|
3.0X800 MM BALL TIP GUIDE WIRE
|
Facility
|
OP
|
$964.60
|
|
| Hospital Charge Code |
3002140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.33 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$945.31
|
| Rate for Payer: Aetna of WY Medicare |
$636.64
|
| Rate for Payer: Altius Commercial |
$926.02
|
| Rate for Payer: Beech Street Commercial |
$945.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.66
|
| Rate for Payer: Cash Price |
$675.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$935.66
|
| Rate for Payer: Cigna of WY Commercial |
$945.31
|
| Rate for Payer: Entrust Commercial |
$916.37
|
| Rate for Payer: First Choice Health Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.82
|
| Rate for Payer: HealthUtah PPO |
$964.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$935.66
|
| Rate for Payer: Multiplan Medicare/VA |
$522.33
|
| Rate for Payer: One Health Plan of WY PPO |
$945.31
|
| Rate for Payer: PacificSource Commercial |
$868.14
|
| Rate for Payer: PHCS PPO |
$945.31
|
| Rate for Payer: Three Rivers PPO |
$723.45
|
| Rate for Payer: TriWest Veterans Administration |
$549.82
|
| Rate for Payer: United Healthcare Commercial |
$921.19
|
| Rate for Payer: United Healthcare Medicare |
$549.82
|
| Rate for Payer: WINHealth Partners Commercial |
$945.31
|
| Rate for Payer: Wise Provider Network Commercial |
$916.37
|
|
|
3.0X800 MM BALL TIP GUIDE WIRE
|
Facility
|
IP
|
$964.60
|
|
| Hospital Charge Code |
3002140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$558.99 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$945.31
|
| Rate for Payer: Aetna of WY Medicare |
$617.34
|
| Rate for Payer: Altius Commercial |
$926.02
|
| Rate for Payer: Beech Street Commercial |
$945.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.66
|
| Rate for Payer: Cash Price |
$675.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$935.66
|
| Rate for Payer: Cigna of WY Commercial |
$945.31
|
| Rate for Payer: Entrust Commercial |
$916.37
|
| Rate for Payer: First Choice Health Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$588.41
|
| Rate for Payer: HealthUtah PPO |
$964.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$935.66
|
| Rate for Payer: Multiplan Medicare/VA |
$558.99
|
| Rate for Payer: One Health Plan of WY PPO |
$945.31
|
| Rate for Payer: PacificSource Commercial |
$868.14
|
| Rate for Payer: PHCS PPO |
$945.31
|
| Rate for Payer: Three Rivers PPO |
$723.45
|
| Rate for Payer: TriWest Veterans Administration |
$588.41
|
| Rate for Payer: United Healthcare Commercial |
$921.19
|
| Rate for Payer: United Healthcare Medicare |
$588.41
|
| Rate for Payer: WINHealth Partners Commercial |
$916.37
|
| Rate for Payer: Wise Provider Network Commercial |
$916.37
|
|
|
3.2 MM ENTRY GUIDE WIRE
|
Facility
|
OP
|
$837.20
|
|
| Hospital Charge Code |
3002134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.34 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$820.46
|
| Rate for Payer: Aetna of WY Medicare |
$552.55
|
| Rate for Payer: Altius Commercial |
$803.71
|
| Rate for Payer: Beech Street Commercial |
$820.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.08
|
| Rate for Payer: Cash Price |
$586.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.08
|
| Rate for Payer: Cigna of WY Commercial |
$820.46
|
| Rate for Payer: Entrust Commercial |
$795.34
|
| Rate for Payer: First Choice Health Commercial |
$795.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$795.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.20
|
| Rate for Payer: HealthUtah PPO |
$837.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.08
|
| Rate for Payer: Multiplan Medicare/VA |
$453.34
|
| Rate for Payer: One Health Plan of WY PPO |
$820.46
|
| Rate for Payer: PacificSource Commercial |
$753.48
|
| Rate for Payer: PHCS PPO |
$820.46
|
| Rate for Payer: Three Rivers PPO |
$627.90
|
| Rate for Payer: TriWest Veterans Administration |
$477.20
|
| Rate for Payer: United Healthcare Commercial |
$799.53
|
| Rate for Payer: United Healthcare Medicare |
$477.20
|
| Rate for Payer: WINHealth Partners Commercial |
$820.46
|
| Rate for Payer: Wise Provider Network Commercial |
$795.34
|
|
|
3.2 MM ENTRY GUIDE WIRE
|
Facility
|
IP
|
$837.20
|
|
| Hospital Charge Code |
3002134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.16 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$820.46
|
| Rate for Payer: Aetna of WY Medicare |
$535.81
|
| Rate for Payer: Altius Commercial |
$803.71
|
| Rate for Payer: Beech Street Commercial |
$820.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.08
|
| Rate for Payer: Cash Price |
$586.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.08
|
| Rate for Payer: Cigna of WY Commercial |
$820.46
|
| Rate for Payer: Entrust Commercial |
$795.34
|
| Rate for Payer: First Choice Health Commercial |
$795.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$795.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$510.69
|
| Rate for Payer: HealthUtah PPO |
$837.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.08
|
| Rate for Payer: Multiplan Medicare/VA |
$485.16
|
| Rate for Payer: One Health Plan of WY PPO |
$820.46
|
| Rate for Payer: PacificSource Commercial |
$753.48
|
| Rate for Payer: PHCS PPO |
$820.46
|
| Rate for Payer: Three Rivers PPO |
$627.90
|
| Rate for Payer: TriWest Veterans Administration |
$510.69
|
| Rate for Payer: United Healthcare Commercial |
$799.53
|
| Rate for Payer: United Healthcare Medicare |
$510.69
|
| Rate for Payer: WINHealth Partners Commercial |
$795.34
|
| Rate for Payer: Wise Provider Network Commercial |
$795.34
|
|
|
3.2 X 180 MM DRILLBIT
|
Facility
|
OP
|
$450.73
|
|
| Hospital Charge Code |
3150189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.07 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$297.48
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.92
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$244.07
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$256.92
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$256.92
|
| Rate for Payer: WINHealth Partners Commercial |
$441.72
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
3.2 X 180 MM DRILLBIT
|
Facility
|
IP
|
$450.73
|
|
| Hospital Charge Code |
3150189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$288.47
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.95
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$261.20
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$274.95
|
| Rate for Payer: WINHealth Partners Commercial |
$428.19
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
35CM 8 CONTACT EXTENSION KIT
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
2800251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.19 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,601.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,521.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,601.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,601.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,493.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
35CM 8 CONTACT EXTENSION KIT
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
2800251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.44 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,732.50
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,496.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,572.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
35 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
35 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
400 SERIES ADULT SKIN TEMP SENSORS
|
Facility
|
OP
|
$5.42
|
|
| Hospital Charge Code |
2500225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.31
|
| Rate for Payer: Aetna of WY Medicare |
$3.58
|
| Rate for Payer: Altius Commercial |
$5.20
|
| Rate for Payer: Beech Street Commercial |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.26
|
| Rate for Payer: Cigna of WY Commercial |
$5.31
|
| Rate for Payer: Entrust Commercial |
$5.15
|
| Rate for Payer: First Choice Health Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.09
|
| Rate for Payer: HealthUtah PPO |
$5.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.26
|
| Rate for Payer: Multiplan Medicare/VA |
$2.93
|
| Rate for Payer: One Health Plan of WY PPO |
$5.31
|
| Rate for Payer: PacificSource Commercial |
$4.88
|
| Rate for Payer: PHCS PPO |
$5.31
|
| Rate for Payer: Three Rivers PPO |
$4.06
|
| Rate for Payer: TriWest Veterans Administration |
$3.09
|
| Rate for Payer: United Healthcare Commercial |
$5.18
|
| Rate for Payer: United Healthcare Medicare |
$3.09
|
| Rate for Payer: WINHealth Partners Commercial |
$5.31
|
| Rate for Payer: Wise Provider Network Commercial |
$5.15
|
|
|
400 SERIES ADULT SKIN TEMP SENSORS
|
Facility
|
IP
|
$5.42
|
|
| Hospital Charge Code |
2500225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.31
|
| Rate for Payer: Aetna of WY Medicare |
$3.47
|
| Rate for Payer: Altius Commercial |
$5.20
|
| Rate for Payer: Beech Street Commercial |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.26
|
| Rate for Payer: Cigna of WY Commercial |
$5.31
|
| Rate for Payer: Entrust Commercial |
$5.15
|
| Rate for Payer: First Choice Health Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.31
|
| Rate for Payer: HealthUtah PPO |
$5.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.26
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$5.31
|
| Rate for Payer: PacificSource Commercial |
$4.88
|
| Rate for Payer: PHCS PPO |
$5.31
|
| Rate for Payer: Three Rivers PPO |
$4.06
|
| Rate for Payer: TriWest Veterans Administration |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$5.18
|
| Rate for Payer: United Healthcare Medicare |
$3.31
|
| Rate for Payer: WINHealth Partners Commercial |
$5.15
|
| Rate for Payer: Wise Provider Network Commercial |
$5.15
|
|
|
40 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
40 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
40MM STRAIGHT ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
40MM STRAIGHT ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
4.3 MM CALIBRATED DRILL
|
Facility
|
IP
|
$1,110.20
|
|
| Hospital Charge Code |
3002135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.36 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,088.00
|
| Rate for Payer: Aetna of WY Medicare |
$710.53
|
| Rate for Payer: Altius Commercial |
$1,065.79
|
| Rate for Payer: Beech Street Commercial |
$1,088.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,076.89
|
| Rate for Payer: Cash Price |
$777.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,088.00
|
| Rate for Payer: Entrust Commercial |
$1,054.69
|
| Rate for Payer: First Choice Health Commercial |
$1,054.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$677.22
|
| Rate for Payer: HealthUtah PPO |
$1,110.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.89
|
| Rate for Payer: Multiplan Medicare/VA |
$643.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,088.00
|
| Rate for Payer: PacificSource Commercial |
$999.18
|
| Rate for Payer: PHCS PPO |
$1,088.00
|
| Rate for Payer: Three Rivers PPO |
$832.65
|
| Rate for Payer: TriWest Veterans Administration |
$677.22
|
| Rate for Payer: United Healthcare Commercial |
$1,060.24
|
| Rate for Payer: United Healthcare Medicare |
$677.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.69
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.69
|
|
|
4.3 MM CALIBRATED DRILL
|
Facility
|
OP
|
$1,110.20
|
|
| Hospital Charge Code |
3002135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$601.17 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,088.00
|
| Rate for Payer: Aetna of WY Medicare |
$732.73
|
| Rate for Payer: Altius Commercial |
$1,065.79
|
| Rate for Payer: Beech Street Commercial |
$1,088.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,076.89
|
| Rate for Payer: Cash Price |
$777.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,088.00
|
| Rate for Payer: Entrust Commercial |
$1,054.69
|
| Rate for Payer: First Choice Health Commercial |
$1,054.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$632.81
|
| Rate for Payer: HealthUtah PPO |
$1,110.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.89
|
| Rate for Payer: Multiplan Medicare/VA |
$601.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,088.00
|
| Rate for Payer: PacificSource Commercial |
$999.18
|
| Rate for Payer: PHCS PPO |
$1,088.00
|
| Rate for Payer: Three Rivers PPO |
$832.65
|
| Rate for Payer: TriWest Veterans Administration |
$632.81
|
| Rate for Payer: United Healthcare Commercial |
$1,060.24
|
| Rate for Payer: United Healthcare Medicare |
$632.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1,088.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.69
|
|
|
4.5 BIO-PUSH LOCK
|
Facility
|
IP
|
$1,260.00
|
|
| Hospital Charge Code |
2650439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.17 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$806.40
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.60
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$730.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$768.60
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$768.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
4.5 BIO-PUSH LOCK
|
Facility
|
OP
|
$1,260.00
|
|
| Hospital Charge Code |
2650439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.29 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$831.60
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$718.20
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$682.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$718.20
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$718.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
45 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
45 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
4.5 X 195 MM DRILLBIT
|
Facility
|
OP
|
$450.73
|
|
| Hospital Charge Code |
3150190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.07 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$297.48
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.92
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$244.07
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$256.92
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$256.92
|
| Rate for Payer: WINHealth Partners Commercial |
$441.72
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
4.5 X 195 MM DRILLBIT
|
Facility
|
IP
|
$450.73
|
|
| Hospital Charge Code |
3150190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$288.47
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.95
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$261.20
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$274.95
|
| Rate for Payer: WINHealth Partners Commercial |
$428.19
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
4K LAPAROSCOPE 0* 5.5 X 300 MM
|
Facility
|
IP
|
$3,024.00
|
|
| Hospital Charge Code |
3003537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,752.41 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,963.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,935.36
|
| Rate for Payer: Altius Commercial |
$2,903.04
|
| Rate for Payer: Beech Street Commercial |
$2,963.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,933.28
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,933.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,963.52
|
| Rate for Payer: Entrust Commercial |
$2,872.80
|
| Rate for Payer: First Choice Health Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,844.64
|
| Rate for Payer: HealthUtah PPO |
$3,024.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,933.28
|
| Rate for Payer: Multiplan Medicare/VA |
$1,752.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,963.52
|
| Rate for Payer: PacificSource Commercial |
$2,721.60
|
| Rate for Payer: PHCS PPO |
$2,963.52
|
| Rate for Payer: Three Rivers PPO |
$2,268.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,844.64
|
| Rate for Payer: United Healthcare Commercial |
$2,887.92
|
| Rate for Payer: United Healthcare Medicare |
$1,844.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,872.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,872.80
|
|
