|
BIOTIN 5 MG CAPSULE [3165]
|
Facility
|
IP
|
$15.22
|
|
|
Service Code
|
NDC 8770140734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$14.46
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
BIOTIN 5 MG CAPSULE [3165]
|
Facility
|
OP
|
$15.22
|
|
|
Service Code
|
NDC 8770140734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.05
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.68
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.24
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$8.68
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
BIOUNI DISPOSABLE CUTTING KIT
|
Facility
|
IP
|
$3,150.00
|
|
| Hospital Charge Code |
3004300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,825.42 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,087.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$3,024.00
|
| Rate for Payer: Beech Street Commercial |
$3,087.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,055.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,055.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,087.00
|
| Rate for Payer: Entrust Commercial |
$2,992.50
|
| Rate for Payer: First Choice Health Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,921.50
|
| Rate for Payer: HealthUtah PPO |
$3,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,055.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,825.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,087.00
|
| Rate for Payer: PacificSource Commercial |
$2,835.00
|
| Rate for Payer: PHCS PPO |
$3,087.00
|
| Rate for Payer: Three Rivers PPO |
$2,362.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,921.50
|
| Rate for Payer: United Healthcare Commercial |
$3,008.25
|
| Rate for Payer: United Healthcare Medicare |
$1,921.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,992.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,992.50
|
|
|
BIOUNI DISPOSABLE CUTTING KIT
|
Facility
|
OP
|
$3,150.00
|
|
| Hospital Charge Code |
3004300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.72 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,087.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,079.00
|
| Rate for Payer: Altius Commercial |
$3,024.00
|
| Rate for Payer: Beech Street Commercial |
$3,087.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,055.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,055.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,087.00
|
| Rate for Payer: Entrust Commercial |
$2,992.50
|
| Rate for Payer: First Choice Health Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,992.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,795.50
|
| Rate for Payer: HealthUtah PPO |
$3,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,055.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,705.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,087.00
|
| Rate for Payer: PacificSource Commercial |
$2,835.00
|
| Rate for Payer: PHCS PPO |
$3,087.00
|
| Rate for Payer: Three Rivers PPO |
$2,362.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,795.50
|
| Rate for Payer: United Healthcare Commercial |
$3,008.25
|
| Rate for Payer: United Healthcare Medicare |
$1,795.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,087.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,992.50
|
|
|
BIOUNI DISPOSABLE CUTTING M17
|
Facility
|
OP
|
$3,679.20
|
|
| Hospital Charge Code |
3004781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,992.29 |
| Max. Negotiated Rate |
$3,679.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,605.62
|
| Rate for Payer: Aetna of WY Medicare |
$2,428.27
|
| Rate for Payer: Altius Commercial |
$3,532.03
|
| Rate for Payer: Beech Street Commercial |
$3,605.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,568.82
|
| Rate for Payer: Cash Price |
$2,575.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,568.82
|
| Rate for Payer: Cigna of WY Commercial |
$3,605.62
|
| Rate for Payer: Entrust Commercial |
$3,495.24
|
| Rate for Payer: First Choice Health Commercial |
$3,495.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,495.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,097.14
|
| Rate for Payer: HealthUtah PPO |
$3,679.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,568.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1,992.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3,605.62
|
| Rate for Payer: PacificSource Commercial |
$3,311.28
|
| Rate for Payer: PHCS PPO |
$3,605.62
|
| Rate for Payer: Three Rivers PPO |
$2,759.40
|
| Rate for Payer: TriWest Veterans Administration |
$2,097.14
|
| Rate for Payer: United Healthcare Commercial |
$3,513.64
|
| Rate for Payer: United Healthcare Medicare |
$2,097.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3,605.62
|
| Rate for Payer: Wise Provider Network Commercial |
$3,495.24
|
|
|
BIOUNI DISPOSABLE CUTTING M17
|
Facility
|
IP
|
$3,679.20
|
|
| Hospital Charge Code |
3004781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,132.10 |
| Max. Negotiated Rate |
$3,679.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,605.62
|
| Rate for Payer: Aetna of WY Medicare |
$2,354.69
|
| Rate for Payer: Altius Commercial |
$3,532.03
|
| Rate for Payer: Beech Street Commercial |
$3,605.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,568.82
|
| Rate for Payer: Cash Price |
$2,575.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,568.82
|
| Rate for Payer: Cigna of WY Commercial |
$3,605.62
|
| Rate for Payer: Entrust Commercial |
$3,495.24
|
| Rate for Payer: First Choice Health Commercial |
$3,495.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,495.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,244.31
|
| Rate for Payer: HealthUtah PPO |
$3,679.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,568.82
|
| Rate for Payer: Multiplan Medicare/VA |
$2,132.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,605.62
|
| Rate for Payer: PacificSource Commercial |
$3,311.28
|
| Rate for Payer: PHCS PPO |
$3,605.62
|
| Rate for Payer: Three Rivers PPO |
$2,759.40
|
| Rate for Payer: TriWest Veterans Administration |
$2,244.31
|
| Rate for Payer: United Healthcare Commercial |
$3,513.64
|
| Rate for Payer: United Healthcare Medicare |
$2,244.31
|
| Rate for Payer: WINHealth Partners Commercial |
$3,495.24
|
| Rate for Payer: Wise Provider Network Commercial |
$3,495.24
|
|
|
BIOUNI DISPOSABLE CUTTING S17
|
Facility
|
IP
|
$4,501.00
|
|
| Hospital Charge Code |
3004398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,608.33 |
| Max. Negotiated Rate |
$4,501.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,410.98
|
| Rate for Payer: Aetna of WY Medicare |
$2,880.64
|
| Rate for Payer: Altius Commercial |
$4,320.96
|
| Rate for Payer: Beech Street Commercial |
$4,410.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,365.97
|
| Rate for Payer: Cash Price |
$3,150.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,365.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,410.98
|
| Rate for Payer: Entrust Commercial |
$4,275.95
|
| Rate for Payer: First Choice Health Commercial |
$4,275.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,275.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,745.61
|
| Rate for Payer: HealthUtah PPO |
$4,501.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,365.97
|
| Rate for Payer: Multiplan Medicare/VA |
$2,608.33
|
| Rate for Payer: One Health Plan of WY PPO |
$4,410.98
|
| Rate for Payer: PacificSource Commercial |
$4,050.90
|
| Rate for Payer: PHCS PPO |
$4,410.98
|
| Rate for Payer: Three Rivers PPO |
$3,375.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,745.61
|
| Rate for Payer: United Healthcare Commercial |
$4,298.46
|
| Rate for Payer: United Healthcare Medicare |
$2,745.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4,275.95
|
| Rate for Payer: Wise Provider Network Commercial |
$4,275.95
|
|
|
BIOUNI DISPOSABLE CUTTING S17
|
Facility
|
OP
|
$4,501.00
|
|
| Hospital Charge Code |
3004398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,437.29 |
| Max. Negotiated Rate |
$4,501.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,410.98
|
| Rate for Payer: Aetna of WY Medicare |
$2,970.66
|
| Rate for Payer: Altius Commercial |
$4,320.96
|
| Rate for Payer: Beech Street Commercial |
$4,410.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,365.97
|
| Rate for Payer: Cash Price |
$3,150.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,365.97
|
| Rate for Payer: Cigna of WY Commercial |
$4,410.98
|
| Rate for Payer: Entrust Commercial |
$4,275.95
|
| Rate for Payer: First Choice Health Commercial |
$4,275.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,275.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,565.57
|
| Rate for Payer: HealthUtah PPO |
$4,501.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,365.97
|
| Rate for Payer: Multiplan Medicare/VA |
$2,437.29
|
| Rate for Payer: One Health Plan of WY PPO |
$4,410.98
|
| Rate for Payer: PacificSource Commercial |
$4,050.90
|
| Rate for Payer: PHCS PPO |
$4,410.98
|
| Rate for Payer: Three Rivers PPO |
$3,375.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,565.57
|
| Rate for Payer: United Healthcare Commercial |
$4,298.46
|
| Rate for Payer: United Healthcare Medicare |
$2,565.57
|
| Rate for Payer: WINHealth Partners Commercial |
$4,410.98
|
| Rate for Payer: Wise Provider Network Commercial |
$4,275.95
|
|
|
BIOUNI DISPOSABLE KIT
|
Facility
|
OP
|
$1,501.50
|
|
| Hospital Charge Code |
3004299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.06 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.47
|
| Rate for Payer: Aetna of WY Medicare |
$990.99
|
| Rate for Payer: Altius Commercial |
$1,441.44
|
| Rate for Payer: Beech Street Commercial |
$1,471.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,456.46
|
| Rate for Payer: Cash Price |
$1,051.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,456.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,471.47
|
| Rate for Payer: Entrust Commercial |
$1,426.42
|
| Rate for Payer: First Choice Health Commercial |
$1,426.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.86
|
| Rate for Payer: HealthUtah PPO |
$1,501.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.46
|
| Rate for Payer: Multiplan Medicare/VA |
$813.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,471.47
|
| Rate for Payer: PacificSource Commercial |
$1,351.35
|
| Rate for Payer: PHCS PPO |
$1,471.47
|
| Rate for Payer: Three Rivers PPO |
$1,126.12
|
| Rate for Payer: TriWest Veterans Administration |
$855.86
|
| Rate for Payer: United Healthcare Commercial |
$1,433.93
|
| Rate for Payer: United Healthcare Medicare |
$855.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,471.47
|
| Rate for Payer: Wise Provider Network Commercial |
$1,426.42
|
|
|
BIOUNI DISPOSABLE KIT
|
Facility
|
IP
|
$1,501.50
|
|
| Hospital Charge Code |
3004299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.12 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.47
|
| Rate for Payer: Aetna of WY Medicare |
$960.96
|
| Rate for Payer: Altius Commercial |
$1,441.44
|
| Rate for Payer: Beech Street Commercial |
$1,471.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,456.46
|
| Rate for Payer: Cash Price |
$1,051.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,456.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,471.47
|
| Rate for Payer: Entrust Commercial |
$1,426.42
|
| Rate for Payer: First Choice Health Commercial |
$1,426.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$915.92
|
| Rate for Payer: HealthUtah PPO |
$1,501.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.46
|
| Rate for Payer: Multiplan Medicare/VA |
$870.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,471.47
|
| Rate for Payer: PacificSource Commercial |
$1,351.35
|
| Rate for Payer: PHCS PPO |
$1,471.47
|
| Rate for Payer: Three Rivers PPO |
$1,126.12
|
| Rate for Payer: TriWest Veterans Administration |
$915.92
|
| Rate for Payer: United Healthcare Commercial |
$1,433.93
|
| Rate for Payer: United Healthcare Medicare |
$915.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,426.42
|
| Rate for Payer: Wise Provider Network Commercial |
$1,426.42
|
|
|
BIOWICK X IMP 5.5MM PEEK 2
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
3003091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.88 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,145.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,465.00
|
| Rate for Payer: Altius Commercial |
$5,040.00
|
| Rate for Payer: Beech Street Commercial |
$5,145.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,092.50
|
| Rate for Payer: Cash Price |
$3,675.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,092.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,145.00
|
| Rate for Payer: Entrust Commercial |
$4,987.50
|
| Rate for Payer: First Choice Health Commercial |
$4,987.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,987.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,992.50
|
| Rate for Payer: HealthUtah PPO |
$5,250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,092.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,842.88
|
| Rate for Payer: One Health Plan of WY PPO |
$5,145.00
|
| Rate for Payer: PacificSource Commercial |
$4,725.00
|
| Rate for Payer: PHCS PPO |
$5,145.00
|
| Rate for Payer: Three Rivers PPO |
$3,937.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,992.50
|
| Rate for Payer: United Healthcare Commercial |
$5,013.75
|
| Rate for Payer: United Healthcare Medicare |
$2,992.50
|
| Rate for Payer: WINHealth Partners Commercial |
$5,145.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,987.50
|
|
|
BIOWICK X IMP 5.5MM PEEK 2
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
3003091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,042.38 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,145.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,360.00
|
| Rate for Payer: Altius Commercial |
$5,040.00
|
| Rate for Payer: Beech Street Commercial |
$5,145.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,092.50
|
| Rate for Payer: Cash Price |
$3,675.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,092.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,145.00
|
| Rate for Payer: Entrust Commercial |
$4,987.50
|
| Rate for Payer: First Choice Health Commercial |
$4,987.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,987.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,202.50
|
| Rate for Payer: HealthUtah PPO |
$5,250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,092.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,042.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,145.00
|
| Rate for Payer: PacificSource Commercial |
$4,725.00
|
| Rate for Payer: PHCS PPO |
$5,145.00
|
| Rate for Payer: Three Rivers PPO |
$3,937.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,202.50
|
| Rate for Payer: United Healthcare Commercial |
$5,013.75
|
| Rate for Payer: United Healthcare Medicare |
$3,202.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,987.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,987.50
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
OP
|
$16.41
|
|
|
Service Code
|
NDC 0574705050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.08
|
| Rate for Payer: Aetna of WY Medicare |
$10.83
|
| Rate for Payer: Altius Commercial |
$15.75
|
| Rate for Payer: Beech Street Commercial |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.92
|
| Rate for Payer: Cigna of WY Commercial |
$16.08
|
| Rate for Payer: Entrust Commercial |
$15.59
|
| Rate for Payer: First Choice Health Commercial |
$15.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.35
|
| Rate for Payer: HealthUtah PPO |
$16.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.89
|
| Rate for Payer: One Health Plan of WY PPO |
$16.08
|
| Rate for Payer: PacificSource Commercial |
$14.77
|
| Rate for Payer: PHCS PPO |
$16.08
|
| Rate for Payer: Three Rivers PPO |
$12.31
|
| Rate for Payer: TriWest Veterans Administration |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$15.67
|
| Rate for Payer: United Healthcare Medicare |
$9.35
|
| Rate for Payer: WINHealth Partners Commercial |
$16.08
|
| Rate for Payer: Wise Provider Network Commercial |
$15.59
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 0574705012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.73
|
| Rate for Payer: Aetna of WY Medicare |
$10.59
|
| Rate for Payer: Altius Commercial |
$15.41
|
| Rate for Payer: Beech Street Commercial |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.57
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.57
|
| Rate for Payer: Cigna of WY Commercial |
$15.73
|
| Rate for Payer: Entrust Commercial |
$15.25
|
| Rate for Payer: First Choice Health Commercial |
$15.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.15
|
| Rate for Payer: HealthUtah PPO |
$16.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.73
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.73
|
| Rate for Payer: Three Rivers PPO |
$12.04
|
| Rate for Payer: TriWest Veterans Administration |
$9.15
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WINHealth Partners Commercial |
$15.73
|
| Rate for Payer: Wise Provider Network Commercial |
$15.25
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
IP
|
$16.41
|
|
|
Service Code
|
NDC 0574705050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.08
|
| Rate for Payer: Aetna of WY Medicare |
$10.50
|
| Rate for Payer: Altius Commercial |
$15.75
|
| Rate for Payer: Beech Street Commercial |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.92
|
| Rate for Payer: Cigna of WY Commercial |
$16.08
|
| Rate for Payer: Entrust Commercial |
$15.59
|
| Rate for Payer: First Choice Health Commercial |
$15.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.01
|
| Rate for Payer: HealthUtah PPO |
$16.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.92
|
| Rate for Payer: Multiplan Medicare/VA |
$9.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.08
|
| Rate for Payer: PacificSource Commercial |
$14.77
|
| Rate for Payer: PHCS PPO |
$16.08
|
| Rate for Payer: Three Rivers PPO |
$12.31
|
| Rate for Payer: TriWest Veterans Administration |
$10.01
|
| Rate for Payer: United Healthcare Commercial |
$15.67
|
| Rate for Payer: United Healthcare Medicare |
$10.01
|
| Rate for Payer: WINHealth Partners Commercial |
$15.59
|
| Rate for Payer: Wise Provider Network Commercial |
$15.59
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 0574705012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.73
|
| Rate for Payer: Aetna of WY Medicare |
$10.27
|
| Rate for Payer: Altius Commercial |
$15.41
|
| Rate for Payer: Beech Street Commercial |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.57
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.57
|
| Rate for Payer: Cigna of WY Commercial |
$15.73
|
| Rate for Payer: Entrust Commercial |
$15.25
|
| Rate for Payer: First Choice Health Commercial |
$15.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.79
|
| Rate for Payer: HealthUtah PPO |
$16.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.57
|
| Rate for Payer: Multiplan Medicare/VA |
$9.30
|
| Rate for Payer: One Health Plan of WY PPO |
$15.73
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.73
|
| Rate for Payer: Three Rivers PPO |
$12.04
|
| Rate for Payer: TriWest Veterans Administration |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare |
$9.79
|
| Rate for Payer: WINHealth Partners Commercial |
$15.25
|
| Rate for Payer: Wise Provider Network Commercial |
$15.25
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [16233]
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
NDC 0904640761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.81
|
| Rate for Payer: Aetna of WY Medicare |
$9.97
|
| Rate for Payer: Altius Commercial |
$14.51
|
| Rate for Payer: Beech Street Commercial |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.66
|
| Rate for Payer: Cigna of WY Commercial |
$14.81
|
| Rate for Payer: Entrust Commercial |
$14.35
|
| Rate for Payer: First Choice Health Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.61
|
| Rate for Payer: HealthUtah PPO |
$15.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.66
|
| Rate for Payer: Multiplan Medicare/VA |
$8.18
|
| Rate for Payer: One Health Plan of WY PPO |
$14.81
|
| Rate for Payer: PacificSource Commercial |
$13.60
|
| Rate for Payer: PHCS PPO |
$14.81
|
| Rate for Payer: Three Rivers PPO |
$11.33
|
| Rate for Payer: TriWest Veterans Administration |
$8.61
|
| Rate for Payer: United Healthcare Commercial |
$14.43
|
| Rate for Payer: United Healthcare Medicare |
$8.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.81
|
| Rate for Payer: Wise Provider Network Commercial |
$14.35
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [16233]
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
NDC 0904640761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.81
|
| Rate for Payer: Aetna of WY Medicare |
$9.67
|
| Rate for Payer: Altius Commercial |
$14.51
|
| Rate for Payer: Beech Street Commercial |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.66
|
| Rate for Payer: Cigna of WY Commercial |
$14.81
|
| Rate for Payer: Entrust Commercial |
$14.35
|
| Rate for Payer: First Choice Health Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.22
|
| Rate for Payer: HealthUtah PPO |
$15.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.66
|
| Rate for Payer: Multiplan Medicare/VA |
$8.76
|
| Rate for Payer: One Health Plan of WY PPO |
$14.81
|
| Rate for Payer: PacificSource Commercial |
$13.60
|
| Rate for Payer: PHCS PPO |
$14.81
|
| Rate for Payer: Three Rivers PPO |
$11.33
|
| Rate for Payer: TriWest Veterans Administration |
$9.22
|
| Rate for Payer: United Healthcare Commercial |
$14.43
|
| Rate for Payer: United Healthcare Medicare |
$9.22
|
| Rate for Payer: WINHealth Partners Commercial |
$14.35
|
| Rate for Payer: Wise Provider Network Commercial |
$14.35
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [12632]
|
Facility
|
IP
|
$15.08
|
|
|
Service Code
|
NDC 4612270326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.78
|
| Rate for Payer: Aetna of WY Medicare |
$9.65
|
| Rate for Payer: Altius Commercial |
$14.48
|
| Rate for Payer: Beech Street Commercial |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.63
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.63
|
| Rate for Payer: Cigna of WY Commercial |
$14.78
|
| Rate for Payer: Entrust Commercial |
$14.33
|
| Rate for Payer: First Choice Health Commercial |
$14.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.20
|
| Rate for Payer: HealthUtah PPO |
$15.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.63
|
| Rate for Payer: Multiplan Medicare/VA |
$8.74
|
| Rate for Payer: One Health Plan of WY PPO |
$14.78
|
| Rate for Payer: PacificSource Commercial |
$13.57
|
| Rate for Payer: PHCS PPO |
$14.78
|
| Rate for Payer: Three Rivers PPO |
$11.31
|
| Rate for Payer: TriWest Veterans Administration |
$9.20
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.33
|
| Rate for Payer: Wise Provider Network Commercial |
$14.33
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [12632]
|
Facility
|
OP
|
$15.08
|
|
|
Service Code
|
NDC 4612270326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.78
|
| Rate for Payer: Aetna of WY Medicare |
$9.95
|
| Rate for Payer: Altius Commercial |
$14.48
|
| Rate for Payer: Beech Street Commercial |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.63
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.63
|
| Rate for Payer: Cigna of WY Commercial |
$14.78
|
| Rate for Payer: Entrust Commercial |
$14.33
|
| Rate for Payer: First Choice Health Commercial |
$14.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.60
|
| Rate for Payer: HealthUtah PPO |
$15.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.63
|
| Rate for Payer: Multiplan Medicare/VA |
$8.17
|
| Rate for Payer: One Health Plan of WY PPO |
$14.78
|
| Rate for Payer: PacificSource Commercial |
$13.57
|
| Rate for Payer: PHCS PPO |
$14.78
|
| Rate for Payer: Three Rivers PPO |
$11.31
|
| Rate for Payer: TriWest Veterans Administration |
$8.60
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Medicare |
$8.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.78
|
| Rate for Payer: Wise Provider Network Commercial |
$14.33
|
|
|
BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [15105]
|
Facility
|
IP
|
$15.35
|
|
|
Service Code
|
NDC 2438502465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.04
|
| Rate for Payer: Aetna of WY Medicare |
$9.82
|
| Rate for Payer: Altius Commercial |
$14.74
|
| Rate for Payer: Beech Street Commercial |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.89
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$15.04
|
| Rate for Payer: Entrust Commercial |
$14.58
|
| Rate for Payer: First Choice Health Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.36
|
| Rate for Payer: HealthUtah PPO |
$15.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.89
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.04
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.04
|
| Rate for Payer: Three Rivers PPO |
$11.51
|
| Rate for Payer: TriWest Veterans Administration |
$9.36
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Medicare |
$9.36
|
| Rate for Payer: WINHealth Partners Commercial |
$14.58
|
| Rate for Payer: Wise Provider Network Commercial |
$14.58
|
|
|
BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [15105]
|
Facility
|
OP
|
$15.35
|
|
|
Service Code
|
NDC 2438502465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.04
|
| Rate for Payer: Aetna of WY Medicare |
$10.13
|
| Rate for Payer: Altius Commercial |
$14.74
|
| Rate for Payer: Beech Street Commercial |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.89
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$15.04
|
| Rate for Payer: Entrust Commercial |
$14.58
|
| Rate for Payer: First Choice Health Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.75
|
| Rate for Payer: HealthUtah PPO |
$15.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.89
|
| Rate for Payer: Multiplan Medicare/VA |
$8.31
|
| Rate for Payer: One Health Plan of WY PPO |
$15.04
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.04
|
| Rate for Payer: Three Rivers PPO |
$11.51
|
| Rate for Payer: TriWest Veterans Administration |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Medicare |
$8.75
|
| Rate for Payer: WINHealth Partners Commercial |
$15.04
|
| Rate for Payer: Wise Provider Network Commercial |
$14.58
|
|
|
BITE GARD DISP TOOTH PROTECTOR
|
Facility
|
OP
|
$6.88
|
|
| Hospital Charge Code |
2650048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.74
|
| Rate for Payer: Aetna of WY Medicare |
$4.54
|
| Rate for Payer: Altius Commercial |
$6.60
|
| Rate for Payer: Beech Street Commercial |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.67
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.67
|
| Rate for Payer: Cigna of WY Commercial |
$6.74
|
| Rate for Payer: Entrust Commercial |
$6.54
|
| Rate for Payer: First Choice Health Commercial |
$6.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.92
|
| Rate for Payer: HealthUtah PPO |
$6.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.67
|
| Rate for Payer: Multiplan Medicare/VA |
$3.73
|
| Rate for Payer: One Health Plan of WY PPO |
$6.74
|
| Rate for Payer: PacificSource Commercial |
$6.19
|
| Rate for Payer: PHCS PPO |
$6.74
|
| Rate for Payer: Three Rivers PPO |
$5.16
|
| Rate for Payer: TriWest Veterans Administration |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare |
$3.92
|
| Rate for Payer: WINHealth Partners Commercial |
$6.74
|
| Rate for Payer: Wise Provider Network Commercial |
$6.54
|
|
|
BITE GARD DISP TOOTH PROTECTOR
|
Facility
|
IP
|
$6.88
|
|
| Hospital Charge Code |
2650048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.74
|
| Rate for Payer: Aetna of WY Medicare |
$4.40
|
| Rate for Payer: Altius Commercial |
$6.60
|
| Rate for Payer: Beech Street Commercial |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.67
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.67
|
| Rate for Payer: Cigna of WY Commercial |
$6.74
|
| Rate for Payer: Entrust Commercial |
$6.54
|
| Rate for Payer: First Choice Health Commercial |
$6.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.20
|
| Rate for Payer: HealthUtah PPO |
$6.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.67
|
| Rate for Payer: Multiplan Medicare/VA |
$3.99
|
| Rate for Payer: One Health Plan of WY PPO |
$6.74
|
| Rate for Payer: PacificSource Commercial |
$6.19
|
| Rate for Payer: PHCS PPO |
$6.74
|
| Rate for Payer: Three Rivers PPO |
$5.16
|
| Rate for Payer: TriWest Veterans Administration |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare |
$4.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6.54
|
| Rate for Payer: Wise Provider Network Commercial |
$6.54
|
|
|
BITE GARD ORAL BITE BLOCK 1140
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
2500172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.39
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
