|
FIBERSTITCH RC CURVED IMPLANT
|
Facility
|
OP
|
$1,732.50
|
|
| Hospital Charge Code |
3004623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.15 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,697.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.45
|
| Rate for Payer: Altius Commercial |
$1,663.20
|
| Rate for Payer: Beech Street Commercial |
$1,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,680.52
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,680.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,697.85
|
| Rate for Payer: Entrust Commercial |
$1,645.88
|
| Rate for Payer: First Choice Health Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$987.52
|
| Rate for Payer: HealthUtah PPO |
$1,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,680.52
|
| Rate for Payer: Multiplan Medicare/VA |
$938.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,697.85
|
| Rate for Payer: PacificSource Commercial |
$1,559.25
|
| Rate for Payer: PHCS PPO |
$1,697.85
|
| Rate for Payer: Three Rivers PPO |
$1,299.38
|
| Rate for Payer: TriWest Veterans Administration |
$987.52
|
| Rate for Payer: United Healthcare Commercial |
$1,654.54
|
| Rate for Payer: United Healthcare Medicare |
$987.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,697.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,645.88
|
|
|
FIBERSTITCH RC CURVED IMPLANT
|
Facility
|
IP
|
$1,732.50
|
|
| Hospital Charge Code |
3004623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.98 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Three Rivers PPO |
$1,299.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,697.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,663.20
|
| Rate for Payer: Beech Street Commercial |
$1,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,680.52
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,680.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,697.85
|
| Rate for Payer: Entrust Commercial |
$1,645.88
|
| Rate for Payer: First Choice Health Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,056.82
|
| Rate for Payer: HealthUtah PPO |
$1,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,680.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,003.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,697.85
|
| Rate for Payer: PacificSource Commercial |
$1,559.25
|
| Rate for Payer: PHCS PPO |
$1,697.85
|
| Rate for Payer: TriWest Veterans Administration |
$1,056.82
|
| Rate for Payer: United Healthcare Commercial |
$1,654.54
|
| Rate for Payer: United Healthcare Medicare |
$1,056.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,645.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,645.88
|
|
|
FIBERSTITCH RC STRAIGHT IMPLANT
|
Facility
|
OP
|
$1,732.50
|
|
| Hospital Charge Code |
3004624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.15 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,697.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.45
|
| Rate for Payer: Altius Commercial |
$1,663.20
|
| Rate for Payer: Beech Street Commercial |
$1,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,680.52
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,680.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,697.85
|
| Rate for Payer: Entrust Commercial |
$1,645.88
|
| Rate for Payer: First Choice Health Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$987.52
|
| Rate for Payer: HealthUtah PPO |
$1,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,680.52
|
| Rate for Payer: Multiplan Medicare/VA |
$938.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,697.85
|
| Rate for Payer: PacificSource Commercial |
$1,559.25
|
| Rate for Payer: PHCS PPO |
$1,697.85
|
| Rate for Payer: Three Rivers PPO |
$1,299.38
|
| Rate for Payer: TriWest Veterans Administration |
$987.52
|
| Rate for Payer: United Healthcare Commercial |
$1,654.54
|
| Rate for Payer: United Healthcare Medicare |
$987.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,697.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,645.88
|
|
|
FIBERSTITCH RC STRAIGHT IMPLANT
|
Facility
|
IP
|
$1,732.50
|
|
| Hospital Charge Code |
3004624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.98 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,697.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,663.20
|
| Rate for Payer: Beech Street Commercial |
$1,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,680.52
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,680.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,697.85
|
| Rate for Payer: Entrust Commercial |
$1,645.88
|
| Rate for Payer: First Choice Health Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,645.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,056.82
|
| Rate for Payer: HealthUtah PPO |
$1,732.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,680.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,003.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,697.85
|
| Rate for Payer: PacificSource Commercial |
$1,559.25
|
| Rate for Payer: PHCS PPO |
$1,697.85
|
| Rate for Payer: Three Rivers PPO |
$1,299.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,056.82
|
| Rate for Payer: United Healthcare Commercial |
$1,654.54
|
| Rate for Payer: United Healthcare Medicare |
$1,056.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,645.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,645.88
|
|
|
FIBERSTITCH REV CURVE AR-4570R
|
Facility
|
IP
|
$2,478.00
|
|
| Hospital Charge Code |
3004399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.00 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,428.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,585.92
|
| Rate for Payer: Altius Commercial |
$2,378.88
|
| Rate for Payer: Beech Street Commercial |
$2,428.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,403.66
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,403.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,428.44
|
| Rate for Payer: Entrust Commercial |
$2,354.10
|
| Rate for Payer: First Choice Health Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,511.58
|
| Rate for Payer: HealthUtah PPO |
$2,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,403.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,436.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,428.44
|
| Rate for Payer: PacificSource Commercial |
$2,230.20
|
| Rate for Payer: PHCS PPO |
$2,428.44
|
| Rate for Payer: Three Rivers PPO |
$1,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,511.58
|
| Rate for Payer: United Healthcare Commercial |
$2,366.49
|
| Rate for Payer: United Healthcare Medicare |
$1,511.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,354.10
|
| Rate for Payer: Wise Provider Network Commercial |
$2,354.10
|
|
|
FIBERSTITCH REV CURVE AR-4570R
|
Facility
|
OP
|
$2,478.00
|
|
| Hospital Charge Code |
3004399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,341.84 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,428.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,635.48
|
| Rate for Payer: Altius Commercial |
$2,378.88
|
| Rate for Payer: Beech Street Commercial |
$2,428.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,403.66
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,403.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,428.44
|
| Rate for Payer: Entrust Commercial |
$2,354.10
|
| Rate for Payer: First Choice Health Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,354.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,412.46
|
| Rate for Payer: HealthUtah PPO |
$2,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,403.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,341.84
|
| Rate for Payer: One Health Plan of WY PPO |
$2,428.44
|
| Rate for Payer: PacificSource Commercial |
$2,230.20
|
| Rate for Payer: PHCS PPO |
$2,428.44
|
| Rate for Payer: Three Rivers PPO |
$1,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,412.46
|
| Rate for Payer: United Healthcare Commercial |
$2,366.49
|
| Rate for Payer: United Healthcare Medicare |
$1,412.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,428.44
|
| Rate for Payer: Wise Provider Network Commercial |
$2,354.10
|
|
|
FIBERTAK 1.8 CURVED DISPOSABLE KIT
|
Facility
|
IP
|
$858.48
|
|
| Hospital Charge Code |
3004763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.49 |
| Max. Negotiated Rate |
$858.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.31
|
| Rate for Payer: Aetna of WY Medicare |
$549.43
|
| Rate for Payer: Altius Commercial |
$824.14
|
| Rate for Payer: Beech Street Commercial |
$841.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$832.73
|
| Rate for Payer: Cash Price |
$600.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$832.73
|
| Rate for Payer: Cigna of WY Commercial |
$841.31
|
| Rate for Payer: Entrust Commercial |
$815.56
|
| Rate for Payer: First Choice Health Commercial |
$815.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$815.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.67
|
| Rate for Payer: HealthUtah PPO |
$858.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$832.73
|
| Rate for Payer: Multiplan Medicare/VA |
$497.49
|
| Rate for Payer: One Health Plan of WY PPO |
$841.31
|
| Rate for Payer: PacificSource Commercial |
$772.63
|
| Rate for Payer: PHCS PPO |
$841.31
|
| Rate for Payer: Three Rivers PPO |
$643.86
|
| Rate for Payer: TriWest Veterans Administration |
$523.67
|
| Rate for Payer: United Healthcare Commercial |
$819.85
|
| Rate for Payer: United Healthcare Medicare |
$523.67
|
| Rate for Payer: WINHealth Partners Commercial |
$815.56
|
| Rate for Payer: Wise Provider Network Commercial |
$815.56
|
|
|
FIBERTAK 1.8 CURVED DISPOSABLE KIT
|
Facility
|
OP
|
$858.48
|
|
| Hospital Charge Code |
3004763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.87 |
| Max. Negotiated Rate |
$858.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$841.31
|
| Rate for Payer: Aetna of WY Medicare |
$566.60
|
| Rate for Payer: Altius Commercial |
$824.14
|
| Rate for Payer: Beech Street Commercial |
$841.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$832.73
|
| Rate for Payer: Cash Price |
$600.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$832.73
|
| Rate for Payer: Cigna of WY Commercial |
$841.31
|
| Rate for Payer: Entrust Commercial |
$815.56
|
| Rate for Payer: First Choice Health Commercial |
$815.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$815.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$489.33
|
| Rate for Payer: HealthUtah PPO |
$858.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$832.73
|
| Rate for Payer: Multiplan Medicare/VA |
$464.87
|
| Rate for Payer: One Health Plan of WY PPO |
$841.31
|
| Rate for Payer: PacificSource Commercial |
$772.63
|
| Rate for Payer: PHCS PPO |
$841.31
|
| Rate for Payer: Three Rivers PPO |
$643.86
|
| Rate for Payer: TriWest Veterans Administration |
$489.33
|
| Rate for Payer: United Healthcare Commercial |
$819.85
|
| Rate for Payer: United Healthcare Medicare |
$489.33
|
| Rate for Payer: WINHealth Partners Commercial |
$841.31
|
| Rate for Payer: Wise Provider Network Commercial |
$815.56
|
|
|
FIBERTAK 1.8 DISPOSABLE KIT
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
3003449
|
|
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
|
|
|
FIBERTAK 1.8 DISPOSABLE KIT
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
3003449
|
|
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
|
|
|
FIBERTAK 1.8MM PERC INSERT KIT
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
3004741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.07 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.29
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$498.07
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$524.29
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$524.29
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
FIBERTAK 1.8MM PERC INSERT KIT
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
3004741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.02 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$588.67
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$892.21
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$561.08
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$533.02
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$561.08
|
| Rate for Payer: United Healthcare Commercial |
$878.41
|
| Rate for Payer: United Healthcare Medicare |
$561.08
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
FIBERTAK 1.8 W/ #2 SUTURE
|
Facility
|
OP
|
$2,100.00
|
|
| Hospital Charge Code |
3003448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.15 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,386.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,037.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,197.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,137.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$2,005.50
|
| Rate for Payer: United Healthcare Medicare |
$1,197.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,058.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
FIBERTAK 1.8 W/ #2 SUTURE
|
Facility
|
IP
|
$2,100.00
|
|
| Hospital Charge Code |
3003448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.95 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,344.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,037.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,281.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,216.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,281.00
|
| Rate for Payer: United Healthcare Commercial |
$2,005.50
|
| Rate for Payer: United Healthcare Medicare |
$1,281.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,995.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
FIBERTAK 2.6 SUTURETAPE 1.3
|
Facility
|
IP
|
$1,382.50
|
|
| Hospital Charge Code |
3004191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.16 |
| Max. Negotiated Rate |
$1,382.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,354.85
|
| Rate for Payer: Aetna of WY Medicare |
$884.80
|
| Rate for Payer: Altius Commercial |
$1,327.20
|
| Rate for Payer: Beech Street Commercial |
$1,354.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,341.02
|
| Rate for Payer: Cash Price |
$967.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,341.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,354.85
|
| Rate for Payer: Entrust Commercial |
$1,313.38
|
| Rate for Payer: First Choice Health Commercial |
$1,313.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,313.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.32
|
| Rate for Payer: HealthUtah PPO |
$1,382.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,341.02
|
| Rate for Payer: Multiplan Medicare/VA |
$801.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,354.85
|
| Rate for Payer: PacificSource Commercial |
$1,244.25
|
| Rate for Payer: PHCS PPO |
$1,354.85
|
| Rate for Payer: Three Rivers PPO |
$1,036.88
|
| Rate for Payer: TriWest Veterans Administration |
$843.32
|
| Rate for Payer: United Healthcare Commercial |
$1,320.29
|
| Rate for Payer: United Healthcare Medicare |
$843.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,313.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,313.38
|
|
|
FIBERTAK 2.6 SUTURETAPE 1.3
|
Facility
|
OP
|
$1,382.50
|
|
| Hospital Charge Code |
3004191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.62 |
| Max. Negotiated Rate |
$1,382.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,354.85
|
| Rate for Payer: Aetna of WY Medicare |
$912.45
|
| Rate for Payer: Altius Commercial |
$1,327.20
|
| Rate for Payer: Beech Street Commercial |
$1,354.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,341.02
|
| Rate for Payer: Cash Price |
$967.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,341.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,354.85
|
| Rate for Payer: Entrust Commercial |
$1,313.38
|
| Rate for Payer: First Choice Health Commercial |
$1,313.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,313.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.02
|
| Rate for Payer: HealthUtah PPO |
$1,382.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,341.02
|
| Rate for Payer: Multiplan Medicare/VA |
$748.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,354.85
|
| Rate for Payer: PacificSource Commercial |
$1,244.25
|
| Rate for Payer: PHCS PPO |
$1,354.85
|
| Rate for Payer: Three Rivers PPO |
$1,036.88
|
| Rate for Payer: TriWest Veterans Administration |
$788.02
|
| Rate for Payer: United Healthcare Commercial |
$1,320.29
|
| Rate for Payer: United Healthcare Medicare |
$788.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,354.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,313.38
|
|
|
FIBERTAK 2.6 TRIPLE SUTURETAPE
|
Facility
|
IP
|
$1,435.00
|
|
| Hospital Charge Code |
3004174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$831.58 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$918.40
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.35
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$831.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$875.35
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$875.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,363.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
FIBERTAK 2.6 TRIPLE SUTURETAPE
|
Facility
|
OP
|
$1,435.00
|
|
| Hospital Charge Code |
3004174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.05 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,406.30
|
| Rate for Payer: Aetna of WY Medicare |
$947.10
|
| Rate for Payer: Altius Commercial |
$1,377.60
|
| Rate for Payer: Beech Street Commercial |
$1,406.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,391.95
|
| Rate for Payer: Cash Price |
$1,004.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,391.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,406.30
|
| Rate for Payer: Entrust Commercial |
$1,363.25
|
| Rate for Payer: First Choice Health Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,363.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.95
|
| Rate for Payer: HealthUtah PPO |
$1,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,391.95
|
| Rate for Payer: Multiplan Medicare/VA |
$777.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,406.30
|
| Rate for Payer: PacificSource Commercial |
$1,291.50
|
| Rate for Payer: PHCS PPO |
$1,406.30
|
| Rate for Payer: Three Rivers PPO |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration |
$817.95
|
| Rate for Payer: United Healthcare Commercial |
$1,370.42
|
| Rate for Payer: United Healthcare Medicare |
$817.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,406.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,363.25
|
|
|
FIBERTAK ANC 2.6MM KNOTLESS
|
Facility
|
OP
|
$1,839.60
|
|
| Hospital Charge Code |
3004519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.14 |
| Max. Negotiated Rate |
$1,839.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,802.81
|
| Rate for Payer: Aetna of WY Medicare |
$1,214.14
|
| Rate for Payer: Altius Commercial |
$1,766.02
|
| Rate for Payer: Beech Street Commercial |
$1,802.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,784.41
|
| Rate for Payer: Cash Price |
$1,287.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.41
|
| Rate for Payer: Cigna of WY Commercial |
$1,802.81
|
| Rate for Payer: Entrust Commercial |
$1,747.62
|
| Rate for Payer: First Choice Health Commercial |
$1,747.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,747.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,048.57
|
| Rate for Payer: HealthUtah PPO |
$1,839.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.41
|
| Rate for Payer: Multiplan Medicare/VA |
$996.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,802.81
|
| Rate for Payer: PacificSource Commercial |
$1,655.64
|
| Rate for Payer: PHCS PPO |
$1,802.81
|
| Rate for Payer: Three Rivers PPO |
$1,379.70
|
| Rate for Payer: TriWest Veterans Administration |
$1,048.57
|
| Rate for Payer: United Healthcare Commercial |
$1,756.82
|
| Rate for Payer: United Healthcare Medicare |
$1,048.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,802.81
|
| Rate for Payer: Wise Provider Network Commercial |
$1,747.62
|
|
|
FIBERTAK ANC 2.6MM KNOTLESS
|
Facility
|
IP
|
$1,839.60
|
|
| Hospital Charge Code |
3004519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.05 |
| Max. Negotiated Rate |
$1,839.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,802.81
|
| Rate for Payer: Aetna of WY Medicare |
$1,177.34
|
| Rate for Payer: Altius Commercial |
$1,766.02
|
| Rate for Payer: Beech Street Commercial |
$1,802.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,784.41
|
| Rate for Payer: Cash Price |
$1,287.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.41
|
| Rate for Payer: Cigna of WY Commercial |
$1,802.81
|
| Rate for Payer: Entrust Commercial |
$1,747.62
|
| Rate for Payer: First Choice Health Commercial |
$1,747.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,747.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,122.16
|
| Rate for Payer: HealthUtah PPO |
$1,839.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.41
|
| Rate for Payer: Multiplan Medicare/VA |
$1,066.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,802.81
|
| Rate for Payer: PacificSource Commercial |
$1,655.64
|
| Rate for Payer: PHCS PPO |
$1,802.81
|
| Rate for Payer: Three Rivers PPO |
$1,379.70
|
| Rate for Payer: TriWest Veterans Administration |
$1,122.16
|
| Rate for Payer: United Healthcare Commercial |
$1,756.82
|
| Rate for Payer: United Healthcare Medicare |
$1,122.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,747.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,747.62
|
|
|
FIBERTAK ANCHOR 1.8 KNOTLESS
|
Facility
|
OP
|
$1,798.72
|
|
| Hospital Charge Code |
3004742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.01 |
| Max. Negotiated Rate |
$1,798.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,762.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,187.16
|
| Rate for Payer: Altius Commercial |
$1,726.77
|
| Rate for Payer: Beech Street Commercial |
$1,762.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,744.76
|
| Rate for Payer: Cash Price |
$1,259.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,744.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,762.75
|
| Rate for Payer: Entrust Commercial |
$1,708.78
|
| Rate for Payer: First Choice Health Commercial |
$1,708.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,708.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,025.27
|
| Rate for Payer: HealthUtah PPO |
$1,798.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,744.76
|
| Rate for Payer: Multiplan Medicare/VA |
$974.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,762.75
|
| Rate for Payer: PacificSource Commercial |
$1,618.85
|
| Rate for Payer: PHCS PPO |
$1,762.75
|
| Rate for Payer: Three Rivers PPO |
$1,349.04
|
| Rate for Payer: TriWest Veterans Administration |
$1,025.27
|
| Rate for Payer: United Healthcare Commercial |
$1,717.78
|
| Rate for Payer: United Healthcare Medicare |
$1,025.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,762.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,708.78
|
|
|
FIBERTAK ANCHOR 1.8 KNOTLESS
|
Facility
|
IP
|
$1,798.72
|
|
| Hospital Charge Code |
3004742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.36 |
| Max. Negotiated Rate |
$1,798.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,762.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,151.18
|
| Rate for Payer: Altius Commercial |
$1,726.77
|
| Rate for Payer: Beech Street Commercial |
$1,762.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,744.76
|
| Rate for Payer: Cash Price |
$1,259.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,744.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,762.75
|
| Rate for Payer: Entrust Commercial |
$1,708.78
|
| Rate for Payer: First Choice Health Commercial |
$1,708.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,708.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,097.22
|
| Rate for Payer: HealthUtah PPO |
$1,798.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,744.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,042.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,762.75
|
| Rate for Payer: PacificSource Commercial |
$1,618.85
|
| Rate for Payer: PHCS PPO |
$1,762.75
|
| Rate for Payer: Three Rivers PPO |
$1,349.04
|
| Rate for Payer: TriWest Veterans Administration |
$1,097.22
|
| Rate for Payer: United Healthcare Commercial |
$1,717.78
|
| Rate for Payer: United Healthcare Medicare |
$1,097.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,708.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,708.78
|
|
|
FIBERTAK ANCHOR 2.6 KIT
|
Facility
|
IP
|
$797.16
|
|
| Hospital Charge Code |
3004192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.95 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$510.18
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$773.25
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.27
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$461.95
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$486.27
|
| Rate for Payer: United Healthcare Commercial |
$761.29
|
| Rate for Payer: United Healthcare Medicare |
$486.27
|
| Rate for Payer: WINHealth Partners Commercial |
$757.30
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
FIBERTAK ANCHOR 2.6 KIT
|
Facility
|
OP
|
$797.16
|
|
| Hospital Charge Code |
3004192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.66 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$526.13
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$773.25
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.38
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$431.66
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$454.38
|
| Rate for Payer: United Healthcare Commercial |
$761.29
|
| Rate for Payer: United Healthcare Medicare |
$454.38
|
| Rate for Payer: WINHealth Partners Commercial |
$781.22
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
FIBERTAK ANCHOR DBL LOADED KNOTLESS KNEE
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
3004750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.83 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,800.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,176.00
|
| Rate for Payer: Altius Commercial |
$1,764.00
|
| Rate for Payer: Beech Street Commercial |
$1,800.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,782.38
|
| Rate for Payer: Cash Price |
$1,286.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,782.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,800.75
|
| Rate for Payer: Entrust Commercial |
$1,745.62
|
| Rate for Payer: First Choice Health Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,120.88
|
| Rate for Payer: HealthUtah PPO |
$1,837.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,782.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,064.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,800.75
|
| Rate for Payer: PacificSource Commercial |
$1,653.75
|
| Rate for Payer: PHCS PPO |
$1,800.75
|
| Rate for Payer: Three Rivers PPO |
$1,378.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,120.88
|
| Rate for Payer: United Healthcare Commercial |
$1,754.81
|
| Rate for Payer: United Healthcare Medicare |
$1,120.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,745.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,745.62
|
|
