|
BOOT XCEL XL TALL 100617-050
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| 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 Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| 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 |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| 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 |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| 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 |
2200060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| 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 |
$74.83
|
| 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 |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| 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 |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XSM SHORT 100618-010
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| 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 Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| 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 |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| 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 |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| Rate for Payer: WINHealth Partners Commercial |
$75.60
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BOOT XCEL XSM TALL 100617-010
|
Facility
|
OP
|
$77.14
|
|
| Hospital Charge Code |
2200059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| 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 Commercial |
$74.05
|
| Rate for Payer: Beech Street Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.83
|
| 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 |
$43.97
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$41.77
|
| 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 |
$43.97
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$43.97
|
| 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 |
2200059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$77.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.60
|
| Rate for Payer: Aetna of WY Medicare |
$49.37
|
| 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 |
$74.83
|
| 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 |
$47.06
|
| Rate for Payer: HealthUtah PPO |
$77.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.83
|
| Rate for Payer: Multiplan Medicare/VA |
$44.70
|
| 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 |
$47.06
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare |
$47.06
|
| Rate for Payer: WINHealth Partners Commercial |
$73.28
|
| Rate for Payer: Wise Provider Network Commercial |
$73.28
|
|
|
BORIC ACID (BULK) POWDER [17850]
|
Facility
|
IP
|
$15.10
|
|
|
Service Code
|
NDC 8770140066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.80
|
| Rate for Payer: Aetna of WY Medicare |
$9.66
|
| Rate for Payer: Altius Commercial |
$14.50
|
| Rate for Payer: Beech Street Commercial |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.65
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.65
|
| Rate for Payer: Cigna of WY Commercial |
$14.80
|
| Rate for Payer: Entrust Commercial |
$14.34
|
| Rate for Payer: First Choice Health Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$15.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.65
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$14.80
|
| Rate for Payer: PacificSource Commercial |
$13.59
|
| Rate for Payer: PHCS PPO |
$14.80
|
| Rate for Payer: Three Rivers PPO |
$11.32
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$14.34
|
| Rate for Payer: Wise Provider Network Commercial |
$14.34
|
|
|
BORIC ACID (BULK) POWDER [17850]
|
Facility
|
OP
|
$15.10
|
|
|
Service Code
|
NDC 8770140066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.80
|
| Rate for Payer: Aetna of WY Medicare |
$9.97
|
| Rate for Payer: Altius Commercial |
$14.50
|
| Rate for Payer: Beech Street Commercial |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.65
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.65
|
| Rate for Payer: Cigna of WY Commercial |
$14.80
|
| Rate for Payer: Entrust Commercial |
$14.34
|
| Rate for Payer: First Choice Health Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.61
|
| Rate for Payer: HealthUtah PPO |
$15.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.65
|
| Rate for Payer: Multiplan Medicare/VA |
$8.18
|
| Rate for Payer: One Health Plan of WY PPO |
$14.80
|
| Rate for Payer: PacificSource Commercial |
$13.59
|
| Rate for Payer: PHCS PPO |
$14.80
|
| Rate for Payer: Three Rivers PPO |
$11.32
|
| Rate for Payer: TriWest Veterans Administration |
$8.61
|
| Rate for Payer: United Healthcare Commercial |
$14.42
|
| Rate for Payer: United Healthcare Medicare |
$8.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.80
|
| Rate for Payer: Wise Provider Network Commercial |
$14.34
|
|
|
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 |
$175.60 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Aetna of WY Medicare |
$193.93
|
| 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 |
$293.93
|
| 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 |
$184.84
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$175.60
|
| 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 |
$184.84
|
| Rate for Payer: United Healthcare Commercial |
$289.38
|
| Rate for Payer: United Healthcare Medicare |
$184.84
|
| 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 |
$164.09 |
| 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 Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.93
|
| 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 |
$172.72
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$164.09
|
| 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 |
$172.72
|
| Rate for Payer: United Healthcare Commercial |
$289.38
|
| Rate for Payer: United Healthcare Medicare |
$172.72
|
| 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 |
$175.60 |
| Max. Negotiated Rate |
$303.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.96
|
| Rate for Payer: Aetna of WY Medicare |
$193.93
|
| 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 |
$293.93
|
| 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 |
$184.84
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$175.60
|
| 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 |
$184.84
|
| Rate for Payer: United Healthcare Commercial |
$289.38
|
| Rate for Payer: United Healthcare Medicare |
$184.84
|
| Rate for Payer: WINHealth Partners Commercial |
$287.87
|
| 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 |
$164.09 |
| 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 Commercial |
$290.90
|
| Rate for Payer: Beech Street Commercial |
$296.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.93
|
| 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 |
$172.72
|
| Rate for Payer: HealthUtah PPO |
$303.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.93
|
| Rate for Payer: Multiplan Medicare/VA |
$164.09
|
| 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 |
$172.72
|
| Rate for Payer: United Healthcare Commercial |
$289.38
|
| Rate for Payer: United Healthcare Medicare |
$172.72
|
| Rate for Payer: WINHealth Partners Commercial |
$296.96
|
| 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 |
$53.61 |
| 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 Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.03
|
| 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 |
$56.43
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| 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 |
$56.43
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$56.43
|
| 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 |
$57.37 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| 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 |
$96.03
|
| 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 |
$60.39
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$57.37
|
| 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 |
$60.39
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$60.39
|
| 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 |
$53.61 |
| 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 Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.03
|
| 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 |
$56.43
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| 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 |
$56.43
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$56.43
|
| 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 |
$57.37 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| 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 |
$96.03
|
| 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 |
$60.39
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$57.37
|
| 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 |
$60.39
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$60.39
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
BOUGIE 36FR MALONEY TUNGSTEN
|
Facility
|
OP
|
$1,260.00
|
|
| Hospital Charge Code |
2700012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.29 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$831.60
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$718.20
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$682.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$718.20
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$718.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
BOUGIE 36FR MALONEY TUNGSTEN
|
Facility
|
IP
|
$1,260.00
|
|
| Hospital Charge Code |
2700012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.17 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$806.40
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,222.20
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.60
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$730.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$768.60
|
| Rate for Payer: United Healthcare Commercial |
$1,203.30
|
| Rate for Payer: United Healthcare Medicare |
$768.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
BOUGIE ESOPH DIALATOR 58
|
Facility
|
OP
|
$752.50
|
|
| Hospital Charge Code |
2650026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.48 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$737.45
|
| Rate for Payer: Aetna of WY Medicare |
$496.65
|
| Rate for Payer: Altius Commercial |
$722.40
|
| Rate for Payer: Beech Street Commercial |
$737.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$729.92
|
| Rate for Payer: Cash Price |
$526.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$729.92
|
| Rate for Payer: Cigna of WY Commercial |
$737.45
|
| Rate for Payer: Entrust Commercial |
$714.88
|
| Rate for Payer: First Choice Health Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$428.92
|
| Rate for Payer: HealthUtah PPO |
$752.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$729.92
|
| Rate for Payer: Multiplan Medicare/VA |
$407.48
|
| Rate for Payer: One Health Plan of WY PPO |
$737.45
|
| Rate for Payer: PacificSource Commercial |
$677.25
|
| Rate for Payer: PHCS PPO |
$737.45
|
| Rate for Payer: Three Rivers PPO |
$564.38
|
| Rate for Payer: TriWest Veterans Administration |
$428.92
|
| Rate for Payer: United Healthcare Commercial |
$718.64
|
| Rate for Payer: United Healthcare Medicare |
$428.92
|
| Rate for Payer: WINHealth Partners Commercial |
$737.45
|
| Rate for Payer: Wise Provider Network Commercial |
$714.88
|
|
|
BOUGIE ESOPH DIALATOR 58
|
Facility
|
IP
|
$752.50
|
|
| Hospital Charge Code |
2650026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.07 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$737.45
|
| Rate for Payer: Aetna of WY Medicare |
$481.60
|
| Rate for Payer: Altius Commercial |
$722.40
|
| Rate for Payer: Beech Street Commercial |
$737.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$729.92
|
| Rate for Payer: Cash Price |
$526.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$729.92
|
| Rate for Payer: Cigna of WY Commercial |
$737.45
|
| Rate for Payer: Entrust Commercial |
$714.88
|
| Rate for Payer: First Choice Health Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$714.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.02
|
| Rate for Payer: HealthUtah PPO |
$752.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$729.92
|
| Rate for Payer: Multiplan Medicare/VA |
$436.07
|
| Rate for Payer: One Health Plan of WY PPO |
$737.45
|
| Rate for Payer: PacificSource Commercial |
$677.25
|
| Rate for Payer: PHCS PPO |
$737.45
|
| Rate for Payer: Three Rivers PPO |
$564.38
|
| Rate for Payer: TriWest Veterans Administration |
$459.02
|
| Rate for Payer: United Healthcare Commercial |
$718.64
|
| Rate for Payer: United Healthcare Medicare |
$459.02
|
| Rate for Payer: WINHealth Partners Commercial |
$714.88
|
| Rate for Payer: Wise Provider Network Commercial |
$714.88
|
|
|
BP CUFF DISP ADULT
|
Facility
|
OP
|
$5.30
|
|
| Hospital Charge Code |
4400317
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.19
|
| Rate for Payer: Aetna of WY Medicare |
$3.50
|
| Rate for Payer: Altius Commercial |
$5.09
|
| Rate for Payer: Beech Street Commercial |
$5.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.14
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.14
|
| Rate for Payer: Cigna of WY Commercial |
$5.19
|
| Rate for Payer: Entrust Commercial |
$5.04
|
| Rate for Payer: First Choice Health Commercial |
$5.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.02
|
| Rate for Payer: HealthUtah PPO |
$5.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.14
|
| Rate for Payer: Multiplan Medicare/VA |
$2.87
|
| Rate for Payer: One Health Plan of WY PPO |
$5.19
|
| Rate for Payer: PacificSource Commercial |
$4.77
|
| Rate for Payer: PHCS PPO |
$5.19
|
| Rate for Payer: Three Rivers PPO |
$3.98
|
| Rate for Payer: TriWest Veterans Administration |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$5.06
|
| Rate for Payer: United Healthcare Medicare |
$3.02
|
| Rate for Payer: WINHealth Partners Commercial |
$5.19
|
| Rate for Payer: Wise Provider Network Commercial |
$5.04
|
|
|
BP CUFF DISP ADULT
|
Facility
|
IP
|
$5.30
|
|
| Hospital Charge Code |
4400317
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.19
|
| Rate for Payer: Aetna of WY Medicare |
$3.39
|
| Rate for Payer: Altius Commercial |
$5.09
|
| Rate for Payer: Beech Street Commercial |
$5.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.14
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.14
|
| Rate for Payer: Cigna of WY Commercial |
$5.19
|
| Rate for Payer: Entrust Commercial |
$5.04
|
| Rate for Payer: First Choice Health Commercial |
$5.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.23
|
| Rate for Payer: HealthUtah PPO |
$5.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.14
|
| Rate for Payer: Multiplan Medicare/VA |
$3.07
|
| Rate for Payer: One Health Plan of WY PPO |
$5.19
|
| Rate for Payer: PacificSource Commercial |
$4.77
|
| Rate for Payer: PHCS PPO |
$5.19
|
| Rate for Payer: Three Rivers PPO |
$3.98
|
| Rate for Payer: TriWest Veterans Administration |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$5.06
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
| Rate for Payer: WINHealth Partners Commercial |
$5.04
|
| Rate for Payer: Wise Provider Network Commercial |
$5.04
|
|
|
BP CUFF DISP ADULT LONG
|
Facility
|
IP
|
$5.83
|
|
| Hospital Charge Code |
4400448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.71
|
| Rate for Payer: Aetna of WY Medicare |
$3.73
|
| Rate for Payer: Altius Commercial |
$5.60
|
| Rate for Payer: Beech Street Commercial |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.66
|
| Rate for Payer: Cigna of WY Commercial |
$5.71
|
| Rate for Payer: Entrust Commercial |
$5.54
|
| Rate for Payer: First Choice Health Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.56
|
| Rate for Payer: HealthUtah PPO |
$5.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5.71
|
| Rate for Payer: PacificSource Commercial |
$5.25
|
| Rate for Payer: PHCS PPO |
$5.71
|
| Rate for Payer: Three Rivers PPO |
$4.37
|
| Rate for Payer: TriWest Veterans Administration |
$3.56
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5.54
|
| Rate for Payer: Wise Provider Network Commercial |
$5.54
|
|
|
BP CUFF DISP ADULT LONG
|
Facility
|
OP
|
$5.83
|
|
| Hospital Charge Code |
4400448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.71
|
| Rate for Payer: Aetna of WY Medicare |
$3.85
|
| Rate for Payer: Altius Commercial |
$5.60
|
| Rate for Payer: Beech Street Commercial |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.66
|
| Rate for Payer: Cigna of WY Commercial |
$5.71
|
| Rate for Payer: Entrust Commercial |
$5.54
|
| Rate for Payer: First Choice Health Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.32
|
| Rate for Payer: HealthUtah PPO |
$5.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.16
|
| Rate for Payer: One Health Plan of WY PPO |
$5.71
|
| Rate for Payer: PacificSource Commercial |
$5.25
|
| Rate for Payer: PHCS PPO |
$5.71
|
| Rate for Payer: Three Rivers PPO |
$4.37
|
| Rate for Payer: TriWest Veterans Administration |
$3.32
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.32
|
| Rate for Payer: WINHealth Partners Commercial |
$5.71
|
| Rate for Payer: Wise Provider Network Commercial |
$5.54
|
|
|
BP CUFF DISP CHILD
|
Facility
|
IP
|
$5.01
|
|
| Hospital Charge Code |
4400315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.91
|
| Rate for Payer: Aetna of WY Medicare |
$3.21
|
| Rate for Payer: Altius Commercial |
$4.81
|
| Rate for Payer: Beech Street Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.86
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.86
|
| Rate for Payer: Cigna of WY Commercial |
$4.91
|
| Rate for Payer: Entrust Commercial |
$4.76
|
| Rate for Payer: First Choice Health Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.06
|
| Rate for Payer: HealthUtah PPO |
$5.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.86
|
| Rate for Payer: Multiplan Medicare/VA |
$2.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4.91
|
| Rate for Payer: PacificSource Commercial |
$4.51
|
| Rate for Payer: PHCS PPO |
$4.91
|
| Rate for Payer: Three Rivers PPO |
$3.76
|
| Rate for Payer: TriWest Veterans Administration |
$3.06
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
| Rate for Payer: United Healthcare Medicare |
$3.06
|
| Rate for Payer: WINHealth Partners Commercial |
$4.76
|
| Rate for Payer: Wise Provider Network Commercial |
$4.76
|
|
|
BP CUFF DISP CHILD
|
Facility
|
OP
|
$5.01
|
|
| Hospital Charge Code |
4400315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.91
|
| Rate for Payer: Aetna of WY Medicare |
$3.31
|
| Rate for Payer: Altius Commercial |
$4.81
|
| Rate for Payer: Beech Street Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.86
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.86
|
| Rate for Payer: Cigna of WY Commercial |
$4.91
|
| Rate for Payer: Entrust Commercial |
$4.76
|
| Rate for Payer: First Choice Health Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.86
|
| Rate for Payer: HealthUtah PPO |
$5.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.86
|
| Rate for Payer: Multiplan Medicare/VA |
$2.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4.91
|
| Rate for Payer: PacificSource Commercial |
$4.51
|
| Rate for Payer: PHCS PPO |
$4.91
|
| Rate for Payer: Three Rivers PPO |
$3.76
|
| Rate for Payer: TriWest Veterans Administration |
$2.86
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WINHealth Partners Commercial |
$4.91
|
| Rate for Payer: Wise Provider Network Commercial |
$4.76
|
|
