|
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
|
|
|
FIBERTAK ANC SP 2.6MM KNOTLESS
|
Facility
|
OP
|
$1,839.60
|
|
| Hospital Charge Code |
3004210
|
|
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 SP 2.6MM KNOTLESS
|
Facility
|
IP
|
$1,839.60
|
|
| Hospital Charge Code |
3004210
|
|
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 BUTTON 2.6MM AR-3680
|
Facility
|
OP
|
$2,761.50
|
|
| Hospital Charge Code |
3004121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.35 |
| Max. Negotiated Rate |
$2,761.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,706.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,822.59
|
| Rate for Payer: Altius Commercial |
$2,651.04
|
| Rate for Payer: Beech Street Commercial |
$2,706.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,678.66
|
| Rate for Payer: Cash Price |
$1,933.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,678.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,706.27
|
| Rate for Payer: Entrust Commercial |
$2,623.42
|
| Rate for Payer: First Choice Health Commercial |
$2,623.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,623.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,574.06
|
| Rate for Payer: HealthUtah PPO |
$2,761.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,678.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,495.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,706.27
|
| Rate for Payer: PacificSource Commercial |
$2,485.35
|
| Rate for Payer: PHCS PPO |
$2,706.27
|
| Rate for Payer: Three Rivers PPO |
$2,071.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,574.06
|
| Rate for Payer: United Healthcare Commercial |
$2,637.23
|
| Rate for Payer: United Healthcare Medicare |
$1,574.06
|
| Rate for Payer: WINHealth Partners Commercial |
$2,706.27
|
| Rate for Payer: Wise Provider Network Commercial |
$2,623.42
|
|
|
FIBERTAK BUTTON 2.6MM AR-3680
|
Facility
|
IP
|
$2,761.50
|
|
| Hospital Charge Code |
3004121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,600.29 |
| Max. Negotiated Rate |
$2,761.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,706.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,767.36
|
| Rate for Payer: Altius Commercial |
$2,651.04
|
| Rate for Payer: Beech Street Commercial |
$2,706.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,678.66
|
| Rate for Payer: Cash Price |
$1,933.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,678.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,706.27
|
| Rate for Payer: Entrust Commercial |
$2,623.42
|
| Rate for Payer: First Choice Health Commercial |
$2,623.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,623.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,684.52
|
| Rate for Payer: HealthUtah PPO |
$2,761.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,678.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,600.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,706.27
|
| Rate for Payer: PacificSource Commercial |
$2,485.35
|
| Rate for Payer: PHCS PPO |
$2,706.27
|
| Rate for Payer: Three Rivers PPO |
$2,071.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,684.52
|
| Rate for Payer: United Healthcare Commercial |
$2,637.23
|
| Rate for Payer: United Healthcare Medicare |
$1,684.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,623.42
|
| Rate for Payer: Wise Provider Network Commercial |
$2,623.42
|
|
|
FIBERTAK BUTTON 2.6MM AR-3681
|
Facility
|
IP
|
$1,732.50
|
|
| Hospital Charge Code |
3004171
|
|
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
|
|
|
FIBERTAK BUTTON 2.6MM AR-3681
|
Facility
|
OP
|
$1,732.50
|
|
| Hospital Charge Code |
3004171
|
|
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
|
|
|
FIBERTAK DISPOSABLE KIT KNEE
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
3004751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$496.92 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$840.35
|
| Rate for Payer: Aetna of WY Medicare |
$548.80
|
| Rate for Payer: Altius Commercial |
$823.20
|
| Rate for Payer: Beech Street Commercial |
$840.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$831.78
|
| Rate for Payer: Cash Price |
$600.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$831.78
|
| Rate for Payer: Cigna of WY Commercial |
$840.35
|
| Rate for Payer: Entrust Commercial |
$814.62
|
| Rate for Payer: First Choice Health Commercial |
$814.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$814.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.08
|
| Rate for Payer: HealthUtah PPO |
$857.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$831.78
|
| Rate for Payer: Multiplan Medicare/VA |
$496.92
|
| Rate for Payer: One Health Plan of WY PPO |
$840.35
|
| Rate for Payer: PacificSource Commercial |
$771.75
|
| Rate for Payer: PHCS PPO |
$840.35
|
| Rate for Payer: Three Rivers PPO |
$643.12
|
| Rate for Payer: TriWest Veterans Administration |
$523.08
|
| Rate for Payer: United Healthcare Commercial |
$818.91
|
| Rate for Payer: United Healthcare Medicare |
$523.08
|
| Rate for Payer: WINHealth Partners Commercial |
$814.62
|
| Rate for Payer: Wise Provider Network Commercial |
$814.62
|
|
|
FIBERTAK DISPOSABLE KIT KNEE
|
Facility
|
OP
|
$857.50
|
|
| Hospital Charge Code |
3004751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.34 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$840.35
|
| Rate for Payer: Aetna of WY Medicare |
$565.95
|
| Rate for Payer: Altius Commercial |
$823.20
|
| Rate for Payer: Beech Street Commercial |
$840.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$831.78
|
| Rate for Payer: Cash Price |
$600.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$831.78
|
| Rate for Payer: Cigna of WY Commercial |
$840.35
|
| Rate for Payer: Entrust Commercial |
$814.62
|
| Rate for Payer: First Choice Health Commercial |
$814.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$814.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$488.78
|
| Rate for Payer: HealthUtah PPO |
$857.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$831.78
|
| Rate for Payer: Multiplan Medicare/VA |
$464.34
|
| Rate for Payer: One Health Plan of WY PPO |
$840.35
|
| Rate for Payer: PacificSource Commercial |
$771.75
|
| Rate for Payer: PHCS PPO |
$840.35
|
| Rate for Payer: Three Rivers PPO |
$643.12
|
| Rate for Payer: TriWest Veterans Administration |
$488.78
|
| Rate for Payer: United Healthcare Commercial |
$818.91
|
| Rate for Payer: United Healthcare Medicare |
$488.78
|
| Rate for Payer: WINHealth Partners Commercial |
$840.35
|
| Rate for Payer: Wise Provider Network Commercial |
$814.62
|
|
|
FIBERTAPE AR-7237
|
Facility
|
IP
|
$332.50
|
|
| Hospital Charge Code |
3001720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$325.85
|
| Rate for Payer: Aetna of WY Medicare |
$212.80
|
| Rate for Payer: Altius Commercial |
$319.20
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.52
|
| Rate for Payer: Cash Price |
$232.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$322.52
|
| Rate for Payer: Cigna of WY Commercial |
$325.85
|
| Rate for Payer: Entrust Commercial |
$315.88
|
| Rate for Payer: First Choice Health Commercial |
$315.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$315.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.82
|
| Rate for Payer: HealthUtah PPO |
$332.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$322.52
|
| Rate for Payer: Multiplan Medicare/VA |
$192.68
|
| Rate for Payer: One Health Plan of WY PPO |
$325.85
|
| Rate for Payer: PacificSource Commercial |
$299.25
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$249.38
|
| Rate for Payer: TriWest Veterans Administration |
$202.82
|
| Rate for Payer: United Healthcare Commercial |
$317.54
|
| Rate for Payer: United Healthcare Medicare |
$202.82
|
| Rate for Payer: WINHealth Partners Commercial |
$315.88
|
| Rate for Payer: Wise Provider Network Commercial |
$315.88
|
|
|
FIBERTAPE AR-7237
|
Facility
|
OP
|
$332.50
|
|
| Hospital Charge Code |
3001720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.05 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$325.85
|
| Rate for Payer: Aetna of WY Medicare |
$219.45
|
| Rate for Payer: Altius Commercial |
$319.20
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.52
|
| Rate for Payer: Cash Price |
$232.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$322.52
|
| Rate for Payer: Cigna of WY Commercial |
$325.85
|
| Rate for Payer: Entrust Commercial |
$315.88
|
| Rate for Payer: First Choice Health Commercial |
$315.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$315.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.52
|
| Rate for Payer: HealthUtah PPO |
$332.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$322.52
|
| Rate for Payer: Multiplan Medicare/VA |
$180.05
|
| Rate for Payer: One Health Plan of WY PPO |
$325.85
|
| Rate for Payer: PacificSource Commercial |
$299.25
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$249.38
|
| Rate for Payer: TriWest Veterans Administration |
$189.52
|
| Rate for Payer: United Healthcare Commercial |
$317.54
|
| Rate for Payer: United Healthcare Medicare |
$189.52
|
| Rate for Payer: WINHealth Partners Commercial |
$325.85
|
| Rate for Payer: Wise Provider Network Commercial |
$315.88
|
|
|
FIBULA ANATOMIC LOCK LEFT 3H
|
Facility
|
OP
|
$4,165.00
|
|
| Hospital Charge Code |
3003316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.35 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,081.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,748.90
|
| Rate for Payer: Altius Commercial |
$3,998.40
|
| Rate for Payer: Beech Street Commercial |
$4,081.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,040.05
|
| Rate for Payer: Cash Price |
$2,915.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,040.05
|
| Rate for Payer: Cigna of WY Commercial |
$4,081.70
|
| Rate for Payer: Entrust Commercial |
$3,956.75
|
| Rate for Payer: First Choice Health Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,374.05
|
| Rate for Payer: HealthUtah PPO |
$4,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,040.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2,255.35
|
| Rate for Payer: One Health Plan of WY PPO |
$4,081.70
|
| Rate for Payer: PacificSource Commercial |
$3,748.50
|
| Rate for Payer: PHCS PPO |
$4,081.70
|
| Rate for Payer: Three Rivers PPO |
$3,123.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,374.05
|
| Rate for Payer: United Healthcare Commercial |
$3,977.58
|
| Rate for Payer: United Healthcare Medicare |
$2,374.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4,081.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3,956.75
|
|
|
FIBULA ANATOMIC LOCK LEFT 3H
|
Facility
|
IP
|
$4,165.00
|
|
| Hospital Charge Code |
3003316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,413.62 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,081.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,665.60
|
| Rate for Payer: Altius Commercial |
$3,998.40
|
| Rate for Payer: Beech Street Commercial |
$4,081.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,040.05
|
| Rate for Payer: Cash Price |
$2,915.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,040.05
|
| Rate for Payer: Cigna of WY Commercial |
$4,081.70
|
| Rate for Payer: Entrust Commercial |
$3,956.75
|
| Rate for Payer: First Choice Health Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,540.65
|
| Rate for Payer: HealthUtah PPO |
$4,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,040.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2,413.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4,081.70
|
| Rate for Payer: PacificSource Commercial |
$3,748.50
|
| Rate for Payer: PHCS PPO |
$4,081.70
|
| Rate for Payer: Three Rivers PPO |
$3,123.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,540.65
|
| Rate for Payer: United Healthcare Commercial |
$3,977.58
|
| Rate for Payer: United Healthcare Medicare |
$2,540.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,956.75
|
|
|
FIBULA ANATOMIC LOCK RIGHT 3H
|
Facility
|
OP
|
$3,955.00
|
|
| Hospital Charge Code |
3002802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,141.63 |
| Max. Negotiated Rate |
$3,955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,875.90
|
| Rate for Payer: Aetna of WY Medicare |
$2,610.30
|
| Rate for Payer: Altius Commercial |
$3,796.80
|
| Rate for Payer: Beech Street Commercial |
$3,875.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,836.35
|
| Rate for Payer: Cash Price |
$2,768.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,836.35
|
| Rate for Payer: Cigna of WY Commercial |
$3,875.90
|
| Rate for Payer: Entrust Commercial |
$3,757.25
|
| Rate for Payer: First Choice Health Commercial |
$3,757.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,757.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,254.35
|
| Rate for Payer: HealthUtah PPO |
$3,955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,836.35
|
| Rate for Payer: Multiplan Medicare/VA |
$2,141.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,875.90
|
| Rate for Payer: PacificSource Commercial |
$3,559.50
|
| Rate for Payer: PHCS PPO |
$3,875.90
|
| Rate for Payer: Three Rivers PPO |
$2,966.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,254.35
|
| Rate for Payer: United Healthcare Commercial |
$3,777.02
|
| Rate for Payer: United Healthcare Medicare |
$2,254.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,875.90
|
| Rate for Payer: Wise Provider Network Commercial |
$3,757.25
|
|
|
FIBULA ANATOMIC LOCK RIGHT 3H
|
Facility
|
IP
|
$3,955.00
|
|
| Hospital Charge Code |
3002802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.92 |
| Max. Negotiated Rate |
$3,955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,875.90
|
| Rate for Payer: Aetna of WY Medicare |
$2,531.20
|
| Rate for Payer: Altius Commercial |
$3,796.80
|
| Rate for Payer: Beech Street Commercial |
$3,875.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,836.35
|
| Rate for Payer: Cash Price |
$2,768.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,836.35
|
| Rate for Payer: Cigna of WY Commercial |
$3,875.90
|
| Rate for Payer: Entrust Commercial |
$3,757.25
|
| Rate for Payer: First Choice Health Commercial |
$3,757.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,757.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,412.55
|
| Rate for Payer: HealthUtah PPO |
$3,955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,836.35
|
| Rate for Payer: Multiplan Medicare/VA |
$2,291.92
|
| Rate for Payer: One Health Plan of WY PPO |
$3,875.90
|
| Rate for Payer: PacificSource Commercial |
$3,559.50
|
| Rate for Payer: PHCS PPO |
$3,875.90
|
| Rate for Payer: Three Rivers PPO |
$2,966.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,412.55
|
| Rate for Payer: United Healthcare Commercial |
$3,777.02
|
| Rate for Payer: United Healthcare Medicare |
$2,412.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,757.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,757.25
|
|
|
FIBULA SHAFT GRAFT
|
Facility
|
OP
|
$4,235.00
|
|
| Hospital Charge Code |
3003234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.25 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,150.30
|
| Rate for Payer: Aetna of WY Medicare |
$2,795.10
|
| Rate for Payer: Altius Commercial |
$4,065.60
|
| Rate for Payer: Beech Street Commercial |
$4,150.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,107.95
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,107.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,150.30
|
| Rate for Payer: Entrust Commercial |
$4,023.25
|
| Rate for Payer: First Choice Health Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,413.95
|
| Rate for Payer: HealthUtah PPO |
$4,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,107.95
|
| Rate for Payer: Multiplan Medicare/VA |
$2,293.25
|
| Rate for Payer: One Health Plan of WY PPO |
$4,150.30
|
| Rate for Payer: PacificSource Commercial |
$3,811.50
|
| Rate for Payer: PHCS PPO |
$4,150.30
|
| Rate for Payer: Three Rivers PPO |
$3,176.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,413.95
|
| Rate for Payer: United Healthcare Commercial |
$4,044.42
|
| Rate for Payer: United Healthcare Medicare |
$2,413.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,150.30
|
| Rate for Payer: Wise Provider Network Commercial |
$4,023.25
|
|
|
FIBULA SHAFT GRAFT
|
Facility
|
IP
|
$4,235.00
|
|
| Hospital Charge Code |
3003234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,454.18 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,150.30
|
| Rate for Payer: Aetna of WY Medicare |
$2,710.40
|
| Rate for Payer: Altius Commercial |
$4,065.60
|
| Rate for Payer: Beech Street Commercial |
$4,150.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,107.95
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,107.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,150.30
|
| Rate for Payer: Entrust Commercial |
$4,023.25
|
| Rate for Payer: First Choice Health Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,583.35
|
| Rate for Payer: HealthUtah PPO |
$4,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,107.95
|
| Rate for Payer: Multiplan Medicare/VA |
$2,454.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,150.30
|
| Rate for Payer: PacificSource Commercial |
$3,811.50
|
| Rate for Payer: PHCS PPO |
$4,150.30
|
| Rate for Payer: Three Rivers PPO |
$3,176.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,583.35
|
| Rate for Payer: United Healthcare Commercial |
$4,044.42
|
| Rate for Payer: United Healthcare Medicare |
$2,583.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4,023.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,023.25
|
|
|
FIDAXOMICIN 200 MG TABLET [92589]
|
Facility
|
OP
|
$326.30
|
|
|
Service Code
|
NDC 5201508001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.69 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.77
|
| Rate for Payer: Aetna of WY Medicare |
$215.36
|
| Rate for Payer: Altius Commercial |
$313.25
|
| Rate for Payer: Beech Street Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.51
|
| Rate for Payer: Cash Price |
$228.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.51
|
| Rate for Payer: Cigna of WY Commercial |
$319.77
|
| Rate for Payer: Entrust Commercial |
$309.98
|
| Rate for Payer: First Choice Health Commercial |
$309.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$309.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.99
|
| Rate for Payer: HealthUtah PPO |
$326.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.51
|
| Rate for Payer: Multiplan Medicare/VA |
$176.69
|
| Rate for Payer: One Health Plan of WY PPO |
$319.77
|
| Rate for Payer: PacificSource Commercial |
$293.67
|
| Rate for Payer: PHCS PPO |
$319.77
|
| Rate for Payer: Three Rivers PPO |
$244.72
|
| Rate for Payer: TriWest Veterans Administration |
$185.99
|
| Rate for Payer: United Healthcare Commercial |
$311.62
|
| Rate for Payer: United Healthcare Medicare |
$185.99
|
| Rate for Payer: WINHealth Partners Commercial |
$319.77
|
| Rate for Payer: Wise Provider Network Commercial |
$309.98
|
|
|
FIDAXOMICIN 200 MG TABLET [92589]
|
Facility
|
IP
|
$326.30
|
|
|
Service Code
|
NDC 5201508001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.09 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.77
|
| Rate for Payer: Aetna of WY Medicare |
$208.83
|
| Rate for Payer: Altius Commercial |
$313.25
|
| Rate for Payer: Beech Street Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.51
|
| Rate for Payer: Cash Price |
$228.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.51
|
| Rate for Payer: Cigna of WY Commercial |
$319.77
|
| Rate for Payer: Entrust Commercial |
$309.98
|
| Rate for Payer: First Choice Health Commercial |
$309.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$309.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.04
|
| Rate for Payer: HealthUtah PPO |
$326.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.51
|
| Rate for Payer: Multiplan Medicare/VA |
$189.09
|
| Rate for Payer: One Health Plan of WY PPO |
$319.77
|
| Rate for Payer: PacificSource Commercial |
$293.67
|
| Rate for Payer: PHCS PPO |
$319.77
|
| Rate for Payer: Three Rivers PPO |
$244.72
|
| Rate for Payer: TriWest Veterans Administration |
$199.04
|
| Rate for Payer: United Healthcare Commercial |
$311.62
|
| Rate for Payer: United Healthcare Medicare |
$199.04
|
| Rate for Payer: WINHealth Partners Commercial |
$309.98
|
| Rate for Payer: Wise Provider Network Commercial |
$309.98
|
|
|
FILTER BLOOD PALL GELSQ40S
|
Facility
|
IP
|
$27.44
|
|
| Hospital Charge Code |
2050011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.89
|
| Rate for Payer: Aetna of WY Medicare |
$17.56
|
| Rate for Payer: Altius Commercial |
$26.34
|
| Rate for Payer: Beech Street Commercial |
$26.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.62
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.62
|
| Rate for Payer: Cigna of WY Commercial |
$26.89
|
| Rate for Payer: Entrust Commercial |
$26.07
|
| Rate for Payer: First Choice Health Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.74
|
| Rate for Payer: HealthUtah PPO |
$27.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.62
|
| Rate for Payer: Multiplan Medicare/VA |
$15.90
|
| Rate for Payer: One Health Plan of WY PPO |
$26.89
|
| Rate for Payer: PacificSource Commercial |
$24.70
|
| Rate for Payer: PHCS PPO |
$26.89
|
| Rate for Payer: Three Rivers PPO |
$20.58
|
| Rate for Payer: TriWest Veterans Administration |
$16.74
|
| Rate for Payer: United Healthcare Commercial |
$26.21
|
| Rate for Payer: United Healthcare Medicare |
$16.74
|
| Rate for Payer: WINHealth Partners Commercial |
$26.07
|
| Rate for Payer: Wise Provider Network Commercial |
$26.07
|
|
|
FILTER BLOOD PALL GELSQ40S
|
Facility
|
OP
|
$27.44
|
|
| Hospital Charge Code |
2050011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.89
|
| Rate for Payer: Aetna of WY Medicare |
$18.11
|
| Rate for Payer: Altius Commercial |
$26.34
|
| Rate for Payer: Beech Street Commercial |
$26.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.62
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.62
|
| Rate for Payer: Cigna of WY Commercial |
$26.89
|
| Rate for Payer: Entrust Commercial |
$26.07
|
| Rate for Payer: First Choice Health Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.64
|
| Rate for Payer: HealthUtah PPO |
$27.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.62
|
| Rate for Payer: Multiplan Medicare/VA |
$14.86
|
| Rate for Payer: One Health Plan of WY PPO |
$26.89
|
| Rate for Payer: PacificSource Commercial |
$24.70
|
| Rate for Payer: PHCS PPO |
$26.89
|
| Rate for Payer: Three Rivers PPO |
$20.58
|
| Rate for Payer: TriWest Veterans Administration |
$15.64
|
| Rate for Payer: United Healthcare Commercial |
$26.21
|
| Rate for Payer: United Healthcare Medicare |
$15.64
|
| Rate for Payer: WINHealth Partners Commercial |
$26.89
|
| Rate for Payer: Wise Provider Network Commercial |
$26.07
|
|
|
FILTER HMEF 1000 DYNJAAHME1
|
Facility
|
OP
|
$4.26
|
|
| Hospital Charge Code |
2500035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.17
|
| Rate for Payer: Aetna of WY Medicare |
$2.81
|
| Rate for Payer: Altius Commercial |
$4.09
|
| Rate for Payer: Beech Street Commercial |
$4.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.13
|
| Rate for Payer: Cigna of WY Commercial |
$4.17
|
| Rate for Payer: Entrust Commercial |
$4.05
|
| Rate for Payer: First Choice Health Commercial |
$4.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.43
|
| Rate for Payer: HealthUtah PPO |
$4.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.13
|
| Rate for Payer: Multiplan Medicare/VA |
$2.31
|
| Rate for Payer: One Health Plan of WY PPO |
$4.17
|
| Rate for Payer: PacificSource Commercial |
$3.83
|
| Rate for Payer: PHCS PPO |
$4.17
|
| Rate for Payer: Three Rivers PPO |
$3.20
|
| Rate for Payer: TriWest Veterans Administration |
$2.43
|
| Rate for Payer: United Healthcare Medicare |
$2.43
|
| Rate for Payer: WINHealth Partners Commercial |
$4.17
|
| Rate for Payer: Wise Provider Network Commercial |
$4.05
|
|
|
FILTER HMEF 1000 DYNJAAHME1
|
Facility
|
IP
|
$4.26
|
|
| Hospital Charge Code |
2500035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.17
|
| Rate for Payer: Aetna of WY Medicare |
$2.73
|
| Rate for Payer: Altius Commercial |
$4.09
|
| Rate for Payer: Beech Street Commercial |
$4.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.13
|
| Rate for Payer: Cigna of WY Commercial |
$4.17
|
| Rate for Payer: Entrust Commercial |
$4.05
|
| Rate for Payer: First Choice Health Commercial |
$4.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.60
|
| Rate for Payer: HealthUtah PPO |
$4.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.13
|
| Rate for Payer: Multiplan Medicare/VA |
$2.47
|
| Rate for Payer: One Health Plan of WY PPO |
$4.17
|
| Rate for Payer: PacificSource Commercial |
$3.83
|
| Rate for Payer: PHCS PPO |
$4.17
|
| Rate for Payer: Three Rivers PPO |
$3.20
|
| Rate for Payer: TriWest Veterans Administration |
$2.60
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: United Healthcare Medicare |
$2.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4.05
|
| Rate for Payer: Wise Provider Network Commercial |
$4.05
|
|
|
FILTER HMEF 750 DISP
|
Facility
|
IP
|
$4.22
|
|
| Hospital Charge Code |
2500036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.14
|
| Rate for Payer: Aetna of WY Medicare |
$2.70
|
| Rate for Payer: Altius Commercial |
$4.05
|
| Rate for Payer: Beech Street Commercial |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.09
|
| Rate for Payer: Cigna of WY Commercial |
$4.14
|
| Rate for Payer: Entrust Commercial |
$4.01
|
| Rate for Payer: First Choice Health Commercial |
$4.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$4.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.09
|
| Rate for Payer: Multiplan Medicare/VA |
$2.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4.14
|
| Rate for Payer: PacificSource Commercial |
$3.80
|
| Rate for Payer: PHCS PPO |
$4.14
|
| Rate for Payer: Three Rivers PPO |
$3.16
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$4.03
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$4.01
|
| Rate for Payer: Wise Provider Network Commercial |
$4.01
|
|
|
FILTER HMEF 750 DISP
|
Facility
|
OP
|
$4.22
|
|
| Hospital Charge Code |
2500036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.14
|
| Rate for Payer: Aetna of WY Medicare |
$2.79
|
| Rate for Payer: Altius Commercial |
$4.05
|
| Rate for Payer: Beech Street Commercial |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.09
|
| Rate for Payer: Cigna of WY Commercial |
$4.14
|
| Rate for Payer: Entrust Commercial |
$4.01
|
| Rate for Payer: First Choice Health Commercial |
$4.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.41
|
| Rate for Payer: HealthUtah PPO |
$4.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.09
|
| Rate for Payer: Multiplan Medicare/VA |
$2.29
|
| Rate for Payer: One Health Plan of WY PPO |
$4.14
|
| Rate for Payer: PacificSource Commercial |
$3.80
|
| Rate for Payer: PHCS PPO |
$4.14
|
| Rate for Payer: Three Rivers PPO |
$3.16
|
| Rate for Payer: TriWest Veterans Administration |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$4.03
|
| Rate for Payer: United Healthcare Medicare |
$2.41
|
| Rate for Payer: WINHealth Partners Commercial |
$4.14
|
| Rate for Payer: Wise Provider Network Commercial |
$4.01
|
|
