|
BONE MARROW NEEDLE VORTEX 13G CLOSED
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.81 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.48
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$506.81
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$533.48
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$533.48
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G CLOSED
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.07
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$576.71
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$607.07
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$607.07
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G CLOSED
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.81 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.48
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$506.81
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$533.48
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$533.48
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G OPEN
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.07
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$576.71
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$607.07
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$607.07
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MARROW NEEDLE VORTEX 8G OPEN
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.81 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.48
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$506.81
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$533.48
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$533.48
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
BONE MILL BOWL ASSY BM210
|
Facility
|
IP
|
$706.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.20 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.59
|
| Rate for Payer: Altius Commercial |
$678.59
|
| Rate for Payer: Beech Street Commercial |
$692.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.33
|
| Rate for Payer: Cash Price |
$494.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.65
|
| Rate for Payer: Cigna of WY Commercial |
$692.72
|
| Rate for Payer: Entrust Commercial |
$671.52
|
| Rate for Payer: First Choice Health Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.53
|
| Rate for Payer: HealthUtah PPO |
$706.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.65
|
| Rate for Payer: Multiplan Medicare/VA |
$443.20
|
| Rate for Payer: One Health Plan of WY PPO |
$692.72
|
| Rate for Payer: PacificSource Commercial |
$636.17
|
| Rate for Payer: PHCS PPO |
$692.72
|
| Rate for Payer: Three Rivers PPO |
$530.14
|
| Rate for Payer: TriWest Veterans Administration |
$466.53
|
| Rate for Payer: United Healthcare Commercial |
$614.97
|
| Rate for Payer: United Healthcare Medicare |
$466.53
|
| Rate for Payer: WINHealth Partners Commercial |
$671.52
|
| Rate for Payer: Wise Provider Network Commercial |
$671.52
|
|
|
BONE MILL BOWL ASSY BM210
|
Facility
|
OP
|
$706.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.48 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.72
|
| Rate for Payer: Aetna of WY Medicare |
$466.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.59
|
| Rate for Payer: Altius Commercial |
$678.59
|
| Rate for Payer: Beech Street Commercial |
$692.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.33
|
| Rate for Payer: Cash Price |
$494.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.65
|
| Rate for Payer: Cigna of WY Commercial |
$692.72
|
| Rate for Payer: Entrust Commercial |
$671.52
|
| Rate for Payer: First Choice Health Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$409.98
|
| Rate for Payer: HealthUtah PPO |
$706.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.65
|
| Rate for Payer: Multiplan Medicare/VA |
$389.48
|
| Rate for Payer: One Health Plan of WY PPO |
$692.72
|
| Rate for Payer: PacificSource Commercial |
$636.17
|
| Rate for Payer: PHCS PPO |
$692.72
|
| Rate for Payer: Three Rivers PPO |
$530.14
|
| Rate for Payer: TriWest Veterans Administration |
$409.98
|
| Rate for Payer: United Healthcare Commercial |
$614.97
|
| Rate for Payer: United Healthcare Medicare |
$409.98
|
| Rate for Payer: WINHealth Partners Commercial |
$692.72
|
| Rate for Payer: Wise Provider Network Commercial |
$671.52
|
|
|
BONE WAX
|
Facility
|
OP
|
$13.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.75
|
| Rate for Payer: Aetna of WY Medicare |
$8.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.49
|
| Rate for Payer: Altius Commercial |
$12.49
|
| Rate for Payer: Beech Street Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.68
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.62
|
| Rate for Payer: Cigna of WY Commercial |
$12.75
|
| Rate for Payer: Entrust Commercial |
$12.36
|
| Rate for Payer: First Choice Health Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.55
|
| Rate for Payer: HealthUtah PPO |
$13.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.62
|
| Rate for Payer: Multiplan Medicare/VA |
$7.17
|
| Rate for Payer: One Health Plan of WY PPO |
$12.75
|
| Rate for Payer: PacificSource Commercial |
$11.71
|
| Rate for Payer: PHCS PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$7.55
|
| Rate for Payer: United Healthcare Commercial |
$11.32
|
| Rate for Payer: United Healthcare Medicare |
$7.55
|
| Rate for Payer: WINHealth Partners Commercial |
$12.75
|
| Rate for Payer: Wise Provider Network Commercial |
$12.36
|
|
|
BONE WAX
|
Facility
|
IP
|
$13.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.49
|
| Rate for Payer: Altius Commercial |
$12.49
|
| Rate for Payer: Beech Street Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.68
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.62
|
| Rate for Payer: Cigna of WY Commercial |
$12.75
|
| Rate for Payer: Entrust Commercial |
$12.36
|
| Rate for Payer: First Choice Health Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.59
|
| Rate for Payer: HealthUtah PPO |
$13.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.62
|
| Rate for Payer: Multiplan Medicare/VA |
$8.16
|
| Rate for Payer: One Health Plan of WY PPO |
$12.75
|
| Rate for Payer: PacificSource Commercial |
$11.71
|
| Rate for Payer: PHCS PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$8.59
|
| Rate for Payer: United Healthcare Commercial |
$11.32
|
| Rate for Payer: United Healthcare Medicare |
$8.59
|
| Rate for Payer: WINHealth Partners Commercial |
$12.36
|
| Rate for Payer: Wise Provider Network Commercial |
$12.36
|
|
|
BOOT XCEL MED SHORT 100618-030
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED SHORT 100618-030
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED TALL 100617-030
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL MED TALL 100617-030
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM SHORT 100618-020
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM SHORT 100618-020
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM TALL 100617-020
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL SM TALL 100617-020
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG SHORT 100618-040
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG SHORT 100618-040
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG TALL 100617-040
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCELT LG TALL 100617-040
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL SHORT 100618-050
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL SHORT 100618-050
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL TALL 100617-050
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$50.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.74
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$42.50
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$44.74
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$44.74
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XL TALL 100617-050
|
Facility
|
IP
|
$77.14
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$74.05
|
| Rate for Payer: Altius Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.83
|
| Rate for Payer: Cigna of WY Commercial |
$75.60
|
| Rate for Payer: Entrust Commercial |
$73.28
|
| Rate for Payer: First Choice Health Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.91
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$48.37
|
| Rate for Payer: One Health Plan of WY PPO |
$75.60
|
| Rate for Payer: PacificSource Commercial |
$69.43
|
| Rate for Payer: PHCS PPO |
$75.60
|
| Rate for Payer: Three Rivers PPO |
$57.86
|
| Rate for Payer: TriWest Veterans Administration |
$50.91
|
| Rate for Payer: United Healthcare Commercial |
$67.11
|
| Rate for Payer: United Healthcare Medicare |
$50.91
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
