|
CATHETER FOLEY 2 WAY 5CC 26FR
|
Facility
|
IP
|
$5.67
|
|
| Hospital Charge Code |
2750020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.63
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.46
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
| Rate for Payer: WINHealth Partners Commercial |
$5.39
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
CATHETER FOLEY 2 WAY 5CC 26FR
|
Facility
|
OP
|
$5.67
|
|
| Hospital Charge Code |
2750020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.74
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.23
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.07
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.23
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
| Rate for Payer: WINHealth Partners Commercial |
$5.56
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
CATHETER FOLEY 2 WAY 5CC 28FR
|
Facility
|
OP
|
$5.67
|
|
| Hospital Charge Code |
2750021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.74
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.23
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.07
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
| Rate for Payer: WINHealth Partners Commercial |
$5.56
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
CATHETER FOLEY 2 WAY 5CC 28FR
|
Facility
|
IP
|
$5.67
|
|
| Hospital Charge Code |
2750021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.63
|
| Rate for Payer: Altius Commercial |
$5.44
|
| Rate for Payer: Beech Street Commercial |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.50
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.50
|
| Rate for Payer: Cigna of WY Commercial |
$5.56
|
| Rate for Payer: Entrust Commercial |
$5.39
|
| Rate for Payer: First Choice Health Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.46
|
| Rate for Payer: HealthUtah PPO |
$5.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5.56
|
| Rate for Payer: PacificSource Commercial |
$5.10
|
| Rate for Payer: PHCS PPO |
$5.56
|
| Rate for Payer: Three Rivers PPO |
$4.25
|
| Rate for Payer: TriWest Veterans Administration |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
| Rate for Payer: WINHealth Partners Commercial |
$5.39
|
| Rate for Payer: Wise Provider Network Commercial |
$5.39
|
|
|
CATHETER FOLEY COUDE 5CC 12FR
|
Facility
|
OP
|
$41.12
|
|
| Hospital Charge Code |
2750022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$27.14
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.44
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$22.27
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$23.44
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$23.44
|
| Rate for Payer: WINHealth Partners Commercial |
$40.30
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER FOLEY COUDE 5CC 12FR
|
Facility
|
IP
|
$41.12
|
|
| Hospital Charge Code |
2750022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$26.32
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$39.06
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER FOLEY COUDE 5CC 14FR
|
Facility
|
OP
|
$41.12
|
|
| Hospital Charge Code |
2750023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$27.14
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.44
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$22.27
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$23.44
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$23.44
|
| Rate for Payer: WINHealth Partners Commercial |
$40.30
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER FOLEY COUDE 5CC 14FR
|
Facility
|
IP
|
$41.12
|
|
| Hospital Charge Code |
2750023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$26.32
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$39.06
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER FOLEY COUDE 5CC 16FR
|
Facility
|
IP
|
$41.12
|
|
| Hospital Charge Code |
2750024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$26.32
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$39.06
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER FOLEY COUDE 5CC 16FR
|
Facility
|
OP
|
$41.12
|
|
| Hospital Charge Code |
2750024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.30
|
| Rate for Payer: Aetna of WY Medicare |
$27.14
|
| Rate for Payer: Altius Commercial |
$39.48
|
| Rate for Payer: Beech Street Commercial |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$28.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.89
|
| Rate for Payer: Cigna of WY Commercial |
$40.30
|
| Rate for Payer: Entrust Commercial |
$39.06
|
| Rate for Payer: First Choice Health Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.44
|
| Rate for Payer: HealthUtah PPO |
$41.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.89
|
| Rate for Payer: Multiplan Medicare/VA |
$22.27
|
| Rate for Payer: One Health Plan of WY PPO |
$40.30
|
| Rate for Payer: PacificSource Commercial |
$37.01
|
| Rate for Payer: PHCS PPO |
$40.30
|
| Rate for Payer: Three Rivers PPO |
$30.84
|
| Rate for Payer: TriWest Veterans Administration |
$23.44
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare |
$23.44
|
| Rate for Payer: WINHealth Partners Commercial |
$40.30
|
| Rate for Payer: Wise Provider Network Commercial |
$39.06
|
|
|
CATHETER IAB MEGA 7.5FR 30CC
|
Facility
|
IP
|
$3,196.72
|
|
| Hospital Charge Code |
3050003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$3,196.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,132.79
|
| Rate for Payer: Aetna of WY Medicare |
$2,045.90
|
| Rate for Payer: Altius Commercial |
$3,068.85
|
| Rate for Payer: Beech Street Commercial |
$3,132.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,100.82
|
| Rate for Payer: Cash Price |
$2,237.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,100.82
|
| Rate for Payer: Cigna of WY Commercial |
$3,132.79
|
| Rate for Payer: Entrust Commercial |
$3,036.88
|
| Rate for Payer: First Choice Health Commercial |
$3,036.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,036.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,950.00
|
| Rate for Payer: HealthUtah PPO |
$3,196.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,100.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1,852.50
|
| Rate for Payer: One Health Plan of WY PPO |
$3,132.79
|
| Rate for Payer: PacificSource Commercial |
$2,877.05
|
| Rate for Payer: PHCS PPO |
$3,132.79
|
| Rate for Payer: Three Rivers PPO |
$2,397.54
|
| Rate for Payer: TriWest Veterans Administration |
$1,950.00
|
| Rate for Payer: United Healthcare Commercial |
$3,052.87
|
| Rate for Payer: United Healthcare Medicare |
$1,950.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,036.88
|
| Rate for Payer: Wise Provider Network Commercial |
$3,036.88
|
|
|
CATHETER IAB MEGA 7.5FR 30CC
|
Facility
|
OP
|
$3,196.72
|
|
| Hospital Charge Code |
3050003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,731.02 |
| Max. Negotiated Rate |
$3,196.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,132.79
|
| Rate for Payer: Aetna of WY Medicare |
$2,109.84
|
| Rate for Payer: Altius Commercial |
$3,068.85
|
| Rate for Payer: Beech Street Commercial |
$3,132.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,100.82
|
| Rate for Payer: Cash Price |
$2,237.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,100.82
|
| Rate for Payer: Cigna of WY Commercial |
$3,132.79
|
| Rate for Payer: Entrust Commercial |
$3,036.88
|
| Rate for Payer: First Choice Health Commercial |
$3,036.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,036.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,822.13
|
| Rate for Payer: HealthUtah PPO |
$3,196.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,100.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1,731.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,132.79
|
| Rate for Payer: PacificSource Commercial |
$2,877.05
|
| Rate for Payer: PHCS PPO |
$3,132.79
|
| Rate for Payer: Three Rivers PPO |
$2,397.54
|
| Rate for Payer: TriWest Veterans Administration |
$1,822.13
|
| Rate for Payer: United Healthcare Commercial |
$3,052.87
|
| Rate for Payer: United Healthcare Medicare |
$1,822.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3,132.79
|
| Rate for Payer: Wise Provider Network Commercial |
$3,036.88
|
|
|
CATHETER IAB SENSATION PLUS 7.5FR 40CC
|
Facility
|
OP
|
$3,487.33
|
|
| Hospital Charge Code |
3050002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,888.39 |
| Max. Negotiated Rate |
$3,487.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,301.64
|
| Rate for Payer: Altius Commercial |
$3,347.84
|
| Rate for Payer: Beech Street Commercial |
$3,417.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,382.71
|
| Rate for Payer: Cash Price |
$2,441.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.58
|
| Rate for Payer: Entrust Commercial |
$3,312.96
|
| Rate for Payer: First Choice Health Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,987.78
|
| Rate for Payer: HealthUtah PPO |
$3,487.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1,888.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.58
|
| Rate for Payer: PacificSource Commercial |
$3,138.60
|
| Rate for Payer: PHCS PPO |
$3,417.58
|
| Rate for Payer: Three Rivers PPO |
$2,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,987.78
|
| Rate for Payer: United Healthcare Commercial |
$3,330.40
|
| Rate for Payer: United Healthcare Medicare |
$1,987.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,417.58
|
| Rate for Payer: Wise Provider Network Commercial |
$3,312.96
|
|
|
CATHETER IAB SENSATION PLUS 7.5FR 40CC
|
Facility
|
IP
|
$3,487.33
|
|
| Hospital Charge Code |
3050002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,020.91 |
| Max. Negotiated Rate |
$3,487.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,231.89
|
| Rate for Payer: Altius Commercial |
$3,347.84
|
| Rate for Payer: Beech Street Commercial |
$3,417.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,382.71
|
| Rate for Payer: Cash Price |
$2,441.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.58
|
| Rate for Payer: Entrust Commercial |
$3,312.96
|
| Rate for Payer: First Choice Health Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,127.27
|
| Rate for Payer: HealthUtah PPO |
$3,487.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.71
|
| Rate for Payer: Multiplan Medicare/VA |
$2,020.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.58
|
| Rate for Payer: PacificSource Commercial |
$3,138.60
|
| Rate for Payer: PHCS PPO |
$3,417.58
|
| Rate for Payer: Three Rivers PPO |
$2,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,127.27
|
| Rate for Payer: United Healthcare Commercial |
$3,330.40
|
| Rate for Payer: United Healthcare Medicare |
$2,127.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,312.96
|
| Rate for Payer: Wise Provider Network Commercial |
$3,312.96
|
|
|
CATHETER IAB SENSATION PLUS 8FR 50CC
|
Facility
|
OP
|
$3,487.33
|
|
| Hospital Charge Code |
3050001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,888.39 |
| Max. Negotiated Rate |
$3,487.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,301.64
|
| Rate for Payer: Altius Commercial |
$3,347.84
|
| Rate for Payer: Beech Street Commercial |
$3,417.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,382.71
|
| Rate for Payer: Cash Price |
$2,441.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.58
|
| Rate for Payer: Entrust Commercial |
$3,312.96
|
| Rate for Payer: First Choice Health Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,987.78
|
| Rate for Payer: HealthUtah PPO |
$3,487.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1,888.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.58
|
| Rate for Payer: PacificSource Commercial |
$3,138.60
|
| Rate for Payer: PHCS PPO |
$3,417.58
|
| Rate for Payer: Three Rivers PPO |
$2,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,987.78
|
| Rate for Payer: United Healthcare Commercial |
$3,330.40
|
| Rate for Payer: United Healthcare Medicare |
$1,987.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,417.58
|
| Rate for Payer: Wise Provider Network Commercial |
$3,312.96
|
|
|
CATHETER IAB SENSATION PLUS 8FR 50CC
|
Facility
|
IP
|
$3,487.33
|
|
| Hospital Charge Code |
3050001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,020.91 |
| Max. Negotiated Rate |
$3,487.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,417.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,231.89
|
| Rate for Payer: Altius Commercial |
$3,347.84
|
| Rate for Payer: Beech Street Commercial |
$3,417.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,382.71
|
| Rate for Payer: Cash Price |
$2,441.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,382.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,417.58
|
| Rate for Payer: Entrust Commercial |
$3,312.96
|
| Rate for Payer: First Choice Health Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,312.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,127.27
|
| Rate for Payer: HealthUtah PPO |
$3,487.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,382.71
|
| Rate for Payer: Multiplan Medicare/VA |
$2,020.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,417.58
|
| Rate for Payer: PacificSource Commercial |
$3,138.60
|
| Rate for Payer: PHCS PPO |
$3,417.58
|
| Rate for Payer: Three Rivers PPO |
$2,615.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,127.27
|
| Rate for Payer: United Healthcare Commercial |
$3,330.40
|
| Rate for Payer: United Healthcare Medicare |
$2,127.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3,312.96
|
| Rate for Payer: Wise Provider Network Commercial |
$3,312.96
|
|
|
CATHETER SHOCKWAVE C2+IVL I 2.5X12MM
|
Facility
|
OP
|
$16,450.00
|
|
| Hospital Charge Code |
3050004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,907.68 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,857.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,376.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$8,907.68
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$9,376.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$9,376.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 2.5X12MM
|
Facility
|
IP
|
$16,450.00
|
|
| Hospital Charge Code |
3050004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,532.78 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,528.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,034.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9,532.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$10,034.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$10,034.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15,627.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 3.0X12MM
|
Facility
|
IP
|
$16,450.00
|
|
| Hospital Charge Code |
3050005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,532.78 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,528.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,034.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9,532.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$10,034.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$10,034.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15,627.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 3.0X12MM
|
Facility
|
OP
|
$16,450.00
|
|
| Hospital Charge Code |
3050005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,907.68 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,857.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,376.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$8,907.68
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$9,376.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$9,376.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 3.5X12MM
|
Facility
|
IP
|
$16,450.00
|
|
| Hospital Charge Code |
3050006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,532.78 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,528.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,034.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9,532.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$10,034.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$10,034.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15,627.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 3.5X12MM
|
Facility
|
OP
|
$16,450.00
|
|
| Hospital Charge Code |
3050006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,907.68 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,857.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,376.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$8,907.68
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$9,376.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$9,376.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 4.0X12MM
|
Facility
|
IP
|
$16,450.00
|
|
| Hospital Charge Code |
3050007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,532.78 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,528.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,034.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9,532.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$10,034.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$10,034.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15,627.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATHETER SHOCKWAVE C2+IVL I 4.0X12MM
|
Facility
|
OP
|
$16,450.00
|
|
| Hospital Charge Code |
3050007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,907.68 |
| Max. Negotiated Rate |
$16,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,121.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,857.00
|
| Rate for Payer: Altius Commercial |
$15,792.00
|
| Rate for Payer: Beech Street Commercial |
$16,121.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,956.50
|
| Rate for Payer: Cash Price |
$11,515.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,956.50
|
| Rate for Payer: Cigna of WY Commercial |
$16,121.00
|
| Rate for Payer: Entrust Commercial |
$15,627.50
|
| Rate for Payer: First Choice Health Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,627.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,376.50
|
| Rate for Payer: HealthUtah PPO |
$16,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,956.50
|
| Rate for Payer: Multiplan Medicare/VA |
$8,907.68
|
| Rate for Payer: One Health Plan of WY PPO |
$16,121.00
|
| Rate for Payer: PacificSource Commercial |
$14,805.00
|
| Rate for Payer: PHCS PPO |
$16,121.00
|
| Rate for Payer: Three Rivers PPO |
$12,337.50
|
| Rate for Payer: TriWest Veterans Administration |
$9,376.50
|
| Rate for Payer: United Healthcare Commercial |
$15,709.75
|
| Rate for Payer: United Healthcare Medicare |
$9,376.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15,627.50
|
|
|
CATH FOGARTY OCCLUSION 3FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
2500250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$82.88
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.00
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$75.05
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
