|
BLADE SURGICAL #10
|
Facility
|
IP
|
$1.09
|
|
| Hospital Charge Code |
2300002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.70
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
BLADE SURGICAL #11
|
Facility
|
OP
|
$1.09
|
|
| Hospital Charge Code |
2300003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.72
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.62
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
BLADE SURGICAL #11
|
Facility
|
IP
|
$1.09
|
|
| Hospital Charge Code |
2300003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.70
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
BLADE SURGICAL #12
|
Facility
|
IP
|
$1.35
|
|
| Hospital Charge Code |
2300004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.32
|
| Rate for Payer: Aetna of WY Medicare |
$0.86
|
| Rate for Payer: Altius Commercial |
$1.30
|
| Rate for Payer: Beech Street Commercial |
$1.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.31
|
| Rate for Payer: Cigna of WY Commercial |
$1.32
|
| Rate for Payer: Entrust Commercial |
$1.28
|
| Rate for Payer: First Choice Health Commercial |
$1.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.32
|
| Rate for Payer: PacificSource Commercial |
$1.22
|
| Rate for Payer: PHCS PPO |
$1.32
|
| Rate for Payer: Three Rivers PPO |
$1.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.28
|
| Rate for Payer: Wise Provider Network Commercial |
$1.28
|
|
|
BLADE SURGICAL #12
|
Facility
|
OP
|
$1.35
|
|
| Hospital Charge Code |
2300004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.32
|
| Rate for Payer: Aetna of WY Medicare |
$0.89
|
| Rate for Payer: Altius Commercial |
$1.30
|
| Rate for Payer: Beech Street Commercial |
$1.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.31
|
| Rate for Payer: Cigna of WY Commercial |
$1.32
|
| Rate for Payer: Entrust Commercial |
$1.28
|
| Rate for Payer: First Choice Health Commercial |
$1.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.32
|
| Rate for Payer: PacificSource Commercial |
$1.22
|
| Rate for Payer: PHCS PPO |
$1.32
|
| Rate for Payer: Three Rivers PPO |
$1.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.32
|
| Rate for Payer: Wise Provider Network Commercial |
$1.28
|
|
|
BLADE SURGICAL #15
|
Facility
|
IP
|
$0.98
|
|
| Hospital Charge Code |
2300005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.96
|
| Rate for Payer: Aetna of WY Medicare |
$0.63
|
| Rate for Payer: Altius Commercial |
$0.94
|
| Rate for Payer: Beech Street Commercial |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.95
|
| Rate for Payer: Cigna of WY Commercial |
$0.96
|
| Rate for Payer: Entrust Commercial |
$0.93
|
| Rate for Payer: First Choice Health Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$0.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.95
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$0.96
|
| Rate for Payer: PacificSource Commercial |
$0.88
|
| Rate for Payer: PHCS PPO |
$0.96
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$0.93
|
| Rate for Payer: Wise Provider Network Commercial |
$0.93
|
|
|
BLADE SURGICAL #15
|
Facility
|
OP
|
$0.98
|
|
| Hospital Charge Code |
2300005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.96
|
| Rate for Payer: Aetna of WY Medicare |
$0.65
|
| Rate for Payer: Altius Commercial |
$0.94
|
| Rate for Payer: Beech Street Commercial |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.95
|
| Rate for Payer: Cigna of WY Commercial |
$0.96
|
| Rate for Payer: Entrust Commercial |
$0.93
|
| Rate for Payer: First Choice Health Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.56
|
| Rate for Payer: HealthUtah PPO |
$0.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.95
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.96
|
| Rate for Payer: PacificSource Commercial |
$0.88
|
| Rate for Payer: PHCS PPO |
$0.96
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WINHealth Partners Commercial |
$0.96
|
| Rate for Payer: Wise Provider Network Commercial |
$0.93
|
|
|
BLADE T-7 DRIVER
|
Facility
|
IP
|
$798.00
|
|
| Hospital Charge Code |
3100322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.44 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Aetna of WY Medicare |
$510.72
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$774.06
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.78
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$462.44
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$486.78
|
| Rate for Payer: United Healthcare Commercial |
$762.09
|
| Rate for Payer: United Healthcare Medicare |
$486.78
|
| Rate for Payer: WINHealth Partners Commercial |
$758.10
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
BLADE T-7 DRIVER
|
Facility
|
OP
|
$798.00
|
|
| Hospital Charge Code |
3100322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.12 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Aetna of WY Medicare |
$526.68
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$774.06
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.86
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$432.12
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$454.86
|
| Rate for Payer: United Healthcare Commercial |
$762.09
|
| Rate for Payer: United Healthcare Medicare |
$454.86
|
| Rate for Payer: WINHealth Partners Commercial |
$782.04
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
BL AG LG MED 9.0X31 2296-3-525
|
Facility
|
IP
|
$74.58
|
|
| Hospital Charge Code |
2650256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.09
|
| Rate for Payer: Aetna of WY Medicare |
$47.73
|
| Rate for Payer: Altius Commercial |
$71.60
|
| Rate for Payer: Beech Street Commercial |
$73.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.34
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.34
|
| Rate for Payer: Cigna of WY Commercial |
$73.09
|
| Rate for Payer: Entrust Commercial |
$70.85
|
| Rate for Payer: First Choice Health Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.49
|
| Rate for Payer: HealthUtah PPO |
$74.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.34
|
| Rate for Payer: Multiplan Medicare/VA |
$43.22
|
| Rate for Payer: One Health Plan of WY PPO |
$73.09
|
| Rate for Payer: PacificSource Commercial |
$67.12
|
| Rate for Payer: PHCS PPO |
$73.09
|
| Rate for Payer: Three Rivers PPO |
$55.94
|
| Rate for Payer: TriWest Veterans Administration |
$45.49
|
| Rate for Payer: United Healthcare Commercial |
$71.22
|
| Rate for Payer: United Healthcare Medicare |
$45.49
|
| Rate for Payer: WINHealth Partners Commercial |
$70.85
|
| Rate for Payer: Wise Provider Network Commercial |
$70.85
|
|
|
BL AG LG MED 9.0X31 2296-3-525
|
Facility
|
OP
|
$74.58
|
|
| Hospital Charge Code |
2650256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.09
|
| Rate for Payer: Aetna of WY Medicare |
$49.22
|
| Rate for Payer: Altius Commercial |
$71.60
|
| Rate for Payer: Beech Street Commercial |
$73.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.34
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.34
|
| Rate for Payer: Cigna of WY Commercial |
$73.09
|
| Rate for Payer: Entrust Commercial |
$70.85
|
| Rate for Payer: First Choice Health Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: HealthUtah PPO |
$74.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.34
|
| Rate for Payer: Multiplan Medicare/VA |
$40.39
|
| Rate for Payer: One Health Plan of WY PPO |
$73.09
|
| Rate for Payer: PacificSource Commercial |
$67.12
|
| Rate for Payer: PHCS PPO |
$73.09
|
| Rate for Payer: Three Rivers PPO |
$55.94
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: United Healthcare Commercial |
$71.22
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: WINHealth Partners Commercial |
$73.09
|
| Rate for Payer: Wise Provider Network Commercial |
$70.85
|
|
|
BLAKEMORE 20FR BALLOON ADULT
|
Facility
|
OP
|
$1,061.59
|
|
| Hospital Charge Code |
2400218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.85 |
| Max. Negotiated Rate |
$1,061.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,040.36
|
| Rate for Payer: Aetna of WY Medicare |
$700.65
|
| Rate for Payer: Altius Commercial |
$1,019.13
|
| Rate for Payer: Beech Street Commercial |
$1,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,029.74
|
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,029.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,040.36
|
| Rate for Payer: Entrust Commercial |
$1,008.51
|
| Rate for Payer: First Choice Health Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$605.11
|
| Rate for Payer: HealthUtah PPO |
$1,061.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,029.74
|
| Rate for Payer: Multiplan Medicare/VA |
$574.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,040.36
|
| Rate for Payer: PacificSource Commercial |
$955.43
|
| Rate for Payer: PHCS PPO |
$1,040.36
|
| Rate for Payer: Three Rivers PPO |
$796.19
|
| Rate for Payer: TriWest Veterans Administration |
$605.11
|
| Rate for Payer: United Healthcare Commercial |
$1,013.82
|
| Rate for Payer: United Healthcare Medicare |
$605.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,040.36
|
| Rate for Payer: Wise Provider Network Commercial |
$1,008.51
|
|
|
BLAKEMORE 20FR BALLOON ADULT
|
Facility
|
IP
|
$1,061.59
|
|
| Hospital Charge Code |
2400218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.19 |
| Max. Negotiated Rate |
$1,061.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,040.36
|
| Rate for Payer: Aetna of WY Medicare |
$679.42
|
| Rate for Payer: Altius Commercial |
$1,019.13
|
| Rate for Payer: Beech Street Commercial |
$1,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,029.74
|
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,029.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,040.36
|
| Rate for Payer: Entrust Commercial |
$1,008.51
|
| Rate for Payer: First Choice Health Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$647.57
|
| Rate for Payer: HealthUtah PPO |
$1,061.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,029.74
|
| Rate for Payer: Multiplan Medicare/VA |
$615.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,040.36
|
| Rate for Payer: PacificSource Commercial |
$955.43
|
| Rate for Payer: PHCS PPO |
$1,040.36
|
| Rate for Payer: Three Rivers PPO |
$796.19
|
| Rate for Payer: TriWest Veterans Administration |
$647.57
|
| Rate for Payer: United Healthcare Commercial |
$1,013.82
|
| Rate for Payer: United Healthcare Medicare |
$647.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,008.51
|
| Rate for Payer: Wise Provider Network Commercial |
$1,008.51
|
|
|
BLD AG XLG WD 39X13 2296-3-508
|
Facility
|
IP
|
$87.36
|
|
| Hospital Charge Code |
3000315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.61
|
| Rate for Payer: Aetna of WY Medicare |
$55.91
|
| Rate for Payer: Altius Commercial |
$83.87
|
| Rate for Payer: Beech Street Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.74
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.74
|
| Rate for Payer: Cigna of WY Commercial |
$85.61
|
| Rate for Payer: Entrust Commercial |
$82.99
|
| Rate for Payer: First Choice Health Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.29
|
| Rate for Payer: HealthUtah PPO |
$87.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.74
|
| Rate for Payer: Multiplan Medicare/VA |
$50.63
|
| Rate for Payer: One Health Plan of WY PPO |
$85.61
|
| Rate for Payer: PacificSource Commercial |
$78.62
|
| Rate for Payer: PHCS PPO |
$85.61
|
| Rate for Payer: Three Rivers PPO |
$65.52
|
| Rate for Payer: TriWest Veterans Administration |
$53.29
|
| Rate for Payer: United Healthcare Commercial |
$83.43
|
| Rate for Payer: United Healthcare Medicare |
$53.29
|
| Rate for Payer: WINHealth Partners Commercial |
$82.99
|
| Rate for Payer: Wise Provider Network Commercial |
$82.99
|
|
|
BLD AG XLG WD 39X13 2296-3-508
|
Facility
|
OP
|
$87.36
|
|
| Hospital Charge Code |
3000315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.31 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: United Healthcare Commercial |
$83.43
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.61
|
| Rate for Payer: Aetna of WY Medicare |
$57.66
|
| Rate for Payer: Altius Commercial |
$83.87
|
| Rate for Payer: Beech Street Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.74
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.74
|
| Rate for Payer: Cigna of WY Commercial |
$85.61
|
| Rate for Payer: Entrust Commercial |
$82.99
|
| Rate for Payer: First Choice Health Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.80
|
| Rate for Payer: HealthUtah PPO |
$87.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.74
|
| Rate for Payer: Multiplan Medicare/VA |
$47.31
|
| Rate for Payer: One Health Plan of WY PPO |
$85.61
|
| Rate for Payer: PacificSource Commercial |
$78.62
|
| Rate for Payer: PHCS PPO |
$85.61
|
| Rate for Payer: Three Rivers PPO |
$65.52
|
| Rate for Payer: TriWest Veterans Administration |
$49.80
|
| Rate for Payer: United Healthcare Medicare |
$49.80
|
| Rate for Payer: WINHealth Partners Commercial |
$85.61
|
| Rate for Payer: Wise Provider Network Commercial |
$82.99
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.24
|
| Rate for Payer: Aetna of WY Medicare |
$28.46
|
| Rate for Payer: Beech Street Commercial |
$131.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.86
|
| Rate for Payer: Cigna of WY Commercial |
$135.24
|
| Rate for Payer: First Choice Health Commercial |
$124.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.46
|
| Rate for Payer: HealthUtah PPO |
$138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.86
|
| Rate for Payer: Multiplan Medicare/VA |
$24.19
|
| Rate for Payer: One Health Plan of WY PPO |
$135.24
|
| Rate for Payer: PacificSource Commercial |
$124.20
|
| Rate for Payer: PHCS PPO |
$131.10
|
| Rate for Payer: Three Rivers PPO |
$103.50
|
| Rate for Payer: TriWest Veterans Administration |
$28.46
|
| Rate for Payer: United Healthcare Commercial |
$131.10
|
| Rate for Payer: WINHealth Partners Commercial |
$117.30
|
|
|
BLOCKER XIA SPINE
|
Facility
|
IP
|
$847.00
|
|
| Hospital Charge Code |
3004321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$830.06
|
| Rate for Payer: Aetna of WY Medicare |
$542.08
|
| Rate for Payer: Altius Commercial |
$813.12
|
| Rate for Payer: Beech Street Commercial |
$830.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.59
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$821.59
|
| Rate for Payer: Cigna of WY Commercial |
$830.06
|
| Rate for Payer: Entrust Commercial |
$804.65
|
| Rate for Payer: First Choice Health Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$516.67
|
| Rate for Payer: HealthUtah PPO |
$847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$821.59
|
| Rate for Payer: Multiplan Medicare/VA |
$490.84
|
| Rate for Payer: One Health Plan of WY PPO |
$830.06
|
| Rate for Payer: PacificSource Commercial |
$762.30
|
| Rate for Payer: PHCS PPO |
$830.06
|
| Rate for Payer: Three Rivers PPO |
$635.25
|
| Rate for Payer: TriWest Veterans Administration |
$516.67
|
| Rate for Payer: United Healthcare Commercial |
$808.88
|
| Rate for Payer: United Healthcare Medicare |
$516.67
|
| Rate for Payer: WINHealth Partners Commercial |
$804.65
|
| Rate for Payer: Wise Provider Network Commercial |
$804.65
|
|
|
BLOCKER XIA SPINE
|
Facility
|
OP
|
$847.00
|
|
| Hospital Charge Code |
3004321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.65 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$830.06
|
| Rate for Payer: Aetna of WY Medicare |
$559.02
|
| Rate for Payer: Altius Commercial |
$813.12
|
| Rate for Payer: Beech Street Commercial |
$830.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.59
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$821.59
|
| Rate for Payer: Cigna of WY Commercial |
$830.06
|
| Rate for Payer: Entrust Commercial |
$804.65
|
| Rate for Payer: First Choice Health Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$804.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$482.79
|
| Rate for Payer: HealthUtah PPO |
$847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$821.59
|
| Rate for Payer: Multiplan Medicare/VA |
$458.65
|
| Rate for Payer: One Health Plan of WY PPO |
$830.06
|
| Rate for Payer: PacificSource Commercial |
$762.30
|
| Rate for Payer: PHCS PPO |
$830.06
|
| Rate for Payer: Three Rivers PPO |
$635.25
|
| Rate for Payer: TriWest Veterans Administration |
$482.79
|
| Rate for Payer: United Healthcare Commercial |
$808.88
|
| Rate for Payer: United Healthcare Medicare |
$482.79
|
| Rate for Payer: WINHealth Partners Commercial |
$830.06
|
| Rate for Payer: Wise Provider Network Commercial |
$804.65
|
|
|
BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 85025
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$49.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: First Choice Health Commercial |
$46.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$49.40
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$49.40
|
| Rate for Payer: WINHealth Partners Commercial |
$49.40
|
|
|
BLOOD COUNT SPUN MICROHEMATOCRIT
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 85013
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$7.00
|
| Rate for Payer: Beech Street Commercial |
$31.35
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: First Choice Health Commercial |
$29.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.00
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$5.95
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$31.35
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$7.00
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
|
|
BLOOD GRAVITY Y-PORT HAND PUMP
|
Facility
|
IP
|
$10.54
|
|
| Hospital Charge Code |
2050101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.75
|
| Rate for Payer: Altius Commercial |
$10.12
|
| Rate for Payer: Beech Street Commercial |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.22
|
| Rate for Payer: Cigna of WY Commercial |
$10.33
|
| Rate for Payer: Entrust Commercial |
$10.01
|
| Rate for Payer: First Choice Health Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.43
|
| Rate for Payer: HealthUtah PPO |
$10.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.22
|
| Rate for Payer: Multiplan Medicare/VA |
$6.11
|
| Rate for Payer: One Health Plan of WY PPO |
$10.33
|
| Rate for Payer: PacificSource Commercial |
$9.49
|
| Rate for Payer: PHCS PPO |
$10.33
|
| Rate for Payer: Three Rivers PPO |
$7.90
|
| Rate for Payer: TriWest Veterans Administration |
$6.43
|
| Rate for Payer: United Healthcare Commercial |
$10.07
|
| Rate for Payer: United Healthcare Medicare |
$6.43
|
| Rate for Payer: WINHealth Partners Commercial |
$10.01
|
| Rate for Payer: Wise Provider Network Commercial |
$10.01
|
|
|
BLOOD GRAVITY Y-PORT HAND PUMP
|
Facility
|
OP
|
$10.54
|
|
| Hospital Charge Code |
2050101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.96
|
| Rate for Payer: Altius Commercial |
$10.12
|
| Rate for Payer: Beech Street Commercial |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.22
|
| Rate for Payer: Cigna of WY Commercial |
$10.33
|
| Rate for Payer: Entrust Commercial |
$10.01
|
| Rate for Payer: First Choice Health Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.01
|
| Rate for Payer: HealthUtah PPO |
$10.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.22
|
| Rate for Payer: Multiplan Medicare/VA |
$5.71
|
| Rate for Payer: One Health Plan of WY PPO |
$10.33
|
| Rate for Payer: PacificSource Commercial |
$9.49
|
| Rate for Payer: PHCS PPO |
$10.33
|
| Rate for Payer: Three Rivers PPO |
$7.90
|
| Rate for Payer: TriWest Veterans Administration |
$6.01
|
| Rate for Payer: United Healthcare Commercial |
$10.07
|
| Rate for Payer: United Healthcare Medicare |
$6.01
|
| Rate for Payer: WINHealth Partners Commercial |
$10.33
|
| Rate for Payer: Wise Provider Network Commercial |
$10.01
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 82270
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$4.38
|
| Rate for Payer: Beech Street Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: First Choice Health Commercial |
$25.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.38
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$3.72
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$26.60
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$26.60
|
| Rate for Payer: WINHealth Partners Commercial |
$26.60
|
|
|
BLUE RANGER PULLEY
|
Facility
|
IP
|
$21.63
|
|
| Hospital Charge Code |
2900012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.20
|
| Rate for Payer: Aetna of WY Medicare |
$13.84
|
| Rate for Payer: Altius Commercial |
$20.76
|
| Rate for Payer: Beech Street Commercial |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.98
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.98
|
| Rate for Payer: Cigna of WY Commercial |
$21.20
|
| Rate for Payer: Entrust Commercial |
$20.55
|
| Rate for Payer: First Choice Health Commercial |
$20.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.19
|
| Rate for Payer: HealthUtah PPO |
$21.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.98
|
| Rate for Payer: Multiplan Medicare/VA |
$12.53
|
| Rate for Payer: One Health Plan of WY PPO |
$21.20
|
| Rate for Payer: PacificSource Commercial |
$19.47
|
| Rate for Payer: PHCS PPO |
$21.20
|
| Rate for Payer: Three Rivers PPO |
$16.22
|
| Rate for Payer: TriWest Veterans Administration |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Medicare |
$13.19
|
| Rate for Payer: WINHealth Partners Commercial |
$20.55
|
| Rate for Payer: Wise Provider Network Commercial |
$20.55
|
|
|
BLUE RANGER PULLEY
|
Facility
|
OP
|
$21.63
|
|
| Hospital Charge Code |
2900012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.20
|
| Rate for Payer: Aetna of WY Medicare |
$14.28
|
| Rate for Payer: Altius Commercial |
$20.76
|
| Rate for Payer: Beech Street Commercial |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.98
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.98
|
| Rate for Payer: Cigna of WY Commercial |
$21.20
|
| Rate for Payer: Entrust Commercial |
$20.55
|
| Rate for Payer: First Choice Health Commercial |
$20.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.33
|
| Rate for Payer: HealthUtah PPO |
$21.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.98
|
| Rate for Payer: Multiplan Medicare/VA |
$11.71
|
| Rate for Payer: One Health Plan of WY PPO |
$21.20
|
| Rate for Payer: PacificSource Commercial |
$19.47
|
| Rate for Payer: PHCS PPO |
$21.20
|
| Rate for Payer: Three Rivers PPO |
$16.22
|
| Rate for Payer: TriWest Veterans Administration |
$12.33
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Medicare |
$12.33
|
| Rate for Payer: WINHealth Partners Commercial |
$21.20
|
| Rate for Payer: Wise Provider Network Commercial |
$20.55
|
|
