|
BOOT XCEL XSM SHORT 100618-010
|
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 XSM SHORT 100618-010
|
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 XSM TALL 100617-010
|
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 XSM TALL 100617-010
|
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
|
|
|
BORIC ACID (BULK) POWDER [17850]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 8770140066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.10
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.10
|
| Rate for Payer: Altius Commercial |
$0.10
|
| Rate for Payer: Beech Street Commercial |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.10
|
| Rate for Payer: Cigna of WY Commercial |
$0.10
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.10
|
| Rate for Payer: PacificSource Commercial |
$0.09
|
| Rate for Payer: PHCS PPO |
$0.10
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.09
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
BORIC ACID (BULK) POWDER [17850]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 8770140066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.10
|
| Rate for Payer: Altius Commercial |
$0.10
|
| Rate for Payer: Beech Street Commercial |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.10
|
| Rate for Payer: Cigna of WY Commercial |
$0.10
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.10
|
| Rate for Payer: PacificSource Commercial |
$0.09
|
| Rate for Payer: PHCS PPO |
$0.10
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.09
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
BORTEZOMIB 2.5 MG/2.5 ML INJECTION (WET SOLR VIAL) [43018632701]
|
Facility
|
IP
|
$303.02
|
|
|
Service Code
|
HCPCS J9049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.99 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.90
|
| Rate for Payer: Altius Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.78
|
| Rate for Payer: Cash Price |
$212.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.93
|
| Rate for Payer: Cigna of WY Commercial |
$296.96
|
| Rate for Payer: Entrust Commercial |
$287.87
|
| Rate for Payer: First Choice Health Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.99
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$189.99
|
| Rate for Payer: One Health Plan of WY PPO |
$296.96
|
| Rate for Payer: PacificSource Commercial |
$272.72
|
| Rate for Payer: PHCS PPO |
$296.96
|
| Rate for Payer: Three Rivers PPO |
$227.26
|
| Rate for Payer: TriWest Veterans Administration |
$199.99
|
| Rate for Payer: United Healthcare Commercial |
$263.63
|
| Rate for Payer: United Healthcare Medicare |
$199.99
|
| Rate for Payer: WINHealth Partners Commercial |
$287.87
|
| Rate for Payer: Wise Provider Network Commercial |
$287.87
|
|
|
BORTEZOMIB 2.5 MG/2.5 ML INJECTION (WET SOLR VIAL) [43018632701]
|
Facility
|
OP
|
$303.02
|
|
|
Service Code
|
HCPCS J9049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Aetna of WY Medicare |
$199.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.90
|
| Rate for Payer: Altius Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.78
|
| Rate for Payer: Cash Price |
$212.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.93
|
| Rate for Payer: Cigna of WY Commercial |
$296.96
|
| Rate for Payer: Entrust Commercial |
$287.87
|
| Rate for Payer: First Choice Health Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.75
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$166.96
|
| Rate for Payer: One Health Plan of WY PPO |
$296.96
|
| Rate for Payer: PacificSource Commercial |
$272.72
|
| Rate for Payer: PHCS PPO |
$296.96
|
| Rate for Payer: Three Rivers PPO |
$227.26
|
| Rate for Payer: TriWest Veterans Administration |
$175.75
|
| Rate for Payer: United Healthcare Commercial |
$263.63
|
| Rate for Payer: United Healthcare Medicare |
$175.75
|
| Rate for Payer: WINHealth Partners Commercial |
$296.96
|
| Rate for Payer: Wise Provider Network Commercial |
$287.87
|
|
|
BORTEZOMIB 2.5 MG INJECTION POWDER FOR SOLUTION [165174]
|
Facility
|
OP
|
$303.02
|
|
|
Service Code
|
HCPCS J9049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Aetna of WY Medicare |
$199.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.90
|
| Rate for Payer: Altius Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.78
|
| Rate for Payer: Cash Price |
$212.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.93
|
| Rate for Payer: Cigna of WY Commercial |
$296.96
|
| Rate for Payer: Entrust Commercial |
$287.87
|
| Rate for Payer: First Choice Health Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.75
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$166.96
|
| Rate for Payer: One Health Plan of WY PPO |
$296.96
|
| Rate for Payer: PacificSource Commercial |
$272.72
|
| Rate for Payer: PHCS PPO |
$296.96
|
| Rate for Payer: Three Rivers PPO |
$227.26
|
| Rate for Payer: TriWest Veterans Administration |
$175.75
|
| Rate for Payer: United Healthcare Commercial |
$263.63
|
| Rate for Payer: United Healthcare Medicare |
$175.75
|
| Rate for Payer: WINHealth Partners Commercial |
$296.96
|
| Rate for Payer: Wise Provider Network Commercial |
$287.87
|
|
|
BORTEZOMIB 2.5 MG INJECTION POWDER FOR SOLUTION [165174]
|
Facility
|
IP
|
$303.02
|
|
|
Service Code
|
HCPCS J9049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.99 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.90
|
| Rate for Payer: Altius Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.78
|
| Rate for Payer: Cash Price |
$212.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.93
|
| Rate for Payer: Cigna of WY Commercial |
$296.96
|
| Rate for Payer: Entrust Commercial |
$287.87
|
| Rate for Payer: First Choice Health Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.99
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$189.99
|
| Rate for Payer: One Health Plan of WY PPO |
$296.96
|
| Rate for Payer: PacificSource Commercial |
$272.72
|
| Rate for Payer: PHCS PPO |
$296.96
|
| Rate for Payer: Three Rivers PPO |
$227.26
|
| Rate for Payer: TriWest Veterans Administration |
$199.99
|
| Rate for Payer: United Healthcare Commercial |
$263.63
|
| Rate for Payer: United Healthcare Medicare |
$199.99
|
| Rate for Payer: WINHealth Partners Commercial |
$287.87
|
| Rate for Payer: Wise Provider Network Commercial |
$287.87
|
|
|
BORTEZOMIB 3.5 MG/1.4 ML INJECTION (WET SOLR VIAL) [43012307001]
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$65.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$97.02
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
BORTEZOMIB 3.5 MG/1.4 ML INJECTION (WET SOLR VIAL) [43012307001]
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.07 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.34
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$62.07
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$65.34
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [28281]
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$65.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$97.02
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [28281]
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.07 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.34
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$62.07
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$65.34
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
BOSTON SCI 6FR AL1 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR AL1 GUIDE CATH
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR AL2 GUIDE CATH
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR AL2 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR CONVEY CLS3.5 GUIDE CATH
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR CONVEY CLS3.5 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR CONVEY CLS3 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR CONVEY CLS3 GUIDE CATH
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR FL3.5 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR FL3.5 GUIDE CATH
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
BOSTON SCI 6FR FL4 GUIDE CATH
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
