|
DRILL BIT 2.6 VARIAX
|
Facility
|
OP
|
$333.83
|
|
| Hospital Charge Code |
3100118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.77 |
| Max. Negotiated Rate |
$333.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$327.15
|
| Rate for Payer: Aetna of WY Medicare |
$220.33
|
| Rate for Payer: Altius Commercial |
$320.48
|
| Rate for Payer: Beech Street Commercial |
$327.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$323.82
|
| Rate for Payer: Cash Price |
$233.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.82
|
| Rate for Payer: Cigna of WY Commercial |
$327.15
|
| Rate for Payer: Entrust Commercial |
$317.14
|
| Rate for Payer: First Choice Health Commercial |
$317.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$317.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.28
|
| Rate for Payer: HealthUtah PPO |
$333.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.82
|
| Rate for Payer: Multiplan Medicare/VA |
$180.77
|
| Rate for Payer: One Health Plan of WY PPO |
$327.15
|
| Rate for Payer: PacificSource Commercial |
$300.45
|
| Rate for Payer: PHCS PPO |
$327.15
|
| Rate for Payer: Three Rivers PPO |
$250.37
|
| Rate for Payer: TriWest Veterans Administration |
$190.28
|
| Rate for Payer: United Healthcare Commercial |
$318.81
|
| Rate for Payer: United Healthcare Medicare |
$190.28
|
| Rate for Payer: WINHealth Partners Commercial |
$327.15
|
| Rate for Payer: Wise Provider Network Commercial |
$317.14
|
|
|
DRILL BIT 2.7/095 TRIMED
|
Facility
|
IP
|
$385.00
|
|
| Hospital Charge Code |
3003351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.11 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$246.40
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.45
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.85
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$223.11
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$234.85
|
| Rate for Payer: United Healthcare Commercial |
$367.68
|
| Rate for Payer: United Healthcare Medicare |
$234.85
|
| Rate for Payer: WINHealth Partners Commercial |
$365.75
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
DRILL BIT 2.7/095 TRIMED
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
3003351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.48 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$254.10
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.45
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.45
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$208.48
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.45
|
| Rate for Payer: United Healthcare Commercial |
$367.68
|
| Rate for Payer: United Healthcare Medicare |
$219.45
|
| Rate for Payer: WINHealth Partners Commercial |
$377.30
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
DRILL BIT 2.7 ANCHORAGE
|
Facility
|
IP
|
$1,310.40
|
|
| Hospital Charge Code |
3100284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$759.38 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,284.19
|
| Rate for Payer: Aetna of WY Medicare |
$838.66
|
| Rate for Payer: Altius Commercial |
$1,257.98
|
| Rate for Payer: Beech Street Commercial |
$1,284.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,271.09
|
| Rate for Payer: Cash Price |
$917.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,271.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,284.19
|
| Rate for Payer: Entrust Commercial |
$1,244.88
|
| Rate for Payer: First Choice Health Commercial |
$1,244.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,244.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$799.34
|
| Rate for Payer: HealthUtah PPO |
$1,310.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,271.09
|
| Rate for Payer: Multiplan Medicare/VA |
$759.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,284.19
|
| Rate for Payer: PacificSource Commercial |
$1,179.36
|
| Rate for Payer: PHCS PPO |
$1,284.19
|
| Rate for Payer: Three Rivers PPO |
$982.80
|
| Rate for Payer: TriWest Veterans Administration |
$799.34
|
| Rate for Payer: United Healthcare Commercial |
$1,251.43
|
| Rate for Payer: United Healthcare Medicare |
$799.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,244.88
|
|
|
DRILL BIT 2.7 ANCHORAGE
|
Facility
|
OP
|
$1,310.40
|
|
| Hospital Charge Code |
3100284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.58 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,284.19
|
| Rate for Payer: Aetna of WY Medicare |
$864.86
|
| Rate for Payer: Altius Commercial |
$1,257.98
|
| Rate for Payer: Beech Street Commercial |
$1,284.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,271.09
|
| Rate for Payer: Cash Price |
$917.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,271.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,284.19
|
| Rate for Payer: Entrust Commercial |
$1,244.88
|
| Rate for Payer: First Choice Health Commercial |
$1,244.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,244.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$746.93
|
| Rate for Payer: HealthUtah PPO |
$1,310.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,271.09
|
| Rate for Payer: Multiplan Medicare/VA |
$709.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,284.19
|
| Rate for Payer: PacificSource Commercial |
$1,179.36
|
| Rate for Payer: PHCS PPO |
$1,284.19
|
| Rate for Payer: Three Rivers PPO |
$982.80
|
| Rate for Payer: TriWest Veterans Administration |
$746.93
|
| Rate for Payer: United Healthcare Commercial |
$1,251.43
|
| Rate for Payer: United Healthcare Medicare |
$746.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,284.19
|
| Rate for Payer: Wise Provider Network Commercial |
$1,244.88
|
|
|
DRILL BIT 2.7MM CANN ACUMED
|
Facility
|
IP
|
$1,631.00
|
|
| Hospital Charge Code |
3003666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.16 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,598.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,043.84
|
| Rate for Payer: Altius Commercial |
$1,565.76
|
| Rate for Payer: Beech Street Commercial |
$1,598.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,582.07
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,582.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,598.38
|
| Rate for Payer: Entrust Commercial |
$1,549.45
|
| Rate for Payer: First Choice Health Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$994.91
|
| Rate for Payer: HealthUtah PPO |
$1,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,582.07
|
| Rate for Payer: Multiplan Medicare/VA |
$945.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,598.38
|
| Rate for Payer: PacificSource Commercial |
$1,467.90
|
| Rate for Payer: PHCS PPO |
$1,598.38
|
| Rate for Payer: Three Rivers PPO |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$994.91
|
| Rate for Payer: United Healthcare Commercial |
$1,557.60
|
| Rate for Payer: United Healthcare Medicare |
$994.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,549.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,549.45
|
|
|
DRILL BIT 2.7MM CANN ACUMED
|
Facility
|
OP
|
$1,631.00
|
|
| Hospital Charge Code |
3003666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.19 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,598.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,076.46
|
| Rate for Payer: Altius Commercial |
$1,565.76
|
| Rate for Payer: Beech Street Commercial |
$1,598.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,582.07
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,582.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,598.38
|
| Rate for Payer: Entrust Commercial |
$1,549.45
|
| Rate for Payer: First Choice Health Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$929.67
|
| Rate for Payer: HealthUtah PPO |
$1,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,582.07
|
| Rate for Payer: Multiplan Medicare/VA |
$883.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,598.38
|
| Rate for Payer: PacificSource Commercial |
$1,467.90
|
| Rate for Payer: PHCS PPO |
$1,598.38
|
| Rate for Payer: Three Rivers PPO |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$929.67
|
| Rate for Payer: United Healthcare Commercial |
$1,557.60
|
| Rate for Payer: United Healthcare Medicare |
$929.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,598.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,549.45
|
|
|
DRILLBIT 2.7MM CANN AO ASNIS
|
Facility
|
IP
|
$766.08
|
|
| Hospital Charge Code |
3100008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.94 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: United Healthcare Commercial |
$731.61
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$750.76
|
| Rate for Payer: Aetna of WY Medicare |
$490.29
|
| Rate for Payer: Altius Commercial |
$735.44
|
| Rate for Payer: Beech Street Commercial |
$750.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.10
|
| Rate for Payer: Cash Price |
$536.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$743.10
|
| Rate for Payer: Cigna of WY Commercial |
$750.76
|
| Rate for Payer: Entrust Commercial |
$727.78
|
| Rate for Payer: First Choice Health Commercial |
$727.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$727.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.31
|
| Rate for Payer: HealthUtah PPO |
$766.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$743.10
|
| Rate for Payer: Multiplan Medicare/VA |
$443.94
|
| Rate for Payer: One Health Plan of WY PPO |
$750.76
|
| Rate for Payer: PacificSource Commercial |
$689.47
|
| Rate for Payer: PHCS PPO |
$750.76
|
| Rate for Payer: Three Rivers PPO |
$574.56
|
| Rate for Payer: TriWest Veterans Administration |
$467.31
|
| Rate for Payer: United Healthcare Medicare |
$467.31
|
| Rate for Payer: WINHealth Partners Commercial |
$727.78
|
| Rate for Payer: Wise Provider Network Commercial |
$727.78
|
|
|
DRILLBIT 2.7MM CANN AO ASNIS
|
Facility
|
OP
|
$766.08
|
|
| Hospital Charge Code |
3100008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.83 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$750.76
|
| Rate for Payer: Aetna of WY Medicare |
$505.61
|
| Rate for Payer: Altius Commercial |
$735.44
|
| Rate for Payer: Beech Street Commercial |
$750.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.10
|
| Rate for Payer: Cash Price |
$536.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$743.10
|
| Rate for Payer: Cigna of WY Commercial |
$750.76
|
| Rate for Payer: Entrust Commercial |
$727.78
|
| Rate for Payer: First Choice Health Commercial |
$727.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$727.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.67
|
| Rate for Payer: HealthUtah PPO |
$766.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$743.10
|
| Rate for Payer: Multiplan Medicare/VA |
$414.83
|
| Rate for Payer: One Health Plan of WY PPO |
$750.76
|
| Rate for Payer: PacificSource Commercial |
$689.47
|
| Rate for Payer: PHCS PPO |
$750.76
|
| Rate for Payer: Three Rivers PPO |
$574.56
|
| Rate for Payer: TriWest Veterans Administration |
$436.67
|
| Rate for Payer: United Healthcare Commercial |
$731.61
|
| Rate for Payer: United Healthcare Medicare |
$436.67
|
| Rate for Payer: WINHealth Partners Commercial |
$750.76
|
| Rate for Payer: Wise Provider Network Commercial |
$727.78
|
|
|
DRILL BIT 2.7MM QUICK LAG
|
Facility
|
OP
|
$1,169.00
|
|
| Hospital Charge Code |
3003667
|
|
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 BIT 2.7MM QUICK LAG
|
Facility
|
IP
|
$1,169.00
|
|
| Hospital Charge Code |
3003667
|
|
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 BIT 2.7 VARIAX
|
Facility
|
OP
|
$381.64
|
|
| Hospital Charge Code |
3100179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.66 |
| Max. Negotiated Rate |
$381.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$374.01
|
| Rate for Payer: Aetna of WY Medicare |
$251.88
|
| Rate for Payer: Altius Commercial |
$366.37
|
| Rate for Payer: Beech Street Commercial |
$374.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.19
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$370.19
|
| Rate for Payer: Cigna of WY Commercial |
$374.01
|
| Rate for Payer: Entrust Commercial |
$362.56
|
| Rate for Payer: First Choice Health Commercial |
$362.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$362.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.53
|
| Rate for Payer: HealthUtah PPO |
$381.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$370.19
|
| Rate for Payer: Multiplan Medicare/VA |
$206.66
|
| Rate for Payer: One Health Plan of WY PPO |
$374.01
|
| Rate for Payer: PacificSource Commercial |
$343.48
|
| Rate for Payer: PHCS PPO |
$374.01
|
| Rate for Payer: Three Rivers PPO |
$286.23
|
| Rate for Payer: TriWest Veterans Administration |
$217.53
|
| Rate for Payer: United Healthcare Commercial |
$364.47
|
| Rate for Payer: United Healthcare Medicare |
$217.53
|
| Rate for Payer: WINHealth Partners Commercial |
$374.01
|
| Rate for Payer: Wise Provider Network Commercial |
$362.56
|
|
|
DRILL BIT 2.7 VARIAX
|
Facility
|
IP
|
$381.64
|
|
| Hospital Charge Code |
3100179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$381.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$374.01
|
| Rate for Payer: Aetna of WY Medicare |
$244.25
|
| Rate for Payer: Altius Commercial |
$366.37
|
| Rate for Payer: Beech Street Commercial |
$374.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$370.19
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$370.19
|
| Rate for Payer: Cigna of WY Commercial |
$374.01
|
| Rate for Payer: Entrust Commercial |
$362.56
|
| Rate for Payer: First Choice Health Commercial |
$362.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$362.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.80
|
| Rate for Payer: HealthUtah PPO |
$381.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$370.19
|
| Rate for Payer: Multiplan Medicare/VA |
$221.16
|
| Rate for Payer: One Health Plan of WY PPO |
$374.01
|
| Rate for Payer: PacificSource Commercial |
$343.48
|
| Rate for Payer: PHCS PPO |
$374.01
|
| Rate for Payer: Three Rivers PPO |
$286.23
|
| Rate for Payer: TriWest Veterans Administration |
$232.80
|
| Rate for Payer: United Healthcare Commercial |
$364.47
|
| Rate for Payer: United Healthcare Medicare |
$232.80
|
| Rate for Payer: WINHealth Partners Commercial |
$362.56
|
| Rate for Payer: Wise Provider Network Commercial |
$362.56
|
|
|
DRILL BIT 2.7 VARIAX
|
Facility
|
OP
|
$297.36
|
|
| Hospital Charge Code |
3100259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.02 |
| Max. Negotiated Rate |
$297.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.41
|
| Rate for Payer: Aetna of WY Medicare |
$196.26
|
| Rate for Payer: Altius Commercial |
$285.47
|
| Rate for Payer: Beech Street Commercial |
$291.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$288.44
|
| Rate for Payer: Cash Price |
$208.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.44
|
| Rate for Payer: Cigna of WY Commercial |
$291.41
|
| Rate for Payer: Entrust Commercial |
$282.49
|
| Rate for Payer: First Choice Health Commercial |
$282.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.50
|
| Rate for Payer: HealthUtah PPO |
$297.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.44
|
| Rate for Payer: Multiplan Medicare/VA |
$161.02
|
| Rate for Payer: One Health Plan of WY PPO |
$291.41
|
| Rate for Payer: PacificSource Commercial |
$267.62
|
| Rate for Payer: PHCS PPO |
$291.41
|
| Rate for Payer: Three Rivers PPO |
$223.02
|
| Rate for Payer: TriWest Veterans Administration |
$169.50
|
| Rate for Payer: United Healthcare Commercial |
$283.98
|
| Rate for Payer: United Healthcare Medicare |
$169.50
|
| Rate for Payer: WINHealth Partners Commercial |
$291.41
|
| Rate for Payer: Wise Provider Network Commercial |
$282.49
|
|
|
DRILL BIT 2.7 VARIAX
|
Facility
|
IP
|
$297.36
|
|
| Hospital Charge Code |
3100259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$297.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.41
|
| Rate for Payer: Aetna of WY Medicare |
$190.31
|
| Rate for Payer: Altius Commercial |
$285.47
|
| Rate for Payer: Beech Street Commercial |
$291.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$288.44
|
| Rate for Payer: Cash Price |
$208.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.44
|
| Rate for Payer: Cigna of WY Commercial |
$291.41
|
| Rate for Payer: Entrust Commercial |
$282.49
|
| Rate for Payer: First Choice Health Commercial |
$282.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.39
|
| Rate for Payer: HealthUtah PPO |
$297.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.44
|
| Rate for Payer: Multiplan Medicare/VA |
$172.32
|
| Rate for Payer: One Health Plan of WY PPO |
$291.41
|
| Rate for Payer: PacificSource Commercial |
$267.62
|
| Rate for Payer: PHCS PPO |
$291.41
|
| Rate for Payer: Three Rivers PPO |
$223.02
|
| Rate for Payer: TriWest Veterans Administration |
$181.39
|
| Rate for Payer: United Healthcare Commercial |
$283.98
|
| Rate for Payer: United Healthcare Medicare |
$181.39
|
| Rate for Payer: WINHealth Partners Commercial |
$282.49
|
| Rate for Payer: Wise Provider Network Commercial |
$282.49
|
|
|
DRILL BIT 2.7 X 100MM Q-C
|
Facility
|
OP
|
$208.25
|
|
| Hospital Charge Code |
3002873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$137.44
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.70
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$112.77
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$118.70
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$118.70
|
| Rate for Payer: WINHealth Partners Commercial |
$204.08
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 2.7 X 100MM Q-C
|
Facility
|
IP
|
$208.25
|
|
| Hospital Charge Code |
3002873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$133.28
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.03
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$120.68
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$127.03
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$127.03
|
| Rate for Payer: WINHealth Partners Commercial |
$197.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 2.7X100MM QC
|
Facility
|
OP
|
$208.25
|
|
| Hospital Charge Code |
2650883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$137.44
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.70
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$112.77
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$118.70
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$118.70
|
| Rate for Payer: WINHealth Partners Commercial |
$204.08
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 2.7X100MM QC
|
Facility
|
IP
|
$208.25
|
|
| Hospital Charge Code |
2650883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$133.28
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.03
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$120.68
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$127.03
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$127.03
|
| Rate for Payer: WINHealth Partners Commercial |
$197.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 2.7 X 50 AO TAP
|
Facility
|
OP
|
$268.80
|
|
| Hospital Charge Code |
3100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.56 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.42
|
| Rate for Payer: Aetna of WY Medicare |
$177.41
|
| Rate for Payer: Altius Commercial |
$258.05
|
| Rate for Payer: Beech Street Commercial |
$263.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.74
|
| Rate for Payer: Cash Price |
$188.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.74
|
| Rate for Payer: Cigna of WY Commercial |
$263.42
|
| Rate for Payer: Entrust Commercial |
$255.36
|
| Rate for Payer: First Choice Health Commercial |
$255.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.22
|
| Rate for Payer: HealthUtah PPO |
$268.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.74
|
| Rate for Payer: Multiplan Medicare/VA |
$145.56
|
| Rate for Payer: One Health Plan of WY PPO |
$263.42
|
| Rate for Payer: PacificSource Commercial |
$241.92
|
| Rate for Payer: PHCS PPO |
$263.42
|
| Rate for Payer: Three Rivers PPO |
$201.60
|
| Rate for Payer: TriWest Veterans Administration |
$153.22
|
| Rate for Payer: United Healthcare Commercial |
$256.70
|
| Rate for Payer: United Healthcare Medicare |
$153.22
|
| Rate for Payer: WINHealth Partners Commercial |
$263.42
|
| Rate for Payer: Wise Provider Network Commercial |
$255.36
|
|
|
DRILL BIT 2.7 X 50 AO TAP
|
Facility
|
IP
|
$268.80
|
|
| Hospital Charge Code |
3100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.77 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.42
|
| Rate for Payer: Aetna of WY Medicare |
$172.03
|
| Rate for Payer: Altius Commercial |
$258.05
|
| Rate for Payer: Beech Street Commercial |
$263.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.74
|
| Rate for Payer: Cash Price |
$188.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.74
|
| Rate for Payer: Cigna of WY Commercial |
$263.42
|
| Rate for Payer: Entrust Commercial |
$255.36
|
| Rate for Payer: First Choice Health Commercial |
$255.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.97
|
| Rate for Payer: HealthUtah PPO |
$268.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.74
|
| Rate for Payer: Multiplan Medicare/VA |
$155.77
|
| Rate for Payer: One Health Plan of WY PPO |
$263.42
|
| Rate for Payer: PacificSource Commercial |
$241.92
|
| Rate for Payer: PHCS PPO |
$263.42
|
| Rate for Payer: Three Rivers PPO |
$201.60
|
| Rate for Payer: TriWest Veterans Administration |
$163.97
|
| Rate for Payer: United Healthcare Commercial |
$256.70
|
| Rate for Payer: United Healthcare Medicare |
$163.97
|
| Rate for Payer: WINHealth Partners Commercial |
$255.36
|
| Rate for Payer: Wise Provider Network Commercial |
$255.36
|
|
|
DRILL BIT 2.8MM ACUMED
|
Facility
|
IP
|
$976.50
|
|
| Hospital Charge Code |
3002200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$956.97
|
| Rate for Payer: Aetna of WY Medicare |
$624.96
|
| Rate for Payer: Altius Commercial |
$937.44
|
| Rate for Payer: Beech Street Commercial |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$947.20
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$947.20
|
| Rate for Payer: Cigna of WY Commercial |
$956.97
|
| Rate for Payer: Entrust Commercial |
$927.68
|
| Rate for Payer: First Choice Health Commercial |
$927.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$927.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$595.66
|
| Rate for Payer: HealthUtah PPO |
$976.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$947.20
|
| Rate for Payer: Multiplan Medicare/VA |
$565.88
|
| Rate for Payer: One Health Plan of WY PPO |
$956.97
|
| Rate for Payer: PacificSource Commercial |
$878.85
|
| Rate for Payer: PHCS PPO |
$956.97
|
| Rate for Payer: Three Rivers PPO |
$732.38
|
| Rate for Payer: TriWest Veterans Administration |
$595.66
|
| Rate for Payer: United Healthcare Commercial |
$932.56
|
| Rate for Payer: United Healthcare Medicare |
$595.66
|
| Rate for Payer: WINHealth Partners Commercial |
$927.68
|
| Rate for Payer: Wise Provider Network Commercial |
$927.68
|
|
|
DRILL BIT 2.8MM ACUMED
|
Facility
|
OP
|
$976.50
|
|
| Hospital Charge Code |
3002200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.77 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$956.97
|
| Rate for Payer: Aetna of WY Medicare |
$644.49
|
| Rate for Payer: Altius Commercial |
$937.44
|
| Rate for Payer: Beech Street Commercial |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$947.20
|
| Rate for Payer: Cash Price |
$683.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$947.20
|
| Rate for Payer: Cigna of WY Commercial |
$956.97
|
| Rate for Payer: Entrust Commercial |
$927.68
|
| Rate for Payer: First Choice Health Commercial |
$927.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$927.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$556.60
|
| Rate for Payer: HealthUtah PPO |
$976.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$947.20
|
| Rate for Payer: Multiplan Medicare/VA |
$528.77
|
| Rate for Payer: One Health Plan of WY PPO |
$956.97
|
| Rate for Payer: PacificSource Commercial |
$878.85
|
| Rate for Payer: PHCS PPO |
$956.97
|
| Rate for Payer: Three Rivers PPO |
$732.38
|
| Rate for Payer: TriWest Veterans Administration |
$556.60
|
| Rate for Payer: United Healthcare Commercial |
$932.56
|
| Rate for Payer: United Healthcare Medicare |
$556.60
|
| Rate for Payer: WINHealth Partners Commercial |
$956.97
|
| Rate for Payer: Wise Provider Network Commercial |
$927.68
|
|
|
DRILL BIT 2.8MM QUICK W/ DEPTH
|
Facility
|
OP
|
$1,137.50
|
|
| Hospital Charge Code |
3003516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.96 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,114.75
|
| Rate for Payer: Aetna of WY Medicare |
$750.75
|
| Rate for Payer: Altius Commercial |
$1,092.00
|
| Rate for Payer: Beech Street Commercial |
$1,114.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,103.38
|
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,114.75
|
| Rate for Payer: Entrust Commercial |
$1,080.62
|
| Rate for Payer: First Choice Health Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$648.38
|
| Rate for Payer: HealthUtah PPO |
$1,137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.38
|
| Rate for Payer: Multiplan Medicare/VA |
$615.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,114.75
|
| Rate for Payer: PacificSource Commercial |
$1,023.75
|
| Rate for Payer: PHCS PPO |
$1,114.75
|
| Rate for Payer: Three Rivers PPO |
$853.12
|
| Rate for Payer: TriWest Veterans Administration |
$648.38
|
| Rate for Payer: United Healthcare Commercial |
$1,086.31
|
| Rate for Payer: United Healthcare Medicare |
$648.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,114.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,080.62
|
|
|
DRILL BIT 2.8MM QUICK W/ DEPTH
|
Facility
|
IP
|
$1,137.50
|
|
| Hospital Charge Code |
3003516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.18 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,114.75
|
| Rate for Payer: Aetna of WY Medicare |
$728.00
|
| Rate for Payer: Altius Commercial |
$1,092.00
|
| Rate for Payer: Beech Street Commercial |
$1,114.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,103.38
|
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,114.75
|
| Rate for Payer: Entrust Commercial |
$1,080.62
|
| Rate for Payer: First Choice Health Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$693.88
|
| Rate for Payer: HealthUtah PPO |
$1,137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.38
|
| Rate for Payer: Multiplan Medicare/VA |
$659.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,114.75
|
| Rate for Payer: PacificSource Commercial |
$1,023.75
|
| Rate for Payer: PHCS PPO |
$1,114.75
|
| Rate for Payer: Three Rivers PPO |
$853.12
|
| Rate for Payer: TriWest Veterans Administration |
$693.88
|
| Rate for Payer: United Healthcare Commercial |
$1,086.31
|
| Rate for Payer: United Healthcare Medicare |
$693.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,080.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,080.62
|
|
