|
BISMUTH SUBSALICYLATE 262 MG TABLET [16154]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 8770127262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.37
|
| Rate for Payer: Beech Street Commercial |
$0.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.38
|
| Rate for Payer: Cigna of WY Commercial |
$0.38
|
| Rate for Payer: Entrust Commercial |
$0.37
|
| Rate for Payer: First Choice Health Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.38
|
| Rate for Payer: PacificSource Commercial |
$0.35
|
| Rate for Payer: PHCS PPO |
$0.38
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.34
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.37
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [16154]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 2438501758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.37
|
| Rate for Payer: Beech Street Commercial |
$0.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.38
|
| Rate for Payer: Cigna of WY Commercial |
$0.38
|
| Rate for Payer: Entrust Commercial |
$0.37
|
| Rate for Payer: First Choice Health Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.38
|
| Rate for Payer: PacificSource Commercial |
$0.35
|
| Rate for Payer: PHCS PPO |
$0.38
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.34
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.37
|
| Rate for Payer: Wise Provider Network Commercial |
$0.37
|
|
|
BITRAC FULL FACE LARGE INTRCH STD ELBOW
|
Facility
|
OP
|
$66.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.00
|
| Rate for Payer: Aetna of WY Medicare |
$43.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.68
|
| Rate for Payer: Altius Commercial |
$63.68
|
| Rate for Payer: Beech Street Commercial |
$65.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.46
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.34
|
| Rate for Payer: Cigna of WY Commercial |
$65.00
|
| Rate for Payer: Entrust Commercial |
$63.01
|
| Rate for Payer: First Choice Health Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.47
|
| Rate for Payer: HealthUtah PPO |
$66.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.34
|
| Rate for Payer: Multiplan Medicare/VA |
$36.55
|
| Rate for Payer: One Health Plan of WY PPO |
$65.00
|
| Rate for Payer: PacificSource Commercial |
$59.70
|
| Rate for Payer: PHCS PPO |
$65.00
|
| Rate for Payer: Three Rivers PPO |
$49.75
|
| Rate for Payer: TriWest Veterans Administration |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
| Rate for Payer: United Healthcare Medicare |
$38.47
|
| Rate for Payer: WINHealth Partners Commercial |
$65.00
|
| Rate for Payer: Wise Provider Network Commercial |
$63.01
|
|
|
BITRAC FULL FACE LARGE INTRCH STD ELBOW
|
Facility
|
IP
|
$66.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.68
|
| Rate for Payer: Altius Commercial |
$63.68
|
| Rate for Payer: Beech Street Commercial |
$65.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.46
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.34
|
| Rate for Payer: Cigna of WY Commercial |
$65.00
|
| Rate for Payer: Entrust Commercial |
$63.01
|
| Rate for Payer: First Choice Health Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.78
|
| Rate for Payer: HealthUtah PPO |
$66.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.34
|
| Rate for Payer: Multiplan Medicare/VA |
$41.59
|
| Rate for Payer: One Health Plan of WY PPO |
$65.00
|
| Rate for Payer: PacificSource Commercial |
$59.70
|
| Rate for Payer: PHCS PPO |
$65.00
|
| Rate for Payer: Three Rivers PPO |
$49.75
|
| Rate for Payer: TriWest Veterans Administration |
$43.78
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
| Rate for Payer: United Healthcare Medicare |
$43.78
|
| Rate for Payer: WINHealth Partners Commercial |
$63.01
|
| Rate for Payer: Wise Provider Network Commercial |
$63.01
|
|
|
BITRAC FULL FACE MEDIUM INTRCH STD ELBOW
|
Facility
|
OP
|
$66.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.00
|
| Rate for Payer: Aetna of WY Medicare |
$43.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.68
|
| Rate for Payer: Altius Commercial |
$63.68
|
| Rate for Payer: Beech Street Commercial |
$65.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.46
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.34
|
| Rate for Payer: Cigna of WY Commercial |
$65.00
|
| Rate for Payer: Entrust Commercial |
$63.01
|
| Rate for Payer: First Choice Health Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.47
|
| Rate for Payer: HealthUtah PPO |
$66.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.34
|
| Rate for Payer: Multiplan Medicare/VA |
$36.55
|
| Rate for Payer: One Health Plan of WY PPO |
$65.00
|
| Rate for Payer: PacificSource Commercial |
$59.70
|
| Rate for Payer: PHCS PPO |
$65.00
|
| Rate for Payer: Three Rivers PPO |
$49.75
|
| Rate for Payer: TriWest Veterans Administration |
$38.47
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
| Rate for Payer: United Healthcare Medicare |
$38.47
|
| Rate for Payer: WINHealth Partners Commercial |
$65.00
|
| Rate for Payer: Wise Provider Network Commercial |
$63.01
|
|
|
BITRAC FULL FACE MEDIUM INTRCH STD ELBOW
|
Facility
|
IP
|
$66.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.68
|
| Rate for Payer: Altius Commercial |
$63.68
|
| Rate for Payer: Beech Street Commercial |
$65.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.46
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.34
|
| Rate for Payer: Cigna of WY Commercial |
$65.00
|
| Rate for Payer: Entrust Commercial |
$63.01
|
| Rate for Payer: First Choice Health Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.78
|
| Rate for Payer: HealthUtah PPO |
$66.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.34
|
| Rate for Payer: Multiplan Medicare/VA |
$41.59
|
| Rate for Payer: One Health Plan of WY PPO |
$65.00
|
| Rate for Payer: PacificSource Commercial |
$59.70
|
| Rate for Payer: PHCS PPO |
$65.00
|
| Rate for Payer: Three Rivers PPO |
$49.75
|
| Rate for Payer: TriWest Veterans Administration |
$43.78
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
| Rate for Payer: United Healthcare Medicare |
$43.78
|
| Rate for Payer: WINHealth Partners Commercial |
$63.01
|
| Rate for Payer: Wise Provider Network Commercial |
$63.01
|
|
|
BITRAC MAX SHIELD ADULT SMALL INTRCH
|
Facility
|
IP
|
$126.70
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$126.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.63
|
| Rate for Payer: Altius Commercial |
$121.63
|
| Rate for Payer: Beech Street Commercial |
$124.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.02
|
| Rate for Payer: Cash Price |
$88.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.90
|
| Rate for Payer: Cigna of WY Commercial |
$124.17
|
| Rate for Payer: Entrust Commercial |
$120.36
|
| Rate for Payer: First Choice Health Commercial |
$120.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.62
|
| Rate for Payer: HealthUtah PPO |
$126.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.90
|
| Rate for Payer: Multiplan Medicare/VA |
$79.44
|
| Rate for Payer: One Health Plan of WY PPO |
$124.17
|
| Rate for Payer: PacificSource Commercial |
$114.03
|
| Rate for Payer: PHCS PPO |
$124.17
|
| Rate for Payer: Three Rivers PPO |
$95.02
|
| Rate for Payer: TriWest Veterans Administration |
$83.62
|
| Rate for Payer: United Healthcare Commercial |
$110.23
|
| Rate for Payer: United Healthcare Medicare |
$83.62
|
| Rate for Payer: WINHealth Partners Commercial |
$120.36
|
| Rate for Payer: Wise Provider Network Commercial |
$120.36
|
|
|
BITRAC MAX SHIELD ADULT SMALL INTRCH
|
Facility
|
OP
|
$126.70
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$126.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.17
|
| Rate for Payer: Aetna of WY Medicare |
$83.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.63
|
| Rate for Payer: Altius Commercial |
$121.63
|
| Rate for Payer: Beech Street Commercial |
$124.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.02
|
| Rate for Payer: Cash Price |
$88.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.90
|
| Rate for Payer: Cigna of WY Commercial |
$124.17
|
| Rate for Payer: Entrust Commercial |
$120.36
|
| Rate for Payer: First Choice Health Commercial |
$120.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.49
|
| Rate for Payer: HealthUtah PPO |
$126.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.90
|
| Rate for Payer: Multiplan Medicare/VA |
$69.81
|
| Rate for Payer: One Health Plan of WY PPO |
$124.17
|
| Rate for Payer: PacificSource Commercial |
$114.03
|
| Rate for Payer: PHCS PPO |
$124.17
|
| Rate for Payer: Three Rivers PPO |
$95.02
|
| Rate for Payer: TriWest Veterans Administration |
$73.49
|
| Rate for Payer: United Healthcare Commercial |
$110.23
|
| Rate for Payer: United Healthcare Medicare |
$73.49
|
| Rate for Payer: WINHealth Partners Commercial |
$124.17
|
| Rate for Payer: Wise Provider Network Commercial |
$120.36
|
|
|
BLADE BEAVER MYRINGOTOMY
|
Facility
|
OP
|
$46.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$46.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.95
|
| Rate for Payer: Aetna of WY Medicare |
$30.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.01
|
| Rate for Payer: Altius Commercial |
$45.01
|
| Rate for Payer: Beech Street Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.48
|
| Rate for Payer: Cigna of WY Commercial |
$45.95
|
| Rate for Payer: Entrust Commercial |
$44.55
|
| Rate for Payer: First Choice Health Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.20
|
| Rate for Payer: HealthUtah PPO |
$46.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.48
|
| Rate for Payer: Multiplan Medicare/VA |
$25.84
|
| Rate for Payer: One Health Plan of WY PPO |
$45.95
|
| Rate for Payer: PacificSource Commercial |
$42.20
|
| Rate for Payer: PHCS PPO |
$45.95
|
| Rate for Payer: Three Rivers PPO |
$35.17
|
| Rate for Payer: TriWest Veterans Administration |
$27.20
|
| Rate for Payer: United Healthcare Commercial |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$27.20
|
| Rate for Payer: WINHealth Partners Commercial |
$45.95
|
| Rate for Payer: Wise Provider Network Commercial |
$44.55
|
|
|
BLADE BEAVER MYRINGOTOMY
|
Facility
|
IP
|
$46.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$46.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.01
|
| Rate for Payer: Altius Commercial |
$45.01
|
| Rate for Payer: Beech Street Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.48
|
| Rate for Payer: Cigna of WY Commercial |
$45.95
|
| Rate for Payer: Entrust Commercial |
$44.55
|
| Rate for Payer: First Choice Health Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.95
|
| Rate for Payer: HealthUtah PPO |
$46.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.48
|
| Rate for Payer: Multiplan Medicare/VA |
$29.40
|
| Rate for Payer: One Health Plan of WY PPO |
$45.95
|
| Rate for Payer: PacificSource Commercial |
$42.20
|
| Rate for Payer: PHCS PPO |
$45.95
|
| Rate for Payer: Three Rivers PPO |
$35.17
|
| Rate for Payer: TriWest Veterans Administration |
$30.95
|
| Rate for Payer: United Healthcare Commercial |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$30.95
|
| Rate for Payer: WINHealth Partners Commercial |
$44.55
|
| Rate for Payer: Wise Provider Network Commercial |
$44.55
|
|
|
BLADE BEAVER S-6900 STUCKI
|
Facility
|
OP
|
$29.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.58
|
| Rate for Payer: Aetna of WY Medicare |
$19.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.99
|
| Rate for Payer: Altius Commercial |
$27.99
|
| Rate for Payer: Beech Street Commercial |
$28.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.94
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.29
|
| Rate for Payer: Cigna of WY Commercial |
$28.58
|
| Rate for Payer: Entrust Commercial |
$27.70
|
| Rate for Payer: First Choice Health Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.91
|
| Rate for Payer: HealthUtah PPO |
$29.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.29
|
| Rate for Payer: Multiplan Medicare/VA |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$28.58
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.58
|
| Rate for Payer: Three Rivers PPO |
$21.87
|
| Rate for Payer: TriWest Veterans Administration |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$25.37
|
| Rate for Payer: United Healthcare Medicare |
$16.91
|
| Rate for Payer: WINHealth Partners Commercial |
$28.58
|
| Rate for Payer: Wise Provider Network Commercial |
$27.70
|
|
|
BLADE BEAVER S-6900 STUCKI
|
Facility
|
IP
|
$29.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.99
|
| Rate for Payer: Altius Commercial |
$27.99
|
| Rate for Payer: Beech Street Commercial |
$28.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.94
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.29
|
| Rate for Payer: Cigna of WY Commercial |
$28.58
|
| Rate for Payer: Entrust Commercial |
$27.70
|
| Rate for Payer: First Choice Health Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.25
|
| Rate for Payer: HealthUtah PPO |
$29.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.29
|
| Rate for Payer: Multiplan Medicare/VA |
$18.28
|
| Rate for Payer: One Health Plan of WY PPO |
$28.58
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.58
|
| Rate for Payer: Three Rivers PPO |
$21.87
|
| Rate for Payer: TriWest Veterans Administration |
$19.25
|
| Rate for Payer: United Healthcare Commercial |
$25.37
|
| Rate for Payer: United Healthcare Medicare |
$19.25
|
| Rate for Payer: WINHealth Partners Commercial |
$27.70
|
| Rate for Payer: Wise Provider Network Commercial |
$27.70
|
|
|
BLADE GRAFT KNIFE PARALLEL 09MM
|
Facility
|
IP
|
$164.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.92
|
| Rate for Payer: Altius Commercial |
$157.92
|
| Rate for Payer: Beech Street Commercial |
$161.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.05
|
| Rate for Payer: Cash Price |
$115.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.56
|
| Rate for Payer: Cigna of WY Commercial |
$161.21
|
| Rate for Payer: Entrust Commercial |
$156.28
|
| Rate for Payer: First Choice Health Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.57
|
| Rate for Payer: HealthUtah PPO |
$164.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.56
|
| Rate for Payer: Multiplan Medicare/VA |
$103.14
|
| Rate for Payer: One Health Plan of WY PPO |
$161.21
|
| Rate for Payer: PacificSource Commercial |
$148.05
|
| Rate for Payer: PHCS PPO |
$161.21
|
| Rate for Payer: Three Rivers PPO |
$123.38
|
| Rate for Payer: TriWest Veterans Administration |
$108.57
|
| Rate for Payer: United Healthcare Commercial |
$143.12
|
| Rate for Payer: United Healthcare Medicare |
$108.57
|
| Rate for Payer: WINHealth Partners Commercial |
$156.28
|
| Rate for Payer: Wise Provider Network Commercial |
$156.28
|
|
|
BLADE GRAFT KNIFE PARALLEL 09MM
|
Facility
|
OP
|
$164.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.21
|
| Rate for Payer: Aetna of WY Medicare |
$108.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.92
|
| Rate for Payer: Altius Commercial |
$157.92
|
| Rate for Payer: Beech Street Commercial |
$161.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.05
|
| Rate for Payer: Cash Price |
$115.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.56
|
| Rate for Payer: Cigna of WY Commercial |
$161.21
|
| Rate for Payer: Entrust Commercial |
$156.28
|
| Rate for Payer: First Choice Health Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.41
|
| Rate for Payer: HealthUtah PPO |
$164.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.56
|
| Rate for Payer: Multiplan Medicare/VA |
$90.64
|
| Rate for Payer: One Health Plan of WY PPO |
$161.21
|
| Rate for Payer: PacificSource Commercial |
$148.05
|
| Rate for Payer: PHCS PPO |
$161.21
|
| Rate for Payer: Three Rivers PPO |
$123.38
|
| Rate for Payer: TriWest Veterans Administration |
$95.41
|
| Rate for Payer: United Healthcare Commercial |
$143.12
|
| Rate for Payer: United Healthcare Medicare |
$95.41
|
| Rate for Payer: WINHealth Partners Commercial |
$161.21
|
| Rate for Payer: Wise Provider Network Commercial |
$156.28
|
|
|
BLADE GRAFT KNIFE PARALLEL 10MM
|
Facility
|
IP
|
$192.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.46
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.82
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$120.48
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$126.82
|
| Rate for Payer: United Healthcare Commercial |
$167.17
|
| Rate for Payer: United Healthcare Medicare |
$126.82
|
| Rate for Payer: WINHealth Partners Commercial |
$182.54
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 10MM
|
Facility
|
OP
|
$192.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$126.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.46
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.45
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$105.87
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$111.45
|
| Rate for Payer: United Healthcare Commercial |
$167.17
|
| Rate for Payer: United Healthcare Medicare |
$111.45
|
| Rate for Payer: WINHealth Partners Commercial |
$188.31
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 11MM
|
Facility
|
IP
|
$192.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.46
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.82
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$120.48
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$126.82
|
| Rate for Payer: United Healthcare Commercial |
$167.17
|
| Rate for Payer: United Healthcare Medicare |
$126.82
|
| Rate for Payer: WINHealth Partners Commercial |
$182.54
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 11MM
|
Facility
|
OP
|
$192.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$126.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.46
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.76
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.45
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$105.87
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$111.45
|
| Rate for Payer: United Healthcare Commercial |
$167.17
|
| Rate for Payer: United Healthcare Medicare |
$111.45
|
| Rate for Payer: WINHealth Partners Commercial |
$188.31
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE, INF,TURB.2.9MM M4
|
Facility
|
OP
|
$895.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.60 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$877.90
|
| Rate for Payer: Aetna of WY Medicare |
$591.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$859.99
|
| Rate for Payer: Altius Commercial |
$859.99
|
| Rate for Payer: Beech Street Commercial |
$877.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$735.47
|
| Rate for Payer: Cash Price |
$627.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$868.95
|
| Rate for Payer: Cigna of WY Commercial |
$877.90
|
| Rate for Payer: Entrust Commercial |
$851.03
|
| Rate for Payer: First Choice Health Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$519.58
|
| Rate for Payer: HealthUtah PPO |
$895.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$868.95
|
| Rate for Payer: Multiplan Medicare/VA |
$493.60
|
| Rate for Payer: One Health Plan of WY PPO |
$877.90
|
| Rate for Payer: PacificSource Commercial |
$806.24
|
| Rate for Payer: PHCS PPO |
$877.90
|
| Rate for Payer: Three Rivers PPO |
$671.86
|
| Rate for Payer: TriWest Veterans Administration |
$519.58
|
| Rate for Payer: United Healthcare Commercial |
$779.36
|
| Rate for Payer: United Healthcare Medicare |
$519.58
|
| Rate for Payer: WINHealth Partners Commercial |
$877.90
|
| Rate for Payer: Wise Provider Network Commercial |
$851.03
|
|
|
BLADE, INF,TURB.2.9MM M4
|
Facility
|
IP
|
$895.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.68 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$877.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$859.99
|
| Rate for Payer: Altius Commercial |
$859.99
|
| Rate for Payer: Beech Street Commercial |
$877.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$735.47
|
| Rate for Payer: Cash Price |
$627.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$868.95
|
| Rate for Payer: Cigna of WY Commercial |
$877.90
|
| Rate for Payer: Entrust Commercial |
$851.03
|
| Rate for Payer: First Choice Health Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.24
|
| Rate for Payer: HealthUtah PPO |
$895.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$868.95
|
| Rate for Payer: Multiplan Medicare/VA |
$561.68
|
| Rate for Payer: One Health Plan of WY PPO |
$877.90
|
| Rate for Payer: PacificSource Commercial |
$806.24
|
| Rate for Payer: PHCS PPO |
$877.90
|
| Rate for Payer: Three Rivers PPO |
$671.86
|
| Rate for Payer: TriWest Veterans Administration |
$591.24
|
| Rate for Payer: United Healthcare Commercial |
$779.36
|
| Rate for Payer: United Healthcare Medicare |
$591.24
|
| Rate for Payer: WINHealth Partners Commercial |
$851.03
|
| Rate for Payer: Wise Provider Network Commercial |
$851.03
|
|
|
BLADE QUADCUT ROTATEABLE 4.3MM
|
Facility
|
IP
|
$773.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.07 |
| Max. Negotiated Rate |
$773.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$758.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$742.68
|
| Rate for Payer: Altius Commercial |
$742.68
|
| Rate for Payer: Beech Street Commercial |
$758.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$635.15
|
| Rate for Payer: Cash Price |
$541.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$750.42
|
| Rate for Payer: Cigna of WY Commercial |
$758.16
|
| Rate for Payer: Entrust Commercial |
$734.95
|
| Rate for Payer: First Choice Health Commercial |
$734.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$734.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$510.60
|
| Rate for Payer: HealthUtah PPO |
$773.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$750.42
|
| Rate for Payer: Multiplan Medicare/VA |
$485.07
|
| Rate for Payer: One Health Plan of WY PPO |
$758.16
|
| Rate for Payer: PacificSource Commercial |
$696.27
|
| Rate for Payer: PHCS PPO |
$758.16
|
| Rate for Payer: Three Rivers PPO |
$580.22
|
| Rate for Payer: TriWest Veterans Administration |
$510.60
|
| Rate for Payer: United Healthcare Commercial |
$673.06
|
| Rate for Payer: United Healthcare Medicare |
$510.60
|
| Rate for Payer: WINHealth Partners Commercial |
$734.95
|
| Rate for Payer: Wise Provider Network Commercial |
$734.95
|
|
|
BLADE QUADCUT ROTATEABLE 4.3MM
|
Facility
|
OP
|
$773.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.27 |
| Max. Negotiated Rate |
$773.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$758.16
|
| Rate for Payer: Aetna of WY Medicare |
$510.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$742.68
|
| Rate for Payer: Altius Commercial |
$742.68
|
| Rate for Payer: Beech Street Commercial |
$758.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$635.15
|
| Rate for Payer: Cash Price |
$541.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$750.42
|
| Rate for Payer: Cigna of WY Commercial |
$758.16
|
| Rate for Payer: Entrust Commercial |
$734.95
|
| Rate for Payer: First Choice Health Commercial |
$734.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$734.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.71
|
| Rate for Payer: HealthUtah PPO |
$773.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$750.42
|
| Rate for Payer: Multiplan Medicare/VA |
$426.27
|
| Rate for Payer: One Health Plan of WY PPO |
$758.16
|
| Rate for Payer: PacificSource Commercial |
$696.27
|
| Rate for Payer: PHCS PPO |
$758.16
|
| Rate for Payer: Three Rivers PPO |
$580.22
|
| Rate for Payer: TriWest Veterans Administration |
$448.71
|
| Rate for Payer: United Healthcare Commercial |
$673.06
|
| Rate for Payer: United Healthcare Medicare |
$448.71
|
| Rate for Payer: WINHealth Partners Commercial |
$758.16
|
| Rate for Payer: Wise Provider Network Commercial |
$734.95
|
|
|
BLADE RECIPROC TK 277-96-276
|
Facility
|
OP
|
$83.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.29
|
| Rate for Payer: Aetna of WY Medicare |
$55.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.61
|
| Rate for Payer: Altius Commercial |
$80.61
|
| Rate for Payer: Beech Street Commercial |
$82.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.94
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.45
|
| Rate for Payer: Cigna of WY Commercial |
$82.29
|
| Rate for Payer: Entrust Commercial |
$79.77
|
| Rate for Payer: First Choice Health Commercial |
$79.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.70
|
| Rate for Payer: HealthUtah PPO |
$83.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.27
|
| Rate for Payer: One Health Plan of WY PPO |
$82.29
|
| Rate for Payer: PacificSource Commercial |
$75.57
|
| Rate for Payer: PHCS PPO |
$82.29
|
| Rate for Payer: Three Rivers PPO |
$62.98
|
| Rate for Payer: TriWest Veterans Administration |
$48.70
|
| Rate for Payer: United Healthcare Commercial |
$73.05
|
| Rate for Payer: United Healthcare Medicare |
$48.70
|
| Rate for Payer: WINHealth Partners Commercial |
$82.29
|
| Rate for Payer: Wise Provider Network Commercial |
$79.77
|
|
|
BLADE RECIPROC TK 277-96-276
|
Facility
|
IP
|
$83.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.61
|
| Rate for Payer: Altius Commercial |
$80.61
|
| Rate for Payer: Beech Street Commercial |
$82.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.94
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.45
|
| Rate for Payer: Cigna of WY Commercial |
$82.29
|
| Rate for Payer: Entrust Commercial |
$79.77
|
| Rate for Payer: First Choice Health Commercial |
$79.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.42
|
| Rate for Payer: HealthUtah PPO |
$83.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.45
|
| Rate for Payer: Multiplan Medicare/VA |
$52.65
|
| Rate for Payer: One Health Plan of WY PPO |
$82.29
|
| Rate for Payer: PacificSource Commercial |
$75.57
|
| Rate for Payer: PHCS PPO |
$82.29
|
| Rate for Payer: Three Rivers PPO |
$62.98
|
| Rate for Payer: TriWest Veterans Administration |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$73.05
|
| Rate for Payer: United Healthcare Medicare |
$55.42
|
| Rate for Payer: WINHealth Partners Commercial |
$79.77
|
| Rate for Payer: Wise Provider Network Commercial |
$79.77
|
|
|
BLADE SAGITTAL SAW 90 DEG ANGLE
|
Facility
|
IP
|
$108.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$108.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.32
|
| Rate for Payer: Altius Commercial |
$104.32
|
| Rate for Payer: Beech Street Commercial |
$106.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.22
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.41
|
| Rate for Payer: Cigna of WY Commercial |
$106.50
|
| Rate for Payer: Entrust Commercial |
$103.24
|
| Rate for Payer: First Choice Health Commercial |
$103.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.72
|
| Rate for Payer: HealthUtah PPO |
$108.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.41
|
| Rate for Payer: Multiplan Medicare/VA |
$68.14
|
| Rate for Payer: One Health Plan of WY PPO |
$106.50
|
| Rate for Payer: PacificSource Commercial |
$97.80
|
| Rate for Payer: PHCS PPO |
$106.50
|
| Rate for Payer: Three Rivers PPO |
$81.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.72
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$71.72
|
| Rate for Payer: WINHealth Partners Commercial |
$103.24
|
| Rate for Payer: Wise Provider Network Commercial |
$103.24
|
|
