|
BIO-COMPRESSION CAN DILATOR TAP 26MM
|
Facility
|
IP
|
$735.84
|
|
| Hospital Charge Code |
3004782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.42 |
| Max. Negotiated Rate |
$735.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.12
|
| Rate for Payer: Aetna of WY Medicare |
$470.94
|
| Rate for Payer: Altius Commercial |
$706.41
|
| Rate for Payer: Beech Street Commercial |
$721.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$713.76
|
| Rate for Payer: Cash Price |
$515.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.76
|
| Rate for Payer: Cigna of WY Commercial |
$721.12
|
| Rate for Payer: Entrust Commercial |
$699.05
|
| Rate for Payer: First Choice Health Commercial |
$699.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.86
|
| Rate for Payer: HealthUtah PPO |
$735.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.76
|
| Rate for Payer: Multiplan Medicare/VA |
$426.42
|
| Rate for Payer: One Health Plan of WY PPO |
$721.12
|
| Rate for Payer: PacificSource Commercial |
$662.26
|
| Rate for Payer: PHCS PPO |
$721.12
|
| Rate for Payer: Three Rivers PPO |
$551.88
|
| Rate for Payer: TriWest Veterans Administration |
$448.86
|
| Rate for Payer: United Healthcare Commercial |
$702.73
|
| Rate for Payer: United Healthcare Medicare |
$448.86
|
| Rate for Payer: WINHealth Partners Commercial |
$699.05
|
| Rate for Payer: Wise Provider Network Commercial |
$699.05
|
|
|
BIO-COMPRESSION CAN DILATOR TAP 26MM
|
Facility
|
OP
|
$735.84
|
|
| Hospital Charge Code |
3004782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.46 |
| Max. Negotiated Rate |
$735.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.12
|
| Rate for Payer: Aetna of WY Medicare |
$485.65
|
| Rate for Payer: Altius Commercial |
$706.41
|
| Rate for Payer: Beech Street Commercial |
$721.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$713.76
|
| Rate for Payer: Cash Price |
$515.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.76
|
| Rate for Payer: Cigna of WY Commercial |
$721.12
|
| Rate for Payer: Entrust Commercial |
$699.05
|
| Rate for Payer: First Choice Health Commercial |
$699.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$419.43
|
| Rate for Payer: HealthUtah PPO |
$735.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.76
|
| Rate for Payer: Multiplan Medicare/VA |
$398.46
|
| Rate for Payer: One Health Plan of WY PPO |
$721.12
|
| Rate for Payer: PacificSource Commercial |
$662.26
|
| Rate for Payer: PHCS PPO |
$721.12
|
| Rate for Payer: Three Rivers PPO |
$551.88
|
| Rate for Payer: TriWest Veterans Administration |
$419.43
|
| Rate for Payer: United Healthcare Commercial |
$702.73
|
| Rate for Payer: United Healthcare Medicare |
$419.43
|
| Rate for Payer: WINHealth Partners Commercial |
$721.12
|
| Rate for Payer: Wise Provider Network Commercial |
$699.05
|
|
|
BIOCOMP SWIVEL 6.25X19.1MM
|
Facility
|
OP
|
$1,218.00
|
|
| Hospital Charge Code |
3004095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.55 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$803.88
|
| Rate for Payer: Altius Commercial |
$1,169.28
|
| Rate for Payer: Beech Street Commercial |
$1,193.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,181.46
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: Entrust Commercial |
$1,157.10
|
| Rate for Payer: First Choice Health Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$694.26
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$659.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,193.64
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$694.26
|
| Rate for Payer: United Healthcare Commercial |
$1,163.19
|
| Rate for Payer: United Healthcare Medicare |
$694.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,193.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1,157.10
|
|
|
BIOCOMP SWIVEL 6.25X19.1MM
|
Facility
|
IP
|
$1,218.00
|
|
| Hospital Charge Code |
3004095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.83 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$779.52
|
| Rate for Payer: Altius Commercial |
$1,169.28
|
| Rate for Payer: Beech Street Commercial |
$1,193.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,181.46
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: Entrust Commercial |
$1,157.10
|
| Rate for Payer: First Choice Health Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$742.98
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$705.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,193.64
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$742.98
|
| Rate for Payer: United Healthcare Commercial |
$1,163.19
|
| Rate for Payer: United Healthcare Medicare |
$742.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,157.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,157.10
|
|
|
BIOCOMP SWIVEL 7X19.1MM
|
Facility
|
OP
|
$1,522.50
|
|
| Hospital Charge Code |
3001951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.43 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,492.05
|
| Rate for Payer: Aetna of WY Medicare |
$1,004.85
|
| Rate for Payer: Altius Commercial |
$1,461.60
|
| Rate for Payer: Beech Street Commercial |
$1,492.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,476.82
|
| Rate for Payer: Cash Price |
$1,065.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,476.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,492.05
|
| Rate for Payer: Entrust Commercial |
$1,446.38
|
| Rate for Payer: First Choice Health Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.82
|
| Rate for Payer: HealthUtah PPO |
$1,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,476.82
|
| Rate for Payer: Multiplan Medicare/VA |
$824.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,492.05
|
| Rate for Payer: PacificSource Commercial |
$1,370.25
|
| Rate for Payer: PHCS PPO |
$1,492.05
|
| Rate for Payer: Three Rivers PPO |
$1,141.88
|
| Rate for Payer: TriWest Veterans Administration |
$867.82
|
| Rate for Payer: United Healthcare Commercial |
$1,453.99
|
| Rate for Payer: United Healthcare Medicare |
$867.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,492.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,446.38
|
|
|
BIOCOMP SWIVEL 7X19.1MM
|
Facility
|
IP
|
$1,522.50
|
|
| Hospital Charge Code |
3001951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.29 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: United Healthcare Commercial |
$1,453.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,492.05
|
| Rate for Payer: Aetna of WY Medicare |
$974.40
|
| Rate for Payer: Altius Commercial |
$1,461.60
|
| Rate for Payer: Beech Street Commercial |
$1,492.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,476.82
|
| Rate for Payer: Cash Price |
$1,065.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,476.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,492.05
|
| Rate for Payer: Entrust Commercial |
$1,446.38
|
| Rate for Payer: First Choice Health Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.72
|
| Rate for Payer: HealthUtah PPO |
$1,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,476.82
|
| Rate for Payer: Multiplan Medicare/VA |
$882.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,492.05
|
| Rate for Payer: PacificSource Commercial |
$1,370.25
|
| Rate for Payer: PHCS PPO |
$1,492.05
|
| Rate for Payer: Three Rivers PPO |
$1,141.88
|
| Rate for Payer: TriWest Veterans Administration |
$928.72
|
| Rate for Payer: United Healthcare Medicare |
$928.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,446.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,446.38
|
|
|
BIOCOMP SWIVEL 8X19.1MM
|
Facility
|
OP
|
$1,522.50
|
|
| Hospital Charge Code |
3001952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.43 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,492.05
|
| Rate for Payer: Aetna of WY Medicare |
$1,004.85
|
| Rate for Payer: Altius Commercial |
$1,461.60
|
| Rate for Payer: Beech Street Commercial |
$1,492.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,476.82
|
| Rate for Payer: Cash Price |
$1,065.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,476.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,492.05
|
| Rate for Payer: Entrust Commercial |
$1,446.38
|
| Rate for Payer: First Choice Health Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.82
|
| Rate for Payer: HealthUtah PPO |
$1,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,476.82
|
| Rate for Payer: Multiplan Medicare/VA |
$824.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,492.05
|
| Rate for Payer: PacificSource Commercial |
$1,370.25
|
| Rate for Payer: PHCS PPO |
$1,492.05
|
| Rate for Payer: Three Rivers PPO |
$1,141.88
|
| Rate for Payer: TriWest Veterans Administration |
$867.82
|
| Rate for Payer: United Healthcare Commercial |
$1,453.99
|
| Rate for Payer: United Healthcare Medicare |
$867.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1,492.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,446.38
|
|
|
BIOCOMP SWIVEL 8X19.1MM
|
Facility
|
IP
|
$1,522.50
|
|
| Hospital Charge Code |
3001952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.29 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,492.05
|
| Rate for Payer: Aetna of WY Medicare |
$974.40
|
| Rate for Payer: Altius Commercial |
$1,461.60
|
| Rate for Payer: Beech Street Commercial |
$1,492.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,476.82
|
| Rate for Payer: Cash Price |
$1,065.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,476.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,492.05
|
| Rate for Payer: Entrust Commercial |
$1,446.38
|
| Rate for Payer: First Choice Health Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,446.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.72
|
| Rate for Payer: HealthUtah PPO |
$1,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,476.82
|
| Rate for Payer: Multiplan Medicare/VA |
$882.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,492.05
|
| Rate for Payer: PacificSource Commercial |
$1,370.25
|
| Rate for Payer: PHCS PPO |
$1,492.05
|
| Rate for Payer: Three Rivers PPO |
$1,141.88
|
| Rate for Payer: TriWest Veterans Administration |
$928.72
|
| Rate for Payer: United Healthcare Commercial |
$1,453.99
|
| Rate for Payer: United Healthcare Medicare |
$928.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,446.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,446.38
|
|
|
BIOGLO FLUORESCEIN SODIUM STRP
|
Facility
|
OP
|
$55.16
|
|
| Hospital Charge Code |
2050119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.87 |
| Max. Negotiated Rate |
$55.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.06
|
| Rate for Payer: Aetna of WY Medicare |
$36.41
|
| Rate for Payer: Altius Commercial |
$52.95
|
| Rate for Payer: Beech Street Commercial |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.51
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.51
|
| Rate for Payer: Cigna of WY Commercial |
$54.06
|
| Rate for Payer: Entrust Commercial |
$52.40
|
| Rate for Payer: First Choice Health Commercial |
$52.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.44
|
| Rate for Payer: HealthUtah PPO |
$55.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.51
|
| Rate for Payer: Multiplan Medicare/VA |
$29.87
|
| Rate for Payer: One Health Plan of WY PPO |
$54.06
|
| Rate for Payer: PacificSource Commercial |
$49.64
|
| Rate for Payer: PHCS PPO |
$54.06
|
| Rate for Payer: Three Rivers PPO |
$41.37
|
| Rate for Payer: TriWest Veterans Administration |
$31.44
|
| Rate for Payer: United Healthcare Commercial |
$52.68
|
| Rate for Payer: United Healthcare Medicare |
$31.44
|
| Rate for Payer: WINHealth Partners Commercial |
$54.06
|
| Rate for Payer: Wise Provider Network Commercial |
$52.40
|
|
|
BIOGLO FLUORESCEIN SODIUM STRP
|
Facility
|
IP
|
$55.16
|
|
| Hospital Charge Code |
2050119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$55.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.06
|
| Rate for Payer: Aetna of WY Medicare |
$35.30
|
| Rate for Payer: Altius Commercial |
$52.95
|
| Rate for Payer: Beech Street Commercial |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.51
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.51
|
| Rate for Payer: Cigna of WY Commercial |
$54.06
|
| Rate for Payer: Entrust Commercial |
$52.40
|
| Rate for Payer: First Choice Health Commercial |
$52.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.65
|
| Rate for Payer: HealthUtah PPO |
$55.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.51
|
| Rate for Payer: Multiplan Medicare/VA |
$31.97
|
| Rate for Payer: One Health Plan of WY PPO |
$54.06
|
| Rate for Payer: PacificSource Commercial |
$49.64
|
| Rate for Payer: PHCS PPO |
$54.06
|
| Rate for Payer: Three Rivers PPO |
$41.37
|
| Rate for Payer: TriWest Veterans Administration |
$33.65
|
| Rate for Payer: United Healthcare Commercial |
$52.68
|
| Rate for Payer: United Healthcare Medicare |
$33.65
|
| Rate for Payer: WINHealth Partners Commercial |
$52.40
|
| Rate for Payer: Wise Provider Network Commercial |
$52.40
|
|
|
BIOINDUCTIVE LARGE W/ DELIVERY
|
Facility
|
IP
|
$13,532.26
|
|
| Hospital Charge Code |
3003557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,841.94 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,660.65
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,126.29
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,254.68
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,841.94
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$8,254.68
|
| Rate for Payer: United Healthcare Commercial |
$12,923.31
|
| Rate for Payer: United Healthcare Medicare |
$8,254.68
|
| Rate for Payer: WINHealth Partners Commercial |
$12,855.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE LARGE W/ DELIVERY
|
Facility
|
OP
|
$13,532.26
|
|
| Hospital Charge Code |
3003557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,327.72 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,931.29
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,126.29
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,713.39
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,327.72
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$7,713.39
|
| Rate for Payer: United Healthcare Commercial |
$12,923.31
|
| Rate for Payer: United Healthcare Medicare |
$7,713.39
|
| Rate for Payer: WINHealth Partners Commercial |
$13,261.61
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE MED W/ DELIVERY
|
Facility
|
OP
|
$13,532.26
|
|
| Hospital Charge Code |
3003556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,327.72 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,931.29
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,126.29
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,713.39
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,327.72
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$7,713.39
|
| Rate for Payer: United Healthcare Commercial |
$12,923.31
|
| Rate for Payer: United Healthcare Medicare |
$7,713.39
|
| Rate for Payer: WINHealth Partners Commercial |
$13,261.61
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE MED W/ DELIVERY
|
Facility
|
IP
|
$13,532.26
|
|
| Hospital Charge Code |
3003556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,841.94 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,660.65
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13,126.29
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,254.68
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,841.94
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$8,254.68
|
| Rate for Payer: United Healthcare Commercial |
$12,923.31
|
| Rate for Payer: United Healthcare Medicare |
$8,254.68
|
| Rate for Payer: WINHealth Partners Commercial |
$12,855.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOLOX HIP CERAMIC HEAD 36
|
Facility
|
IP
|
$6,163.50
|
|
| Hospital Charge Code |
3002003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,571.75 |
| Max. Negotiated Rate |
$6,163.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,040.23
|
| Rate for Payer: Aetna of WY Medicare |
$3,944.64
|
| Rate for Payer: Altius Commercial |
$5,916.96
|
| Rate for Payer: Beech Street Commercial |
$6,040.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,978.60
|
| Rate for Payer: Cash Price |
$4,314.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,978.60
|
| Rate for Payer: Cigna of WY Commercial |
$6,040.23
|
| Rate for Payer: Entrust Commercial |
$5,855.32
|
| Rate for Payer: First Choice Health Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,759.74
|
| Rate for Payer: HealthUtah PPO |
$6,163.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,978.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,571.75
|
| Rate for Payer: One Health Plan of WY PPO |
$6,040.23
|
| Rate for Payer: PacificSource Commercial |
$5,547.15
|
| Rate for Payer: PHCS PPO |
$6,040.23
|
| Rate for Payer: Three Rivers PPO |
$4,622.62
|
| Rate for Payer: TriWest Veterans Administration |
$3,759.74
|
| Rate for Payer: United Healthcare Commercial |
$5,886.14
|
| Rate for Payer: United Healthcare Medicare |
$3,759.74
|
| Rate for Payer: WINHealth Partners Commercial |
$5,855.32
|
| Rate for Payer: Wise Provider Network Commercial |
$5,855.32
|
|
|
BIOLOX HIP CERAMIC HEAD 36
|
Facility
|
OP
|
$6,163.50
|
|
| Hospital Charge Code |
3002003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.54 |
| Max. Negotiated Rate |
$6,163.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,040.23
|
| Rate for Payer: Aetna of WY Medicare |
$4,067.91
|
| Rate for Payer: Altius Commercial |
$5,916.96
|
| Rate for Payer: Beech Street Commercial |
$6,040.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,978.60
|
| Rate for Payer: Cash Price |
$4,314.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,978.60
|
| Rate for Payer: Cigna of WY Commercial |
$6,040.23
|
| Rate for Payer: Entrust Commercial |
$5,855.32
|
| Rate for Payer: First Choice Health Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,513.20
|
| Rate for Payer: HealthUtah PPO |
$6,163.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,978.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,337.54
|
| Rate for Payer: One Health Plan of WY PPO |
$6,040.23
|
| Rate for Payer: PacificSource Commercial |
$5,547.15
|
| Rate for Payer: PHCS PPO |
$6,040.23
|
| Rate for Payer: Three Rivers PPO |
$4,622.62
|
| Rate for Payer: TriWest Veterans Administration |
$3,513.20
|
| Rate for Payer: United Healthcare Commercial |
$5,886.14
|
| Rate for Payer: United Healthcare Medicare |
$3,513.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,040.23
|
| Rate for Payer: Wise Provider Network Commercial |
$5,855.32
|
|
|
BIOLOX HIP CERAMIC HEAD 36, -3
|
Facility
|
IP
|
$6,163.50
|
|
| Hospital Charge Code |
3002008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,571.75 |
| Max. Negotiated Rate |
$6,163.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,040.23
|
| Rate for Payer: Aetna of WY Medicare |
$3,944.64
|
| Rate for Payer: Altius Commercial |
$5,916.96
|
| Rate for Payer: Beech Street Commercial |
$6,040.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,978.60
|
| Rate for Payer: Cash Price |
$4,314.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,978.60
|
| Rate for Payer: Cigna of WY Commercial |
$6,040.23
|
| Rate for Payer: Entrust Commercial |
$5,855.32
|
| Rate for Payer: First Choice Health Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,759.74
|
| Rate for Payer: HealthUtah PPO |
$6,163.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,978.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,571.75
|
| Rate for Payer: One Health Plan of WY PPO |
$6,040.23
|
| Rate for Payer: PacificSource Commercial |
$5,547.15
|
| Rate for Payer: PHCS PPO |
$6,040.23
|
| Rate for Payer: Three Rivers PPO |
$4,622.62
|
| Rate for Payer: TriWest Veterans Administration |
$3,759.74
|
| Rate for Payer: United Healthcare Commercial |
$5,886.14
|
| Rate for Payer: United Healthcare Medicare |
$3,759.74
|
| Rate for Payer: WINHealth Partners Commercial |
$5,855.32
|
| Rate for Payer: Wise Provider Network Commercial |
$5,855.32
|
|
|
BIOLOX HIP CERAMIC HEAD 36, -3
|
Facility
|
OP
|
$6,163.50
|
|
| Hospital Charge Code |
3002008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.54 |
| Max. Negotiated Rate |
$6,163.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,040.23
|
| Rate for Payer: Aetna of WY Medicare |
$4,067.91
|
| Rate for Payer: Altius Commercial |
$5,916.96
|
| Rate for Payer: Beech Street Commercial |
$6,040.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,978.60
|
| Rate for Payer: Cash Price |
$4,314.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,978.60
|
| Rate for Payer: Cigna of WY Commercial |
$6,040.23
|
| Rate for Payer: Entrust Commercial |
$5,855.32
|
| Rate for Payer: First Choice Health Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,855.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,513.20
|
| Rate for Payer: HealthUtah PPO |
$6,163.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,978.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,337.54
|
| Rate for Payer: One Health Plan of WY PPO |
$6,040.23
|
| Rate for Payer: PacificSource Commercial |
$5,547.15
|
| Rate for Payer: PHCS PPO |
$6,040.23
|
| Rate for Payer: Three Rivers PPO |
$4,622.62
|
| Rate for Payer: TriWest Veterans Administration |
$3,513.20
|
| Rate for Payer: United Healthcare Commercial |
$5,886.14
|
| Rate for Payer: United Healthcare Medicare |
$3,513.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,040.23
|
| Rate for Payer: Wise Provider Network Commercial |
$5,855.32
|
|
|
BIOMET TIBIAL LOCKING BAR
|
Facility
|
OP
|
$500.50
|
|
| Hospital Charge Code |
3004638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.02 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.49
|
| Rate for Payer: Aetna of WY Medicare |
$330.33
|
| Rate for Payer: Altius Commercial |
$480.48
|
| Rate for Payer: Beech Street Commercial |
$490.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$485.48
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.48
|
| Rate for Payer: Cigna of WY Commercial |
$490.49
|
| Rate for Payer: Entrust Commercial |
$475.48
|
| Rate for Payer: First Choice Health Commercial |
$475.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$285.28
|
| Rate for Payer: HealthUtah PPO |
$500.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.48
|
| Rate for Payer: Multiplan Medicare/VA |
$271.02
|
| Rate for Payer: One Health Plan of WY PPO |
$490.49
|
| Rate for Payer: PacificSource Commercial |
$450.45
|
| Rate for Payer: PHCS PPO |
$490.49
|
| Rate for Payer: Three Rivers PPO |
$375.38
|
| Rate for Payer: TriWest Veterans Administration |
$285.28
|
| Rate for Payer: United Healthcare Commercial |
$477.98
|
| Rate for Payer: United Healthcare Medicare |
$285.28
|
| Rate for Payer: WINHealth Partners Commercial |
$490.49
|
| Rate for Payer: Wise Provider Network Commercial |
$475.48
|
|
|
BIOMET TIBIAL LOCKING BAR
|
Facility
|
IP
|
$500.50
|
|
| Hospital Charge Code |
3004638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.04 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.49
|
| Rate for Payer: Aetna of WY Medicare |
$320.32
|
| Rate for Payer: Altius Commercial |
$480.48
|
| Rate for Payer: Beech Street Commercial |
$490.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$485.48
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.48
|
| Rate for Payer: Cigna of WY Commercial |
$490.49
|
| Rate for Payer: Entrust Commercial |
$475.48
|
| Rate for Payer: First Choice Health Commercial |
$475.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$305.30
|
| Rate for Payer: HealthUtah PPO |
$500.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.48
|
| Rate for Payer: Multiplan Medicare/VA |
$290.04
|
| Rate for Payer: One Health Plan of WY PPO |
$490.49
|
| Rate for Payer: PacificSource Commercial |
$450.45
|
| Rate for Payer: PHCS PPO |
$490.49
|
| Rate for Payer: Three Rivers PPO |
$375.38
|
| Rate for Payer: TriWest Veterans Administration |
$305.30
|
| Rate for Payer: United Healthcare Commercial |
$477.98
|
| Rate for Payer: United Healthcare Medicare |
$305.30
|
| Rate for Payer: WINHealth Partners Commercial |
$475.48
|
| Rate for Payer: Wise Provider Network Commercial |
$475.48
|
|
|
BIOPATCH CHG 1" DISK 4150
|
Facility
|
IP
|
$20.53
|
|
| Hospital Charge Code |
2650566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.12
|
| Rate for Payer: Aetna of WY Medicare |
$13.14
|
| Rate for Payer: Altius Commercial |
$19.71
|
| Rate for Payer: Beech Street Commercial |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.91
|
| Rate for Payer: Cigna of WY Commercial |
$20.12
|
| Rate for Payer: Entrust Commercial |
$19.50
|
| Rate for Payer: First Choice Health Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.52
|
| Rate for Payer: HealthUtah PPO |
$20.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.91
|
| Rate for Payer: Multiplan Medicare/VA |
$11.90
|
| Rate for Payer: One Health Plan of WY PPO |
$20.12
|
| Rate for Payer: PacificSource Commercial |
$18.48
|
| Rate for Payer: PHCS PPO |
$20.12
|
| Rate for Payer: Three Rivers PPO |
$15.40
|
| Rate for Payer: TriWest Veterans Administration |
$12.52
|
| Rate for Payer: United Healthcare Commercial |
$19.61
|
| Rate for Payer: United Healthcare Medicare |
$12.52
|
| Rate for Payer: WINHealth Partners Commercial |
$19.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.50
|
|
|
BIOPATCH CHG 1" DISK 4150
|
Facility
|
OP
|
$20.53
|
|
| Hospital Charge Code |
2650566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.12
|
| Rate for Payer: Aetna of WY Medicare |
$13.55
|
| Rate for Payer: Altius Commercial |
$19.71
|
| Rate for Payer: Beech Street Commercial |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.91
|
| Rate for Payer: Cigna of WY Commercial |
$20.12
|
| Rate for Payer: Entrust Commercial |
$19.50
|
| Rate for Payer: First Choice Health Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.70
|
| Rate for Payer: HealthUtah PPO |
$20.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.91
|
| Rate for Payer: Multiplan Medicare/VA |
$11.12
|
| Rate for Payer: One Health Plan of WY PPO |
$20.12
|
| Rate for Payer: PacificSource Commercial |
$18.48
|
| Rate for Payer: PHCS PPO |
$20.12
|
| Rate for Payer: Three Rivers PPO |
$15.40
|
| Rate for Payer: TriWest Veterans Administration |
$11.70
|
| Rate for Payer: United Healthcare Commercial |
$19.61
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
| Rate for Payer: WINHealth Partners Commercial |
$20.12
|
| Rate for Payer: Wise Provider Network Commercial |
$19.50
|
|
|
BIOPSY BONE OPEN SUPERFICIAL
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 20240
|
| Min. Negotiated Rate |
$114.16 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.90
|
| Rate for Payer: Aetna of WY Medicare |
$134.31
|
| Rate for Payer: Beech Street Commercial |
$574.75
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.85
|
| Rate for Payer: Cigna of WY Commercial |
$592.90
|
| Rate for Payer: First Choice Health Commercial |
$544.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.31
|
| Rate for Payer: HealthUtah PPO |
$605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.85
|
| Rate for Payer: Multiplan Medicare/VA |
$114.16
|
| Rate for Payer: One Health Plan of WY PPO |
$592.90
|
| Rate for Payer: PacificSource Commercial |
$544.50
|
| Rate for Payer: PHCS PPO |
$574.75
|
| Rate for Payer: Three Rivers PPO |
$453.75
|
| Rate for Payer: TriWest Veterans Administration |
$134.31
|
| Rate for Payer: United Healthcare Commercial |
$574.75
|
| Rate for Payer: WINHealth Partners Commercial |
$514.25
|
|
|
BIOPSY BONE TROCAR/NEEDLE DEEP
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 20225 80
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$583.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$571.34
|
| Rate for Payer: Beech Street Commercial |
$553.85
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$565.51
|
| Rate for Payer: Cigna of WY Commercial |
$571.34
|
| Rate for Payer: First Choice Health Commercial |
$524.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$553.85
|
| Rate for Payer: HealthUtah PPO |
$583.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$565.51
|
| Rate for Payer: One Health Plan of WY PPO |
$571.34
|
| Rate for Payer: PacificSource Commercial |
$524.70
|
| Rate for Payer: PHCS PPO |
$553.85
|
| Rate for Payer: Three Rivers PPO |
$437.25
|
| Rate for Payer: United Healthcare Commercial |
$553.85
|
| Rate for Payer: WINHealth Partners Commercial |
$495.55
|
|
|
BIOPSY BONE TROCAR/NEEDLE DEEP
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 20225
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$583.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$571.34
|
| Rate for Payer: Aetna of WY Medicare |
$122.62
|
| Rate for Payer: Beech Street Commercial |
$553.85
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$565.51
|
| Rate for Payer: Cigna of WY Commercial |
$571.34
|
| Rate for Payer: First Choice Health Commercial |
$524.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$553.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.62
|
| Rate for Payer: HealthUtah PPO |
$583.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$565.51
|
| Rate for Payer: Multiplan Medicare/VA |
$104.23
|
| Rate for Payer: One Health Plan of WY PPO |
$571.34
|
| Rate for Payer: PacificSource Commercial |
$524.70
|
| Rate for Payer: PHCS PPO |
$553.85
|
| Rate for Payer: Three Rivers PPO |
$437.25
|
| Rate for Payer: TriWest Veterans Administration |
$122.62
|
| Rate for Payer: United Healthcare Commercial |
$553.85
|
| Rate for Payer: WINHealth Partners Commercial |
$495.55
|
|
