|
STORZ SCOPE INTUB FLEX 3.5 X 65
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.12 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$905.52
|
| Rate for Payer: Aetna of WY Medicare |
$609.84
|
| 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 |
$535.92
|
| Rate for Payer: HealthUtah PPO |
$924.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$896.28
|
| Rate for Payer: Multiplan Medicare/VA |
$509.12
|
| 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 |
$535.92
|
| Rate for Payer: United Healthcare Commercial |
$803.88
|
| Rate for Payer: United Healthcare Medicare |
$535.92
|
| Rate for Payer: WINHealth Partners Commercial |
$905.52
|
| Rate for Payer: Wise Provider Network Commercial |
$877.80
|
|
|
STORZ SCOPE INTUB FLEX 5.3 X 65
|
Facility
|
OP
|
$953.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.27 |
| Max. Negotiated Rate |
$953.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$934.24
|
| Rate for Payer: Aetna of WY Medicare |
$629.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$915.18
|
| Rate for Payer: Altius Commercial |
$915.18
|
| Rate for Payer: Beech Street Commercial |
$934.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$782.67
|
| Rate for Payer: Cash Price |
$667.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$924.71
|
| Rate for Payer: Cigna of WY Commercial |
$934.24
|
| Rate for Payer: Entrust Commercial |
$905.64
|
| Rate for Payer: First Choice Health Commercial |
$905.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$905.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.92
|
| Rate for Payer: HealthUtah PPO |
$953.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$924.71
|
| Rate for Payer: Multiplan Medicare/VA |
$525.27
|
| Rate for Payer: One Health Plan of WY PPO |
$934.24
|
| Rate for Payer: PacificSource Commercial |
$857.98
|
| Rate for Payer: PHCS PPO |
$934.24
|
| Rate for Payer: Three Rivers PPO |
$714.98
|
| Rate for Payer: TriWest Veterans Administration |
$552.92
|
| Rate for Payer: United Healthcare Commercial |
$829.38
|
| Rate for Payer: United Healthcare Medicare |
$552.92
|
| Rate for Payer: WINHealth Partners Commercial |
$934.24
|
| Rate for Payer: Wise Provider Network Commercial |
$905.64
|
|
|
STORZ SCOPE INTUB FLEX 5.3 X 65
|
Facility
|
IP
|
$953.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.73 |
| Max. Negotiated Rate |
$953.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$934.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$915.18
|
| Rate for Payer: Altius Commercial |
$915.18
|
| Rate for Payer: Beech Street Commercial |
$934.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$782.67
|
| Rate for Payer: Cash Price |
$667.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$924.71
|
| Rate for Payer: Cigna of WY Commercial |
$934.24
|
| Rate for Payer: Entrust Commercial |
$905.64
|
| Rate for Payer: First Choice Health Commercial |
$905.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$905.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.18
|
| Rate for Payer: HealthUtah PPO |
$953.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$924.71
|
| Rate for Payer: Multiplan Medicare/VA |
$597.73
|
| Rate for Payer: One Health Plan of WY PPO |
$934.24
|
| Rate for Payer: PacificSource Commercial |
$857.98
|
| Rate for Payer: PHCS PPO |
$934.24
|
| Rate for Payer: Three Rivers PPO |
$714.98
|
| Rate for Payer: TriWest Veterans Administration |
$629.18
|
| Rate for Payer: United Healthcare Commercial |
$829.38
|
| Rate for Payer: United Healthcare Medicare |
$629.18
|
| Rate for Payer: WINHealth Partners Commercial |
$905.64
|
| Rate for Payer: Wise Provider Network Commercial |
$905.64
|
|
|
STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 59525 AS
|
| Hospital Charge Code |
59525
|
| Min. Negotiated Rate |
$382.87 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,424.92
|
| Rate for Payer: Aetna of WY Medicare |
$450.44
|
| Rate for Payer: Beech Street Commercial |
$1,381.30
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,410.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,424.92
|
| Rate for Payer: First Choice Health Commercial |
$1,308.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,381.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.44
|
| Rate for Payer: HealthUtah PPO |
$1,454.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,410.38
|
| Rate for Payer: Multiplan Medicare/VA |
$382.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,424.92
|
| Rate for Payer: PacificSource Commercial |
$1,308.60
|
| Rate for Payer: PHCS PPO |
$1,381.30
|
| Rate for Payer: Three Rivers PPO |
$1,090.50
|
| Rate for Payer: TriWest Veterans Administration |
$450.44
|
| Rate for Payer: United Healthcare Commercial |
$1,264.98
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.90
|
|
|
STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 59525
|
| Hospital Charge Code |
59525
|
| Min. Negotiated Rate |
$382.87 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,424.92
|
| Rate for Payer: Aetna of WY Medicare |
$450.44
|
| Rate for Payer: Beech Street Commercial |
$1,381.30
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,410.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,424.92
|
| Rate for Payer: First Choice Health Commercial |
$1,308.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,381.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.44
|
| Rate for Payer: HealthUtah PPO |
$1,454.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,410.38
|
| Rate for Payer: Multiplan Medicare/VA |
$382.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,424.92
|
| Rate for Payer: PacificSource Commercial |
$1,308.60
|
| Rate for Payer: PHCS PPO |
$1,381.30
|
| Rate for Payer: Three Rivers PPO |
$1,090.50
|
| Rate for Payer: TriWest Veterans Administration |
$450.44
|
| Rate for Payer: United Healthcare Commercial |
$1,264.98
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.90
|
|
|
STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 59525 80
|
| Hospital Charge Code |
59525
|
| Min. Negotiated Rate |
$382.87 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,424.92
|
| Rate for Payer: Aetna of WY Medicare |
$450.44
|
| Rate for Payer: Beech Street Commercial |
$1,381.30
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: Cash Price |
$1,017.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,410.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,424.92
|
| Rate for Payer: First Choice Health Commercial |
$1,308.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,381.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.44
|
| Rate for Payer: HealthUtah PPO |
$1,454.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,410.38
|
| Rate for Payer: Multiplan Medicare/VA |
$382.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,424.92
|
| Rate for Payer: PacificSource Commercial |
$1,308.60
|
| Rate for Payer: PHCS PPO |
$1,381.30
|
| Rate for Payer: Three Rivers PPO |
$1,090.50
|
| Rate for Payer: TriWest Veterans Administration |
$450.44
|
| Rate for Payer: United Healthcare Commercial |
$1,264.98
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.90
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
29540
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$16.44
|
| Rate for Payer: Beech Street Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: First Choice Health Commercial |
$87.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.44
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$13.97
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$92.15
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.44
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$16.44
|
| Rate for Payer: WINHealth Partners Commercial |
$82.45
|
|
|
STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
29260
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$18.08
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.08
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$15.37
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$18.08
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$18.08
|
| Rate for Payer: WINHealth Partners Commercial |
$86.70
|
|
|
STRAPPING HAND/FINGER
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
29280
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$19.22
|
| Rate for Payer: Beech Street Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: First Choice Health Commercial |
$93.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$16.34
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$98.80
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$19.22
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$19.22
|
| Rate for Payer: WINHealth Partners Commercial |
$88.40
|
|
|
STRAPPING HIP
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
29520
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.58
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$114.95
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.37
|
| Rate for Payer: Cigna of WY Commercial |
$118.58
|
| Rate for Payer: First Choice Health Commercial |
$108.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.37
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$118.58
|
| Rate for Payer: PacificSource Commercial |
$108.90
|
| Rate for Payer: PHCS PPO |
$114.95
|
| Rate for Payer: Three Rivers PPO |
$90.75
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$105.27
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$102.85
|
|
|
STRAPPING KNEE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
29530
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$86.70
|
|
|
STRAPPING SHOULDER
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
29240
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$17.18
|
| Rate for Payer: Beech Street Commercial |
$99.75
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: First Choice Health Commercial |
$94.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.18
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$14.60
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$99.75
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$17.18
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$17.18
|
| Rate for Payer: WINHealth Partners Commercial |
$89.25
|
|
|
STRAPPING TOES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
29550
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$10.63
|
| Rate for Payer: Beech Street Commercial |
$63.65
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: First Choice Health Commercial |
$60.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.63
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$9.04
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$63.65
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.63
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
| Rate for Payer: United Healthcare Medicare |
$10.63
|
| Rate for Payer: WINHealth Partners Commercial |
$56.95
|
|
|
STRAPPING UNNA BOOT
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 29580 50
|
| Hospital Charge Code |
29580
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.26
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$462.65
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.39
|
| Rate for Payer: Cigna of WY Commercial |
$477.26
|
| Rate for Payer: First Choice Health Commercial |
$438.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.39
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$477.26
|
| Rate for Payer: PacificSource Commercial |
$438.30
|
| Rate for Payer: PHCS PPO |
$462.65
|
| Rate for Payer: Three Rivers PPO |
$365.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$423.69
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$413.95
|
|
|
STRAPPING UNNA BOOT
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
29580
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Aetna of WY Medicare |
$24.94
|
| Rate for Payer: Beech Street Commercial |
$230.85
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: First Choice Health Commercial |
$218.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: Multiplan Medicare/VA |
$21.20
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$230.85
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$211.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$206.55
|
|
|
STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
61782
|
| Min. Negotiated Rate |
$139.37 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$878.08
|
| Rate for Payer: Aetna of WY Medicare |
$163.96
|
| Rate for Payer: Beech Street Commercial |
$851.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$869.12
|
| Rate for Payer: Cigna of WY Commercial |
$878.08
|
| Rate for Payer: First Choice Health Commercial |
$806.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$851.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.96
|
| Rate for Payer: HealthUtah PPO |
$896.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$869.12
|
| Rate for Payer: Multiplan Medicare/VA |
$139.37
|
| Rate for Payer: One Health Plan of WY PPO |
$878.08
|
| Rate for Payer: PacificSource Commercial |
$806.40
|
| Rate for Payer: PHCS PPO |
$851.20
|
| Rate for Payer: Three Rivers PPO |
$672.00
|
| Rate for Payer: TriWest Veterans Administration |
$163.96
|
| Rate for Payer: United Healthcare Commercial |
$779.52
|
| Rate for Payer: United Healthcare Medicare |
$163.96
|
| Rate for Payer: WINHealth Partners Commercial |
$761.60
|
|
|
STRYKER 70MM BLD COAT & INSUL
|
Facility
|
IP
|
$13.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.04
|
| Rate for Payer: Altius Commercial |
$13.04
|
| Rate for Payer: Beech Street Commercial |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.15
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.17
|
| Rate for Payer: Cigna of WY Commercial |
$13.31
|
| Rate for Payer: Entrust Commercial |
$12.90
|
| Rate for Payer: First Choice Health Commercial |
$12.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.96
|
| Rate for Payer: HealthUtah PPO |
$13.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.17
|
| Rate for Payer: Multiplan Medicare/VA |
$8.51
|
| Rate for Payer: One Health Plan of WY PPO |
$13.31
|
| Rate for Payer: PacificSource Commercial |
$12.22
|
| Rate for Payer: PHCS PPO |
$13.31
|
| Rate for Payer: Three Rivers PPO |
$10.18
|
| Rate for Payer: TriWest Veterans Administration |
$8.96
|
| Rate for Payer: United Healthcare Commercial |
$11.81
|
| Rate for Payer: United Healthcare Medicare |
$8.96
|
| Rate for Payer: WINHealth Partners Commercial |
$12.90
|
| Rate for Payer: Wise Provider Network Commercial |
$12.90
|
|
|
STRYKER 70MM BLD COAT & INSUL
|
Facility
|
OP
|
$13.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.31
|
| Rate for Payer: Aetna of WY Medicare |
$8.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.04
|
| Rate for Payer: Altius Commercial |
$13.04
|
| Rate for Payer: Beech Street Commercial |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.15
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.17
|
| Rate for Payer: Cigna of WY Commercial |
$13.31
|
| Rate for Payer: Entrust Commercial |
$12.90
|
| Rate for Payer: First Choice Health Commercial |
$12.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.88
|
| Rate for Payer: HealthUtah PPO |
$13.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.17
|
| Rate for Payer: Multiplan Medicare/VA |
$7.48
|
| Rate for Payer: One Health Plan of WY PPO |
$13.31
|
| Rate for Payer: PacificSource Commercial |
$12.22
|
| Rate for Payer: PHCS PPO |
$13.31
|
| Rate for Payer: Three Rivers PPO |
$10.18
|
| Rate for Payer: TriWest Veterans Administration |
$7.88
|
| Rate for Payer: United Healthcare Commercial |
$11.81
|
| Rate for Payer: United Healthcare Medicare |
$7.88
|
| Rate for Payer: WINHealth Partners Commercial |
$13.31
|
| Rate for Payer: Wise Provider Network Commercial |
$12.90
|
|
|
STRYKER BONE MILL MEDIUM BLADE
|
Facility
|
OP
|
$1,848.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,018.25 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,811.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,219.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,774.08
|
| Rate for Payer: Altius Commercial |
$1,774.08
|
| Rate for Payer: Beech Street Commercial |
$1,811.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,517.21
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,792.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,811.04
|
| Rate for Payer: Entrust Commercial |
$1,755.60
|
| Rate for Payer: First Choice Health Commercial |
$1,755.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,755.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,071.84
|
| Rate for Payer: HealthUtah PPO |
$1,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,792.56
|
| Rate for Payer: Multiplan Medicare/VA |
$1,018.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,811.04
|
| Rate for Payer: PacificSource Commercial |
$1,663.20
|
| Rate for Payer: PHCS PPO |
$1,811.04
|
| Rate for Payer: Three Rivers PPO |
$1,386.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,071.84
|
| Rate for Payer: United Healthcare Commercial |
$1,607.76
|
| Rate for Payer: United Healthcare Medicare |
$1,071.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,811.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1,755.60
|
|
|
STRYKER BONE MILL MEDIUM BLADE
|
Facility
|
IP
|
$1,848.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,158.70 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,811.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,774.08
|
| Rate for Payer: Altius Commercial |
$1,774.08
|
| Rate for Payer: Beech Street Commercial |
$1,811.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,517.21
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,792.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,811.04
|
| Rate for Payer: Entrust Commercial |
$1,755.60
|
| Rate for Payer: First Choice Health Commercial |
$1,755.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,755.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,219.68
|
| Rate for Payer: HealthUtah PPO |
$1,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,792.56
|
| Rate for Payer: Multiplan Medicare/VA |
$1,158.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,811.04
|
| Rate for Payer: PacificSource Commercial |
$1,663.20
|
| Rate for Payer: PHCS PPO |
$1,811.04
|
| Rate for Payer: Three Rivers PPO |
$1,386.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,219.68
|
| Rate for Payer: United Healthcare Commercial |
$1,607.76
|
| Rate for Payer: United Healthcare Medicare |
$1,219.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,755.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,755.60
|
|
|
STRYKER BONE MILL PREP CARTRIDGE
|
Facility
|
OP
|
$2,551.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,405.83 |
| Max. Negotiated Rate |
$2,551.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,500.39
|
| Rate for Payer: Aetna of WY Medicare |
$1,683.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,449.36
|
| Rate for Payer: Altius Commercial |
$2,449.36
|
| Rate for Payer: Beech Street Commercial |
$2,500.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,094.72
|
| Rate for Payer: Cash Price |
$1,785.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,474.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,500.39
|
| Rate for Payer: Entrust Commercial |
$2,423.85
|
| Rate for Payer: First Choice Health Commercial |
$2,423.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,423.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,479.82
|
| Rate for Payer: HealthUtah PPO |
$2,551.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,474.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,405.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,500.39
|
| Rate for Payer: PacificSource Commercial |
$2,296.28
|
| Rate for Payer: PHCS PPO |
$2,500.39
|
| Rate for Payer: Three Rivers PPO |
$1,913.56
|
| Rate for Payer: TriWest Veterans Administration |
$1,479.82
|
| Rate for Payer: United Healthcare Commercial |
$2,219.74
|
| Rate for Payer: United Healthcare Medicare |
$1,479.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,500.39
|
| Rate for Payer: Wise Provider Network Commercial |
$2,423.85
|
|
|
STRYKER BONE MILL PREP CARTRIDGE
|
Facility
|
IP
|
$2,551.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.74 |
| Max. Negotiated Rate |
$2,551.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,500.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,449.36
|
| Rate for Payer: Altius Commercial |
$2,449.36
|
| Rate for Payer: Beech Street Commercial |
$2,500.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,094.72
|
| Rate for Payer: Cash Price |
$1,785.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,474.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,500.39
|
| Rate for Payer: Entrust Commercial |
$2,423.85
|
| Rate for Payer: First Choice Health Commercial |
$2,423.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,423.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,683.94
|
| Rate for Payer: HealthUtah PPO |
$2,551.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,474.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,599.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,500.39
|
| Rate for Payer: PacificSource Commercial |
$2,296.28
|
| Rate for Payer: PHCS PPO |
$2,500.39
|
| Rate for Payer: Three Rivers PPO |
$1,913.56
|
| Rate for Payer: TriWest Veterans Administration |
$1,683.94
|
| Rate for Payer: United Healthcare Commercial |
$2,219.74
|
| Rate for Payer: United Healthcare Medicare |
$1,683.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,423.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2,423.85
|
|
|
STRYK ESEP 125MM BLADE COATED
|
Facility
|
IP
|
$14.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$14.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.63
|
| Rate for Payer: Altius Commercial |
$13.63
|
| Rate for Payer: Beech Street Commercial |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.77
|
| Rate for Payer: Cigna of WY Commercial |
$13.92
|
| Rate for Payer: Entrust Commercial |
$13.49
|
| Rate for Payer: First Choice Health Commercial |
$13.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.37
|
| Rate for Payer: HealthUtah PPO |
$14.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.77
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$13.92
|
| Rate for Payer: PacificSource Commercial |
$12.78
|
| Rate for Payer: PHCS PPO |
$13.92
|
| Rate for Payer: Three Rivers PPO |
$10.65
|
| Rate for Payer: TriWest Veterans Administration |
$9.37
|
| Rate for Payer: United Healthcare Commercial |
$12.35
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WINHealth Partners Commercial |
$13.49
|
| Rate for Payer: Wise Provider Network Commercial |
$13.49
|
|
|
STRYK ESEP 125MM BLADE COATED
|
Facility
|
OP
|
$14.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$14.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.63
|
| Rate for Payer: Altius Commercial |
$13.63
|
| Rate for Payer: Beech Street Commercial |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.77
|
| Rate for Payer: Cigna of WY Commercial |
$13.92
|
| Rate for Payer: Entrust Commercial |
$13.49
|
| Rate for Payer: First Choice Health Commercial |
$13.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.24
|
| Rate for Payer: HealthUtah PPO |
$14.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.77
|
| Rate for Payer: Multiplan Medicare/VA |
$7.82
|
| Rate for Payer: One Health Plan of WY PPO |
$13.92
|
| Rate for Payer: PacificSource Commercial |
$12.78
|
| Rate for Payer: PHCS PPO |
$13.92
|
| Rate for Payer: Three Rivers PPO |
$10.65
|
| Rate for Payer: TriWest Veterans Administration |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.35
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
| Rate for Payer: WINHealth Partners Commercial |
$13.92
|
| Rate for Payer: Wise Provider Network Commercial |
$13.49
|
|
|
STRYK E-SEP SLEEVE 125MM
|
Facility
|
IP
|
$11.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.44
|
| Rate for Payer: Altius Commercial |
$11.44
|
| Rate for Payer: Beech Street Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.56
|
| Rate for Payer: Cigna of WY Commercial |
$11.68
|
| Rate for Payer: Entrust Commercial |
$11.32
|
| Rate for Payer: First Choice Health Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.87
|
| Rate for Payer: HealthUtah PPO |
$11.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.56
|
| Rate for Payer: Multiplan Medicare/VA |
$7.47
|
| Rate for Payer: One Health Plan of WY PPO |
$11.68
|
| Rate for Payer: PacificSource Commercial |
$10.73
|
| Rate for Payer: PHCS PPO |
$11.68
|
| Rate for Payer: Three Rivers PPO |
$8.94
|
| Rate for Payer: TriWest Veterans Administration |
$7.87
|
| Rate for Payer: United Healthcare Commercial |
$10.37
|
| Rate for Payer: United Healthcare Medicare |
$7.87
|
| Rate for Payer: WINHealth Partners Commercial |
$11.32
|
| Rate for Payer: Wise Provider Network Commercial |
$11.32
|
|
