|
BS BALLOON ESOP DILATOR 8-10
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
2650894
|
|
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 8-10
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
2650894
|
|
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 CLIK X ANCHOR SC-4318
|
Facility
|
OP
|
$1,312.50
|
|
| Hospital Charge Code |
2800447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.72 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$866.25
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$748.12
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$710.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$748.12
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$748.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,286.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
BS CLIK X ANCHOR SC-4318
|
Facility
|
IP
|
$1,312.50
|
|
| Hospital Charge Code |
2800447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.59 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$840.00
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$800.62
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$760.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$800.62
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$800.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,246.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
BS CLIK X MRI ANCHOR
|
Facility
|
IP
|
$1,312.50
|
|
| Hospital Charge Code |
2800307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.59 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$840.00
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$800.62
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$760.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$800.62
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$800.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,246.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
BS CLIK X MRI ANCHOR
|
Facility
|
OP
|
$1,312.50
|
|
| Hospital Charge Code |
2800307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.72 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$866.25
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$748.12
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$710.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$748.12
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$748.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,286.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
BS CRE ESOPH COLONIC 12MM
|
Facility
|
IP
|
$697.90
|
|
| Hospital Charge Code |
2650507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.43 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$446.66
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.72
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$404.43
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$425.72
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$425.72
|
| Rate for Payer: WINHealth Partners Commercial |
$663.00
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS CRE ESOPH COLONIC 12MM
|
Facility
|
OP
|
$697.90
|
|
| Hospital Charge Code |
2650507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.91 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$460.61
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$397.80
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$377.91
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$683.94
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS CRE ESOPH COLONIC 15MM
|
Facility
|
OP
|
$697.90
|
|
| Hospital Charge Code |
2650508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.91 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$460.61
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$397.80
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$377.91
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$683.94
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS CRE ESOPH COLONIC 15MM
|
Facility
|
IP
|
$697.90
|
|
| Hospital Charge Code |
2650508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.43 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$446.66
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.72
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$404.43
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$425.72
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$425.72
|
| Rate for Payer: WINHealth Partners Commercial |
$663.00
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS CRE ESOPH COLONIC 18MM
|
Facility
|
IP
|
$697.90
|
|
| Hospital Charge Code |
2650509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.43 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$446.66
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.72
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$404.43
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$425.72
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$425.72
|
| Rate for Payer: WINHealth Partners Commercial |
$663.00
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS CRE ESOPH COLONIC 18MM
|
Facility
|
OP
|
$697.90
|
|
| Hospital Charge Code |
2650509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.91 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$683.94
|
| Rate for Payer: Aetna of WY Medicare |
$460.61
|
| Rate for Payer: Altius Commercial |
$669.98
|
| Rate for Payer: Beech Street Commercial |
$683.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$676.96
|
| Rate for Payer: Cash Price |
$488.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$676.96
|
| Rate for Payer: Cigna of WY Commercial |
$683.94
|
| Rate for Payer: Entrust Commercial |
$663.00
|
| Rate for Payer: First Choice Health Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$663.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$397.80
|
| Rate for Payer: HealthUtah PPO |
$697.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$676.96
|
| Rate for Payer: Multiplan Medicare/VA |
$377.91
|
| Rate for Payer: One Health Plan of WY PPO |
$683.94
|
| Rate for Payer: PacificSource Commercial |
$628.11
|
| Rate for Payer: PHCS PPO |
$683.94
|
| Rate for Payer: Three Rivers PPO |
$523.42
|
| Rate for Payer: TriWest Veterans Administration |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$666.49
|
| Rate for Payer: United Healthcare Medicare |
$397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$683.94
|
| Rate for Payer: Wise Provider Network Commercial |
$663.00
|
|
|
BS FORCEP RADIAL JAW 4
|
Facility
|
IP
|
$14.96
|
|
| Hospital Charge Code |
2650388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.66
|
| Rate for Payer: Aetna of WY Medicare |
$9.57
|
| Rate for Payer: Altius Commercial |
$14.36
|
| Rate for Payer: Beech Street Commercial |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.51
|
| Rate for Payer: Cigna of WY Commercial |
$14.66
|
| Rate for Payer: Entrust Commercial |
$14.21
|
| Rate for Payer: First Choice Health Commercial |
$14.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.13
|
| Rate for Payer: HealthUtah PPO |
$14.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.51
|
| Rate for Payer: Multiplan Medicare/VA |
$8.67
|
| Rate for Payer: One Health Plan of WY PPO |
$14.66
|
| Rate for Payer: PacificSource Commercial |
$13.46
|
| Rate for Payer: PHCS PPO |
$14.66
|
| Rate for Payer: Three Rivers PPO |
$11.22
|
| Rate for Payer: TriWest Veterans Administration |
$9.13
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
| Rate for Payer: United Healthcare Medicare |
$9.13
|
| Rate for Payer: WINHealth Partners Commercial |
$14.21
|
| Rate for Payer: Wise Provider Network Commercial |
$14.21
|
|
|
BS FORCEP RADIAL JAW 4
|
Facility
|
OP
|
$14.96
|
|
| Hospital Charge Code |
2650388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.66
|
| Rate for Payer: Aetna of WY Medicare |
$9.87
|
| Rate for Payer: Altius Commercial |
$14.36
|
| Rate for Payer: Beech Street Commercial |
$14.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.51
|
| Rate for Payer: Cigna of WY Commercial |
$14.66
|
| Rate for Payer: Entrust Commercial |
$14.21
|
| Rate for Payer: First Choice Health Commercial |
$14.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.53
|
| Rate for Payer: HealthUtah PPO |
$14.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.51
|
| Rate for Payer: Multiplan Medicare/VA |
$8.10
|
| Rate for Payer: One Health Plan of WY PPO |
$14.66
|
| Rate for Payer: PacificSource Commercial |
$13.46
|
| Rate for Payer: PHCS PPO |
$14.66
|
| Rate for Payer: Three Rivers PPO |
$11.22
|
| Rate for Payer: TriWest Veterans Administration |
$8.53
|
| Rate for Payer: United Healthcare Commercial |
$14.29
|
| Rate for Payer: United Healthcare Medicare |
$8.53
|
| Rate for Payer: WINHealth Partners Commercial |
$14.66
|
| Rate for Payer: Wise Provider Network Commercial |
$14.21
|
|
|
BS INTRODUCER
|
Facility
|
OP
|
$192.50
|
|
| Hospital Charge Code |
2800362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.24 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.65
|
| Rate for Payer: Aetna of WY Medicare |
$127.05
|
| Rate for Payer: Altius Commercial |
$184.80
|
| Rate for Payer: Beech Street Commercial |
$188.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.72
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.72
|
| Rate for Payer: Cigna of WY Commercial |
$188.65
|
| Rate for Payer: Entrust Commercial |
$182.88
|
| Rate for Payer: First Choice Health Commercial |
$182.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.72
|
| Rate for Payer: HealthUtah PPO |
$192.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.72
|
| Rate for Payer: Multiplan Medicare/VA |
$104.24
|
| Rate for Payer: One Health Plan of WY PPO |
$188.65
|
| Rate for Payer: PacificSource Commercial |
$173.25
|
| Rate for Payer: PHCS PPO |
$188.65
|
| Rate for Payer: Three Rivers PPO |
$144.38
|
| Rate for Payer: TriWest Veterans Administration |
$109.72
|
| Rate for Payer: United Healthcare Commercial |
$183.84
|
| Rate for Payer: United Healthcare Medicare |
$109.72
|
| Rate for Payer: WINHealth Partners Commercial |
$188.65
|
| Rate for Payer: Wise Provider Network Commercial |
$182.88
|
|
|
BS INTRODUCER
|
Facility
|
IP
|
$192.50
|
|
| Hospital Charge Code |
2800362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.65
|
| Rate for Payer: Aetna of WY Medicare |
$123.20
|
| Rate for Payer: Altius Commercial |
$184.80
|
| Rate for Payer: Beech Street Commercial |
$188.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.72
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.72
|
| Rate for Payer: Cigna of WY Commercial |
$188.65
|
| Rate for Payer: Entrust Commercial |
$182.88
|
| Rate for Payer: First Choice Health Commercial |
$182.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.42
|
| Rate for Payer: HealthUtah PPO |
$192.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.72
|
| Rate for Payer: Multiplan Medicare/VA |
$111.55
|
| Rate for Payer: One Health Plan of WY PPO |
$188.65
|
| Rate for Payer: PacificSource Commercial |
$173.25
|
| Rate for Payer: PHCS PPO |
$188.65
|
| Rate for Payer: Three Rivers PPO |
$144.38
|
| Rate for Payer: TriWest Veterans Administration |
$117.42
|
| Rate for Payer: United Healthcare Commercial |
$183.84
|
| Rate for Payer: United Healthcare Medicare |
$117.42
|
| Rate for Payer: WINHealth Partners Commercial |
$182.88
|
| Rate for Payer: Wise Provider Network Commercial |
$182.88
|
|
|
BS LEAD KIT ARTISAN 70CM 2 X 8
|
Facility
|
OP
|
$14,875.00
|
|
| Hospital Charge Code |
2800432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,054.81 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,577.50
|
| Rate for Payer: Aetna of WY Medicare |
$9,817.50
|
| Rate for Payer: Altius Commercial |
$14,280.00
|
| Rate for Payer: Beech Street Commercial |
$14,577.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14,428.75
|
| Rate for Payer: Cash Price |
$10,412.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,428.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,577.50
|
| Rate for Payer: Entrust Commercial |
$14,131.25
|
| Rate for Payer: First Choice Health Commercial |
$14,131.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,131.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,478.75
|
| Rate for Payer: HealthUtah PPO |
$14,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,428.75
|
| Rate for Payer: Multiplan Medicare/VA |
$8,054.81
|
| Rate for Payer: One Health Plan of WY PPO |
$14,577.50
|
| Rate for Payer: PacificSource Commercial |
$13,387.50
|
| Rate for Payer: PHCS PPO |
$14,577.50
|
| Rate for Payer: Three Rivers PPO |
$11,156.25
|
| Rate for Payer: TriWest Veterans Administration |
$8,478.75
|
| Rate for Payer: United Healthcare Commercial |
$14,205.62
|
| Rate for Payer: United Healthcare Medicare |
$8,478.75
|
| Rate for Payer: WINHealth Partners Commercial |
$14,577.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14,131.25
|
|
|
BS LEAD KIT ARTISAN 70CM 2 X 8
|
Facility
|
IP
|
$14,875.00
|
|
| Hospital Charge Code |
2800432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,620.06 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,577.50
|
| Rate for Payer: Aetna of WY Medicare |
$9,520.00
|
| Rate for Payer: Altius Commercial |
$14,280.00
|
| Rate for Payer: Beech Street Commercial |
$14,577.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14,428.75
|
| Rate for Payer: Cash Price |
$10,412.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,428.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,577.50
|
| Rate for Payer: Entrust Commercial |
$14,131.25
|
| Rate for Payer: First Choice Health Commercial |
$14,131.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,131.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,073.75
|
| Rate for Payer: HealthUtah PPO |
$14,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,428.75
|
| Rate for Payer: Multiplan Medicare/VA |
$8,620.06
|
| Rate for Payer: One Health Plan of WY PPO |
$14,577.50
|
| Rate for Payer: PacificSource Commercial |
$13,387.50
|
| Rate for Payer: PHCS PPO |
$14,577.50
|
| Rate for Payer: Three Rivers PPO |
$11,156.25
|
| Rate for Payer: TriWest Veterans Administration |
$9,073.75
|
| Rate for Payer: United Healthcare Commercial |
$14,205.62
|
| Rate for Payer: United Healthcare Medicare |
$9,073.75
|
| Rate for Payer: WINHealth Partners Commercial |
$14,131.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14,131.25
|
|
|
BS LEAD KIT MRI 50CM 2 X 8
|
Facility
|
IP
|
$37,310.00
|
|
| Hospital Charge Code |
2800359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,621.14 |
| Max. Negotiated Rate |
$37,310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36,563.80
|
| Rate for Payer: Aetna of WY Medicare |
$23,878.40
|
| Rate for Payer: Altius Commercial |
$35,817.60
|
| Rate for Payer: Beech Street Commercial |
$36,563.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36,190.70
|
| Rate for Payer: Cash Price |
$26,117.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$36,190.70
|
| Rate for Payer: Cigna of WY Commercial |
$36,563.80
|
| Rate for Payer: Entrust Commercial |
$35,444.50
|
| Rate for Payer: First Choice Health Commercial |
$35,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22,759.10
|
| Rate for Payer: HealthUtah PPO |
$37,310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36,190.70
|
| Rate for Payer: Multiplan Medicare/VA |
$21,621.14
|
| Rate for Payer: One Health Plan of WY PPO |
$36,563.80
|
| Rate for Payer: PacificSource Commercial |
$33,579.00
|
| Rate for Payer: PHCS PPO |
$36,563.80
|
| Rate for Payer: Three Rivers PPO |
$27,982.50
|
| Rate for Payer: TriWest Veterans Administration |
$22,759.10
|
| Rate for Payer: United Healthcare Commercial |
$35,631.05
|
| Rate for Payer: United Healthcare Medicare |
$22,759.10
|
| Rate for Payer: WINHealth Partners Commercial |
$35,444.50
|
| Rate for Payer: Wise Provider Network Commercial |
$35,444.50
|
|
|
BS LEAD KIT MRI 50CM 2 X 8
|
Facility
|
OP
|
$37,310.00
|
|
| Hospital Charge Code |
2800359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,203.36 |
| Max. Negotiated Rate |
$37,310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36,563.80
|
| Rate for Payer: Aetna of WY Medicare |
$24,624.60
|
| Rate for Payer: Altius Commercial |
$35,817.60
|
| Rate for Payer: Beech Street Commercial |
$36,563.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36,190.70
|
| Rate for Payer: Cash Price |
$26,117.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$36,190.70
|
| Rate for Payer: Cigna of WY Commercial |
$36,563.80
|
| Rate for Payer: Entrust Commercial |
$35,444.50
|
| Rate for Payer: First Choice Health Commercial |
$35,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21,266.70
|
| Rate for Payer: HealthUtah PPO |
$37,310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36,190.70
|
| Rate for Payer: Multiplan Medicare/VA |
$20,203.36
|
| Rate for Payer: One Health Plan of WY PPO |
$36,563.80
|
| Rate for Payer: PacificSource Commercial |
$33,579.00
|
| Rate for Payer: PHCS PPO |
$36,563.80
|
| Rate for Payer: Three Rivers PPO |
$27,982.50
|
| Rate for Payer: TriWest Veterans Administration |
$21,266.70
|
| Rate for Payer: United Healthcare Commercial |
$35,631.05
|
| Rate for Payer: United Healthcare Medicare |
$21,266.70
|
| Rate for Payer: WINHealth Partners Commercial |
$36,563.80
|
| Rate for Payer: Wise Provider Network Commercial |
$35,444.50
|
|
|
BS LINEAR 50CM 8 CONTACT LEADS
|
Facility
|
OP
|
$6,650.00
|
|
| Hospital Charge Code |
2800315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,600.98 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,389.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,790.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.98
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,790.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$3,790.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,517.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
BS LINEAR 50CM 8 CONTACT LEADS
|
Facility
|
IP
|
$6,650.00
|
|
| Hospital Charge Code |
2800315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,853.68 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,256.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,056.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,056.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$4,056.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,317.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
BS LINEAR 70CM 8 CONTACT LEADS
|
Facility
|
OP
|
$6,650.00
|
|
| Hospital Charge Code |
2800361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,600.98 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,389.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,790.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.98
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,790.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$3,790.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,517.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
BS LINEAR 70CM 8 CONTACT LEADS
|
Facility
|
IP
|
$6,650.00
|
|
| Hospital Charge Code |
2800361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,853.68 |
| Max. Negotiated Rate |
$6,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,517.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,256.00
|
| Rate for Payer: Altius Commercial |
$6,384.00
|
| Rate for Payer: Beech Street Commercial |
$6,517.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,655.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,450.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,517.00
|
| Rate for Payer: Entrust Commercial |
$6,317.50
|
| Rate for Payer: First Choice Health Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,317.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,056.50
|
| Rate for Payer: HealthUtah PPO |
$6,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,450.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,517.00
|
| Rate for Payer: PacificSource Commercial |
$5,985.00
|
| Rate for Payer: PHCS PPO |
$6,517.00
|
| Rate for Payer: Three Rivers PPO |
$4,987.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,056.50
|
| Rate for Payer: United Healthcare Commercial |
$6,350.75
|
| Rate for Payer: United Healthcare Medicare |
$4,056.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,317.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,317.50
|
|
|
BSMART ADAPTER NERVE BLOCK
|
Facility
|
OP
|
$36.28
|
|
| Hospital Charge Code |
2500153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.55
|
| Rate for Payer: Aetna of WY Medicare |
$23.94
|
| Rate for Payer: Altius Commercial |
$34.83
|
| Rate for Payer: Beech Street Commercial |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.19
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.19
|
| Rate for Payer: Cigna of WY Commercial |
$35.55
|
| Rate for Payer: Entrust Commercial |
$34.47
|
| Rate for Payer: First Choice Health Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.68
|
| Rate for Payer: HealthUtah PPO |
$36.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.19
|
| Rate for Payer: Multiplan Medicare/VA |
$19.65
|
| Rate for Payer: One Health Plan of WY PPO |
$35.55
|
| Rate for Payer: PacificSource Commercial |
$32.65
|
| Rate for Payer: PHCS PPO |
$35.55
|
| Rate for Payer: Three Rivers PPO |
$27.21
|
| Rate for Payer: TriWest Veterans Administration |
$20.68
|
| Rate for Payer: United Healthcare Commercial |
$34.65
|
| Rate for Payer: United Healthcare Medicare |
$20.68
|
| Rate for Payer: WINHealth Partners Commercial |
$35.55
|
| Rate for Payer: Wise Provider Network Commercial |
$34.47
|
|
