|
STAPLER RELOAD 80MM 3.8MM
|
Facility
|
OP
|
$273.77
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.85 |
| Max. Negotiated Rate |
$273.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.29
|
| Rate for Payer: Aetna of WY Medicare |
$180.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$262.82
|
| Rate for Payer: Altius Commercial |
$262.82
|
| Rate for Payer: Beech Street Commercial |
$268.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.77
|
| Rate for Payer: Cash Price |
$191.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.56
|
| Rate for Payer: Cigna of WY Commercial |
$268.29
|
| Rate for Payer: Entrust Commercial |
$260.08
|
| Rate for Payer: First Choice Health Commercial |
$260.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.79
|
| Rate for Payer: HealthUtah PPO |
$273.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.56
|
| Rate for Payer: Multiplan Medicare/VA |
$150.85
|
| Rate for Payer: One Health Plan of WY PPO |
$268.29
|
| Rate for Payer: PacificSource Commercial |
$246.39
|
| Rate for Payer: PHCS PPO |
$268.29
|
| Rate for Payer: Three Rivers PPO |
$205.33
|
| Rate for Payer: TriWest Veterans Administration |
$158.79
|
| Rate for Payer: United Healthcare Commercial |
$238.18
|
| Rate for Payer: United Healthcare Medicare |
$158.79
|
| Rate for Payer: WINHealth Partners Commercial |
$268.29
|
| Rate for Payer: Wise Provider Network Commercial |
$260.08
|
|
|
STAPLER RELOAD 80MM 3.8MM
|
Facility
|
IP
|
$273.77
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.65 |
| Max. Negotiated Rate |
$273.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$262.82
|
| Rate for Payer: Altius Commercial |
$262.82
|
| Rate for Payer: Beech Street Commercial |
$268.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.77
|
| Rate for Payer: Cash Price |
$191.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.56
|
| Rate for Payer: Cigna of WY Commercial |
$268.29
|
| Rate for Payer: Entrust Commercial |
$260.08
|
| Rate for Payer: First Choice Health Commercial |
$260.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.69
|
| Rate for Payer: HealthUtah PPO |
$273.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.56
|
| Rate for Payer: Multiplan Medicare/VA |
$171.65
|
| Rate for Payer: One Health Plan of WY PPO |
$268.29
|
| Rate for Payer: PacificSource Commercial |
$246.39
|
| Rate for Payer: PHCS PPO |
$268.29
|
| Rate for Payer: Three Rivers PPO |
$205.33
|
| Rate for Payer: TriWest Veterans Administration |
$180.69
|
| Rate for Payer: United Healthcare Commercial |
$238.18
|
| Rate for Payer: United Healthcare Medicare |
$180.69
|
| Rate for Payer: WINHealth Partners Commercial |
$260.08
|
| Rate for Payer: Wise Provider Network Commercial |
$260.08
|
|
|
STAPLER RELOAD CONTOUR 40MM
|
Facility
|
OP
|
$287.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.14 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$189.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$275.52
|
| Rate for Payer: Altius Commercial |
$275.52
|
| Rate for Payer: Beech Street Commercial |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$235.63
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: Entrust Commercial |
$272.65
|
| Rate for Payer: First Choice Health Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.46
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$158.14
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$281.26
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.46
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$166.46
|
| Rate for Payer: WINHealth Partners Commercial |
$281.26
|
| Rate for Payer: Wise Provider Network Commercial |
$272.65
|
|
|
STAPLER RELOAD CONTOUR 40MM
|
Facility
|
IP
|
$287.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.95 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$275.52
|
| Rate for Payer: Altius Commercial |
$275.52
|
| Rate for Payer: Beech Street Commercial |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$235.63
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: Entrust Commercial |
$272.65
|
| Rate for Payer: First Choice Health Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.42
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$179.95
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$281.26
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$189.42
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$189.42
|
| Rate for Payer: WINHealth Partners Commercial |
$272.65
|
| Rate for Payer: Wise Provider Network Commercial |
$272.65
|
|
|
STAPLER RELOAD GIA 45MM PURPLE
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
STAPLER RELOAD GIA 45MM PURPLE
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
STAPLER RELOAD GIA 60MM PURPLE
|
Facility
|
OP
|
$665.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.70
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$366.42
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$385.70
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$385.70
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
STAPLER RELOAD GIA 60MM PURPLE
|
Facility
|
IP
|
$665.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
STAPLER RELOAD GIA 60MM TAN
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.28 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$289.28
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$304.50
|
| Rate for Payer: WINHealth Partners Commercial |
$514.50
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
STAPLER RELOAD GIA 60MM TAN
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.18 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$329.18
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
| Rate for Payer: WINHealth Partners Commercial |
$498.75
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
STAPLER RELOAD TA 60MM BLUE
|
Facility
|
OP
|
$66.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Aetna of WY Medicare |
$43.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.57
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$36.64
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$38.57
|
| Rate for Payer: WINHealth Partners Commercial |
$65.17
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
STAPLER RELOAD TA 60MM BLUE
|
Facility
|
IP
|
$66.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.89
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$41.70
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$43.89
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
| Rate for Payer: WINHealth Partners Commercial |
$63.18
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
STAPLER SKIN 35 WIDE ETHICON
|
Facility
|
IP
|
$16.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.71
|
| Rate for Payer: Altius Commercial |
$15.71
|
| Rate for Payer: Beech Street Commercial |
$16.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.87
|
| Rate for Payer: Cigna of WY Commercial |
$16.03
|
| Rate for Payer: Entrust Commercial |
$15.54
|
| Rate for Payer: First Choice Health Commercial |
$15.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.80
|
| Rate for Payer: HealthUtah PPO |
$16.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.87
|
| Rate for Payer: Multiplan Medicare/VA |
$10.26
|
| Rate for Payer: One Health Plan of WY PPO |
$16.03
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.03
|
| Rate for Payer: Three Rivers PPO |
$12.27
|
| Rate for Payer: TriWest Veterans Administration |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$14.23
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WINHealth Partners Commercial |
$15.54
|
| Rate for Payer: Wise Provider Network Commercial |
$15.54
|
|
|
STAPLER SKIN 35 WIDE ETHICON
|
Facility
|
OP
|
$16.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.03
|
| Rate for Payer: Aetna of WY Medicare |
$10.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.71
|
| Rate for Payer: Altius Commercial |
$15.71
|
| Rate for Payer: Beech Street Commercial |
$16.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.87
|
| Rate for Payer: Cigna of WY Commercial |
$16.03
|
| Rate for Payer: Entrust Commercial |
$15.54
|
| Rate for Payer: First Choice Health Commercial |
$15.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$16.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.87
|
| Rate for Payer: Multiplan Medicare/VA |
$9.01
|
| Rate for Payer: One Health Plan of WY PPO |
$16.03
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.03
|
| Rate for Payer: Three Rivers PPO |
$12.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$14.23
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$16.03
|
| Rate for Payer: Wise Provider Network Commercial |
$15.54
|
|
|
STAPLER SKIN DS-5
|
Facility
|
OP
|
$12.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.51
|
| Rate for Payer: Aetna of WY Medicare |
$8.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.26
|
| Rate for Payer: Altius Commercial |
$12.26
|
| Rate for Payer: Beech Street Commercial |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.39
|
| Rate for Payer: Cigna of WY Commercial |
$12.51
|
| Rate for Payer: Entrust Commercial |
$12.13
|
| Rate for Payer: First Choice Health Commercial |
$12.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.41
|
| Rate for Payer: HealthUtah PPO |
$12.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.39
|
| Rate for Payer: Multiplan Medicare/VA |
$7.04
|
| Rate for Payer: One Health Plan of WY PPO |
$12.51
|
| Rate for Payer: PacificSource Commercial |
$11.49
|
| Rate for Payer: PHCS PPO |
$12.51
|
| Rate for Payer: Three Rivers PPO |
$9.58
|
| Rate for Payer: TriWest Veterans Administration |
$7.41
|
| Rate for Payer: United Healthcare Commercial |
$11.11
|
| Rate for Payer: United Healthcare Medicare |
$7.41
|
| Rate for Payer: WINHealth Partners Commercial |
$12.51
|
| Rate for Payer: Wise Provider Network Commercial |
$12.13
|
|
|
STAPLER SKIN DS-5
|
Facility
|
IP
|
$12.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.26
|
| Rate for Payer: Altius Commercial |
$12.26
|
| Rate for Payer: Beech Street Commercial |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.39
|
| Rate for Payer: Cigna of WY Commercial |
$12.51
|
| Rate for Payer: Entrust Commercial |
$12.13
|
| Rate for Payer: First Choice Health Commercial |
$12.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.43
|
| Rate for Payer: HealthUtah PPO |
$12.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.39
|
| Rate for Payer: Multiplan Medicare/VA |
$8.01
|
| Rate for Payer: One Health Plan of WY PPO |
$12.51
|
| Rate for Payer: PacificSource Commercial |
$11.49
|
| Rate for Payer: PHCS PPO |
$12.51
|
| Rate for Payer: Three Rivers PPO |
$9.58
|
| Rate for Payer: TriWest Veterans Administration |
$8.43
|
| Rate for Payer: United Healthcare Commercial |
$11.11
|
| Rate for Payer: United Healthcare Medicare |
$8.43
|
| Rate for Payer: WINHealth Partners Commercial |
$12.13
|
| Rate for Payer: Wise Provider Network Commercial |
$12.13
|
|
|
STAPLER TA 60MM 3.8MM BLUE
|
Facility
|
OP
|
$206.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.78 |
| Max. Negotiated Rate |
$206.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.37
|
| Rate for Payer: Aetna of WY Medicare |
$136.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$198.24
|
| Rate for Payer: Altius Commercial |
$198.24
|
| Rate for Payer: Beech Street Commercial |
$202.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.54
|
| Rate for Payer: Cash Price |
$144.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.30
|
| Rate for Payer: Cigna of WY Commercial |
$202.37
|
| Rate for Payer: Entrust Commercial |
$196.18
|
| Rate for Payer: First Choice Health Commercial |
$196.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.77
|
| Rate for Payer: HealthUtah PPO |
$206.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.30
|
| Rate for Payer: Multiplan Medicare/VA |
$113.78
|
| Rate for Payer: One Health Plan of WY PPO |
$202.37
|
| Rate for Payer: PacificSource Commercial |
$185.85
|
| Rate for Payer: PHCS PPO |
$202.37
|
| Rate for Payer: Three Rivers PPO |
$154.88
|
| Rate for Payer: TriWest Veterans Administration |
$119.77
|
| Rate for Payer: United Healthcare Commercial |
$179.66
|
| Rate for Payer: United Healthcare Medicare |
$119.77
|
| Rate for Payer: WINHealth Partners Commercial |
$202.37
|
| Rate for Payer: Wise Provider Network Commercial |
$196.18
|
|
|
STAPLER TA 60MM 3.8MM BLUE
|
Facility
|
IP
|
$206.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$206.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$198.24
|
| Rate for Payer: Altius Commercial |
$198.24
|
| Rate for Payer: Beech Street Commercial |
$202.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.54
|
| Rate for Payer: Cash Price |
$144.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.30
|
| Rate for Payer: Cigna of WY Commercial |
$202.37
|
| Rate for Payer: Entrust Commercial |
$196.18
|
| Rate for Payer: First Choice Health Commercial |
$196.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.29
|
| Rate for Payer: HealthUtah PPO |
$206.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.30
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$202.37
|
| Rate for Payer: PacificSource Commercial |
$185.85
|
| Rate for Payer: PHCS PPO |
$202.37
|
| Rate for Payer: Three Rivers PPO |
$154.88
|
| Rate for Payer: TriWest Veterans Administration |
$136.29
|
| Rate for Payer: United Healthcare Commercial |
$179.66
|
| Rate for Payer: United Healthcare Medicare |
$136.29
|
| Rate for Payer: WINHealth Partners Commercial |
$196.18
|
| Rate for Payer: Wise Provider Network Commercial |
$196.18
|
|
|
STAR SLEEVE AR-1606
|
Facility
|
IP
|
$286.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.42 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$280.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$274.71
|
| Rate for Payer: Altius Commercial |
$274.71
|
| Rate for Payer: Beech Street Commercial |
$280.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$234.94
|
| Rate for Payer: Cash Price |
$200.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$277.58
|
| Rate for Payer: Cigna of WY Commercial |
$280.44
|
| Rate for Payer: Entrust Commercial |
$271.85
|
| Rate for Payer: First Choice Health Commercial |
$271.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$271.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.87
|
| Rate for Payer: HealthUtah PPO |
$286.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$277.58
|
| Rate for Payer: Multiplan Medicare/VA |
$179.42
|
| Rate for Payer: One Health Plan of WY PPO |
$280.44
|
| Rate for Payer: PacificSource Commercial |
$257.54
|
| Rate for Payer: PHCS PPO |
$280.44
|
| Rate for Payer: Three Rivers PPO |
$214.62
|
| Rate for Payer: TriWest Veterans Administration |
$188.87
|
| Rate for Payer: United Healthcare Commercial |
$248.96
|
| Rate for Payer: United Healthcare Medicare |
$188.87
|
| Rate for Payer: WINHealth Partners Commercial |
$271.85
|
| Rate for Payer: Wise Provider Network Commercial |
$271.85
|
|
|
STAR SLEEVE AR-1606
|
Facility
|
OP
|
$286.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.67 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$280.44
|
| Rate for Payer: Aetna of WY Medicare |
$188.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$274.71
|
| Rate for Payer: Altius Commercial |
$274.71
|
| Rate for Payer: Beech Street Commercial |
$280.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$234.94
|
| Rate for Payer: Cash Price |
$200.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$277.58
|
| Rate for Payer: Cigna of WY Commercial |
$280.44
|
| Rate for Payer: Entrust Commercial |
$271.85
|
| Rate for Payer: First Choice Health Commercial |
$271.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$271.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.97
|
| Rate for Payer: HealthUtah PPO |
$286.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$277.58
|
| Rate for Payer: Multiplan Medicare/VA |
$157.67
|
| Rate for Payer: One Health Plan of WY PPO |
$280.44
|
| Rate for Payer: PacificSource Commercial |
$257.54
|
| Rate for Payer: PHCS PPO |
$280.44
|
| Rate for Payer: Three Rivers PPO |
$214.62
|
| Rate for Payer: TriWest Veterans Administration |
$165.97
|
| Rate for Payer: United Healthcare Commercial |
$248.96
|
| Rate for Payer: United Healthcare Medicare |
$165.97
|
| Rate for Payer: WINHealth Partners Commercial |
$280.44
|
| Rate for Payer: Wise Provider Network Commercial |
$271.85
|
|
|
STAR SLEEVE COMPACT AR-1606C
|
Facility
|
OP
|
$245.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.37
|
| Rate for Payer: Aetna of WY Medicare |
$161.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.47
|
| Rate for Payer: Altius Commercial |
$235.47
|
| Rate for Payer: Beech Street Commercial |
$240.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.37
|
| Rate for Payer: Cash Price |
$171.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.92
|
| Rate for Payer: Cigna of WY Commercial |
$240.37
|
| Rate for Payer: Entrust Commercial |
$233.02
|
| Rate for Payer: First Choice Health Commercial |
$233.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.26
|
| Rate for Payer: HealthUtah PPO |
$245.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.92
|
| Rate for Payer: Multiplan Medicare/VA |
$135.15
|
| Rate for Payer: One Health Plan of WY PPO |
$240.37
|
| Rate for Payer: PacificSource Commercial |
$220.75
|
| Rate for Payer: PHCS PPO |
$240.37
|
| Rate for Payer: Three Rivers PPO |
$183.96
|
| Rate for Payer: TriWest Veterans Administration |
$142.26
|
| Rate for Payer: United Healthcare Commercial |
$213.39
|
| Rate for Payer: United Healthcare Medicare |
$142.26
|
| Rate for Payer: WINHealth Partners Commercial |
$240.37
|
| Rate for Payer: Wise Provider Network Commercial |
$233.02
|
|
|
STAR SLEEVE COMPACT AR-1606C
|
Facility
|
IP
|
$245.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.79 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.47
|
| Rate for Payer: Altius Commercial |
$235.47
|
| Rate for Payer: Beech Street Commercial |
$240.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.37
|
| Rate for Payer: Cash Price |
$171.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.92
|
| Rate for Payer: Cigna of WY Commercial |
$240.37
|
| Rate for Payer: Entrust Commercial |
$233.02
|
| Rate for Payer: First Choice Health Commercial |
$233.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.88
|
| Rate for Payer: HealthUtah PPO |
$245.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.92
|
| Rate for Payer: Multiplan Medicare/VA |
$153.79
|
| Rate for Payer: One Health Plan of WY PPO |
$240.37
|
| Rate for Payer: PacificSource Commercial |
$220.75
|
| Rate for Payer: PHCS PPO |
$240.37
|
| Rate for Payer: Three Rivers PPO |
$183.96
|
| Rate for Payer: TriWest Veterans Administration |
$161.88
|
| Rate for Payer: United Healthcare Commercial |
$213.39
|
| Rate for Payer: United Healthcare Medicare |
$161.88
|
| Rate for Payer: WINHealth Partners Commercial |
$233.02
|
| Rate for Payer: Wise Provider Network Commercial |
$233.02
|
|
|
STATIC OR DYNAMI AFO PRE CST
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
L4396
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$196.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$196.03
|
| Rate for Payer: Beech Street Commercial |
$103.55
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: First Choice Health Commercial |
$98.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.03
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$166.63
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$103.55
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$196.03
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$196.03
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
|
|
STATLOCK PICC PLUS
|
Facility
|
OP
|
$13.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$13.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.98
|
| Rate for Payer: Aetna of WY Medicare |
$8.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.72
|
| Rate for Payer: Altius Commercial |
$12.72
|
| Rate for Payer: Beech Street Commercial |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.85
|
| Rate for Payer: Cigna of WY Commercial |
$12.98
|
| Rate for Payer: Entrust Commercial |
$12.59
|
| Rate for Payer: First Choice Health Commercial |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.68
|
| Rate for Payer: HealthUtah PPO |
$13.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.85
|
| Rate for Payer: Multiplan Medicare/VA |
$7.30
|
| Rate for Payer: One Health Plan of WY PPO |
$12.98
|
| Rate for Payer: PacificSource Commercial |
$11.92
|
| Rate for Payer: PHCS PPO |
$12.98
|
| Rate for Payer: Three Rivers PPO |
$9.94
|
| Rate for Payer: TriWest Veterans Administration |
$7.68
|
| Rate for Payer: United Healthcare Commercial |
$11.53
|
| Rate for Payer: United Healthcare Medicare |
$7.68
|
| Rate for Payer: WINHealth Partners Commercial |
$12.98
|
| Rate for Payer: Wise Provider Network Commercial |
$12.59
|
|
|
STATLOCK PICC PLUS
|
Facility
|
IP
|
$13.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$13.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.72
|
| Rate for Payer: Altius Commercial |
$12.72
|
| Rate for Payer: Beech Street Commercial |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.85
|
| Rate for Payer: Cigna of WY Commercial |
$12.98
|
| Rate for Payer: Entrust Commercial |
$12.59
|
| Rate for Payer: First Choice Health Commercial |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.74
|
| Rate for Payer: HealthUtah PPO |
$13.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.31
|
| Rate for Payer: One Health Plan of WY PPO |
$12.98
|
| Rate for Payer: PacificSource Commercial |
$11.92
|
| Rate for Payer: PHCS PPO |
$12.98
|
| Rate for Payer: Three Rivers PPO |
$9.94
|
| Rate for Payer: TriWest Veterans Administration |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$11.53
|
| Rate for Payer: United Healthcare Medicare |
$8.74
|
| Rate for Payer: WINHealth Partners Commercial |
$12.59
|
| Rate for Payer: Wise Provider Network Commercial |
$12.59
|
|
