|
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
|
|
|
BS OR CABLE 2X8 & EXTENSION
|
Facility
|
OP
|
$3.50
|
|
| Hospital Charge Code |
2800187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.43
|
| Rate for Payer: Aetna of WY Medicare |
$2.31
|
| Rate for Payer: Altius Commercial |
$3.36
|
| Rate for Payer: Beech Street Commercial |
$3.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.43
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.00
|
| Rate for Payer: HealthUtah PPO |
$3.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3.43
|
| Rate for Payer: PacificSource Commercial |
$3.15
|
| Rate for Payer: PHCS PPO |
$3.43
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$3.34
|
| Rate for Payer: United Healthcare Medicare |
$2.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3.43
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BS OR CABLE 2X8 & EXTENSION
|
Facility
|
IP
|
$3.50
|
|
| Hospital Charge Code |
2800187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.43
|
| Rate for Payer: Aetna of WY Medicare |
$2.24
|
| Rate for Payer: Altius Commercial |
$3.36
|
| Rate for Payer: Beech Street Commercial |
$3.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.43
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$2.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3.43
|
| Rate for Payer: PacificSource Commercial |
$3.15
|
| Rate for Payer: PHCS PPO |
$3.43
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$3.34
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.32
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
|
BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$7,671.00
|
|
|
Service Code
|
HCPCS 58954
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$7,671.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,517.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,081.55
|
| Rate for Payer: Beech Street Commercial |
$7,287.45
|
| Rate for Payer: Cash Price |
$5,369.70
|
| Rate for Payer: Cash Price |
$5,369.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,440.87
|
| Rate for Payer: Cigna of WY Commercial |
$7,517.58
|
| Rate for Payer: First Choice Health Commercial |
$6,903.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,287.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,081.55
|
| Rate for Payer: HealthUtah PPO |
$7,671.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,440.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1,769.32
|
| Rate for Payer: One Health Plan of WY PPO |
$7,517.58
|
| Rate for Payer: PacificSource Commercial |
$6,903.90
|
| Rate for Payer: PHCS PPO |
$7,287.45
|
| Rate for Payer: Three Rivers PPO |
$5,753.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,081.55
|
| Rate for Payer: United Healthcare Commercial |
$7,287.45
|
| Rate for Payer: WINHealth Partners Commercial |
$6,520.35
|
|
|
BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$7,079.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$1,635.69 |
| Max. Negotiated Rate |
$7,079.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,937.42
|
| Rate for Payer: Aetna of WY Medicare |
$1,924.34
|
| Rate for Payer: Beech Street Commercial |
$6,725.05
|
| Rate for Payer: Cash Price |
$4,955.30
|
| Rate for Payer: Cash Price |
$4,955.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,866.63
|
| Rate for Payer: Cigna of WY Commercial |
$6,937.42
|
| Rate for Payer: First Choice Health Commercial |
$6,371.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,725.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,924.34
|
| Rate for Payer: HealthUtah PPO |
$7,079.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,866.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,635.69
|
| Rate for Payer: One Health Plan of WY PPO |
$6,937.42
|
| Rate for Payer: PacificSource Commercial |
$6,371.10
|
| Rate for Payer: PHCS PPO |
$6,725.05
|
| Rate for Payer: Three Rivers PPO |
$5,309.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,924.34
|
| Rate for Payer: United Healthcare Commercial |
$6,725.05
|
| Rate for Payer: WINHealth Partners Commercial |
$6,017.15
|
|
|
BS PRECISION M8 ADAPTER 55CM
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
BS PRECISION M8 ADAPTER 55CM
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
BS PULSE GENERATOR KIT SC-1132
|
Facility
|
OP
|
$83,125.00
|
|
| Hospital Charge Code |
2800182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45,012.19 |
| Max. Negotiated Rate |
$83,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81,462.50
|
| Rate for Payer: Aetna of WY Medicare |
$54,862.50
|
| Rate for Payer: Altius Commercial |
$79,800.00
|
| Rate for Payer: Beech Street Commercial |
$81,462.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80,631.25
|
| Rate for Payer: Cash Price |
$58,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$80,631.25
|
| Rate for Payer: Cigna of WY Commercial |
$81,462.50
|
| Rate for Payer: Entrust Commercial |
$78,968.75
|
| Rate for Payer: First Choice Health Commercial |
$78,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47,381.25
|
| Rate for Payer: HealthUtah PPO |
$83,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80,631.25
|
| Rate for Payer: Multiplan Medicare/VA |
$45,012.19
|
| Rate for Payer: One Health Plan of WY PPO |
$81,462.50
|
| Rate for Payer: PacificSource Commercial |
$74,812.50
|
| Rate for Payer: PHCS PPO |
$81,462.50
|
| Rate for Payer: Three Rivers PPO |
$62,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$47,381.25
|
| Rate for Payer: United Healthcare Commercial |
$79,384.38
|
| Rate for Payer: United Healthcare Medicare |
$47,381.25
|
| Rate for Payer: WINHealth Partners Commercial |
$81,462.50
|
| Rate for Payer: Wise Provider Network Commercial |
$78,968.75
|
|
|
BS PULSE GENERATOR KIT SC-1132
|
Facility
|
IP
|
$83,125.00
|
|
| Hospital Charge Code |
2800182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48,170.94 |
| Max. Negotiated Rate |
$83,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81,462.50
|
| Rate for Payer: Aetna of WY Medicare |
$53,200.00
|
| Rate for Payer: Altius Commercial |
$79,800.00
|
| Rate for Payer: Beech Street Commercial |
$81,462.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80,631.25
|
| Rate for Payer: Cash Price |
$58,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$80,631.25
|
| Rate for Payer: Cigna of WY Commercial |
$81,462.50
|
| Rate for Payer: Entrust Commercial |
$78,968.75
|
| Rate for Payer: First Choice Health Commercial |
$78,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50,706.25
|
| Rate for Payer: HealthUtah PPO |
$83,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80,631.25
|
| Rate for Payer: Multiplan Medicare/VA |
$48,170.94
|
| Rate for Payer: One Health Plan of WY PPO |
$81,462.50
|
| Rate for Payer: PacificSource Commercial |
$74,812.50
|
| Rate for Payer: PHCS PPO |
$81,462.50
|
| Rate for Payer: Three Rivers PPO |
$62,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$50,706.25
|
| Rate for Payer: United Healthcare Commercial |
$79,384.38
|
| Rate for Payer: United Healthcare Medicare |
$50,706.25
|
| Rate for Payer: WINHealth Partners Commercial |
$78,968.75
|
| Rate for Payer: Wise Provider Network Commercial |
$78,968.75
|
|
|
BS REMOTE CONTROL SC-5562-1
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800360
|
|
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 REMOTE CONTROL SC-5562-1
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800360
|
|
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 RESOLUTION CLIP 235CM
|
Facility
|
OP
|
$542.50
|
|
| Hospital Charge Code |
2650495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.76 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$531.65
|
| Rate for Payer: Aetna of WY Medicare |
$358.05
|
| Rate for Payer: Altius Commercial |
$520.80
|
| Rate for Payer: Beech Street Commercial |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$526.22
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.22
|
| Rate for Payer: Cigna of WY Commercial |
$531.65
|
| Rate for Payer: Entrust Commercial |
$515.38
|
| Rate for Payer: First Choice Health Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.22
|
| Rate for Payer: HealthUtah PPO |
$542.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$293.76
|
| Rate for Payer: One Health Plan of WY PPO |
$531.65
|
| Rate for Payer: PacificSource Commercial |
$488.25
|
| Rate for Payer: PHCS PPO |
$531.65
|
| Rate for Payer: Three Rivers PPO |
$406.88
|
| Rate for Payer: TriWest Veterans Administration |
$309.22
|
| Rate for Payer: United Healthcare Commercial |
$518.09
|
| Rate for Payer: United Healthcare Medicare |
$309.22
|
| Rate for Payer: WINHealth Partners Commercial |
$531.65
|
| Rate for Payer: Wise Provider Network Commercial |
$515.38
|
|
|
BS RESOLUTION CLIP 235CM
|
Facility
|
IP
|
$542.50
|
|
| Hospital Charge Code |
2650495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.38 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$531.65
|
| Rate for Payer: Aetna of WY Medicare |
$347.20
|
| Rate for Payer: Altius Commercial |
$520.80
|
| Rate for Payer: Beech Street Commercial |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$526.22
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.22
|
| Rate for Payer: Cigna of WY Commercial |
$531.65
|
| Rate for Payer: Entrust Commercial |
$515.38
|
| Rate for Payer: First Choice Health Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.92
|
| Rate for Payer: HealthUtah PPO |
$542.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$314.38
|
| Rate for Payer: One Health Plan of WY PPO |
$531.65
|
| Rate for Payer: PacificSource Commercial |
$488.25
|
| Rate for Payer: PHCS PPO |
$531.65
|
| Rate for Payer: Three Rivers PPO |
$406.88
|
| Rate for Payer: TriWest Veterans Administration |
$330.92
|
| Rate for Payer: United Healthcare Commercial |
$518.09
|
| Rate for Payer: United Healthcare Medicare |
$330.92
|
| Rate for Payer: WINHealth Partners Commercial |
$515.38
|
| Rate for Payer: Wise Provider Network Commercial |
$515.38
|
|
|
BS SENSATION SHORT THROW SNARE
|
Facility
|
IP
|
$57.96
|
|
| Hospital Charge Code |
2650392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.59 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.80
|
| Rate for Payer: Aetna of WY Medicare |
$37.09
|
| Rate for Payer: Altius Commercial |
$55.64
|
| Rate for Payer: Beech Street Commercial |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.22
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.22
|
| Rate for Payer: Cigna of WY Commercial |
$56.80
|
| Rate for Payer: Entrust Commercial |
$55.06
|
| Rate for Payer: First Choice Health Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.36
|
| Rate for Payer: HealthUtah PPO |
$57.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.22
|
| Rate for Payer: Multiplan Medicare/VA |
$33.59
|
| Rate for Payer: One Health Plan of WY PPO |
$56.80
|
| Rate for Payer: PacificSource Commercial |
$52.16
|
| Rate for Payer: PHCS PPO |
$56.80
|
| Rate for Payer: Three Rivers PPO |
$43.47
|
| Rate for Payer: TriWest Veterans Administration |
$35.36
|
| Rate for Payer: United Healthcare Commercial |
$55.35
|
| Rate for Payer: United Healthcare Medicare |
$35.36
|
| Rate for Payer: WINHealth Partners Commercial |
$55.06
|
| Rate for Payer: Wise Provider Network Commercial |
$55.06
|
|
|
BS SENSATION SHORT THROW SNARE
|
Facility
|
OP
|
$57.96
|
|
| Hospital Charge Code |
2650392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.80
|
| Rate for Payer: Aetna of WY Medicare |
$38.25
|
| Rate for Payer: Altius Commercial |
$55.64
|
| Rate for Payer: Beech Street Commercial |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.22
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.22
|
| Rate for Payer: Cigna of WY Commercial |
$56.80
|
| Rate for Payer: Entrust Commercial |
$55.06
|
| Rate for Payer: First Choice Health Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.04
|
| Rate for Payer: HealthUtah PPO |
$57.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.22
|
| Rate for Payer: Multiplan Medicare/VA |
$31.39
|
| Rate for Payer: One Health Plan of WY PPO |
$56.80
|
| Rate for Payer: PacificSource Commercial |
$52.16
|
| Rate for Payer: PHCS PPO |
$56.80
|
| Rate for Payer: Three Rivers PPO |
$43.47
|
| Rate for Payer: TriWest Veterans Administration |
$33.04
|
| Rate for Payer: United Healthcare Commercial |
$55.35
|
| Rate for Payer: United Healthcare Medicare |
$33.04
|
| Rate for Payer: WINHealth Partners Commercial |
$56.80
|
| Rate for Payer: Wise Provider Network Commercial |
$55.06
|
|
|
BS SPECTRA PULSE GEN SC-1160
|
Facility
|
IP
|
$86,625.00
|
|
| Hospital Charge Code |
2800358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50,199.19 |
| Max. Negotiated Rate |
$86,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84,892.50
|
| Rate for Payer: Aetna of WY Medicare |
$55,440.00
|
| Rate for Payer: Altius Commercial |
$83,160.00
|
| Rate for Payer: Beech Street Commercial |
$84,892.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84,026.25
|
| Rate for Payer: Cash Price |
$60,637.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$84,026.25
|
| Rate for Payer: Cigna of WY Commercial |
$84,892.50
|
| Rate for Payer: Entrust Commercial |
$82,293.75
|
| Rate for Payer: First Choice Health Commercial |
$82,293.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82,293.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52,841.25
|
| Rate for Payer: HealthUtah PPO |
$86,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84,026.25
|
| Rate for Payer: Multiplan Medicare/VA |
$50,199.19
|
| Rate for Payer: One Health Plan of WY PPO |
$84,892.50
|
| Rate for Payer: PacificSource Commercial |
$77,962.50
|
| Rate for Payer: PHCS PPO |
$84,892.50
|
| Rate for Payer: Three Rivers PPO |
$64,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$52,841.25
|
| Rate for Payer: United Healthcare Commercial |
$82,726.88
|
| Rate for Payer: United Healthcare Medicare |
$52,841.25
|
| Rate for Payer: WINHealth Partners Commercial |
$82,293.75
|
| Rate for Payer: Wise Provider Network Commercial |
$82,293.75
|
|
|
BS SPECTRA PULSE GEN SC-1160
|
Facility
|
OP
|
$86,625.00
|
|
| Hospital Charge Code |
2800358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46,907.44 |
| Max. Negotiated Rate |
$86,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84,892.50
|
| Rate for Payer: Aetna of WY Medicare |
$57,172.50
|
| Rate for Payer: Altius Commercial |
$83,160.00
|
| Rate for Payer: Beech Street Commercial |
$84,892.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84,026.25
|
| Rate for Payer: Cash Price |
$60,637.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$84,026.25
|
| Rate for Payer: Cigna of WY Commercial |
$84,892.50
|
| Rate for Payer: Entrust Commercial |
$82,293.75
|
| Rate for Payer: First Choice Health Commercial |
$82,293.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82,293.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49,376.25
|
| Rate for Payer: HealthUtah PPO |
$86,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84,026.25
|
| Rate for Payer: Multiplan Medicare/VA |
$46,907.44
|
| Rate for Payer: One Health Plan of WY PPO |
$84,892.50
|
| Rate for Payer: PacificSource Commercial |
$77,962.50
|
| Rate for Payer: PHCS PPO |
$84,892.50
|
| Rate for Payer: Three Rivers PPO |
$64,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$49,376.25
|
| Rate for Payer: United Healthcare Commercial |
$82,726.88
|
| Rate for Payer: United Healthcare Medicare |
$49,376.25
|
| Rate for Payer: WINHealth Partners Commercial |
$84,892.50
|
| Rate for Payer: Wise Provider Network Commercial |
$82,293.75
|
|
|
BS TUNNELER 35CM SC-4252
|
Facility
|
IP
|
$437.50
|
|
| Hospital Charge Code |
2800332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.53 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$280.00
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.88
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$253.53
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$266.88
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$266.88
|
| Rate for Payer: WINHealth Partners Commercial |
$415.62
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
|
BS TUNNELER 35CM SC-4252
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
2800332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.91 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$288.75
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.38
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$236.91
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$249.38
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$249.38
|
| Rate for Payer: WINHealth Partners Commercial |
$428.75
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
|
BS WAVEWRITER PRIME GENERATOR
|
Facility
|
OP
|
$78,750.00
|
|
| Hospital Charge Code |
2800450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42,643.12 |
| Max. Negotiated Rate |
$78,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77,175.00
|
| Rate for Payer: Aetna of WY Medicare |
$51,975.00
|
| Rate for Payer: Altius Commercial |
$75,600.00
|
| Rate for Payer: Beech Street Commercial |
$77,175.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76,387.50
|
| Rate for Payer: Cash Price |
$55,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$76,387.50
|
| Rate for Payer: Cigna of WY Commercial |
$77,175.00
|
| Rate for Payer: Entrust Commercial |
$74,812.50
|
| Rate for Payer: First Choice Health Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44,887.50
|
| Rate for Payer: HealthUtah PPO |
$78,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76,387.50
|
| Rate for Payer: Multiplan Medicare/VA |
$42,643.12
|
| Rate for Payer: One Health Plan of WY PPO |
$77,175.00
|
| Rate for Payer: PacificSource Commercial |
$70,875.00
|
| Rate for Payer: PHCS PPO |
$77,175.00
|
| Rate for Payer: Three Rivers PPO |
$59,062.50
|
| Rate for Payer: TriWest Veterans Administration |
$44,887.50
|
| Rate for Payer: United Healthcare Commercial |
$75,206.25
|
| Rate for Payer: United Healthcare Medicare |
$44,887.50
|
| Rate for Payer: WINHealth Partners Commercial |
$77,175.00
|
| Rate for Payer: Wise Provider Network Commercial |
$74,812.50
|
|
|
BS WAVEWRITER PRIME GENERATOR
|
Facility
|
IP
|
$78,750.00
|
|
| Hospital Charge Code |
2800450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45,635.62 |
| Max. Negotiated Rate |
$78,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77,175.00
|
| Rate for Payer: Aetna of WY Medicare |
$50,400.00
|
| Rate for Payer: Altius Commercial |
$75,600.00
|
| Rate for Payer: Beech Street Commercial |
$77,175.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76,387.50
|
| Rate for Payer: Cash Price |
$55,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$76,387.50
|
| Rate for Payer: Cigna of WY Commercial |
$77,175.00
|
| Rate for Payer: Entrust Commercial |
$74,812.50
|
| Rate for Payer: First Choice Health Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48,037.50
|
| Rate for Payer: HealthUtah PPO |
$78,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76,387.50
|
| Rate for Payer: Multiplan Medicare/VA |
$45,635.62
|
| Rate for Payer: One Health Plan of WY PPO |
$77,175.00
|
| Rate for Payer: PacificSource Commercial |
$70,875.00
|
| Rate for Payer: PHCS PPO |
$77,175.00
|
| Rate for Payer: Three Rivers PPO |
$59,062.50
|
| Rate for Payer: TriWest Veterans Administration |
$48,037.50
|
| Rate for Payer: United Healthcare Commercial |
$75,206.25
|
| Rate for Payer: United Healthcare Medicare |
$48,037.50
|
| Rate for Payer: WINHealth Partners Commercial |
$74,812.50
|
| Rate for Payer: Wise Provider Network Commercial |
$74,812.50
|
|
|
BS WAVEWRITER PULSE GENERATOR
|
Facility
|
IP
|
$78,750.00
|
|
| Hospital Charge Code |
2800442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45,635.62 |
| Max. Negotiated Rate |
$78,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77,175.00
|
| Rate for Payer: Aetna of WY Medicare |
$50,400.00
|
| Rate for Payer: Altius Commercial |
$75,600.00
|
| Rate for Payer: Beech Street Commercial |
$77,175.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76,387.50
|
| Rate for Payer: Cash Price |
$55,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$76,387.50
|
| Rate for Payer: Cigna of WY Commercial |
$77,175.00
|
| Rate for Payer: Entrust Commercial |
$74,812.50
|
| Rate for Payer: First Choice Health Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48,037.50
|
| Rate for Payer: HealthUtah PPO |
$78,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76,387.50
|
| Rate for Payer: Multiplan Medicare/VA |
$45,635.62
|
| Rate for Payer: One Health Plan of WY PPO |
$77,175.00
|
| Rate for Payer: PacificSource Commercial |
$70,875.00
|
| Rate for Payer: PHCS PPO |
$77,175.00
|
| Rate for Payer: Three Rivers PPO |
$59,062.50
|
| Rate for Payer: TriWest Veterans Administration |
$48,037.50
|
| Rate for Payer: United Healthcare Commercial |
$75,206.25
|
| Rate for Payer: United Healthcare Medicare |
$48,037.50
|
| Rate for Payer: WINHealth Partners Commercial |
$74,812.50
|
| Rate for Payer: Wise Provider Network Commercial |
$74,812.50
|
|
|
BS WAVEWRITER PULSE GENERATOR
|
Facility
|
OP
|
$78,750.00
|
|
| Hospital Charge Code |
2800442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42,643.12 |
| Max. Negotiated Rate |
$78,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77,175.00
|
| Rate for Payer: Aetna of WY Medicare |
$51,975.00
|
| Rate for Payer: Altius Commercial |
$75,600.00
|
| Rate for Payer: Beech Street Commercial |
$77,175.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76,387.50
|
| Rate for Payer: Cash Price |
$55,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$76,387.50
|
| Rate for Payer: Cigna of WY Commercial |
$77,175.00
|
| Rate for Payer: Entrust Commercial |
$74,812.50
|
| Rate for Payer: First Choice Health Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44,887.50
|
| Rate for Payer: HealthUtah PPO |
$78,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76,387.50
|
| Rate for Payer: Multiplan Medicare/VA |
$42,643.12
|
| Rate for Payer: One Health Plan of WY PPO |
$77,175.00
|
| Rate for Payer: PacificSource Commercial |
$70,875.00
|
| Rate for Payer: PHCS PPO |
$77,175.00
|
| Rate for Payer: Three Rivers PPO |
$59,062.50
|
| Rate for Payer: TriWest Veterans Administration |
$44,887.50
|
| Rate for Payer: United Healthcare Commercial |
$75,206.25
|
| Rate for Payer: United Healthcare Medicare |
$44,887.50
|
| Rate for Payer: WINHealth Partners Commercial |
$77,175.00
|
| Rate for Payer: Wise Provider Network Commercial |
$74,812.50
|
|
|
BUCKS TRACTION
|
Facility
|
IP
|
$31.01
|
|
| Hospital Charge Code |
2200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.39
|
| Rate for Payer: Aetna of WY Medicare |
$19.85
|
| Rate for Payer: Altius Commercial |
$29.77
|
| Rate for Payer: Beech Street Commercial |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.08
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.08
|
| Rate for Payer: Cigna of WY Commercial |
$30.39
|
| Rate for Payer: Entrust Commercial |
$29.46
|
| Rate for Payer: First Choice Health Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.92
|
| Rate for Payer: HealthUtah PPO |
$31.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.08
|
| Rate for Payer: Multiplan Medicare/VA |
$17.97
|
| Rate for Payer: One Health Plan of WY PPO |
$30.39
|
| Rate for Payer: PacificSource Commercial |
$27.91
|
| Rate for Payer: PHCS PPO |
$30.39
|
| Rate for Payer: Three Rivers PPO |
$23.26
|
| Rate for Payer: TriWest Veterans Administration |
$18.92
|
| Rate for Payer: United Healthcare Commercial |
$29.61
|
| Rate for Payer: United Healthcare Medicare |
$18.92
|
| Rate for Payer: WINHealth Partners Commercial |
$29.46
|
| Rate for Payer: Wise Provider Network Commercial |
$29.46
|
|
|
BUCKS TRACTION
|
Facility
|
OP
|
$31.01
|
|
| Hospital Charge Code |
2200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.39
|
| Rate for Payer: Aetna of WY Medicare |
$20.47
|
| Rate for Payer: Altius Commercial |
$29.77
|
| Rate for Payer: Beech Street Commercial |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.08
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.08
|
| Rate for Payer: Cigna of WY Commercial |
$30.39
|
| Rate for Payer: Entrust Commercial |
$29.46
|
| Rate for Payer: First Choice Health Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.68
|
| Rate for Payer: HealthUtah PPO |
$31.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.08
|
| Rate for Payer: Multiplan Medicare/VA |
$16.79
|
| Rate for Payer: One Health Plan of WY PPO |
$30.39
|
| Rate for Payer: PacificSource Commercial |
$27.91
|
| Rate for Payer: PHCS PPO |
$30.39
|
| Rate for Payer: Three Rivers PPO |
$23.26
|
| Rate for Payer: TriWest Veterans Administration |
$17.68
|
| Rate for Payer: United Healthcare Commercial |
$29.61
|
| Rate for Payer: United Healthcare Medicare |
$17.68
|
| Rate for Payer: WINHealth Partners Commercial |
$30.39
|
| Rate for Payer: Wise Provider Network Commercial |
$29.46
|
|
