|
GRAFT STRATOFUSE LORD 5° 06MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 06MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 10MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 10MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 07MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 07MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 09MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 09MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 08MM
|
Facility
|
IP
|
$4,812.50
|
|
| Hospital Charge Code |
3004552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.84 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,080.00
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,935.62
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,788.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,935.62
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,935.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,571.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT STRATOFUSE LORD 5° 08MM
|
Facility
|
OP
|
$4,812.50
|
|
| Hospital Charge Code |
3004552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.97 |
| Max. Negotiated Rate |
$4,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,716.25
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.25
|
| Rate for Payer: Altius Commercial |
$4,620.00
|
| Rate for Payer: Beech Street Commercial |
$4,716.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,668.12
|
| Rate for Payer: Cash Price |
$3,368.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,716.25
|
| Rate for Payer: Entrust Commercial |
$4,571.88
|
| Rate for Payer: First Choice Health Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,571.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,743.12
|
| Rate for Payer: HealthUtah PPO |
$4,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2,605.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,716.25
|
| Rate for Payer: PacificSource Commercial |
$4,331.25
|
| Rate for Payer: PHCS PPO |
$4,716.25
|
| Rate for Payer: Three Rivers PPO |
$3,609.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,743.12
|
| Rate for Payer: United Healthcare Commercial |
$4,595.94
|
| Rate for Payer: United Healthcare Medicare |
$2,743.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4,716.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,571.88
|
|
|
GRAFT TENSION BREAK PINS
|
Facility
|
IP
|
$130.10
|
|
| Hospital Charge Code |
2650747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.50
|
| Rate for Payer: Aetna of WY Medicare |
$83.26
|
| Rate for Payer: Altius Commercial |
$124.90
|
| Rate for Payer: Beech Street Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.20
|
| Rate for Payer: Cigna of WY Commercial |
$127.50
|
| Rate for Payer: Entrust Commercial |
$123.60
|
| Rate for Payer: First Choice Health Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.36
|
| Rate for Payer: HealthUtah PPO |
$130.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.20
|
| Rate for Payer: Multiplan Medicare/VA |
$75.39
|
| Rate for Payer: One Health Plan of WY PPO |
$127.50
|
| Rate for Payer: PacificSource Commercial |
$117.09
|
| Rate for Payer: PHCS PPO |
$127.50
|
| Rate for Payer: Three Rivers PPO |
$97.58
|
| Rate for Payer: TriWest Veterans Administration |
$79.36
|
| Rate for Payer: United Healthcare Commercial |
$124.25
|
| Rate for Payer: United Healthcare Medicare |
$79.36
|
| Rate for Payer: WINHealth Partners Commercial |
$123.60
|
| Rate for Payer: Wise Provider Network Commercial |
$123.60
|
|
|
GRAFT TENSION BREAK PINS
|
Facility
|
OP
|
$130.10
|
|
| Hospital Charge Code |
2650747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.50
|
| Rate for Payer: Aetna of WY Medicare |
$85.87
|
| Rate for Payer: Altius Commercial |
$124.90
|
| Rate for Payer: Beech Street Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.20
|
| Rate for Payer: Cigna of WY Commercial |
$127.50
|
| Rate for Payer: Entrust Commercial |
$123.60
|
| Rate for Payer: First Choice Health Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.16
|
| Rate for Payer: HealthUtah PPO |
$130.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.20
|
| Rate for Payer: Multiplan Medicare/VA |
$70.45
|
| Rate for Payer: One Health Plan of WY PPO |
$127.50
|
| Rate for Payer: PacificSource Commercial |
$117.09
|
| Rate for Payer: PHCS PPO |
$127.50
|
| Rate for Payer: Three Rivers PPO |
$97.58
|
| Rate for Payer: TriWest Veterans Administration |
$74.16
|
| Rate for Payer: United Healthcare Commercial |
$124.25
|
| Rate for Payer: United Healthcare Medicare |
$74.16
|
| Rate for Payer: WINHealth Partners Commercial |
$127.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.60
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [46063]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS J1626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.08
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$25.72
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$27.08
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$27.08
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [46063]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS J1626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$30.40
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.98
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$27.53
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$28.98
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
GREENLINE AMERICAN MAC 2 BLADE
|
Facility
|
IP
|
$126.91
|
|
| Hospital Charge Code |
2500209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$81.22
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.42
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$73.54
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$77.42
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$77.42
|
| Rate for Payer: WINHealth Partners Commercial |
$120.56
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE AMERICAN MAC 2 BLADE
|
Facility
|
OP
|
$126.91
|
|
| Hospital Charge Code |
2500209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$83.76
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.34
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$68.72
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$72.34
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$72.34
|
| Rate for Payer: WINHealth Partners Commercial |
$124.37
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE AMERICAN MAC 3 BLADE
|
Facility
|
IP
|
$126.91
|
|
| Hospital Charge Code |
2500208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$81.22
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.42
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$73.54
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$77.42
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$77.42
|
| Rate for Payer: WINHealth Partners Commercial |
$120.56
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE AMERICAN MAC 3 BLADE
|
Facility
|
OP
|
$126.91
|
|
| Hospital Charge Code |
2500208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$83.76
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.34
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$68.72
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$72.34
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$72.34
|
| Rate for Payer: WINHealth Partners Commercial |
$124.37
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE F/O ENGLISH MAC SZ3
|
Facility
|
OP
|
$126.91
|
|
| Hospital Charge Code |
2500188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$83.76
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.34
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$68.72
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$72.34
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$72.34
|
| Rate for Payer: WINHealth Partners Commercial |
$124.37
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE F/O ENGLISH MAC SZ3
|
Facility
|
IP
|
$126.91
|
|
| Hospital Charge Code |
2500188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$126.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.37
|
| Rate for Payer: Aetna of WY Medicare |
$81.22
|
| Rate for Payer: Altius Commercial |
$121.83
|
| Rate for Payer: Beech Street Commercial |
$124.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.10
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.10
|
| Rate for Payer: Cigna of WY Commercial |
$124.37
|
| Rate for Payer: Entrust Commercial |
$120.56
|
| Rate for Payer: First Choice Health Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.42
|
| Rate for Payer: HealthUtah PPO |
$126.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.10
|
| Rate for Payer: Multiplan Medicare/VA |
$73.54
|
| Rate for Payer: One Health Plan of WY PPO |
$124.37
|
| Rate for Payer: PacificSource Commercial |
$114.22
|
| Rate for Payer: PHCS PPO |
$124.37
|
| Rate for Payer: Three Rivers PPO |
$95.18
|
| Rate for Payer: TriWest Veterans Administration |
$77.42
|
| Rate for Payer: United Healthcare Commercial |
$121.20
|
| Rate for Payer: United Healthcare Medicare |
$77.42
|
| Rate for Payer: WINHealth Partners Commercial |
$120.56
|
| Rate for Payer: Wise Provider Network Commercial |
$120.56
|
|
|
GREENLINE LED HDL MED STANDARD
|
Facility
|
IP
|
$268.28
|
|
| Hospital Charge Code |
2500201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.47 |
| Max. Negotiated Rate |
$268.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.91
|
| Rate for Payer: Aetna of WY Medicare |
$171.70
|
| Rate for Payer: Altius Commercial |
$257.55
|
| Rate for Payer: Beech Street Commercial |
$262.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.23
|
| Rate for Payer: Cash Price |
$187.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.23
|
| Rate for Payer: Cigna of WY Commercial |
$262.91
|
| Rate for Payer: Entrust Commercial |
$254.87
|
| Rate for Payer: First Choice Health Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.65
|
| Rate for Payer: HealthUtah PPO |
$268.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.23
|
| Rate for Payer: Multiplan Medicare/VA |
$155.47
|
| Rate for Payer: One Health Plan of WY PPO |
$262.91
|
| Rate for Payer: PacificSource Commercial |
$241.45
|
| Rate for Payer: PHCS PPO |
$262.91
|
| Rate for Payer: Three Rivers PPO |
$201.21
|
| Rate for Payer: TriWest Veterans Administration |
$163.65
|
| Rate for Payer: United Healthcare Commercial |
$256.21
|
| Rate for Payer: United Healthcare Medicare |
$163.65
|
| Rate for Payer: WINHealth Partners Commercial |
$254.87
|
| Rate for Payer: Wise Provider Network Commercial |
$254.87
|
|
|
GREENLINE LED HDL MED STANDARD
|
Facility
|
OP
|
$268.28
|
|
| Hospital Charge Code |
2500201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$268.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.91
|
| Rate for Payer: Aetna of WY Medicare |
$177.06
|
| Rate for Payer: Altius Commercial |
$257.55
|
| Rate for Payer: Beech Street Commercial |
$262.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.23
|
| Rate for Payer: Cash Price |
$187.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.23
|
| Rate for Payer: Cigna of WY Commercial |
$262.91
|
| Rate for Payer: Entrust Commercial |
$254.87
|
| Rate for Payer: First Choice Health Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.92
|
| Rate for Payer: HealthUtah PPO |
$268.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.23
|
| Rate for Payer: Multiplan Medicare/VA |
$145.27
|
| Rate for Payer: One Health Plan of WY PPO |
$262.91
|
| Rate for Payer: PacificSource Commercial |
$241.45
|
| Rate for Payer: PHCS PPO |
$262.91
|
| Rate for Payer: Three Rivers PPO |
$201.21
|
| Rate for Payer: TriWest Veterans Administration |
$152.92
|
| Rate for Payer: United Healthcare Commercial |
$256.21
|
| Rate for Payer: United Healthcare Medicare |
$152.92
|
| Rate for Payer: WINHealth Partners Commercial |
$262.91
|
| Rate for Payer: Wise Provider Network Commercial |
$254.87
|
|
|
GREENLINE LED HDL PENLIGHT 2AA
|
Facility
|
IP
|
$268.28
|
|
| Hospital Charge Code |
2500200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.47 |
| Max. Negotiated Rate |
$268.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.91
|
| Rate for Payer: Aetna of WY Medicare |
$171.70
|
| Rate for Payer: Altius Commercial |
$257.55
|
| Rate for Payer: Beech Street Commercial |
$262.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.23
|
| Rate for Payer: Cash Price |
$187.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.23
|
| Rate for Payer: Cigna of WY Commercial |
$262.91
|
| Rate for Payer: Entrust Commercial |
$254.87
|
| Rate for Payer: First Choice Health Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.65
|
| Rate for Payer: HealthUtah PPO |
$268.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.23
|
| Rate for Payer: Multiplan Medicare/VA |
$155.47
|
| Rate for Payer: One Health Plan of WY PPO |
$262.91
|
| Rate for Payer: PacificSource Commercial |
$241.45
|
| Rate for Payer: PHCS PPO |
$262.91
|
| Rate for Payer: Three Rivers PPO |
$201.21
|
| Rate for Payer: TriWest Veterans Administration |
$163.65
|
| Rate for Payer: United Healthcare Commercial |
$256.21
|
| Rate for Payer: United Healthcare Medicare |
$163.65
|
| Rate for Payer: WINHealth Partners Commercial |
$254.87
|
| Rate for Payer: Wise Provider Network Commercial |
$254.87
|
|
|
GREENLINE LED HDL PENLIGHT 2AA
|
Facility
|
OP
|
$268.28
|
|
| Hospital Charge Code |
2500200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$268.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.91
|
| Rate for Payer: Aetna of WY Medicare |
$177.06
|
| Rate for Payer: Altius Commercial |
$257.55
|
| Rate for Payer: Beech Street Commercial |
$262.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.23
|
| Rate for Payer: Cash Price |
$187.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.23
|
| Rate for Payer: Cigna of WY Commercial |
$262.91
|
| Rate for Payer: Entrust Commercial |
$254.87
|
| Rate for Payer: First Choice Health Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.92
|
| Rate for Payer: HealthUtah PPO |
$268.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.23
|
| Rate for Payer: Multiplan Medicare/VA |
$145.27
|
| Rate for Payer: One Health Plan of WY PPO |
$262.91
|
| Rate for Payer: PacificSource Commercial |
$241.45
|
| Rate for Payer: PHCS PPO |
$262.91
|
| Rate for Payer: Three Rivers PPO |
$201.21
|
| Rate for Payer: TriWest Veterans Administration |
$152.92
|
| Rate for Payer: United Healthcare Commercial |
$256.21
|
| Rate for Payer: United Healthcare Medicare |
$152.92
|
| Rate for Payer: WINHealth Partners Commercial |
$262.91
|
| Rate for Payer: Wise Provider Network Commercial |
$254.87
|
|
|
GREENLINE LED HDL STUBBY 2AA
|
Facility
|
OP
|
$268.28
|
|
| Hospital Charge Code |
2500199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$268.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.91
|
| Rate for Payer: Aetna of WY Medicare |
$177.06
|
| Rate for Payer: Altius Commercial |
$257.55
|
| Rate for Payer: Beech Street Commercial |
$262.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.23
|
| Rate for Payer: Cash Price |
$187.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.23
|
| Rate for Payer: Cigna of WY Commercial |
$262.91
|
| Rate for Payer: Entrust Commercial |
$254.87
|
| Rate for Payer: First Choice Health Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.92
|
| Rate for Payer: HealthUtah PPO |
$268.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.23
|
| Rate for Payer: Multiplan Medicare/VA |
$145.27
|
| Rate for Payer: One Health Plan of WY PPO |
$262.91
|
| Rate for Payer: PacificSource Commercial |
$241.45
|
| Rate for Payer: PHCS PPO |
$262.91
|
| Rate for Payer: Three Rivers PPO |
$201.21
|
| Rate for Payer: TriWest Veterans Administration |
$152.92
|
| Rate for Payer: United Healthcare Commercial |
$256.21
|
| Rate for Payer: United Healthcare Medicare |
$152.92
|
| Rate for Payer: WINHealth Partners Commercial |
$262.91
|
| Rate for Payer: Wise Provider Network Commercial |
$254.87
|
|
