|
DRILL SPEEDGUIDE 2.0X30MM AO
|
Facility
|
IP
|
$526.40
|
|
| Hospital Charge Code |
3003778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.05 |
| Max. Negotiated Rate |
$526.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$515.87
|
| Rate for Payer: Aetna of WY Medicare |
$336.90
|
| Rate for Payer: Altius Commercial |
$505.34
|
| Rate for Payer: Beech Street Commercial |
$515.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$510.61
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$510.61
|
| Rate for Payer: Cigna of WY Commercial |
$515.87
|
| Rate for Payer: Entrust Commercial |
$500.08
|
| Rate for Payer: First Choice Health Commercial |
$500.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.10
|
| Rate for Payer: HealthUtah PPO |
$526.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$510.61
|
| Rate for Payer: Multiplan Medicare/VA |
$305.05
|
| Rate for Payer: One Health Plan of WY PPO |
$515.87
|
| Rate for Payer: PacificSource Commercial |
$473.76
|
| Rate for Payer: PHCS PPO |
$515.87
|
| Rate for Payer: Three Rivers PPO |
$394.80
|
| Rate for Payer: TriWest Veterans Administration |
$321.10
|
| Rate for Payer: United Healthcare Commercial |
$502.71
|
| Rate for Payer: United Healthcare Medicare |
$321.10
|
| Rate for Payer: WINHealth Partners Commercial |
$500.08
|
| Rate for Payer: Wise Provider Network Commercial |
$500.08
|
|
|
DRILL SPEEDGUIDE 2.0X30MM AO
|
Facility
|
OP
|
$526.40
|
|
| Hospital Charge Code |
3003778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.05 |
| Max. Negotiated Rate |
$526.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$515.87
|
| Rate for Payer: Aetna of WY Medicare |
$347.42
|
| Rate for Payer: Altius Commercial |
$505.34
|
| Rate for Payer: Beech Street Commercial |
$515.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$510.61
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$510.61
|
| Rate for Payer: Cigna of WY Commercial |
$515.87
|
| Rate for Payer: Entrust Commercial |
$500.08
|
| Rate for Payer: First Choice Health Commercial |
$500.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.05
|
| Rate for Payer: HealthUtah PPO |
$526.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$510.61
|
| Rate for Payer: Multiplan Medicare/VA |
$285.05
|
| Rate for Payer: One Health Plan of WY PPO |
$515.87
|
| Rate for Payer: PacificSource Commercial |
$473.76
|
| Rate for Payer: PHCS PPO |
$515.87
|
| Rate for Payer: Three Rivers PPO |
$394.80
|
| Rate for Payer: TriWest Veterans Administration |
$300.05
|
| Rate for Payer: United Healthcare Commercial |
$502.71
|
| Rate for Payer: United Healthcare Medicare |
$300.05
|
| Rate for Payer: WINHealth Partners Commercial |
$515.87
|
| Rate for Payer: Wise Provider Network Commercial |
$500.08
|
|
|
DRILL TWIST S-COUPLE 3.5X70 MM
|
Facility
|
OP
|
$371.07
|
|
| Hospital Charge Code |
3003245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: HealthUtah PPO |
$371.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$363.65
|
| Rate for Payer: Aetna of WY Medicare |
$244.91
|
| Rate for Payer: Altius Commercial |
$356.23
|
| Rate for Payer: Beech Street Commercial |
$363.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.94
|
| Rate for Payer: Cash Price |
$259.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.94
|
| Rate for Payer: Cigna of WY Commercial |
$363.65
|
| Rate for Payer: Entrust Commercial |
$352.52
|
| Rate for Payer: First Choice Health Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.94
|
| Rate for Payer: Multiplan Medicare/VA |
$200.93
|
| Rate for Payer: One Health Plan of WY PPO |
$363.65
|
| Rate for Payer: PacificSource Commercial |
$333.96
|
| Rate for Payer: PHCS PPO |
$363.65
|
| Rate for Payer: Three Rivers PPO |
$278.30
|
| Rate for Payer: TriWest Veterans Administration |
$211.51
|
| Rate for Payer: United Healthcare Commercial |
$354.37
|
| Rate for Payer: United Healthcare Medicare |
$211.51
|
| Rate for Payer: WINHealth Partners Commercial |
$363.65
|
| Rate for Payer: Wise Provider Network Commercial |
$352.52
|
|
|
DRILL TWIST S-COUPLE 3.5X70 MM
|
Facility
|
IP
|
$371.07
|
|
| Hospital Charge Code |
3003245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$363.65
|
| Rate for Payer: Aetna of WY Medicare |
$237.48
|
| Rate for Payer: Altius Commercial |
$356.23
|
| Rate for Payer: Beech Street Commercial |
$363.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.94
|
| Rate for Payer: Cash Price |
$259.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.94
|
| Rate for Payer: Cigna of WY Commercial |
$363.65
|
| Rate for Payer: Entrust Commercial |
$352.52
|
| Rate for Payer: First Choice Health Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.35
|
| Rate for Payer: HealthUtah PPO |
$371.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.94
|
| Rate for Payer: Multiplan Medicare/VA |
$215.04
|
| Rate for Payer: One Health Plan of WY PPO |
$363.65
|
| Rate for Payer: PacificSource Commercial |
$333.96
|
| Rate for Payer: PHCS PPO |
$363.65
|
| Rate for Payer: Three Rivers PPO |
$278.30
|
| Rate for Payer: TriWest Veterans Administration |
$226.35
|
| Rate for Payer: United Healthcare Commercial |
$354.37
|
| Rate for Payer: United Healthcare Medicare |
$226.35
|
| Rate for Payer: WINHealth Partners Commercial |
$352.52
|
| Rate for Payer: Wise Provider Network Commercial |
$352.52
|
|
|
DRILL TWIST SCP 2.9 X 70MM
|
Facility
|
IP
|
$341.14
|
|
| Hospital Charge Code |
3004061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.69 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$334.32
|
| Rate for Payer: Aetna of WY Medicare |
$218.33
|
| Rate for Payer: Altius Commercial |
$327.49
|
| Rate for Payer: Beech Street Commercial |
$334.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.91
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$330.91
|
| Rate for Payer: Cigna of WY Commercial |
$334.32
|
| Rate for Payer: Entrust Commercial |
$324.08
|
| Rate for Payer: First Choice Health Commercial |
$324.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$324.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.10
|
| Rate for Payer: HealthUtah PPO |
$341.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$330.91
|
| Rate for Payer: Multiplan Medicare/VA |
$197.69
|
| Rate for Payer: One Health Plan of WY PPO |
$334.32
|
| Rate for Payer: PacificSource Commercial |
$307.03
|
| Rate for Payer: PHCS PPO |
$334.32
|
| Rate for Payer: Three Rivers PPO |
$255.86
|
| Rate for Payer: TriWest Veterans Administration |
$208.10
|
| Rate for Payer: United Healthcare Commercial |
$325.79
|
| Rate for Payer: United Healthcare Medicare |
$208.10
|
| Rate for Payer: WINHealth Partners Commercial |
$324.08
|
| Rate for Payer: Wise Provider Network Commercial |
$324.08
|
|
|
DRILL TWIST SCP 2.9 X 70MM
|
Facility
|
OP
|
$341.14
|
|
| Hospital Charge Code |
3004061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.73 |
| Max. Negotiated Rate |
$341.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$334.32
|
| Rate for Payer: Aetna of WY Medicare |
$225.15
|
| Rate for Payer: Altius Commercial |
$327.49
|
| Rate for Payer: Beech Street Commercial |
$334.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.91
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$330.91
|
| Rate for Payer: Cigna of WY Commercial |
$334.32
|
| Rate for Payer: Entrust Commercial |
$324.08
|
| Rate for Payer: First Choice Health Commercial |
$324.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$324.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.45
|
| Rate for Payer: HealthUtah PPO |
$341.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$330.91
|
| Rate for Payer: Multiplan Medicare/VA |
$184.73
|
| Rate for Payer: One Health Plan of WY PPO |
$334.32
|
| Rate for Payer: PacificSource Commercial |
$307.03
|
| Rate for Payer: PHCS PPO |
$334.32
|
| Rate for Payer: Three Rivers PPO |
$255.86
|
| Rate for Payer: TriWest Veterans Administration |
$194.45
|
| Rate for Payer: United Healthcare Commercial |
$325.79
|
| Rate for Payer: United Healthcare Medicare |
$194.45
|
| Rate for Payer: WINHealth Partners Commercial |
$334.32
|
| Rate for Payer: Wise Provider Network Commercial |
$324.08
|
|
|
DRILL TWIST SCP 4.0 X 70MM
|
Facility
|
IP
|
$371.07
|
|
| Hospital Charge Code |
3004064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$363.65
|
| Rate for Payer: Aetna of WY Medicare |
$237.48
|
| Rate for Payer: Altius Commercial |
$356.23
|
| Rate for Payer: Beech Street Commercial |
$363.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.94
|
| Rate for Payer: Cash Price |
$259.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.94
|
| Rate for Payer: Cigna of WY Commercial |
$363.65
|
| Rate for Payer: Entrust Commercial |
$352.52
|
| Rate for Payer: First Choice Health Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.35
|
| Rate for Payer: HealthUtah PPO |
$371.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.94
|
| Rate for Payer: Multiplan Medicare/VA |
$215.04
|
| Rate for Payer: One Health Plan of WY PPO |
$363.65
|
| Rate for Payer: PacificSource Commercial |
$333.96
|
| Rate for Payer: PHCS PPO |
$363.65
|
| Rate for Payer: Three Rivers PPO |
$278.30
|
| Rate for Payer: TriWest Veterans Administration |
$226.35
|
| Rate for Payer: United Healthcare Commercial |
$354.37
|
| Rate for Payer: United Healthcare Medicare |
$226.35
|
| Rate for Payer: WINHealth Partners Commercial |
$352.52
|
| Rate for Payer: Wise Provider Network Commercial |
$352.52
|
|
|
DRILL TWIST SCP 4.0 X 70MM
|
Facility
|
OP
|
$371.07
|
|
| Hospital Charge Code |
3004064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$371.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$363.65
|
| Rate for Payer: Aetna of WY Medicare |
$244.91
|
| Rate for Payer: Altius Commercial |
$356.23
|
| Rate for Payer: Beech Street Commercial |
$363.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.94
|
| Rate for Payer: Cash Price |
$259.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.94
|
| Rate for Payer: Cigna of WY Commercial |
$363.65
|
| Rate for Payer: Entrust Commercial |
$352.52
|
| Rate for Payer: First Choice Health Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$352.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.51
|
| Rate for Payer: HealthUtah PPO |
$371.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.94
|
| Rate for Payer: Multiplan Medicare/VA |
$200.93
|
| Rate for Payer: One Health Plan of WY PPO |
$363.65
|
| Rate for Payer: PacificSource Commercial |
$333.96
|
| Rate for Payer: PHCS PPO |
$363.65
|
| Rate for Payer: Three Rivers PPO |
$278.30
|
| Rate for Payer: TriWest Veterans Administration |
$211.51
|
| Rate for Payer: United Healthcare Commercial |
$354.37
|
| Rate for Payer: United Healthcare Medicare |
$211.51
|
| Rate for Payer: WINHealth Partners Commercial |
$363.65
|
| Rate for Payer: Wise Provider Network Commercial |
$352.52
|
|
|
DRILL WIRE PASS 1.1 1608-2-63
|
Facility
|
IP
|
$116.16
|
|
| Hospital Charge Code |
2650344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.84
|
| Rate for Payer: Aetna of WY Medicare |
$74.34
|
| Rate for Payer: Altius Commercial |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.84
|
| Rate for Payer: Entrust Commercial |
$110.35
|
| Rate for Payer: First Choice Health Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.86
|
| Rate for Payer: HealthUtah PPO |
$116.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$67.31
|
| Rate for Payer: One Health Plan of WY PPO |
$113.84
|
| Rate for Payer: PacificSource Commercial |
$104.54
|
| Rate for Payer: PHCS PPO |
$113.84
|
| Rate for Payer: Three Rivers PPO |
$87.12
|
| Rate for Payer: TriWest Veterans Administration |
$70.86
|
| Rate for Payer: United Healthcare Commercial |
$110.93
|
| Rate for Payer: United Healthcare Medicare |
$70.86
|
| Rate for Payer: WINHealth Partners Commercial |
$110.35
|
| Rate for Payer: Wise Provider Network Commercial |
$110.35
|
|
|
DRILL WIRE PASS 1.1 1608-2-63
|
Facility
|
OP
|
$116.16
|
|
| Hospital Charge Code |
2650344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.84
|
| Rate for Payer: Aetna of WY Medicare |
$76.67
|
| Rate for Payer: Altius Commercial |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.84
|
| Rate for Payer: Entrust Commercial |
$110.35
|
| Rate for Payer: First Choice Health Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.21
|
| Rate for Payer: HealthUtah PPO |
$116.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$62.90
|
| Rate for Payer: One Health Plan of WY PPO |
$113.84
|
| Rate for Payer: PacificSource Commercial |
$104.54
|
| Rate for Payer: PHCS PPO |
$113.84
|
| Rate for Payer: Three Rivers PPO |
$87.12
|
| Rate for Payer: TriWest Veterans Administration |
$66.21
|
| Rate for Payer: United Healthcare Commercial |
$110.93
|
| Rate for Payer: United Healthcare Medicare |
$66.21
|
| Rate for Payer: WINHealth Partners Commercial |
$113.84
|
| Rate for Payer: Wise Provider Network Commercial |
$110.35
|
|
|
DRILL WIRE PASS 1.5 1608-2-59
|
Facility
|
OP
|
$136.08
|
|
| Hospital Charge Code |
2650346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.36
|
| Rate for Payer: Aetna of WY Medicare |
$89.81
|
| Rate for Payer: Altius Commercial |
$130.64
|
| Rate for Payer: Beech Street Commercial |
$133.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$95.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.00
|
| Rate for Payer: Cigna of WY Commercial |
$133.36
|
| Rate for Payer: Entrust Commercial |
$129.28
|
| Rate for Payer: First Choice Health Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.57
|
| Rate for Payer: HealthUtah PPO |
$136.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.00
|
| Rate for Payer: Multiplan Medicare/VA |
$73.69
|
| Rate for Payer: One Health Plan of WY PPO |
$133.36
|
| Rate for Payer: PacificSource Commercial |
$122.47
|
| Rate for Payer: PHCS PPO |
$133.36
|
| Rate for Payer: Three Rivers PPO |
$102.06
|
| Rate for Payer: TriWest Veterans Administration |
$77.57
|
| Rate for Payer: United Healthcare Commercial |
$129.96
|
| Rate for Payer: United Healthcare Medicare |
$77.57
|
| Rate for Payer: WINHealth Partners Commercial |
$133.36
|
| Rate for Payer: Wise Provider Network Commercial |
$129.28
|
|
|
DRILL WIRE PASS 1.5 1608-2-59
|
Facility
|
IP
|
$136.08
|
|
| Hospital Charge Code |
2650346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.86 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.36
|
| Rate for Payer: Aetna of WY Medicare |
$87.09
|
| Rate for Payer: Altius Commercial |
$130.64
|
| Rate for Payer: Beech Street Commercial |
$133.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$95.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.00
|
| Rate for Payer: Cigna of WY Commercial |
$133.36
|
| Rate for Payer: Entrust Commercial |
$129.28
|
| Rate for Payer: First Choice Health Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.01
|
| Rate for Payer: HealthUtah PPO |
$136.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.00
|
| Rate for Payer: Multiplan Medicare/VA |
$78.86
|
| Rate for Payer: One Health Plan of WY PPO |
$133.36
|
| Rate for Payer: PacificSource Commercial |
$122.47
|
| Rate for Payer: PHCS PPO |
$133.36
|
| Rate for Payer: Three Rivers PPO |
$102.06
|
| Rate for Payer: TriWest Veterans Administration |
$83.01
|
| Rate for Payer: United Healthcare Commercial |
$129.96
|
| Rate for Payer: United Healthcare Medicare |
$83.01
|
| Rate for Payer: WINHealth Partners Commercial |
$129.28
|
| Rate for Payer: Wise Provider Network Commercial |
$129.28
|
|
|
DRILL WIRE PASS 2.0 1608-2-61
|
Facility
|
IP
|
$116.16
|
|
| Hospital Charge Code |
2650347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: United Healthcare Commercial |
$110.93
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.84
|
| Rate for Payer: Aetna of WY Medicare |
$74.34
|
| Rate for Payer: Altius Commercial |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.84
|
| Rate for Payer: Entrust Commercial |
$110.35
|
| Rate for Payer: First Choice Health Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.86
|
| Rate for Payer: HealthUtah PPO |
$116.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$67.31
|
| Rate for Payer: One Health Plan of WY PPO |
$113.84
|
| Rate for Payer: PacificSource Commercial |
$104.54
|
| Rate for Payer: PHCS PPO |
$113.84
|
| Rate for Payer: Three Rivers PPO |
$87.12
|
| Rate for Payer: TriWest Veterans Administration |
$70.86
|
| Rate for Payer: United Healthcare Medicare |
$70.86
|
| Rate for Payer: WINHealth Partners Commercial |
$110.35
|
| Rate for Payer: Wise Provider Network Commercial |
$110.35
|
|
|
DRILL WIRE PASS 2.0 1608-2-61
|
Facility
|
OP
|
$116.16
|
|
| Hospital Charge Code |
2650347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.84
|
| Rate for Payer: Aetna of WY Medicare |
$76.67
|
| Rate for Payer: Altius Commercial |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.84
|
| Rate for Payer: Entrust Commercial |
$110.35
|
| Rate for Payer: First Choice Health Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.21
|
| Rate for Payer: HealthUtah PPO |
$116.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$62.90
|
| Rate for Payer: One Health Plan of WY PPO |
$113.84
|
| Rate for Payer: PacificSource Commercial |
$104.54
|
| Rate for Payer: PHCS PPO |
$113.84
|
| Rate for Payer: Three Rivers PPO |
$87.12
|
| Rate for Payer: TriWest Veterans Administration |
$66.21
|
| Rate for Payer: United Healthcare Commercial |
$110.93
|
| Rate for Payer: United Healthcare Medicare |
$66.21
|
| Rate for Payer: WINHealth Partners Commercial |
$113.84
|
| Rate for Payer: Wise Provider Network Commercial |
$110.35
|
|
|
DRIVE 1.5MM HEX CANNULATED
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
3002426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.81 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$498.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$473.81
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$498.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$498.75
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
DRIVE 1.5MM HEX CANNULATED
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
3002426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.06 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$560.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$507.06
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$533.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$533.75
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
DRIVE HEX TIP 1.5MM SM SHAFT
|
Facility
|
OP
|
$1,151.50
|
|
| Hospital Charge Code |
3000745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$623.54 |
| Max. Negotiated Rate |
$1,151.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,128.47
|
| Rate for Payer: Aetna of WY Medicare |
$759.99
|
| Rate for Payer: Altius Commercial |
$1,105.44
|
| Rate for Payer: Beech Street Commercial |
$1,128.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,116.96
|
| Rate for Payer: Cash Price |
$806.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,116.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,128.47
|
| Rate for Payer: Entrust Commercial |
$1,093.92
|
| Rate for Payer: First Choice Health Commercial |
$1,093.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,093.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$656.36
|
| Rate for Payer: HealthUtah PPO |
$1,151.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,116.96
|
| Rate for Payer: Multiplan Medicare/VA |
$623.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,128.47
|
| Rate for Payer: PacificSource Commercial |
$1,036.35
|
| Rate for Payer: PHCS PPO |
$1,128.47
|
| Rate for Payer: Three Rivers PPO |
$863.62
|
| Rate for Payer: TriWest Veterans Administration |
$656.36
|
| Rate for Payer: United Healthcare Commercial |
$1,099.68
|
| Rate for Payer: United Healthcare Medicare |
$656.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,128.47
|
| Rate for Payer: Wise Provider Network Commercial |
$1,093.92
|
|
|
DRIVE HEX TIP 1.5MM SM SHAFT
|
Facility
|
IP
|
$1,151.50
|
|
| Hospital Charge Code |
3000745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.29 |
| Max. Negotiated Rate |
$1,151.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,128.47
|
| Rate for Payer: Aetna of WY Medicare |
$736.96
|
| Rate for Payer: Altius Commercial |
$1,105.44
|
| Rate for Payer: Beech Street Commercial |
$1,128.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,116.96
|
| Rate for Payer: Cash Price |
$806.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,116.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,128.47
|
| Rate for Payer: Entrust Commercial |
$1,093.92
|
| Rate for Payer: First Choice Health Commercial |
$1,093.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,093.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$702.42
|
| Rate for Payer: HealthUtah PPO |
$1,151.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,116.96
|
| Rate for Payer: Multiplan Medicare/VA |
$667.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,128.47
|
| Rate for Payer: PacificSource Commercial |
$1,036.35
|
| Rate for Payer: PHCS PPO |
$1,128.47
|
| Rate for Payer: Three Rivers PPO |
$863.62
|
| Rate for Payer: TriWest Veterans Administration |
$702.42
|
| Rate for Payer: United Healthcare Commercial |
$1,099.68
|
| Rate for Payer: United Healthcare Medicare |
$702.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,093.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1,093.92
|
|
|
DRIVER 1.5MM HEX ACULOC 2
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
3003173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.07 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,344.56
|
| Rate for Payer: Aetna of WY Medicare |
$878.08
|
| Rate for Payer: Altius Commercial |
$1,317.12
|
| Rate for Payer: Beech Street Commercial |
$1,344.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,330.84
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,330.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,344.56
|
| Rate for Payer: Entrust Commercial |
$1,303.40
|
| Rate for Payer: First Choice Health Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$836.92
|
| Rate for Payer: HealthUtah PPO |
$1,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,330.84
|
| Rate for Payer: Multiplan Medicare/VA |
$795.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,344.56
|
| Rate for Payer: PacificSource Commercial |
$1,234.80
|
| Rate for Payer: PHCS PPO |
$1,344.56
|
| Rate for Payer: Three Rivers PPO |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration |
$836.92
|
| Rate for Payer: United Healthcare Commercial |
$1,310.26
|
| Rate for Payer: United Healthcare Medicare |
$836.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,303.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,303.40
|
|
|
DRIVER 1.5MM HEX ACULOC 2
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
3003173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.94 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,344.56
|
| Rate for Payer: Aetna of WY Medicare |
$905.52
|
| Rate for Payer: Altius Commercial |
$1,317.12
|
| Rate for Payer: Beech Street Commercial |
$1,344.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,330.84
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,330.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,344.56
|
| Rate for Payer: Entrust Commercial |
$1,303.40
|
| Rate for Payer: First Choice Health Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$782.04
|
| Rate for Payer: HealthUtah PPO |
$1,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,330.84
|
| Rate for Payer: Multiplan Medicare/VA |
$742.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,344.56
|
| Rate for Payer: PacificSource Commercial |
$1,234.80
|
| Rate for Payer: PHCS PPO |
$1,344.56
|
| Rate for Payer: Three Rivers PPO |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration |
$782.04
|
| Rate for Payer: United Healthcare Commercial |
$1,310.26
|
| Rate for Payer: United Healthcare Medicare |
$782.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,303.40
|
|
|
DRIVER 1.5MM HEXALOBE ACUMED
|
Facility
|
IP
|
$1,466.50
|
|
| Hospital Charge Code |
3004275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$849.84 |
| Max. Negotiated Rate |
$1,466.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,437.17
|
| Rate for Payer: Aetna of WY Medicare |
$938.56
|
| Rate for Payer: Altius Commercial |
$1,407.84
|
| Rate for Payer: Beech Street Commercial |
$1,437.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,422.50
|
| Rate for Payer: Cash Price |
$1,026.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,422.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,437.17
|
| Rate for Payer: Entrust Commercial |
$1,393.18
|
| Rate for Payer: First Choice Health Commercial |
$1,393.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,393.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$894.56
|
| Rate for Payer: HealthUtah PPO |
$1,466.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,422.50
|
| Rate for Payer: Multiplan Medicare/VA |
$849.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,437.17
|
| Rate for Payer: PacificSource Commercial |
$1,319.85
|
| Rate for Payer: PHCS PPO |
$1,437.17
|
| Rate for Payer: Three Rivers PPO |
$1,099.88
|
| Rate for Payer: TriWest Veterans Administration |
$894.56
|
| Rate for Payer: United Healthcare Commercial |
$1,400.51
|
| Rate for Payer: United Healthcare Medicare |
$894.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,393.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,393.18
|
|
|
DRIVER 1.5MM HEXALOBE ACUMED
|
Facility
|
OP
|
$1,466.50
|
|
| Hospital Charge Code |
3004275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$794.11 |
| Max. Negotiated Rate |
$1,466.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,437.17
|
| Rate for Payer: Aetna of WY Medicare |
$967.89
|
| Rate for Payer: Altius Commercial |
$1,407.84
|
| Rate for Payer: Beech Street Commercial |
$1,437.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,422.50
|
| Rate for Payer: Cash Price |
$1,026.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,422.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,437.17
|
| Rate for Payer: Entrust Commercial |
$1,393.18
|
| Rate for Payer: First Choice Health Commercial |
$1,393.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,393.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$835.90
|
| Rate for Payer: HealthUtah PPO |
$1,466.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,422.50
|
| Rate for Payer: Multiplan Medicare/VA |
$794.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,437.17
|
| Rate for Payer: PacificSource Commercial |
$1,319.85
|
| Rate for Payer: PHCS PPO |
$1,437.17
|
| Rate for Payer: Three Rivers PPO |
$1,099.88
|
| Rate for Payer: TriWest Veterans Administration |
$835.90
|
| Rate for Payer: United Healthcare Commercial |
$1,400.51
|
| Rate for Payer: United Healthcare Medicare |
$835.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,437.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1,393.18
|
|
|
DRIVER 2.5MM CANNULATED ACUMED
|
Facility
|
OP
|
$4,060.00
|
|
| Hospital Charge Code |
3003749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,198.49 |
| Max. Negotiated Rate |
$4,060.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,978.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,679.60
|
| Rate for Payer: Altius Commercial |
$3,897.60
|
| Rate for Payer: Beech Street Commercial |
$3,978.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,938.20
|
| Rate for Payer: Cash Price |
$2,842.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,938.20
|
| Rate for Payer: Cigna of WY Commercial |
$3,978.80
|
| Rate for Payer: Entrust Commercial |
$3,857.00
|
| Rate for Payer: First Choice Health Commercial |
$3,857.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,857.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,314.20
|
| Rate for Payer: HealthUtah PPO |
$4,060.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,938.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,198.49
|
| Rate for Payer: One Health Plan of WY PPO |
$3,978.80
|
| Rate for Payer: PacificSource Commercial |
$3,654.00
|
| Rate for Payer: PHCS PPO |
$3,978.80
|
| Rate for Payer: Three Rivers PPO |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,314.20
|
| Rate for Payer: United Healthcare Commercial |
$3,877.30
|
| Rate for Payer: United Healthcare Medicare |
$2,314.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,978.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3,857.00
|
|
|
DRIVER 2.5MM CANNULATED ACUMED
|
Facility
|
IP
|
$4,060.00
|
|
| Hospital Charge Code |
3003749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,352.77 |
| Max. Negotiated Rate |
$4,060.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,978.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,598.40
|
| Rate for Payer: Altius Commercial |
$3,897.60
|
| Rate for Payer: Beech Street Commercial |
$3,978.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,938.20
|
| Rate for Payer: Cash Price |
$2,842.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,938.20
|
| Rate for Payer: Cigna of WY Commercial |
$3,978.80
|
| Rate for Payer: Entrust Commercial |
$3,857.00
|
| Rate for Payer: First Choice Health Commercial |
$3,857.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,857.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,476.60
|
| Rate for Payer: HealthUtah PPO |
$4,060.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,938.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,352.77
|
| Rate for Payer: One Health Plan of WY PPO |
$3,978.80
|
| Rate for Payer: PacificSource Commercial |
$3,654.00
|
| Rate for Payer: PHCS PPO |
$3,978.80
|
| Rate for Payer: Three Rivers PPO |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,476.60
|
| Rate for Payer: United Healthcare Commercial |
$3,877.30
|
| Rate for Payer: United Healthcare Medicare |
$2,476.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,857.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,857.00
|
|
|
DRIVER BIT 1.5MM
|
Facility
|
OP
|
$294.00
|
|
| Hospital Charge Code |
3002949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.04
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.18
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.58
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$159.20
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.58
|
| Rate for Payer: United Healthcare Commercial |
$280.77
|
| Rate for Payer: United Healthcare Medicare |
$167.58
|
| Rate for Payer: WINHealth Partners Commercial |
$288.12
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
