|
STATLOCK STABILITY ARTERIAL ULT TRICOT
|
Facility
|
OP
|
$10.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.59
|
| Rate for Payer: Aetna of WY Medicare |
$7.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.38
|
| Rate for Payer: Altius Commercial |
$10.38
|
| Rate for Payer: Beech Street Commercial |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.88
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.49
|
| Rate for Payer: Cigna of WY Commercial |
$10.59
|
| Rate for Payer: Entrust Commercial |
$10.27
|
| Rate for Payer: First Choice Health Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.27
|
| Rate for Payer: HealthUtah PPO |
$10.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.49
|
| Rate for Payer: Multiplan Medicare/VA |
$5.96
|
| Rate for Payer: One Health Plan of WY PPO |
$10.59
|
| Rate for Payer: PacificSource Commercial |
$9.73
|
| Rate for Payer: PHCS PPO |
$10.59
|
| Rate for Payer: Three Rivers PPO |
$8.11
|
| Rate for Payer: TriWest Veterans Administration |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
| Rate for Payer: United Healthcare Medicare |
$6.27
|
| Rate for Payer: WINHealth Partners Commercial |
$10.59
|
| Rate for Payer: Wise Provider Network Commercial |
$10.27
|
|
|
STATLOCK STABILITY ARTERIAL ULT TRICOT
|
Facility
|
IP
|
$10.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.38
|
| Rate for Payer: Altius Commercial |
$10.38
|
| Rate for Payer: Beech Street Commercial |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.88
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.49
|
| Rate for Payer: Cigna of WY Commercial |
$10.59
|
| Rate for Payer: Entrust Commercial |
$10.27
|
| Rate for Payer: First Choice Health Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.13
|
| Rate for Payer: HealthUtah PPO |
$10.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.49
|
| Rate for Payer: Multiplan Medicare/VA |
$6.78
|
| Rate for Payer: One Health Plan of WY PPO |
$10.59
|
| Rate for Payer: PacificSource Commercial |
$9.73
|
| Rate for Payer: PHCS PPO |
$10.59
|
| Rate for Payer: Three Rivers PPO |
$8.11
|
| Rate for Payer: TriWest Veterans Administration |
$7.13
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
| Rate for Payer: United Healthcare Medicare |
$7.13
|
| Rate for Payer: WINHealth Partners Commercial |
$10.27
|
| Rate for Payer: Wise Provider Network Commercial |
$10.27
|
|
|
STAYFIX CATH FASTNER SM 680ME
|
Facility
|
IP
|
$26.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.00
|
| Rate for Payer: Altius Commercial |
$25.00
|
| Rate for Payer: Beech Street Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.38
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.26
|
| Rate for Payer: Cigna of WY Commercial |
$25.52
|
| Rate for Payer: Entrust Commercial |
$24.74
|
| Rate for Payer: First Choice Health Commercial |
$24.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.19
|
| Rate for Payer: HealthUtah PPO |
$26.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.26
|
| Rate for Payer: Multiplan Medicare/VA |
$16.33
|
| Rate for Payer: One Health Plan of WY PPO |
$25.52
|
| Rate for Payer: PacificSource Commercial |
$23.44
|
| Rate for Payer: PHCS PPO |
$25.52
|
| Rate for Payer: Three Rivers PPO |
$19.53
|
| Rate for Payer: TriWest Veterans Administration |
$17.19
|
| Rate for Payer: United Healthcare Commercial |
$22.65
|
| Rate for Payer: United Healthcare Medicare |
$17.19
|
| Rate for Payer: WINHealth Partners Commercial |
$24.74
|
| Rate for Payer: Wise Provider Network Commercial |
$24.74
|
|
|
STAYFIX CATH FASTNER SM 680ME
|
Facility
|
OP
|
$26.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.52
|
| Rate for Payer: Aetna of WY Medicare |
$17.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.00
|
| Rate for Payer: Altius Commercial |
$25.00
|
| Rate for Payer: Beech Street Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.38
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.26
|
| Rate for Payer: Cigna of WY Commercial |
$25.52
|
| Rate for Payer: Entrust Commercial |
$24.74
|
| Rate for Payer: First Choice Health Commercial |
$24.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.10
|
| Rate for Payer: HealthUtah PPO |
$26.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.26
|
| Rate for Payer: Multiplan Medicare/VA |
$14.35
|
| Rate for Payer: One Health Plan of WY PPO |
$25.52
|
| Rate for Payer: PacificSource Commercial |
$23.44
|
| Rate for Payer: PHCS PPO |
$25.52
|
| Rate for Payer: Three Rivers PPO |
$19.53
|
| Rate for Payer: TriWest Veterans Administration |
$15.10
|
| Rate for Payer: United Healthcare Commercial |
$22.65
|
| Rate for Payer: United Healthcare Medicare |
$15.10
|
| Rate for Payer: WINHealth Partners Commercial |
$25.52
|
| Rate for Payer: Wise Provider Network Commercial |
$24.74
|
|
|
STEINMANN PIN 3.2
|
Facility
|
OP
|
$51.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.42
|
| Rate for Payer: Aetna of WY Medicare |
$33.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.39
|
| Rate for Payer: Altius Commercial |
$49.39
|
| Rate for Payer: Beech Street Commercial |
$50.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.24
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.91
|
| Rate for Payer: Cigna of WY Commercial |
$50.42
|
| Rate for Payer: Entrust Commercial |
$48.88
|
| Rate for Payer: First Choice Health Commercial |
$48.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.84
|
| Rate for Payer: HealthUtah PPO |
$51.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.91
|
| Rate for Payer: Multiplan Medicare/VA |
$28.35
|
| Rate for Payer: One Health Plan of WY PPO |
$50.42
|
| Rate for Payer: PacificSource Commercial |
$46.30
|
| Rate for Payer: PHCS PPO |
$50.42
|
| Rate for Payer: Three Rivers PPO |
$38.59
|
| Rate for Payer: TriWest Veterans Administration |
$29.84
|
| Rate for Payer: United Healthcare Commercial |
$44.76
|
| Rate for Payer: United Healthcare Medicare |
$29.84
|
| Rate for Payer: WINHealth Partners Commercial |
$50.42
|
| Rate for Payer: Wise Provider Network Commercial |
$48.88
|
|
|
STEINMANN PIN 3.2
|
Facility
|
IP
|
$51.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$51.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.39
|
| Rate for Payer: Altius Commercial |
$49.39
|
| Rate for Payer: Beech Street Commercial |
$50.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.24
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.91
|
| Rate for Payer: Cigna of WY Commercial |
$50.42
|
| Rate for Payer: Entrust Commercial |
$48.88
|
| Rate for Payer: First Choice Health Commercial |
$48.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.96
|
| Rate for Payer: HealthUtah PPO |
$51.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.91
|
| Rate for Payer: Multiplan Medicare/VA |
$32.26
|
| Rate for Payer: One Health Plan of WY PPO |
$50.42
|
| Rate for Payer: PacificSource Commercial |
$46.30
|
| Rate for Payer: PHCS PPO |
$50.42
|
| Rate for Payer: Three Rivers PPO |
$38.59
|
| Rate for Payer: TriWest Veterans Administration |
$33.96
|
| Rate for Payer: United Healthcare Commercial |
$44.76
|
| Rate for Payer: United Healthcare Medicare |
$33.96
|
| Rate for Payer: WINHealth Partners Commercial |
$48.88
|
| Rate for Payer: Wise Provider Network Commercial |
$48.88
|
|
|
STENT 6X24 DBL PIGTAIL
|
Facility
|
OP
|
$185.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.93
|
| Rate for Payer: Aetna of WY Medicare |
$122.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.21
|
| Rate for Payer: Altius Commercial |
$178.21
|
| Rate for Payer: Beech Street Commercial |
$181.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.41
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.07
|
| Rate for Payer: Cigna of WY Commercial |
$181.93
|
| Rate for Payer: Entrust Commercial |
$176.36
|
| Rate for Payer: First Choice Health Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.67
|
| Rate for Payer: HealthUtah PPO |
$185.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.07
|
| Rate for Payer: Multiplan Medicare/VA |
$102.29
|
| Rate for Payer: One Health Plan of WY PPO |
$181.93
|
| Rate for Payer: PacificSource Commercial |
$167.08
|
| Rate for Payer: PHCS PPO |
$181.93
|
| Rate for Payer: Three Rivers PPO |
$139.23
|
| Rate for Payer: TriWest Veterans Administration |
$107.67
|
| Rate for Payer: United Healthcare Commercial |
$161.51
|
| Rate for Payer: United Healthcare Medicare |
$107.67
|
| Rate for Payer: WINHealth Partners Commercial |
$181.93
|
| Rate for Payer: Wise Provider Network Commercial |
$176.36
|
|
|
STENT 6X24 DBL PIGTAIL
|
Facility
|
IP
|
$185.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.21
|
| Rate for Payer: Altius Commercial |
$178.21
|
| Rate for Payer: Beech Street Commercial |
$181.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.41
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.07
|
| Rate for Payer: Cigna of WY Commercial |
$181.93
|
| Rate for Payer: Entrust Commercial |
$176.36
|
| Rate for Payer: First Choice Health Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.52
|
| Rate for Payer: HealthUtah PPO |
$185.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.07
|
| Rate for Payer: Multiplan Medicare/VA |
$116.40
|
| Rate for Payer: One Health Plan of WY PPO |
$181.93
|
| Rate for Payer: PacificSource Commercial |
$167.08
|
| Rate for Payer: PHCS PPO |
$181.93
|
| Rate for Payer: Three Rivers PPO |
$139.23
|
| Rate for Payer: TriWest Veterans Administration |
$122.52
|
| Rate for Payer: United Healthcare Commercial |
$161.51
|
| Rate for Payer: United Healthcare Medicare |
$122.52
|
| Rate for Payer: WINHealth Partners Commercial |
$176.36
|
| Rate for Payer: Wise Provider Network Commercial |
$176.36
|
|
|
STENT 6X26 DBL PIGTAIL
|
Facility
|
IP
|
$185.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.21
|
| Rate for Payer: Altius Commercial |
$178.21
|
| Rate for Payer: Beech Street Commercial |
$181.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.41
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.07
|
| Rate for Payer: Cigna of WY Commercial |
$181.93
|
| Rate for Payer: Entrust Commercial |
$176.36
|
| Rate for Payer: First Choice Health Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.52
|
| Rate for Payer: HealthUtah PPO |
$185.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.07
|
| Rate for Payer: Multiplan Medicare/VA |
$116.40
|
| Rate for Payer: One Health Plan of WY PPO |
$181.93
|
| Rate for Payer: PacificSource Commercial |
$167.08
|
| Rate for Payer: PHCS PPO |
$181.93
|
| Rate for Payer: Three Rivers PPO |
$139.23
|
| Rate for Payer: TriWest Veterans Administration |
$122.52
|
| Rate for Payer: United Healthcare Commercial |
$161.51
|
| Rate for Payer: United Healthcare Medicare |
$122.52
|
| Rate for Payer: WINHealth Partners Commercial |
$176.36
|
| Rate for Payer: Wise Provider Network Commercial |
$176.36
|
|
|
STENT 6X26 DBL PIGTAIL
|
Facility
|
OP
|
$185.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.93
|
| Rate for Payer: Aetna of WY Medicare |
$122.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.21
|
| Rate for Payer: Altius Commercial |
$178.21
|
| Rate for Payer: Beech Street Commercial |
$181.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.41
|
| Rate for Payer: Cash Price |
$129.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.07
|
| Rate for Payer: Cigna of WY Commercial |
$181.93
|
| Rate for Payer: Entrust Commercial |
$176.36
|
| Rate for Payer: First Choice Health Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.67
|
| Rate for Payer: HealthUtah PPO |
$185.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.07
|
| Rate for Payer: Multiplan Medicare/VA |
$102.29
|
| Rate for Payer: One Health Plan of WY PPO |
$181.93
|
| Rate for Payer: PacificSource Commercial |
$167.08
|
| Rate for Payer: PHCS PPO |
$181.93
|
| Rate for Payer: Three Rivers PPO |
$139.23
|
| Rate for Payer: TriWest Veterans Administration |
$107.67
|
| Rate for Payer: United Healthcare Commercial |
$161.51
|
| Rate for Payer: United Healthcare Medicare |
$107.67
|
| Rate for Payer: WINHealth Partners Commercial |
$181.93
|
| Rate for Payer: Wise Provider Network Commercial |
$176.36
|
|
|
STENT 6 X 28 DBL PIGTALE
|
Facility
|
OP
|
$224.07
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.59
|
| Rate for Payer: Aetna of WY Medicare |
$147.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.11
|
| Rate for Payer: Altius Commercial |
$215.11
|
| Rate for Payer: Beech Street Commercial |
$219.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$183.96
|
| Rate for Payer: Cash Price |
$156.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.35
|
| Rate for Payer: Cigna of WY Commercial |
$219.59
|
| Rate for Payer: Entrust Commercial |
$212.87
|
| Rate for Payer: First Choice Health Commercial |
$212.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$224.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.35
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$219.59
|
| Rate for Payer: PacificSource Commercial |
$201.66
|
| Rate for Payer: PHCS PPO |
$219.59
|
| Rate for Payer: Three Rivers PPO |
$168.05
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$194.94
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$219.59
|
| Rate for Payer: Wise Provider Network Commercial |
$212.87
|
|
|
STENT 6 X 28 DBL PIGTALE
|
Facility
|
IP
|
$224.07
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.49 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.11
|
| Rate for Payer: Altius Commercial |
$215.11
|
| Rate for Payer: Beech Street Commercial |
$219.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$183.96
|
| Rate for Payer: Cash Price |
$156.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.35
|
| Rate for Payer: Cigna of WY Commercial |
$219.59
|
| Rate for Payer: Entrust Commercial |
$212.87
|
| Rate for Payer: First Choice Health Commercial |
$212.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.89
|
| Rate for Payer: HealthUtah PPO |
$224.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.49
|
| Rate for Payer: One Health Plan of WY PPO |
$219.59
|
| Rate for Payer: PacificSource Commercial |
$201.66
|
| Rate for Payer: PHCS PPO |
$219.59
|
| Rate for Payer: Three Rivers PPO |
$168.05
|
| Rate for Payer: TriWest Veterans Administration |
$147.89
|
| Rate for Payer: United Healthcare Commercial |
$194.94
|
| Rate for Payer: United Healthcare Medicare |
$147.89
|
| Rate for Payer: WINHealth Partners Commercial |
$212.87
|
| Rate for Payer: Wise Provider Network Commercial |
$212.87
|
|
|
STENT URETERAL 7 FR X 24 CM
|
Facility
|
IP
|
$237.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.99 |
| Max. Negotiated Rate |
$237.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$232.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$228.12
|
| Rate for Payer: Altius Commercial |
$228.12
|
| Rate for Payer: Beech Street Commercial |
$232.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.09
|
| Rate for Payer: Cash Price |
$166.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.49
|
| Rate for Payer: Cigna of WY Commercial |
$232.87
|
| Rate for Payer: Entrust Commercial |
$225.74
|
| Rate for Payer: First Choice Health Commercial |
$225.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$225.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.83
|
| Rate for Payer: HealthUtah PPO |
$237.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.49
|
| Rate for Payer: Multiplan Medicare/VA |
$148.99
|
| Rate for Payer: One Health Plan of WY PPO |
$232.87
|
| Rate for Payer: PacificSource Commercial |
$213.86
|
| Rate for Payer: PHCS PPO |
$232.87
|
| Rate for Payer: Three Rivers PPO |
$178.22
|
| Rate for Payer: TriWest Veterans Administration |
$156.83
|
| Rate for Payer: United Healthcare Commercial |
$206.73
|
| Rate for Payer: United Healthcare Medicare |
$156.83
|
| Rate for Payer: WINHealth Partners Commercial |
$225.74
|
| Rate for Payer: Wise Provider Network Commercial |
$225.74
|
|
|
STENT URETERAL 7 FR X 24 CM
|
Facility
|
OP
|
$237.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.93 |
| Max. Negotiated Rate |
$237.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$232.87
|
| Rate for Payer: Aetna of WY Medicare |
$156.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$228.12
|
| Rate for Payer: Altius Commercial |
$228.12
|
| Rate for Payer: Beech Street Commercial |
$232.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.09
|
| Rate for Payer: Cash Price |
$166.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.49
|
| Rate for Payer: Cigna of WY Commercial |
$232.87
|
| Rate for Payer: Entrust Commercial |
$225.74
|
| Rate for Payer: First Choice Health Commercial |
$225.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$225.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$137.82
|
| Rate for Payer: HealthUtah PPO |
$237.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.49
|
| Rate for Payer: Multiplan Medicare/VA |
$130.93
|
| Rate for Payer: One Health Plan of WY PPO |
$232.87
|
| Rate for Payer: PacificSource Commercial |
$213.86
|
| Rate for Payer: PHCS PPO |
$232.87
|
| Rate for Payer: Three Rivers PPO |
$178.22
|
| Rate for Payer: TriWest Veterans Administration |
$137.82
|
| Rate for Payer: United Healthcare Commercial |
$206.73
|
| Rate for Payer: United Healthcare Medicare |
$137.82
|
| Rate for Payer: WINHealth Partners Commercial |
$232.87
|
| Rate for Payer: Wise Provider Network Commercial |
$225.74
|
|
|
STENT URETERAL 7 FR X 26 CM
|
Facility
|
OP
|
$228.48
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.91
|
| Rate for Payer: Aetna of WY Medicare |
$150.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$219.34
|
| Rate for Payer: Altius Commercial |
$219.34
|
| Rate for Payer: Beech Street Commercial |
$223.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.58
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.63
|
| Rate for Payer: Cigna of WY Commercial |
$223.91
|
| Rate for Payer: Entrust Commercial |
$217.06
|
| Rate for Payer: First Choice Health Commercial |
$217.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.52
|
| Rate for Payer: HealthUtah PPO |
$228.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.63
|
| Rate for Payer: Multiplan Medicare/VA |
$125.89
|
| Rate for Payer: One Health Plan of WY PPO |
$223.91
|
| Rate for Payer: PacificSource Commercial |
$205.63
|
| Rate for Payer: PHCS PPO |
$223.91
|
| Rate for Payer: Three Rivers PPO |
$171.36
|
| Rate for Payer: TriWest Veterans Administration |
$132.52
|
| Rate for Payer: United Healthcare Commercial |
$198.78
|
| Rate for Payer: United Healthcare Medicare |
$132.52
|
| Rate for Payer: WINHealth Partners Commercial |
$223.91
|
| Rate for Payer: Wise Provider Network Commercial |
$217.06
|
|
|
STENT URETERAL 7 FR X 26 CM
|
Facility
|
IP
|
$228.48
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$219.34
|
| Rate for Payer: Altius Commercial |
$219.34
|
| Rate for Payer: Beech Street Commercial |
$223.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.58
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.63
|
| Rate for Payer: Cigna of WY Commercial |
$223.91
|
| Rate for Payer: Entrust Commercial |
$217.06
|
| Rate for Payer: First Choice Health Commercial |
$217.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$228.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.63
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$223.91
|
| Rate for Payer: PacificSource Commercial |
$205.63
|
| Rate for Payer: PHCS PPO |
$223.91
|
| Rate for Payer: Three Rivers PPO |
$171.36
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$198.78
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$217.06
|
| Rate for Payer: Wise Provider Network Commercial |
$217.06
|
|
|
STOCKINET IMPERVIOUS 12"X48"
|
Facility
|
IP
|
$11.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.46
|
| Rate for Payer: Altius Commercial |
$11.46
|
| Rate for Payer: Beech Street Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.58
|
| Rate for Payer: Cigna of WY Commercial |
$11.70
|
| Rate for Payer: Entrust Commercial |
$11.34
|
| Rate for Payer: First Choice Health Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.88
|
| Rate for Payer: HealthUtah PPO |
$11.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.58
|
| Rate for Payer: Multiplan Medicare/VA |
$7.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.70
|
| Rate for Payer: PacificSource Commercial |
$10.75
|
| Rate for Payer: PHCS PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$8.96
|
| Rate for Payer: TriWest Veterans Administration |
$7.88
|
| Rate for Payer: United Healthcare Commercial |
$10.39
|
| Rate for Payer: United Healthcare Medicare |
$7.88
|
| Rate for Payer: WINHealth Partners Commercial |
$11.34
|
| Rate for Payer: Wise Provider Network Commercial |
$11.34
|
|
|
STOCKINET IMPERVIOUS 12"X48"
|
Facility
|
OP
|
$11.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.70
|
| Rate for Payer: Aetna of WY Medicare |
$7.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.46
|
| Rate for Payer: Altius Commercial |
$11.46
|
| Rate for Payer: Beech Street Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.58
|
| Rate for Payer: Cigna of WY Commercial |
$11.70
|
| Rate for Payer: Entrust Commercial |
$11.34
|
| Rate for Payer: First Choice Health Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.93
|
| Rate for Payer: HealthUtah PPO |
$11.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.58
|
| Rate for Payer: Multiplan Medicare/VA |
$6.58
|
| Rate for Payer: One Health Plan of WY PPO |
$11.70
|
| Rate for Payer: PacificSource Commercial |
$10.75
|
| Rate for Payer: PHCS PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$8.96
|
| Rate for Payer: TriWest Veterans Administration |
$6.93
|
| Rate for Payer: United Healthcare Commercial |
$10.39
|
| Rate for Payer: United Healthcare Medicare |
$6.93
|
| Rate for Payer: WINHealth Partners Commercial |
$11.70
|
| Rate for Payer: Wise Provider Network Commercial |
$11.34
|
|
|
STOCKINET IMPERVIOUS STERILE 9"X36"
|
Facility
|
OP
|
$9.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.94
|
| Rate for Payer: Aetna of WY Medicare |
$6.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.76
|
| Rate for Payer: Altius Commercial |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.85
|
| Rate for Payer: Cigna of WY Commercial |
$8.94
|
| Rate for Payer: Entrust Commercial |
$8.66
|
| Rate for Payer: First Choice Health Commercial |
$8.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.29
|
| Rate for Payer: HealthUtah PPO |
$9.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.85
|
| Rate for Payer: Multiplan Medicare/VA |
$5.03
|
| Rate for Payer: One Health Plan of WY PPO |
$8.94
|
| Rate for Payer: PacificSource Commercial |
$8.21
|
| Rate for Payer: PHCS PPO |
$8.94
|
| Rate for Payer: Three Rivers PPO |
$6.84
|
| Rate for Payer: TriWest Veterans Administration |
$5.29
|
| Rate for Payer: United Healthcare Commercial |
$7.93
|
| Rate for Payer: United Healthcare Medicare |
$5.29
|
| Rate for Payer: WINHealth Partners Commercial |
$8.94
|
| Rate for Payer: Wise Provider Network Commercial |
$8.66
|
|
|
STOCKINET IMPERVIOUS STERILE 9"X36"
|
Facility
|
IP
|
$9.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.76
|
| Rate for Payer: Altius Commercial |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.85
|
| Rate for Payer: Cigna of WY Commercial |
$8.94
|
| Rate for Payer: Entrust Commercial |
$8.66
|
| Rate for Payer: First Choice Health Commercial |
$8.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.02
|
| Rate for Payer: HealthUtah PPO |
$9.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.85
|
| Rate for Payer: Multiplan Medicare/VA |
$5.72
|
| Rate for Payer: One Health Plan of WY PPO |
$8.94
|
| Rate for Payer: PacificSource Commercial |
$8.21
|
| Rate for Payer: PHCS PPO |
$8.94
|
| Rate for Payer: Three Rivers PPO |
$6.84
|
| Rate for Payer: TriWest Veterans Administration |
$6.02
|
| Rate for Payer: United Healthcare Commercial |
$7.93
|
| Rate for Payer: United Healthcare Medicare |
$6.02
|
| Rate for Payer: WINHealth Partners Commercial |
$8.66
|
| Rate for Payer: Wise Provider Network Commercial |
$8.66
|
|
|
STORZ C-MAC S LARYNGOSCOPE D-BLADE
|
Facility
|
IP
|
$50.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.45
|
| Rate for Payer: Altius Commercial |
$48.45
|
| Rate for Payer: Beech Street Commercial |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.44
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.96
|
| Rate for Payer: Cigna of WY Commercial |
$49.46
|
| Rate for Payer: Entrust Commercial |
$47.95
|
| Rate for Payer: First Choice Health Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.31
|
| Rate for Payer: HealthUtah PPO |
$50.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.96
|
| Rate for Payer: Multiplan Medicare/VA |
$31.64
|
| Rate for Payer: One Health Plan of WY PPO |
$49.46
|
| Rate for Payer: PacificSource Commercial |
$45.42
|
| Rate for Payer: PHCS PPO |
$49.46
|
| Rate for Payer: Three Rivers PPO |
$37.85
|
| Rate for Payer: TriWest Veterans Administration |
$33.31
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicare |
$33.31
|
| Rate for Payer: WINHealth Partners Commercial |
$47.95
|
| Rate for Payer: Wise Provider Network Commercial |
$47.95
|
|
|
STORZ C-MAC S LARYNGOSCOPE D-BLADE
|
Facility
|
OP
|
$50.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.46
|
| Rate for Payer: Aetna of WY Medicare |
$33.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.45
|
| Rate for Payer: Altius Commercial |
$48.45
|
| Rate for Payer: Beech Street Commercial |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.44
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.96
|
| Rate for Payer: Cigna of WY Commercial |
$49.46
|
| Rate for Payer: Entrust Commercial |
$47.95
|
| Rate for Payer: First Choice Health Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.27
|
| Rate for Payer: HealthUtah PPO |
$50.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.96
|
| Rate for Payer: Multiplan Medicare/VA |
$27.81
|
| Rate for Payer: One Health Plan of WY PPO |
$49.46
|
| Rate for Payer: PacificSource Commercial |
$45.42
|
| Rate for Payer: PHCS PPO |
$49.46
|
| Rate for Payer: Three Rivers PPO |
$37.85
|
| Rate for Payer: TriWest Veterans Administration |
$29.27
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicare |
$29.27
|
| Rate for Payer: WINHealth Partners Commercial |
$49.46
|
| Rate for Payer: Wise Provider Network Commercial |
$47.95
|
|
|
STORZ C-MAC S LARYNGOSCOPE MAC #4
|
Facility
|
IP
|
$50.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.45
|
| Rate for Payer: Altius Commercial |
$48.45
|
| Rate for Payer: Beech Street Commercial |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.44
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.96
|
| Rate for Payer: Cigna of WY Commercial |
$49.46
|
| Rate for Payer: Entrust Commercial |
$47.95
|
| Rate for Payer: First Choice Health Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.31
|
| Rate for Payer: HealthUtah PPO |
$50.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.96
|
| Rate for Payer: Multiplan Medicare/VA |
$31.64
|
| Rate for Payer: One Health Plan of WY PPO |
$49.46
|
| Rate for Payer: PacificSource Commercial |
$45.42
|
| Rate for Payer: PHCS PPO |
$49.46
|
| Rate for Payer: Three Rivers PPO |
$37.85
|
| Rate for Payer: TriWest Veterans Administration |
$33.31
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicare |
$33.31
|
| Rate for Payer: WINHealth Partners Commercial |
$47.95
|
| Rate for Payer: Wise Provider Network Commercial |
$47.95
|
|
|
STORZ C-MAC S LARYNGOSCOPE MAC #4
|
Facility
|
OP
|
$50.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.46
|
| Rate for Payer: Aetna of WY Medicare |
$33.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.45
|
| Rate for Payer: Altius Commercial |
$48.45
|
| Rate for Payer: Beech Street Commercial |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.44
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.96
|
| Rate for Payer: Cigna of WY Commercial |
$49.46
|
| Rate for Payer: Entrust Commercial |
$47.95
|
| Rate for Payer: First Choice Health Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.27
|
| Rate for Payer: HealthUtah PPO |
$50.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.96
|
| Rate for Payer: Multiplan Medicare/VA |
$27.81
|
| Rate for Payer: One Health Plan of WY PPO |
$49.46
|
| Rate for Payer: PacificSource Commercial |
$45.42
|
| Rate for Payer: PHCS PPO |
$49.46
|
| Rate for Payer: Three Rivers PPO |
$37.85
|
| Rate for Payer: TriWest Veterans Administration |
$29.27
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicare |
$29.27
|
| Rate for Payer: WINHealth Partners Commercial |
$49.46
|
| Rate for Payer: Wise Provider Network Commercial |
$47.95
|
|
|
STORZ SCOPE INTUB FLEX 3.5 X 65
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.35 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$905.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$887.04
|
| Rate for Payer: Altius Commercial |
$887.04
|
| Rate for Payer: Beech Street Commercial |
$905.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$758.60
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$896.28
|
| Rate for Payer: Cigna of WY Commercial |
$905.52
|
| Rate for Payer: Entrust Commercial |
$877.80
|
| Rate for Payer: First Choice Health Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.84
|
| Rate for Payer: HealthUtah PPO |
$924.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$896.28
|
| Rate for Payer: Multiplan Medicare/VA |
$579.35
|
| Rate for Payer: One Health Plan of WY PPO |
$905.52
|
| Rate for Payer: PacificSource Commercial |
$831.60
|
| Rate for Payer: PHCS PPO |
$905.52
|
| Rate for Payer: Three Rivers PPO |
$693.00
|
| Rate for Payer: TriWest Veterans Administration |
$609.84
|
| Rate for Payer: United Healthcare Commercial |
$803.88
|
| Rate for Payer: United Healthcare Medicare |
$609.84
|
| Rate for Payer: WINHealth Partners Commercial |
$877.80
|
| Rate for Payer: Wise Provider Network Commercial |
$877.80
|
|
