|
BOSTON SCI 6FR FL4 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 FR4 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 FR4 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 6 FR JL3.5 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 6 FR JL3.5 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 6 FR JL4 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 6 FR JL4 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 JR4 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 JR4 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 LCB 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 LCB 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 COMET II PRESSURE GUIDEWIRE
|
Facility
|
OP
|
$2,315.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.70 |
| Max. Negotiated Rate |
$2,315.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,268.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,528.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,222.64
|
| Rate for Payer: Altius Commercial |
$2,222.64
|
| Rate for Payer: Beech Street Commercial |
$2,268.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,900.82
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,245.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,268.94
|
| Rate for Payer: Entrust Commercial |
$2,199.49
|
| Rate for Payer: First Choice Health Commercial |
$2,199.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,199.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,342.84
|
| Rate for Payer: HealthUtah PPO |
$2,315.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,245.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,275.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,268.94
|
| Rate for Payer: PacificSource Commercial |
$2,083.72
|
| Rate for Payer: PHCS PPO |
$2,268.94
|
| Rate for Payer: Three Rivers PPO |
$1,736.44
|
| Rate for Payer: TriWest Veterans Administration |
$1,342.84
|
| Rate for Payer: United Healthcare Commercial |
$2,014.27
|
| Rate for Payer: United Healthcare Medicare |
$1,342.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,268.94
|
| Rate for Payer: Wise Provider Network Commercial |
$2,199.49
|
|
|
BOSTON SCI COMET II PRESSURE GUIDEWIRE
|
Facility
|
IP
|
$2,315.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,451.66 |
| Max. Negotiated Rate |
$2,315.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,268.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,222.64
|
| Rate for Payer: Altius Commercial |
$2,222.64
|
| Rate for Payer: Beech Street Commercial |
$2,268.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,900.82
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,245.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,268.94
|
| Rate for Payer: Entrust Commercial |
$2,199.49
|
| Rate for Payer: First Choice Health Commercial |
$2,199.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,199.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,528.06
|
| Rate for Payer: HealthUtah PPO |
$2,315.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,245.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,451.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,268.94
|
| Rate for Payer: PacificSource Commercial |
$2,083.72
|
| Rate for Payer: PHCS PPO |
$2,268.94
|
| Rate for Payer: Three Rivers PPO |
$1,736.44
|
| Rate for Payer: TriWest Veterans Administration |
$1,528.06
|
| Rate for Payer: United Healthcare Commercial |
$2,014.27
|
| Rate for Payer: United Healthcare Medicare |
$1,528.06
|
| Rate for Payer: WINHealth Partners Commercial |
$2,199.49
|
| Rate for Payer: Wise Provider Network Commercial |
$2,199.49
|
|
|
BOSTON SCI DIAGNOSTIC AL1 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AL1 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AL2 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AL2 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AR1 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AR1 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AR2 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC AR2 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC FL3.5 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC FL3.5 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC FL4.5 5FR X 100CM
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
BOSTON SCI DIAGNOSTIC FL4.5 5FR X 100CM
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
