United Healthcare Medicare |
$975.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,677.27
|
| Rate for Payer: Wise Provider Network Commercial |
$1,625.92
|
|
|
DRILL ACUTRAK 2 MINI LONG
|
Facility
|
IP
|
$2,275.00
|
|
| Hospital Charge Code |
3002167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,318.36 |
| Max. Negotiated Rate |
$2,275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,229.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,456.00
|
| Rate for Payer: Altius Commercial |
$2,184.00
|
| Rate for Payer: Beech Street Commercial |
$2,229.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,206.75
|
| Rate for Payer: Cash Price |
$1,592.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,206.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,229.50
|
| Rate for Payer: Entrust Commercial |
$2,161.25
|
| Rate for Payer: First Choice Health Commercial |
$2,161.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,161.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,387.75
|
| Rate for Payer: HealthUtah PPO |
$2,275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,206.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,318.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,229.50
|
| Rate for Payer: PacificSource Commercial |
$2,047.50
|
| Rate for Payer: PHCS PPO |
$2,229.50
|
| Rate for Payer: Three Rivers PPO |
$1,706.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,387.75
|
| Rate for Payer: United Healthcare Commercial |
$2,172.62
|
| Rate for Payer: United Healthcare Medicare |
$1,387.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,161.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,161.25
|
|
|
DRILL ACUTRAK 2 MINI LONG
|
Facility
|
OP
|
$2,275.00
|
|
| Hospital Charge Code |
3002167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,231.91 |
| Max. Negotiated Rate |
$2,275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,229.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,501.50
|
| Rate for Payer: Altius Commercial |
$2,184.00
|
| Rate for Payer: Beech Street Commercial |
$2,229.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,206.75
|
| Rate for Payer: Cash Price |
$1,592.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,206.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,229.50
|
| Rate for Payer: Entrust Commercial |
$2,161.25
|
| Rate for Payer: First Choice Health Commercial |
$2,161.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,161.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,296.75
|
| Rate for Payer: HealthUtah PPO |
$2,275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,206.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,231.91
|
| Rate for Payer: One Health Plan of WY PPO |
$2,229.50
|
| Rate for Payer: PacificSource Commercial |
$2,047.50
|
| Rate for Payer: PHCS PPO |
$2,229.50
|
| Rate for Payer: Three Rivers PPO |
$1,706.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,296.75
|
| Rate for Payer: United Healthcare Commercial |
$2,172.62
|
| Rate for Payer: United Healthcare Medicare |
$1,296.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,229.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,161.25
|
|
|
DRILL ACUTRAK 2 MINI PROFILE
|
Facility
|
OP
|
$2,047.50
|
|
| Hospital Charge Code |
3002166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.72 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,006.55
|
| Rate for Payer: Aetna of WY Medicare |
$1,351.35
|
| Rate for Payer: Altius Commercial |
$1,965.60
|
| Rate for Payer: Beech Street Commercial |
$2,006.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.08
|
| Rate for Payer: Cash Price |
$1,433.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,986.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,006.55
|
| Rate for Payer: Entrust Commercial |
$1,945.12
|
| Rate for Payer: First Choice Health Commercial |
$1,945.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,945.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,167.08
|
| Rate for Payer: HealthUtah PPO |
$2,047.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,986.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,006.55
|
| Rate for Payer: PacificSource Commercial |
$1,842.75
|
| Rate for Payer: PHCS PPO |
$2,006.55
|
| Rate for Payer: Three Rivers PPO |
$1,535.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,167.08
|
| Rate for Payer: United Healthcare Commercial |
$1,955.36
|
| Rate for Payer: United Healthcare Medicare |
$1,167.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,006.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,945.12
|
|
|
DRILL ACUTRAK 2 MINI PROFILE
|
Facility
|
IP
|
$2,047.50
|
|
| Hospital Charge Code |
3002166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,186.53 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,006.55
|
| Rate for Payer: Aetna of WY Medicare |
$1,310.40
|
| Rate for Payer: Altius Commercial |
$1,965.60
|
| Rate for Payer: Beech Street Commercial |
$2,006.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.08
|
| Rate for Payer: Cash Price |
$1,433.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,986.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,006.55
|
| Rate for Payer: Entrust Commercial |
$1,945.12
|
| Rate for Payer: First Choice Health Commercial |
$1,945.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,945.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,248.98
|
| Rate for Payer: HealthUtah PPO |
$2,047.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,986.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1,186.53
|
| Rate for Payer: One Health Plan of WY PPO |
$2,006.55
|
| Rate for Payer: PacificSource Commercial |
$1,842.75
|
| Rate for Payer: PHCS PPO |
$2,006.55
|
| Rate for Payer: Three Rivers PPO |
$1,535.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,248.98
|
| Rate for Payer: United Healthcare Commercial |
$1,955.36
|
| Rate for Payer: United Healthcare Medicare |
$1,248.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,945.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,945.12
|
|
|
DRILL AO 2.0X135 TRAUMA
|
Facility
|
OP
|
$408.80
|
|
| Hospital Charge Code |
3100527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.37 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$269.81
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.02
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$221.37
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$233.02
|
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: United Healthcare Medicare |
$233.02
|
| Rate for Payer: WINHealth Partners Commercial |
$400.62
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 2.0X135 TRAUMA
|
Facility
|
IP
|
$408.80
|
|
| Hospital Charge Code |
3100527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.90 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$261.63
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.37
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$236.90
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$249.37
|
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: United Healthcare Medicare |
$249.37
|
| Rate for Payer: WINHealth Partners Commercial |
$388.36
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 2.5 STRYKER
|
Facility
|
OP
|
$656.88
|
|
| Hospital Charge Code |
3100417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.70 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: United Healthcare Commercial |
$627.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$643.74
|
| Rate for Payer: Aetna of WY Medicare |
$433.54
|
| Rate for Payer: Altius Commercial |
$630.60
|
| Rate for Payer: Beech Street Commercial |
$643.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$637.17
|
| Rate for Payer: Cash Price |
$459.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$637.17
|
| Rate for Payer: Cigna of WY Commercial |
$643.74
|
| Rate for Payer: Entrust Commercial |
$624.04
|
| Rate for Payer: First Choice Health Commercial |
$624.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$624.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$374.42
|
| Rate for Payer: HealthUtah PPO |
$656.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$637.17
|
| Rate for Payer: Multiplan Medicare/VA |
$355.70
|
| Rate for Payer: One Health Plan of WY PPO |
$643.74
|
| Rate for Payer: PacificSource Commercial |
$591.19
|
| Rate for Payer: PHCS PPO |
$643.74
|
| Rate for Payer: Three Rivers PPO |
$492.66
|
| Rate for Payer: TriWest Veterans Administration |
$374.42
|
| Rate for Payer: United Healthcare Medicare |
$374.42
|
| Rate for Payer: WINHealth Partners Commercial |
$643.74
|
| Rate for Payer: Wise Provider Network Commercial |
$624.04
|
|
|
DRILL AO 2.5 STRYKER
|
Facility
|
IP
|
$656.88
|
|
| Hospital Charge Code |
3100417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.66 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$643.74
|
| Rate for Payer: Aetna of WY Medicare |
$420.40
|
| Rate for Payer: Altius Commercial |
$630.60
|
| Rate for Payer: Beech Street Commercial |
$643.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$637.17
|
| Rate for Payer: Cash Price |
$459.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$637.17
|
| Rate for Payer: Cigna of WY Commercial |
$643.74
|
| Rate for Payer: Entrust Commercial |
$624.04
|
| Rate for Payer: First Choice Health Commercial |
$624.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$624.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.70
|
| Rate for Payer: HealthUtah PPO |
$656.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$637.17
|
| Rate for Payer: Multiplan Medicare/VA |
$380.66
|
| Rate for Payer: One Health Plan of WY PPO |
$643.74
|
| Rate for Payer: PacificSource Commercial |
$591.19
|
| Rate for Payer: PHCS PPO |
$643.74
|
| Rate for Payer: Three Rivers PPO |
$492.66
|
| Rate for Payer: TriWest Veterans Administration |
$400.70
|
| Rate for Payer: United Healthcare Commercial |
$627.32
|
| Rate for Payer: United Healthcare Medicare |
$400.70
|
| Rate for Payer: WINHealth Partners Commercial |
$624.04
|
| Rate for Payer: Wise Provider Network Commercial |
$624.04
|
|
|
DRILL AO 2.6X135 TRAUMA
|
Facility
|
IP
|
$408.80
|
|
| Hospital Charge Code |
3100528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.90 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$261.63
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.37
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$236.90
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$249.37
|
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: United Healthcare Medicare |
$249.37
|
| Rate for Payer: WINHealth Partners Commercial |
$388.36
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 2.6X135 TRAUMA
|
Facility
|
OP
|
$408.80
|
|
| Hospital Charge Code |
3100528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.37 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$269.81
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.02
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$221.37
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$233.02
|
| Rate for Payer: United Healthcare Medicare |
$233.02
|
| Rate for Payer: WINHealth Partners Commercial |
$400.62
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 2.7X122 TRAUMA
|
Facility
|
IP
|
$408.80
|
|
| Hospital Charge Code |
3100529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.90 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$261.63
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.37
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$236.90
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$249.37
|
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: United Healthcare Medicare |
$249.37
|
| Rate for Payer: WINHealth Partners Commercial |
$388.36
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 2.7X122 TRAUMA
|
Facility
|
OP
|
$408.80
|
|
| Hospital Charge Code |
3100529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.37 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$400.62
|
| Rate for Payer: Aetna of WY Medicare |
$269.81
|
| Rate for Payer: Altius Commercial |
$392.45
|
| Rate for Payer: Beech Street Commercial |
$400.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$396.54
|
| Rate for Payer: Cash Price |
$286.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$396.54
|
| Rate for Payer: Cigna of WY Commercial |
$400.62
|
| Rate for Payer: Entrust Commercial |
$388.36
|
| Rate for Payer: First Choice Health Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$388.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.02
|
| Rate for Payer: HealthUtah PPO |
$408.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$396.54
|
| Rate for Payer: Multiplan Medicare/VA |
$221.37
|
| Rate for Payer: One Health Plan of WY PPO |
$400.62
|
| Rate for Payer: PacificSource Commercial |
$367.92
|
| Rate for Payer: PHCS PPO |
$400.62
|
| Rate for Payer: Three Rivers PPO |
$306.60
|
| Rate for Payer: TriWest Veterans Administration |
$233.02
|
| Rate for Payer: United Healthcare Commercial |
$390.40
|
| Rate for Payer: United Healthcare Medicare |
$233.02
|
| Rate for Payer: WINHealth Partners Commercial |
$400.62
|
| Rate for Payer: Wise Provider Network Commercial |
$388.36
|
|
|
DRILL AO 3.1 STRYKER
|
Facility
|
IP
|
$392.84
|
|
| Hospital Charge Code |
3100418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.65 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$384.98
|
| Rate for Payer: Aetna of WY Medicare |
$251.42
|
| Rate for Payer: Altius Commercial |
$377.13
|
| Rate for Payer: Beech Street Commercial |
$384.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.05
|
| Rate for Payer: Cash Price |
$274.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.05
|
| Rate for Payer: Cigna of WY Commercial |
$384.98
|
| Rate for Payer: Entrust Commercial |
$373.20
|
| Rate for Payer: First Choice Health Commercial |
$373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.63
|
| Rate for Payer: HealthUtah PPO |
$392.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.05
|
| Rate for Payer: Multiplan Medicare/VA |
$227.65
|
| Rate for Payer: One Health Plan of WY PPO |
$384.98
|
| Rate for Payer: PacificSource Commercial |
$353.56
|
| Rate for Payer: PHCS PPO |
$384.98
|
| Rate for Payer: Three Rivers PPO |
$294.63
|
| Rate for Payer: TriWest Veterans Administration |
$239.63
|
| Rate for Payer: United Healthcare Commercial |
$375.16
|
| Rate for Payer: United Healthcare Medicare |
$239.63
|
| Rate for Payer: WINHealth Partners Commercial |
$373.20
|
| Rate for Payer: Wise Provider Network Commercial |
$373.20
|
|
|
DRILL AO 3.1 STRYKER
|
Facility
|
OP
|
$392.84
|
|
| Hospital Charge Code |
3100418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.72 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$384.98
|
| Rate for Payer: Aetna of WY Medicare |
$259.27
|
| Rate for Payer: Altius Commercial |
$377.13
|
| Rate for Payer: Beech Street Commercial |
$384.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.05
|
| Rate for Payer: Cash Price |
$274.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.05
|
| Rate for Payer: Cigna of WY Commercial |
$384.98
|
| Rate for Payer: Entrust Commercial |
$373.20
|
| Rate for Payer: First Choice Health Commercial |
$373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.92
|
| Rate for Payer: HealthUtah PPO |
$392.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.05
|
| Rate for Payer: Multiplan Medicare/VA |
$212.72
|
| Rate for Payer: One Health Plan of WY PPO |
$384.98
|
| Rate for Payer: PacificSource Commercial |
$353.56
|
| Rate for Payer: PHCS PPO |
$384.98
|
| Rate for Payer: Three Rivers PPO |
$294.63
|
| Rate for Payer: TriWest Veterans Administration |
$223.92
|
| Rate for Payer: United Healthcare Commercial |
$375.16
|
| Rate for Payer: United Healthcare Medicare |
$223.92
|
| Rate for Payer: WINHealth Partners Commercial |
$384.98
|
| Rate for Payer: Wise Provider Network Commercial |
$373.20
|
|
|
DRILL ASSY 7MM BONE GRAFT
|
Facility
|
IP
|
$2,989.00
|
|
| Hospital Charge Code |
3004052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,732.13 |
| Max. Negotiated Rate |
$2,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,929.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,912.96
|
| Rate for Payer: Altius Commercial |
$2,869.44
|
| Rate for Payer: Beech Street Commercial |
$2,929.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,899.33
|
| Rate for Payer: Cash Price |
$2,092.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,899.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,929.22
|
| Rate for Payer: Entrust Commercial |
$2,839.55
|
| Rate for Payer: First Choice Health Commercial |
$2,839.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,839.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,823.29
|
| Rate for Payer: HealthUtah PPO |
$2,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,899.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,732.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,929.22
|
| Rate for Payer: PacificSource Commercial |
$2,690.10
|
| Rate for Payer: PHCS PPO |
$2,929.22
|
| Rate for Payer: Three Rivers PPO |
$2,241.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,823.29
|
| Rate for Payer: United Healthcare Commercial |
$2,854.50
|
| Rate for Payer: United Healthcare Medicare |
$1,823.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,839.55
|
| Rate for Payer: Wise Provider Network Commercial |
$2,839.55
|
|
|
DRILL ASSY 7MM BONE GRAFT
|
Facility
|
OP
|
$2,989.00
|
|
| Hospital Charge Code |
3004052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,618.54 |
| Max. Negotiated Rate |
$2,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,929.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,972.74
|
| Rate for Payer: Altius Commercial |
$2,869.44
|
| Rate for Payer: Beech Street Commercial |
$2,929.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,899.33
|
| Rate for Payer: Cash Price |
$2,092.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,899.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,929.22
|
| Rate for Payer: Entrust Commercial |
$2,839.55
|
| Rate for Payer: First Choice Health Commercial |
$2,839.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,839.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,703.73
|
| Rate for Payer: HealthUtah PPO |
$2,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,899.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,618.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,929.22
|
| Rate for Payer: PacificSource Commercial |
$2,690.10
|
| Rate for Payer: PHCS PPO |
$2,929.22
|
| Rate for Payer: Three Rivers PPO |
$2,241.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,703.73
|
| Rate for Payer: United Healthcare Commercial |
$2,854.50
|
| Rate for Payer: United Healthcare Medicare |
$1,703.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,929.22
|
| Rate for Payer: Wise Provider Network Commercial |
$2,839.55
|
|
|
DRILL BIT 10.5MM CANN 1218-105
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3004465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$436.80
|
| 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 |
$416.32
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$395.51
|
| 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 |
$416.32
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$416.32
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
DRILL BIT 10.5MM CANN 1218-105
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
3004465
|
|
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 BIT 11.5 CAN AR-1218-115
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3003819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$436.80
|
| 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 |
$416.32
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$395.51
|
| 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 |
$416.32
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$416.32
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
