|
DRIVER MDTP MINI QUICK CONNECT
|
Facility
|
OP
|
$191.52
|
|
| Hospital Charge Code |
3003406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.69
|
| Rate for Payer: Aetna of WY Medicare |
$126.40
|
| Rate for Payer: Altius Commercial |
$183.86
|
| Rate for Payer: Beech Street Commercial |
$187.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.77
|
| Rate for Payer: Cash Price |
$134.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.77
|
| Rate for Payer: Cigna of WY Commercial |
$187.69
|
| Rate for Payer: Entrust Commercial |
$181.94
|
| Rate for Payer: First Choice Health Commercial |
$181.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.17
|
| Rate for Payer: HealthUtah PPO |
$191.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.77
|
| Rate for Payer: Multiplan Medicare/VA |
$103.71
|
| Rate for Payer: One Health Plan of WY PPO |
$187.69
|
| Rate for Payer: PacificSource Commercial |
$172.37
|
| Rate for Payer: PHCS PPO |
$187.69
|
| Rate for Payer: Three Rivers PPO |
$143.64
|
| Rate for Payer: TriWest Veterans Administration |
$109.17
|
| Rate for Payer: United Healthcare Commercial |
$182.90
|
| Rate for Payer: United Healthcare Medicare |
$109.17
|
| Rate for Payer: WINHealth Partners Commercial |
$187.69
|
| Rate for Payer: Wise Provider Network Commercial |
$181.94
|
|
|
DRIVER MDTP MINI QUICK CONNECT
|
Facility
|
IP
|
$191.52
|
|
| Hospital Charge Code |
3003406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.99 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.69
|
| Rate for Payer: Aetna of WY Medicare |
$122.57
|
| Rate for Payer: Altius Commercial |
$183.86
|
| Rate for Payer: Beech Street Commercial |
$187.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.77
|
| Rate for Payer: Cash Price |
$134.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.77
|
| Rate for Payer: Cigna of WY Commercial |
$187.69
|
| Rate for Payer: Entrust Commercial |
$181.94
|
| Rate for Payer: First Choice Health Commercial |
$181.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.83
|
| Rate for Payer: HealthUtah PPO |
$191.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.77
|
| Rate for Payer: Multiplan Medicare/VA |
$110.99
|
| Rate for Payer: One Health Plan of WY PPO |
$187.69
|
| Rate for Payer: PacificSource Commercial |
$172.37
|
| Rate for Payer: PHCS PPO |
$187.69
|
| Rate for Payer: Three Rivers PPO |
$143.64
|
| Rate for Payer: TriWest Veterans Administration |
$116.83
|
| Rate for Payer: United Healthcare Commercial |
$182.90
|
| Rate for Payer: United Healthcare Medicare |
$116.83
|
| Rate for Payer: WINHealth Partners Commercial |
$181.94
|
| Rate for Payer: Wise Provider Network Commercial |
$181.94
|
|
|
DRIVER Q/C CANNULATER 5.0 HEX TIP
|
Facility
|
IP
|
$918.75
|
|
| Hospital Charge Code |
3004642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.42 |
| Max. Negotiated Rate |
$918.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$900.38
|
| Rate for Payer: Aetna of WY Medicare |
$588.00
|
| Rate for Payer: Altius Commercial |
$882.00
|
| Rate for Payer: Beech Street Commercial |
$900.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$891.19
|
| Rate for Payer: Cash Price |
$643.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$891.19
|
| Rate for Payer: Cigna of WY Commercial |
$900.38
|
| Rate for Payer: Entrust Commercial |
$872.81
|
| Rate for Payer: First Choice Health Commercial |
$872.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$872.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$560.44
|
| Rate for Payer: HealthUtah PPO |
$918.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$891.19
|
| Rate for Payer: Multiplan Medicare/VA |
$532.42
|
| Rate for Payer: One Health Plan of WY PPO |
$900.38
|
| Rate for Payer: PacificSource Commercial |
$826.88
|
| Rate for Payer: PHCS PPO |
$900.38
|
| Rate for Payer: Three Rivers PPO |
$689.06
|
| Rate for Payer: TriWest Veterans Administration |
$560.44
|
| Rate for Payer: United Healthcare Commercial |
$877.41
|
| Rate for Payer: United Healthcare Medicare |
$560.44
|
| Rate for Payer: WINHealth Partners Commercial |
$872.81
|
| Rate for Payer: Wise Provider Network Commercial |
$872.81
|
|
|
DRIVER Q/C CANNULATER 5.0 HEX TIP
|
Facility
|
OP
|
$918.75
|
|
| Hospital Charge Code |
3004642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.50 |
| Max. Negotiated Rate |
$918.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$900.38
|
| Rate for Payer: Aetna of WY Medicare |
$606.38
|
| Rate for Payer: Altius Commercial |
$882.00
|
| Rate for Payer: Beech Street Commercial |
$900.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$891.19
|
| Rate for Payer: Cash Price |
$643.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$891.19
|
| Rate for Payer: Cigna of WY Commercial |
$900.38
|
| Rate for Payer: Entrust Commercial |
$872.81
|
| Rate for Payer: First Choice Health Commercial |
$872.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$872.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.69
|
| Rate for Payer: HealthUtah PPO |
$918.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$891.19
|
| Rate for Payer: Multiplan Medicare/VA |
$497.50
|
| Rate for Payer: One Health Plan of WY PPO |
$900.38
|
| Rate for Payer: PacificSource Commercial |
$826.88
|
| Rate for Payer: PHCS PPO |
$900.38
|
| Rate for Payer: Three Rivers PPO |
$689.06
|
| Rate for Payer: TriWest Veterans Administration |
$523.69
|
| Rate for Payer: United Healthcare Commercial |
$877.41
|
| Rate for Payer: United Healthcare Medicare |
$523.69
|
| Rate for Payer: WINHealth Partners Commercial |
$900.38
|
| Rate for Payer: Wise Provider Network Commercial |
$872.81
|
|
|
DRIVER SQUARE 1.7MM
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
3003036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.34 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$475.30
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.30
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$265.34
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$279.30
|
| Rate for Payer: United Healthcare Commercial |
$467.95
|
| Rate for Payer: United Healthcare Medicare |
$279.30
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
DRIVER SQUARE 1.7MM
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
3003036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.96 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$313.60
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$475.30
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.90
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$283.96
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.90
|
| Rate for Payer: United Healthcare Commercial |
$467.95
|
| Rate for Payer: United Healthcare Medicare |
$298.90
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
DRIVER T-15 HEXALOBE 6" ACUMED
|
Facility
|
OP
|
$1,708.00
|
|
| Hospital Charge Code |
3004268
|
|
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
|
|
|
DRIVER T-15 HEXALOBE 6" ACUMED
|
Facility
|
IP
|
$1,708.00
|
|
| Hospital Charge Code |
3004268
|
|
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
|
|
|
DRIVER T-15 HEXALOBE ACUMED
|
Facility
|
OP
|
$2,418.50
|
|
| Hospital Charge Code |
3003458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,309.62 |
| Max. Negotiated Rate |
$2,418.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,370.13
|
| Rate for Payer: Aetna of WY Medicare |
$1,596.21
|
| Rate for Payer: Altius Commercial |
$2,321.76
|
| Rate for Payer: Beech Street Commercial |
$2,370.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,345.94
|
| Rate for Payer: Cash Price |
$1,692.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,345.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,370.13
|
| Rate for Payer: Entrust Commercial |
$2,297.58
|
| Rate for Payer: First Choice Health Commercial |
$2,297.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,297.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,378.54
|
| Rate for Payer: HealthUtah PPO |
$2,418.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,345.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,309.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,370.13
|
| Rate for Payer: PacificSource Commercial |
$2,176.65
|
| Rate for Payer: PHCS PPO |
$2,370.13
|
| Rate for Payer: Three Rivers PPO |
$1,813.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,378.54
|
| Rate for Payer: United Healthcare Commercial |
$2,309.67
|
| Rate for Payer: United Healthcare Medicare |
$1,378.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2,370.13
|
| Rate for Payer: Wise Provider Network Commercial |
$2,297.58
|
|
|
DRIVER T-15 HEXALOBE ACUMED
|
Facility
|
IP
|
$2,418.50
|
|
| Hospital Charge Code |
3003458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,401.52 |
| Max. Negotiated Rate |
$2,418.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,370.13
|
| Rate for Payer: Aetna of WY Medicare |
$1,547.84
|
| Rate for Payer: Altius Commercial |
$2,321.76
|
| Rate for Payer: Beech Street Commercial |
$2,370.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,345.94
|
| Rate for Payer: Cash Price |
$1,692.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,345.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,370.13
|
| Rate for Payer: Entrust Commercial |
$2,297.58
|
| Rate for Payer: First Choice Health Commercial |
$2,297.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,297.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,475.28
|
| Rate for Payer: HealthUtah PPO |
$2,418.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,345.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,401.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,370.13
|
| Rate for Payer: PacificSource Commercial |
$2,176.65
|
| Rate for Payer: PHCS PPO |
$2,370.13
|
| Rate for Payer: Three Rivers PPO |
$1,813.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,475.28
|
| Rate for Payer: United Healthcare Commercial |
$2,309.67
|
| Rate for Payer: United Healthcare Medicare |
$1,475.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,297.58
|
| Rate for Payer: Wise Provider Network Commercial |
$2,297.58
|
|
|
DRIVER T-15 SHORT ZIMMER
|
Facility
|
IP
|
$2,870.00
|
|
| Hospital Charge Code |
3004357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,663.16 |
| Max. Negotiated Rate |
$2,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,812.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,836.80
|
| Rate for Payer: Altius Commercial |
$2,755.20
|
| Rate for Payer: Beech Street Commercial |
$2,812.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,783.90
|
| Rate for Payer: Cash Price |
$2,009.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,783.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,812.60
|
| Rate for Payer: Entrust Commercial |
$2,726.50
|
| Rate for Payer: First Choice Health Commercial |
$2,726.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,726.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,750.70
|
| Rate for Payer: HealthUtah PPO |
$2,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,783.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,663.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,812.60
|
| Rate for Payer: PacificSource Commercial |
$2,583.00
|
| Rate for Payer: PHCS PPO |
$2,812.60
|
| Rate for Payer: Three Rivers PPO |
$2,152.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,750.70
|
| Rate for Payer: United Healthcare Commercial |
$2,740.85
|
| Rate for Payer: United Healthcare Medicare |
$1,750.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,726.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,726.50
|
|
|
DRIVER T-15 SHORT ZIMMER
|
Facility
|
OP
|
$2,870.00
|
|
| Hospital Charge Code |
3004357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,554.10 |
| Max. Negotiated Rate |
$2,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,812.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,894.20
|
| Rate for Payer: Altius Commercial |
$2,755.20
|
| Rate for Payer: Beech Street Commercial |
$2,812.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,783.90
|
| Rate for Payer: Cash Price |
$2,009.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,783.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,812.60
|
| Rate for Payer: Entrust Commercial |
$2,726.50
|
| Rate for Payer: First Choice Health Commercial |
$2,726.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,726.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,635.90
|
| Rate for Payer: HealthUtah PPO |
$2,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,783.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,554.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,812.60
|
| Rate for Payer: PacificSource Commercial |
$2,583.00
|
| Rate for Payer: PHCS PPO |
$2,812.60
|
| Rate for Payer: Three Rivers PPO |
$2,152.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,635.90
|
| Rate for Payer: United Healthcare Commercial |
$2,740.85
|
| Rate for Payer: United Healthcare Medicare |
$1,635.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,812.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,726.50
|
|
|
DRIVER T-15 ZIMMER
|
Facility
|
OP
|
$1,886.50
|
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.54 |
| Max. Negotiated Rate |
$1,886.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,848.77
|
| Rate for Payer: Aetna of WY Medicare |
$1,245.09
|
| Rate for Payer: Altius Commercial |
$1,811.04
|
| Rate for Payer: Beech Street Commercial |
$1,848.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,829.90
|
| Rate for Payer: Cash Price |
$1,320.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,829.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,848.77
|
| Rate for Payer: Entrust Commercial |
$1,792.18
|
| Rate for Payer: First Choice Health Commercial |
$1,792.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,792.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,075.30
|
| Rate for Payer: HealthUtah PPO |
$1,886.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,829.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,021.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,848.77
|
| Rate for Payer: PacificSource Commercial |
$1,697.85
|
| Rate for Payer: PHCS PPO |
$1,848.77
|
| Rate for Payer: Three Rivers PPO |
$1,414.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,075.30
|
| Rate for Payer: United Healthcare Commercial |
$1,801.61
|
| Rate for Payer: United Healthcare Medicare |
$1,075.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,848.77
|
| Rate for Payer: Wise Provider Network Commercial |
$1,792.18
|
|
|
DRIVER T-15 ZIMMER
|
Facility
|
IP
|
$1,886.50
|
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,093.23 |
| Max. Negotiated Rate |
$1,886.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,848.77
|
| Rate for Payer: Aetna of WY Medicare |
$1,207.36
|
| Rate for Payer: Altius Commercial |
$1,811.04
|
| Rate for Payer: Beech Street Commercial |
$1,848.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,829.90
|
| Rate for Payer: Cash Price |
$1,320.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,829.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,848.77
|
| Rate for Payer: Entrust Commercial |
$1,792.18
|
| Rate for Payer: First Choice Health Commercial |
$1,792.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,792.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,150.76
|
| Rate for Payer: HealthUtah PPO |
$1,886.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,829.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,093.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,848.77
|
| Rate for Payer: PacificSource Commercial |
$1,697.85
|
| Rate for Payer: PHCS PPO |
$1,848.77
|
| Rate for Payer: Three Rivers PPO |
$1,414.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,150.76
|
| Rate for Payer: United Healthcare Commercial |
$1,801.61
|
| Rate for Payer: United Healthcare Medicare |
$1,150.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,792.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,792.18
|
|
|
DRIVER T-8 HEXALOBE ACUMED
|
Facility
|
IP
|
$822.50
|
|
| Hospital Charge Code |
3003548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$526.40
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.72
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$476.64
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$501.72
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$501.72
|
| Rate for Payer: WINHealth Partners Commercial |
$781.38
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
DRIVER T-8 HEXALOBE ACUMED
|
Facility
|
OP
|
$822.50
|
|
| Hospital Charge Code |
3003548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$542.85
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.82
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$445.38
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$468.82
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$468.82
|
| Rate for Payer: WINHealth Partners Commercial |
$806.05
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
DRIVER TIP 1.5MM ACUTRAK 2
|
Facility
|
IP
|
$1,221.50
|
|
| Hospital Charge Code |
3003031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$707.86 |
| Max. Negotiated Rate |
$1,221.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.07
|
| Rate for Payer: Aetna of WY Medicare |
$781.76
|
| Rate for Payer: Altius Commercial |
$1,172.64
|
| Rate for Payer: Beech Street Commercial |
$1,197.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,184.86
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,184.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.07
|
| Rate for Payer: Entrust Commercial |
$1,160.42
|
| Rate for Payer: First Choice Health Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.12
|
| Rate for Payer: HealthUtah PPO |
$1,221.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,184.86
|
| Rate for Payer: Multiplan Medicare/VA |
$707.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.07
|
| Rate for Payer: PacificSource Commercial |
$1,099.35
|
| Rate for Payer: PHCS PPO |
$1,197.07
|
| Rate for Payer: Three Rivers PPO |
$916.12
|
| Rate for Payer: TriWest Veterans Administration |
$745.12
|
| Rate for Payer: United Healthcare Commercial |
$1,166.53
|
| Rate for Payer: United Healthcare Medicare |
$745.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,160.42
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.42
|
|
|
DRIVER TIP 1.5MM ACUTRAK 2
|
Facility
|
OP
|
$1,221.50
|
|
| Hospital Charge Code |
3003031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.44 |
| Max. Negotiated Rate |
$1,221.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.07
|
| Rate for Payer: Aetna of WY Medicare |
$806.19
|
| Rate for Payer: Altius Commercial |
$1,172.64
|
| Rate for Payer: Beech Street Commercial |
$1,197.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,184.86
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,184.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.07
|
| Rate for Payer: Entrust Commercial |
$1,160.42
|
| Rate for Payer: First Choice Health Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.26
|
| Rate for Payer: HealthUtah PPO |
$1,221.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,184.86
|
| Rate for Payer: Multiplan Medicare/VA |
$661.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.07
|
| Rate for Payer: PacificSource Commercial |
$1,099.35
|
| Rate for Payer: PHCS PPO |
$1,197.07
|
| Rate for Payer: Three Rivers PPO |
$916.12
|
| Rate for Payer: TriWest Veterans Administration |
$696.26
|
| Rate for Payer: United Healthcare Commercial |
$1,166.53
|
| Rate for Payer: United Healthcare Medicare |
$696.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.42
|
|
|
DRIVER TIP 2.0MM ACUTRAK 2
|
Facility
|
IP
|
$1,631.00
|
|
| Hospital Charge Code |
3003434
|
|
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
|
|
|
DRIVER TIP 2.0MM ACUTRAK 2
|
Facility
|
OP
|
$1,631.00
|
|
| Hospital Charge Code |
3003434
|
|
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
|
|
|
DRIVER TIP 2.5MM ACUTRAK 2
|
Facility
|
IP
|
$1,221.50
|
|
| Hospital Charge Code |
3004038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$707.86 |
| Max. Negotiated Rate |
$1,221.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.07
|
| Rate for Payer: Aetna of WY Medicare |
$781.76
|
| Rate for Payer: Altius Commercial |
$1,172.64
|
| Rate for Payer: Beech Street Commercial |
$1,197.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,184.86
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,184.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.07
|
| Rate for Payer: Entrust Commercial |
$1,160.42
|
| Rate for Payer: First Choice Health Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.12
|
| Rate for Payer: HealthUtah PPO |
$1,221.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,184.86
|
| Rate for Payer: Multiplan Medicare/VA |
$707.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.07
|
| Rate for Payer: PacificSource Commercial |
$1,099.35
|
| Rate for Payer: PHCS PPO |
$1,197.07
|
| Rate for Payer: Three Rivers PPO |
$916.12
|
| Rate for Payer: TriWest Veterans Administration |
$745.12
|
| Rate for Payer: United Healthcare Commercial |
$1,166.53
|
| Rate for Payer: United Healthcare Medicare |
$745.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,160.42
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.42
|
|
|
DRIVER TIP 2.5MM ACUTRAK 2
|
Facility
|
OP
|
$1,221.50
|
|
| Hospital Charge Code |
3004038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.44 |
| Max. Negotiated Rate |
$1,221.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.07
|
| Rate for Payer: Aetna of WY Medicare |
$806.19
|
| Rate for Payer: Altius Commercial |
$1,172.64
|
| Rate for Payer: Beech Street Commercial |
$1,197.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,184.86
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,184.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.07
|
| Rate for Payer: Entrust Commercial |
$1,160.42
|
| Rate for Payer: First Choice Health Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.26
|
| Rate for Payer: HealthUtah PPO |
$1,221.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,184.86
|
| Rate for Payer: Multiplan Medicare/VA |
$661.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.07
|
| Rate for Payer: PacificSource Commercial |
$1,099.35
|
| Rate for Payer: PHCS PPO |
$1,197.07
|
| Rate for Payer: Three Rivers PPO |
$916.12
|
| Rate for Payer: TriWest Veterans Administration |
$696.26
|
| Rate for Payer: United Healthcare Commercial |
$1,166.53
|
| Rate for Payer: United Healthcare Medicare |
$696.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.42
|
|
|
DRIVER TORX 8.0 X 110 MM AO
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
3004265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$232.96
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.04
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$210.94
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$222.04
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$222.04
|
| Rate for Payer: WINHealth Partners Commercial |
$345.80
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
DRIVER TORX 8.0 X 110 MM AO
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
3004265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$240.24
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.48
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$197.11
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$207.48
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$207.48
|
| Rate for Payer: WINHealth Partners Commercial |
$356.72
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
DRIVE SHAFT CAN T15 HEXALOBE
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
3004184
|
|
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
|
|
