|
BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 94070 26
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$26.35
|
| Rate for Payer: Beech Street Commercial |
$142.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: First Choice Health Commercial |
$135.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.35
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$22.40
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$142.50
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.35
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
|
|
BS 16 CONTACT PULSE GENERATOR
|
Facility
|
OP
|
$77,525.00
|
|
| Hospital Charge Code |
2800305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41,979.79 |
| Max. Negotiated Rate |
$77,525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75,974.50
|
| Rate for Payer: Aetna of WY Medicare |
$51,166.50
|
| Rate for Payer: Altius Commercial |
$74,424.00
|
| Rate for Payer: Beech Street Commercial |
$75,974.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75,199.25
|
| Rate for Payer: Cash Price |
$54,267.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$75,199.25
|
| Rate for Payer: Cigna of WY Commercial |
$75,974.50
|
| Rate for Payer: Entrust Commercial |
$73,648.75
|
| Rate for Payer: First Choice Health Commercial |
$73,648.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73,648.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44,189.25
|
| Rate for Payer: HealthUtah PPO |
$77,525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75,199.25
|
| Rate for Payer: Multiplan Medicare/VA |
$41,979.79
|
| Rate for Payer: One Health Plan of WY PPO |
$75,974.50
|
| Rate for Payer: PacificSource Commercial |
$69,772.50
|
| Rate for Payer: PHCS PPO |
$75,974.50
|
| Rate for Payer: Three Rivers PPO |
$58,143.75
|
| Rate for Payer: TriWest Veterans Administration |
$44,189.25
|
| Rate for Payer: United Healthcare Commercial |
$74,036.38
|
| Rate for Payer: United Healthcare Medicare |
$44,189.25
|
| Rate for Payer: WINHealth Partners Commercial |
$75,974.50
|
| Rate for Payer: Wise Provider Network Commercial |
$73,648.75
|
|
|
BS 16 CONTACT PULSE GENERATOR
|
Facility
|
IP
|
$77,525.00
|
|
| Hospital Charge Code |
2800305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44,925.74 |
| Max. Negotiated Rate |
$77,525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75,974.50
|
| Rate for Payer: Aetna of WY Medicare |
$49,616.00
|
| Rate for Payer: Altius Commercial |
$74,424.00
|
| Rate for Payer: Beech Street Commercial |
$75,974.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75,199.25
|
| Rate for Payer: Cash Price |
$54,267.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$75,199.25
|
| Rate for Payer: Cigna of WY Commercial |
$75,974.50
|
| Rate for Payer: Entrust Commercial |
$73,648.75
|
| Rate for Payer: First Choice Health Commercial |
$73,648.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73,648.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47,290.25
|
| Rate for Payer: HealthUtah PPO |
$77,525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75,199.25
|
| Rate for Payer: Multiplan Medicare/VA |
$44,925.74
|
| Rate for Payer: One Health Plan of WY PPO |
$75,974.50
|
| Rate for Payer: PacificSource Commercial |
$69,772.50
|
| Rate for Payer: PHCS PPO |
$75,974.50
|
| Rate for Payer: Three Rivers PPO |
$58,143.75
|
| Rate for Payer: TriWest Veterans Administration |
$47,290.25
|
| Rate for Payer: United Healthcare Commercial |
$74,036.38
|
| Rate for Payer: United Healthcare Medicare |
$47,290.25
|
| Rate for Payer: WINHealth Partners Commercial |
$73,648.75
|
| Rate for Payer: Wise Provider Network Commercial |
$73,648.75
|
|
|
BS 70CM STYLET KIT & STEERING CAP
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
2800453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.96 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$313.60
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$475.30
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.90
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$283.96
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.90
|
| Rate for Payer: United Healthcare Commercial |
$467.95
|
| Rate for Payer: United Healthcare Medicare |
$298.90
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
BS 70CM STYLET KIT & STEERING CAP
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
2800453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.34 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$475.30
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.30
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$265.34
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$279.30
|
| Rate for Payer: United Healthcare Commercial |
$467.95
|
| Rate for Payer: United Healthcare Medicare |
$279.30
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
BS 74CM 8 CONTACT LEADS
|
Facility
|
IP
|
$8,645.00
|
|
| Hospital Charge Code |
2800306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,009.78 |
| Max. Negotiated Rate |
$8,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,472.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,532.80
|
| Rate for Payer: Altius Commercial |
$8,299.20
|
| Rate for Payer: Beech Street Commercial |
$8,472.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,385.65
|
| Rate for Payer: Cash Price |
$6,051.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,385.65
|
| Rate for Payer: Cigna of WY Commercial |
$8,472.10
|
| Rate for Payer: Entrust Commercial |
$8,212.75
|
| Rate for Payer: First Choice Health Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,273.45
|
| Rate for Payer: HealthUtah PPO |
$8,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,385.65
|
| Rate for Payer: Multiplan Medicare/VA |
$5,009.78
|
| Rate for Payer: One Health Plan of WY PPO |
$8,472.10
|
| Rate for Payer: PacificSource Commercial |
$7,780.50
|
| Rate for Payer: PHCS PPO |
$8,472.10
|
| Rate for Payer: Three Rivers PPO |
$6,483.75
|
| Rate for Payer: TriWest Veterans Administration |
$5,273.45
|
| Rate for Payer: United Healthcare Commercial |
$8,255.98
|
| Rate for Payer: United Healthcare Medicare |
$5,273.45
|
| Rate for Payer: WINHealth Partners Commercial |
$8,212.75
|
| Rate for Payer: Wise Provider Network Commercial |
$8,212.75
|
|
|
BS 74CM 8 CONTACT LEADS
|
Facility
|
OP
|
$8,645.00
|
|
| Hospital Charge Code |
2800306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.27 |
| Max. Negotiated Rate |
$8,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,472.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,705.70
|
| Rate for Payer: Altius Commercial |
$8,299.20
|
| Rate for Payer: Beech Street Commercial |
$8,472.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,385.65
|
| Rate for Payer: Cash Price |
$6,051.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,385.65
|
| Rate for Payer: Cigna of WY Commercial |
$8,472.10
|
| Rate for Payer: Entrust Commercial |
$8,212.75
|
| Rate for Payer: First Choice Health Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,927.65
|
| Rate for Payer: HealthUtah PPO |
$8,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,385.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4,681.27
|
| Rate for Payer: One Health Plan of WY PPO |
$8,472.10
|
| Rate for Payer: PacificSource Commercial |
$7,780.50
|
| Rate for Payer: PHCS PPO |
$8,472.10
|
| Rate for Payer: Three Rivers PPO |
$6,483.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,927.65
|
| Rate for Payer: United Healthcare Commercial |
$8,255.98
|
| Rate for Payer: United Healthcare Medicare |
$4,927.65
|
| Rate for Payer: WINHealth Partners Commercial |
$8,472.10
|
| Rate for Payer: Wise Provider Network Commercial |
$8,212.75
|
|
|
BS ALLIANCE II SYRINGE
|
Facility
|
OP
|
$102.20
|
|
| Hospital Charge Code |
2650401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: United Healthcare Commercial |
$97.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Aetna of WY Medicare |
$67.45
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.13
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.25
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$55.34
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$58.25
|
| Rate for Payer: United Healthcare Medicare |
$58.25
|
| Rate for Payer: WINHealth Partners Commercial |
$100.16
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
BS ALLIANCE II SYRINGE
|
Facility
|
IP
|
$102.20
|
|
| Hospital Charge Code |
2650401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Aetna of WY Medicare |
$65.41
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.13
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.34
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$59.22
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$62.34
|
| Rate for Payer: United Healthcare Commercial |
$97.60
|
| Rate for Payer: United Healthcare Medicare |
$62.34
|
| Rate for Payer: WINHealth Partners Commercial |
$97.09
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
BS ALPHA PRIME PULSE GENERATOR
|
Facility
|
OP
|
$88,375.00
|
|
| Hospital Charge Code |
2800431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47,855.06 |
| Max. Negotiated Rate |
$88,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86,607.50
|
| Rate for Payer: Aetna of WY Medicare |
$58,327.50
|
| Rate for Payer: Altius Commercial |
$84,840.00
|
| Rate for Payer: Beech Street Commercial |
$86,607.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85,723.75
|
| Rate for Payer: Cash Price |
$61,862.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$85,723.75
|
| Rate for Payer: Cigna of WY Commercial |
$86,607.50
|
| Rate for Payer: Entrust Commercial |
$83,956.25
|
| Rate for Payer: First Choice Health Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50,373.75
|
| Rate for Payer: HealthUtah PPO |
$88,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85,723.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47,855.06
|
| Rate for Payer: One Health Plan of WY PPO |
$86,607.50
|
| Rate for Payer: PacificSource Commercial |
$79,537.50
|
| Rate for Payer: PHCS PPO |
$86,607.50
|
| Rate for Payer: Three Rivers PPO |
$66,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$50,373.75
|
| Rate for Payer: United Healthcare Commercial |
$84,398.12
|
| Rate for Payer: United Healthcare Medicare |
$50,373.75
|
| Rate for Payer: WINHealth Partners Commercial |
$86,607.50
|
| Rate for Payer: Wise Provider Network Commercial |
$83,956.25
|
|
|
BS ALPHA PRIME PULSE GENERATOR
|
Facility
|
IP
|
$88,375.00
|
|
| Hospital Charge Code |
2800431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51,213.31 |
| Max. Negotiated Rate |
$88,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86,607.50
|
| Rate for Payer: Aetna of WY Medicare |
$56,560.00
|
| Rate for Payer: Altius Commercial |
$84,840.00
|
| Rate for Payer: Beech Street Commercial |
$86,607.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85,723.75
|
| Rate for Payer: Cash Price |
$61,862.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$85,723.75
|
| Rate for Payer: Cigna of WY Commercial |
$86,607.50
|
| Rate for Payer: Entrust Commercial |
$83,956.25
|
| Rate for Payer: First Choice Health Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53,908.75
|
| Rate for Payer: HealthUtah PPO |
$88,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85,723.75
|
| Rate for Payer: Multiplan Medicare/VA |
$51,213.31
|
| Rate for Payer: One Health Plan of WY PPO |
$86,607.50
|
| Rate for Payer: PacificSource Commercial |
$79,537.50
|
| Rate for Payer: PHCS PPO |
$86,607.50
|
| Rate for Payer: Three Rivers PPO |
$66,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$53,908.75
|
| Rate for Payer: United Healthcare Commercial |
$84,398.12
|
| Rate for Payer: United Healthcare Medicare |
$53,908.75
|
| Rate for Payer: WINHealth Partners Commercial |
$83,956.25
|
| Rate for Payer: Wise Provider Network Commercial |
$83,956.25
|
|
|
BS ALPHA PULSE GENERATOR KIT
|
Facility
|
IP
|
$88,375.00
|
|
| Hospital Charge Code |
2800428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51,213.31 |
| Max. Negotiated Rate |
$88,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86,607.50
|
| Rate for Payer: Aetna of WY Medicare |
$56,560.00
|
| Rate for Payer: Altius Commercial |
$84,840.00
|
| Rate for Payer: Beech Street Commercial |
$86,607.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85,723.75
|
| Rate for Payer: Cash Price |
$61,862.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$85,723.75
|
| Rate for Payer: Cigna of WY Commercial |
$86,607.50
|
| Rate for Payer: Entrust Commercial |
$83,956.25
|
| Rate for Payer: First Choice Health Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53,908.75
|
| Rate for Payer: HealthUtah PPO |
$88,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85,723.75
|
| Rate for Payer: Multiplan Medicare/VA |
$51,213.31
|
| Rate for Payer: One Health Plan of WY PPO |
$86,607.50
|
| Rate for Payer: PacificSource Commercial |
$79,537.50
|
| Rate for Payer: PHCS PPO |
$86,607.50
|
| Rate for Payer: Three Rivers PPO |
$66,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$53,908.75
|
| Rate for Payer: United Healthcare Commercial |
$84,398.12
|
| Rate for Payer: United Healthcare Medicare |
$53,908.75
|
| Rate for Payer: WINHealth Partners Commercial |
$83,956.25
|
| Rate for Payer: Wise Provider Network Commercial |
$83,956.25
|
|
|
BS ALPHA PULSE GENERATOR KIT
|
Facility
|
OP
|
$88,375.00
|
|
| Hospital Charge Code |
2800428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47,855.06 |
| Max. Negotiated Rate |
$88,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86,607.50
|
| Rate for Payer: Aetna of WY Medicare |
$58,327.50
|
| Rate for Payer: Altius Commercial |
$84,840.00
|
| Rate for Payer: Beech Street Commercial |
$86,607.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85,723.75
|
| Rate for Payer: Cash Price |
$61,862.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$85,723.75
|
| Rate for Payer: Cigna of WY Commercial |
$86,607.50
|
| Rate for Payer: Entrust Commercial |
$83,956.25
|
| Rate for Payer: First Choice Health Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83,956.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50,373.75
|
| Rate for Payer: HealthUtah PPO |
$88,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85,723.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47,855.06
|
| Rate for Payer: One Health Plan of WY PPO |
$86,607.50
|
| Rate for Payer: PacificSource Commercial |
$79,537.50
|
| Rate for Payer: PHCS PPO |
$86,607.50
|
| Rate for Payer: Three Rivers PPO |
$66,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$50,373.75
|
| Rate for Payer: United Healthcare Commercial |
$84,398.12
|
| Rate for Payer: United Healthcare Medicare |
$50,373.75
|
| Rate for Payer: WINHealth Partners Commercial |
$86,607.50
|
| Rate for Payer: Wise Provider Network Commercial |
$83,956.25
|
|
|
BS ALPHA REMOTE CONTROL
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
BS ALPHA REMOTE CONTROL
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
BS AVISTA MRI LEAD SC-2408-56
|
Facility
|
IP
|
$8,645.00
|
|
| Hospital Charge Code |
2800331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,009.78 |
| Max. Negotiated Rate |
$8,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,472.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,532.80
|
| Rate for Payer: Altius Commercial |
$8,299.20
|
| Rate for Payer: Beech Street Commercial |
$8,472.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,385.65
|
| Rate for Payer: Cash Price |
$6,051.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,385.65
|
| Rate for Payer: Cigna of WY Commercial |
$8,472.10
|
| Rate for Payer: Entrust Commercial |
$8,212.75
|
| Rate for Payer: First Choice Health Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,273.45
|
| Rate for Payer: HealthUtah PPO |
$8,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,385.65
|
| Rate for Payer: Multiplan Medicare/VA |
$5,009.78
|
| Rate for Payer: One Health Plan of WY PPO |
$8,472.10
|
| Rate for Payer: PacificSource Commercial |
$7,780.50
|
| Rate for Payer: PHCS PPO |
$8,472.10
|
| Rate for Payer: Three Rivers PPO |
$6,483.75
|
| Rate for Payer: TriWest Veterans Administration |
$5,273.45
|
| Rate for Payer: United Healthcare Commercial |
$8,255.98
|
| Rate for Payer: United Healthcare Medicare |
$5,273.45
|
| Rate for Payer: WINHealth Partners Commercial |
$8,212.75
|
| Rate for Payer: Wise Provider Network Commercial |
$8,212.75
|
|
|
BS AVISTA MRI LEAD SC-2408-56
|
Facility
|
OP
|
$8,645.00
|
|
| Hospital Charge Code |
2800331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.27 |
| Max. Negotiated Rate |
$8,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,472.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,705.70
|
| Rate for Payer: Altius Commercial |
$8,299.20
|
| Rate for Payer: Beech Street Commercial |
$8,472.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,385.65
|
| Rate for Payer: Cash Price |
$6,051.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,385.65
|
| Rate for Payer: Cigna of WY Commercial |
$8,472.10
|
| Rate for Payer: Entrust Commercial |
$8,212.75
|
| Rate for Payer: First Choice Health Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,212.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,927.65
|
| Rate for Payer: HealthUtah PPO |
$8,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,385.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4,681.27
|
| Rate for Payer: One Health Plan of WY PPO |
$8,472.10
|
| Rate for Payer: PacificSource Commercial |
$7,780.50
|
| Rate for Payer: PHCS PPO |
$8,472.10
|
| Rate for Payer: Three Rivers PPO |
$6,483.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,927.65
|
| Rate for Payer: United Healthcare Commercial |
$8,255.98
|
| Rate for Payer: United Healthcare Medicare |
$4,927.65
|
| Rate for Payer: WINHealth Partners Commercial |
$8,472.10
|
| Rate for Payer: Wise Provider Network Commercial |
$8,212.75
|
|
|
BS BALLOON ESOP DILATOR 10-
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
2650394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$385.28
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$367.22
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$348.86
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$367.22
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$367.22
|
| Rate for Payer: WINHealth Partners Commercial |
$571.90
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR 10-
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
2650394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$397.32
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.14
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$325.98
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$343.14
|
| Rate for Payer: WINHealth Partners Commercial |
$589.96
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR 12-
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
2650395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$385.28
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$367.22
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$348.86
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$367.22
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$367.22
|
| Rate for Payer: WINHealth Partners Commercial |
$571.90
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR 12-
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
2650395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$397.32
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.14
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$325.98
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$343.14
|
| Rate for Payer: WINHealth Partners Commercial |
$589.96
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR15
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
2650396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$385.28
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$367.22
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$348.86
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$367.22
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$367.22
|
| Rate for Payer: WINHealth Partners Commercial |
$571.90
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR15
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
2650396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$397.32
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.14
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$325.98
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$343.14
|
| Rate for Payer: WINHealth Partners Commercial |
$589.96
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR18
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
2650397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$385.28
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$367.22
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$348.86
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$367.22
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$367.22
|
| Rate for Payer: WINHealth Partners Commercial |
$571.90
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
BS BALLOON ESOP DILATOR18
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
2650397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$397.32
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$583.94
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.14
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$325.98
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$343.14
|
| Rate for Payer: United Healthcare Commercial |
$574.91
|
| Rate for Payer: United Healthcare Medicare |
$343.14
|
| Rate for Payer: WINHealth Partners Commercial |
$589.96
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
