|
BUR 6.0 EGG 14 FLU 1607-2-3
|
Facility
|
IP
|
$111.30
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$106.85
|
| Rate for Payer: Altius Commercial |
$106.85
|
| Rate for Payer: Beech Street Commercial |
$109.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.38
|
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.96
|
| Rate for Payer: Cigna of WY Commercial |
$109.07
|
| Rate for Payer: Entrust Commercial |
$105.74
|
| Rate for Payer: First Choice Health Commercial |
$105.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.46
|
| Rate for Payer: HealthUtah PPO |
$111.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.96
|
| Rate for Payer: Multiplan Medicare/VA |
$69.79
|
| Rate for Payer: One Health Plan of WY PPO |
$109.07
|
| Rate for Payer: PacificSource Commercial |
$100.17
|
| Rate for Payer: PHCS PPO |
$109.07
|
| Rate for Payer: Three Rivers PPO |
$83.48
|
| Rate for Payer: TriWest Veterans Administration |
$73.46
|
| Rate for Payer: United Healthcare Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare |
$73.46
|
| Rate for Payer: WINHealth Partners Commercial |
$105.74
|
| Rate for Payer: Wise Provider Network Commercial |
$105.74
|
|
|
BURR 3MM 1.75" 0277-010-230
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
BURR 3MM 1.75" 0277-010-230
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
BUR RD FAST CUT 5.5 1608-6-141
|
Facility
|
IP
|
$116.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$116.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.39
|
| Rate for Payer: Altius Commercial |
$111.39
|
| Rate for Payer: Beech Street Commercial |
$113.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.26
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.55
|
| Rate for Payer: Cigna of WY Commercial |
$113.71
|
| Rate for Payer: Entrust Commercial |
$110.23
|
| Rate for Payer: First Choice Health Commercial |
$110.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.58
|
| Rate for Payer: HealthUtah PPO |
$116.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.75
|
| Rate for Payer: One Health Plan of WY PPO |
$113.71
|
| Rate for Payer: PacificSource Commercial |
$104.43
|
| Rate for Payer: PHCS PPO |
$113.71
|
| Rate for Payer: Three Rivers PPO |
$87.02
|
| Rate for Payer: TriWest Veterans Administration |
$76.58
|
| Rate for Payer: United Healthcare Commercial |
$100.95
|
| Rate for Payer: United Healthcare Medicare |
$76.58
|
| Rate for Payer: WINHealth Partners Commercial |
$110.23
|
| Rate for Payer: Wise Provider Network Commercial |
$110.23
|
|
|
BUR RD FAST CUT 5.5 1608-6-141
|
Facility
|
OP
|
$116.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.93 |
| Max. Negotiated Rate |
$116.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.71
|
| Rate for Payer: Aetna of WY Medicare |
$76.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.39
|
| Rate for Payer: Altius Commercial |
$111.39
|
| Rate for Payer: Beech Street Commercial |
$113.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.26
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.55
|
| Rate for Payer: Cigna of WY Commercial |
$113.71
|
| Rate for Payer: Entrust Commercial |
$110.23
|
| Rate for Payer: First Choice Health Commercial |
$110.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.30
|
| Rate for Payer: HealthUtah PPO |
$116.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.93
|
| Rate for Payer: One Health Plan of WY PPO |
$113.71
|
| Rate for Payer: PacificSource Commercial |
$104.43
|
| Rate for Payer: PHCS PPO |
$113.71
|
| Rate for Payer: Three Rivers PPO |
$87.02
|
| Rate for Payer: TriWest Veterans Administration |
$67.30
|
| Rate for Payer: United Healthcare Commercial |
$100.95
|
| Rate for Payer: United Healthcare Medicare |
$67.30
|
| Rate for Payer: WINHealth Partners Commercial |
$113.71
|
| Rate for Payer: Wise Provider Network Commercial |
$110.23
|
|
|
BURR DR. CLYDE 3.0 5820-107-30
|
Facility
|
OP
|
$370.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.98 |
| Max. Negotiated Rate |
$370.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.80
|
| Rate for Payer: Aetna of WY Medicare |
$244.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.39
|
| Rate for Payer: Altius Commercial |
$355.39
|
| Rate for Payer: Beech Street Commercial |
$362.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.93
|
| Rate for Payer: Cash Price |
$259.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.09
|
| Rate for Payer: Cigna of WY Commercial |
$362.80
|
| Rate for Payer: Entrust Commercial |
$351.69
|
| Rate for Payer: First Choice Health Commercial |
$351.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.72
|
| Rate for Payer: HealthUtah PPO |
$370.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.09
|
| Rate for Payer: Multiplan Medicare/VA |
$203.98
|
| Rate for Payer: One Health Plan of WY PPO |
$362.80
|
| Rate for Payer: PacificSource Commercial |
$333.18
|
| Rate for Payer: PHCS PPO |
$362.80
|
| Rate for Payer: Three Rivers PPO |
$277.65
|
| Rate for Payer: TriWest Veterans Administration |
$214.72
|
| Rate for Payer: United Healthcare Commercial |
$322.07
|
| Rate for Payer: United Healthcare Medicare |
$214.72
|
| Rate for Payer: WINHealth Partners Commercial |
$362.80
|
| Rate for Payer: Wise Provider Network Commercial |
$351.69
|
|
|
BURR DR. CLYDE 3.0 5820-107-30
|
Facility
|
IP
|
$370.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.12 |
| Max. Negotiated Rate |
$370.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.39
|
| Rate for Payer: Altius Commercial |
$355.39
|
| Rate for Payer: Beech Street Commercial |
$362.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.93
|
| Rate for Payer: Cash Price |
$259.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$359.09
|
| Rate for Payer: Cigna of WY Commercial |
$362.80
|
| Rate for Payer: Entrust Commercial |
$351.69
|
| Rate for Payer: First Choice Health Commercial |
$351.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.33
|
| Rate for Payer: HealthUtah PPO |
$370.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.09
|
| Rate for Payer: Multiplan Medicare/VA |
$232.12
|
| Rate for Payer: One Health Plan of WY PPO |
$362.80
|
| Rate for Payer: PacificSource Commercial |
$333.18
|
| Rate for Payer: PHCS PPO |
$362.80
|
| Rate for Payer: Three Rivers PPO |
$277.65
|
| Rate for Payer: TriWest Veterans Administration |
$244.33
|
| Rate for Payer: United Healthcare Commercial |
$322.07
|
| Rate for Payer: United Healthcare Medicare |
$244.33
|
| Rate for Payer: WINHealth Partners Commercial |
$351.69
|
| Rate for Payer: Wise Provider Network Commercial |
$351.69
|
|
|
BURR DRIL PIL PT3.0 1608-2-133
|
Facility
|
IP
|
$120.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$116.12
|
| Rate for Payer: Altius Commercial |
$116.12
|
| Rate for Payer: Beech Street Commercial |
$118.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.31
|
| Rate for Payer: Cash Price |
$84.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.33
|
| Rate for Payer: Cigna of WY Commercial |
$118.54
|
| Rate for Payer: Entrust Commercial |
$114.91
|
| Rate for Payer: First Choice Health Commercial |
$114.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.83
|
| Rate for Payer: HealthUtah PPO |
$120.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.33
|
| Rate for Payer: Multiplan Medicare/VA |
$75.84
|
| Rate for Payer: One Health Plan of WY PPO |
$118.54
|
| Rate for Payer: PacificSource Commercial |
$108.86
|
| Rate for Payer: PHCS PPO |
$118.54
|
| Rate for Payer: Three Rivers PPO |
$90.72
|
| Rate for Payer: TriWest Veterans Administration |
$79.83
|
| Rate for Payer: United Healthcare Commercial |
$105.24
|
| Rate for Payer: United Healthcare Medicare |
$79.83
|
| Rate for Payer: WINHealth Partners Commercial |
$114.91
|
| Rate for Payer: Wise Provider Network Commercial |
$114.91
|
|
|
BURR DRIL PIL PT3.0 1608-2-133
|
Facility
|
OP
|
$120.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.65 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.54
|
| Rate for Payer: Aetna of WY Medicare |
$79.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$116.12
|
| Rate for Payer: Altius Commercial |
$116.12
|
| Rate for Payer: Beech Street Commercial |
$118.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.31
|
| Rate for Payer: Cash Price |
$84.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.33
|
| Rate for Payer: Cigna of WY Commercial |
$118.54
|
| Rate for Payer: Entrust Commercial |
$114.91
|
| Rate for Payer: First Choice Health Commercial |
$114.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.16
|
| Rate for Payer: HealthUtah PPO |
$120.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.33
|
| Rate for Payer: Multiplan Medicare/VA |
$66.65
|
| Rate for Payer: One Health Plan of WY PPO |
$118.54
|
| Rate for Payer: PacificSource Commercial |
$108.86
|
| Rate for Payer: PHCS PPO |
$118.54
|
| Rate for Payer: Three Rivers PPO |
$90.72
|
| Rate for Payer: TriWest Veterans Administration |
$70.16
|
| Rate for Payer: United Healthcare Commercial |
$105.24
|
| Rate for Payer: United Healthcare Medicare |
$70.16
|
| Rate for Payer: WINHealth Partners Commercial |
$118.54
|
| Rate for Payer: Wise Provider Network Commercial |
$114.91
|
|
|
BURR EGG DRIL 4.0 1608-2-35
|
Facility
|
OP
|
$131.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$131.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.42
|
| Rate for Payer: Aetna of WY Medicare |
$86.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.80
|
| Rate for Payer: Altius Commercial |
$125.80
|
| Rate for Payer: Beech Street Commercial |
$128.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.58
|
| Rate for Payer: Cash Price |
$91.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.11
|
| Rate for Payer: Cigna of WY Commercial |
$128.42
|
| Rate for Payer: Entrust Commercial |
$124.49
|
| Rate for Payer: First Choice Health Commercial |
$124.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.00
|
| Rate for Payer: HealthUtah PPO |
$131.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.11
|
| Rate for Payer: Multiplan Medicare/VA |
$72.20
|
| Rate for Payer: One Health Plan of WY PPO |
$128.42
|
| Rate for Payer: PacificSource Commercial |
$117.94
|
| Rate for Payer: PHCS PPO |
$128.42
|
| Rate for Payer: Three Rivers PPO |
$98.28
|
| Rate for Payer: TriWest Veterans Administration |
$76.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare |
$76.00
|
| Rate for Payer: WINHealth Partners Commercial |
$128.42
|
| Rate for Payer: Wise Provider Network Commercial |
$124.49
|
|
|
BURR EGG DRIL 4.0 1608-2-35
|
Facility
|
IP
|
$131.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$131.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.80
|
| Rate for Payer: Altius Commercial |
$125.80
|
| Rate for Payer: Beech Street Commercial |
$128.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.58
|
| Rate for Payer: Cash Price |
$91.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.11
|
| Rate for Payer: Cigna of WY Commercial |
$128.42
|
| Rate for Payer: Entrust Commercial |
$124.49
|
| Rate for Payer: First Choice Health Commercial |
$124.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.49
|
| Rate for Payer: HealthUtah PPO |
$131.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.11
|
| Rate for Payer: Multiplan Medicare/VA |
$82.16
|
| Rate for Payer: One Health Plan of WY PPO |
$128.42
|
| Rate for Payer: PacificSource Commercial |
$117.94
|
| Rate for Payer: PHCS PPO |
$128.42
|
| Rate for Payer: Three Rivers PPO |
$98.28
|
| Rate for Payer: TriWest Veterans Administration |
$86.49
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare |
$86.49
|
| Rate for Payer: WINHealth Partners Commercial |
$124.49
|
| Rate for Payer: Wise Provider Network Commercial |
$124.49
|
|
|
BURR OPTHALMIC TIP 1MM 0001
|
Facility
|
OP
|
$30.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$30.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.36
|
| Rate for Payer: Aetna of WY Medicare |
$20.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.74
|
| Rate for Payer: Altius Commercial |
$29.74
|
| Rate for Payer: Beech Street Commercial |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.43
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.05
|
| Rate for Payer: Cigna of WY Commercial |
$30.36
|
| Rate for Payer: Entrust Commercial |
$29.43
|
| Rate for Payer: First Choice Health Commercial |
$29.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.97
|
| Rate for Payer: HealthUtah PPO |
$30.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.05
|
| Rate for Payer: Multiplan Medicare/VA |
$17.07
|
| Rate for Payer: One Health Plan of WY PPO |
$30.36
|
| Rate for Payer: PacificSource Commercial |
$27.88
|
| Rate for Payer: PHCS PPO |
$30.36
|
| Rate for Payer: Three Rivers PPO |
$23.24
|
| Rate for Payer: TriWest Veterans Administration |
$17.97
|
| Rate for Payer: United Healthcare Commercial |
$26.95
|
| Rate for Payer: United Healthcare Medicare |
$17.97
|
| Rate for Payer: WINHealth Partners Commercial |
$30.36
|
| Rate for Payer: Wise Provider Network Commercial |
$29.43
|
|
|
BURR OPTHALMIC TIP 1MM 0001
|
Facility
|
IP
|
$30.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$30.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.74
|
| Rate for Payer: Altius Commercial |
$29.74
|
| Rate for Payer: Beech Street Commercial |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.43
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.05
|
| Rate for Payer: Cigna of WY Commercial |
$30.36
|
| Rate for Payer: Entrust Commercial |
$29.43
|
| Rate for Payer: First Choice Health Commercial |
$29.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.45
|
| Rate for Payer: HealthUtah PPO |
$30.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.05
|
| Rate for Payer: Multiplan Medicare/VA |
$19.42
|
| Rate for Payer: One Health Plan of WY PPO |
$30.36
|
| Rate for Payer: PacificSource Commercial |
$27.88
|
| Rate for Payer: PHCS PPO |
$30.36
|
| Rate for Payer: Three Rivers PPO |
$23.24
|
| Rate for Payer: TriWest Veterans Administration |
$20.45
|
| Rate for Payer: United Healthcare Commercial |
$26.95
|
| Rate for Payer: United Healthcare Medicare |
$20.45
|
| Rate for Payer: WINHealth Partners Commercial |
$29.43
|
| Rate for Payer: Wise Provider Network Commercial |
$29.43
|
|
|
BURR OVAL 8 FLUTE 4MM 8400OBE
|
Facility
|
IP
|
$241.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.22 |
| Max. Negotiated Rate |
$241.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.53
|
| Rate for Payer: Altius Commercial |
$231.53
|
| Rate for Payer: Beech Street Commercial |
$236.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.01
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.94
|
| Rate for Payer: Cigna of WY Commercial |
$236.36
|
| Rate for Payer: Entrust Commercial |
$229.12
|
| Rate for Payer: First Choice Health Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.18
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$151.22
|
| Rate for Payer: One Health Plan of WY PPO |
$236.36
|
| Rate for Payer: PacificSource Commercial |
$217.06
|
| Rate for Payer: PHCS PPO |
$236.36
|
| Rate for Payer: Three Rivers PPO |
$180.88
|
| Rate for Payer: TriWest Veterans Administration |
$159.18
|
| Rate for Payer: United Healthcare Commercial |
$209.83
|
| Rate for Payer: United Healthcare Medicare |
$159.18
|
| Rate for Payer: WINHealth Partners Commercial |
$229.12
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
|
BURR OVAL 8 FLUTE 4MM 8400OBE
|
Facility
|
OP
|
$241.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$241.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.36
|
| Rate for Payer: Aetna of WY Medicare |
$159.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.53
|
| Rate for Payer: Altius Commercial |
$231.53
|
| Rate for Payer: Beech Street Commercial |
$236.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.01
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.94
|
| Rate for Payer: Cigna of WY Commercial |
$236.36
|
| Rate for Payer: Entrust Commercial |
$229.12
|
| Rate for Payer: First Choice Health Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.88
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$132.89
|
| Rate for Payer: One Health Plan of WY PPO |
$236.36
|
| Rate for Payer: PacificSource Commercial |
$217.06
|
| Rate for Payer: PHCS PPO |
$236.36
|
| Rate for Payer: Three Rivers PPO |
$180.88
|
| Rate for Payer: TriWest Veterans Administration |
$139.88
|
| Rate for Payer: United Healthcare Commercial |
$209.83
|
| Rate for Payer: United Healthcare Medicare |
$139.88
|
| Rate for Payer: WINHealth Partners Commercial |
$236.36
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
|
BURR OVAL 8 FLUTE 5MM 8500OBE
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
BURR OVAL 8 FLUTE 5MM 8500OBE
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
BURR RD POLISH 2.0 1608-6-159
|
Facility
|
IP
|
$99.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$99.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.09
|
| Rate for Payer: Altius Commercial |
$95.09
|
| Rate for Payer: Beech Street Commercial |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.32
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.08
|
| Rate for Payer: Cigna of WY Commercial |
$97.07
|
| Rate for Payer: Entrust Commercial |
$94.10
|
| Rate for Payer: First Choice Health Commercial |
$94.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.37
|
| Rate for Payer: HealthUtah PPO |
$99.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.08
|
| Rate for Payer: Multiplan Medicare/VA |
$62.10
|
| Rate for Payer: One Health Plan of WY PPO |
$97.07
|
| Rate for Payer: PacificSource Commercial |
$89.14
|
| Rate for Payer: PHCS PPO |
$97.07
|
| Rate for Payer: Three Rivers PPO |
$74.29
|
| Rate for Payer: TriWest Veterans Administration |
$65.37
|
| Rate for Payer: United Healthcare Commercial |
$86.17
|
| Rate for Payer: United Healthcare Medicare |
$65.37
|
| Rate for Payer: WINHealth Partners Commercial |
$94.10
|
| Rate for Payer: Wise Provider Network Commercial |
$94.10
|
|
|
BURR RD POLISH 2.0 1608-6-159
|
Facility
|
OP
|
$99.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.58 |
| Max. Negotiated Rate |
$99.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.07
|
| Rate for Payer: Aetna of WY Medicare |
$65.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.09
|
| Rate for Payer: Altius Commercial |
$95.09
|
| Rate for Payer: Beech Street Commercial |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.32
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.08
|
| Rate for Payer: Cigna of WY Commercial |
$97.07
|
| Rate for Payer: Entrust Commercial |
$94.10
|
| Rate for Payer: First Choice Health Commercial |
$94.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.45
|
| Rate for Payer: HealthUtah PPO |
$99.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.08
|
| Rate for Payer: Multiplan Medicare/VA |
$54.58
|
| Rate for Payer: One Health Plan of WY PPO |
$97.07
|
| Rate for Payer: PacificSource Commercial |
$89.14
|
| Rate for Payer: PHCS PPO |
$97.07
|
| Rate for Payer: Three Rivers PPO |
$74.29
|
| Rate for Payer: TriWest Veterans Administration |
$57.45
|
| Rate for Payer: United Healthcare Commercial |
$86.17
|
| Rate for Payer: United Healthcare Medicare |
$57.45
|
| Rate for Payer: WINHealth Partners Commercial |
$97.07
|
| Rate for Payer: Wise Provider Network Commercial |
$94.10
|
|
|
BURR RD POLISH 4.0 1608-6-165
|
Facility
|
OP
|
$105.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.69
|
| Rate for Payer: Aetna of WY Medicare |
$69.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$101.58
|
| Rate for Payer: Altius Commercial |
$101.58
|
| Rate for Payer: Beech Street Commercial |
$103.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.87
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.64
|
| Rate for Payer: Cigna of WY Commercial |
$103.69
|
| Rate for Payer: Entrust Commercial |
$100.52
|
| Rate for Payer: First Choice Health Commercial |
$100.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.37
|
| Rate for Payer: HealthUtah PPO |
$105.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.64
|
| Rate for Payer: Multiplan Medicare/VA |
$58.30
|
| Rate for Payer: One Health Plan of WY PPO |
$103.69
|
| Rate for Payer: PacificSource Commercial |
$95.23
|
| Rate for Payer: PHCS PPO |
$103.69
|
| Rate for Payer: Three Rivers PPO |
$79.36
|
| Rate for Payer: TriWest Veterans Administration |
$61.37
|
| Rate for Payer: United Healthcare Commercial |
$92.05
|
| Rate for Payer: United Healthcare Medicare |
$61.37
|
| Rate for Payer: WINHealth Partners Commercial |
$103.69
|
| Rate for Payer: Wise Provider Network Commercial |
$100.52
|
|
|
BURR RD POLISH 4.0 1608-6-165
|
Facility
|
IP
|
$105.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$101.58
|
| Rate for Payer: Altius Commercial |
$101.58
|
| Rate for Payer: Beech Street Commercial |
$103.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.87
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.64
|
| Rate for Payer: Cigna of WY Commercial |
$103.69
|
| Rate for Payer: Entrust Commercial |
$100.52
|
| Rate for Payer: First Choice Health Commercial |
$100.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.83
|
| Rate for Payer: HealthUtah PPO |
$105.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.64
|
| Rate for Payer: Multiplan Medicare/VA |
$66.34
|
| Rate for Payer: One Health Plan of WY PPO |
$103.69
|
| Rate for Payer: PacificSource Commercial |
$95.23
|
| Rate for Payer: PHCS PPO |
$103.69
|
| Rate for Payer: Three Rivers PPO |
$79.36
|
| Rate for Payer: TriWest Veterans Administration |
$69.83
|
| Rate for Payer: United Healthcare Commercial |
$92.05
|
| Rate for Payer: United Healthcare Medicare |
$69.83
|
| Rate for Payer: WINHealth Partners Commercial |
$100.52
|
| Rate for Payer: Wise Provider Network Commercial |
$100.52
|
|
|
BURR ROUND 10FLUTE 3MM 9300RBT
|
Facility
|
IP
|
$269.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.18 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.03
|
| Rate for Payer: Altius Commercial |
$259.03
|
| Rate for Payer: Beech Street Commercial |
$264.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.52
|
| Rate for Payer: Cash Price |
$188.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.73
|
| Rate for Payer: Cigna of WY Commercial |
$264.42
|
| Rate for Payer: Entrust Commercial |
$256.33
|
| Rate for Payer: First Choice Health Commercial |
$256.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.08
|
| Rate for Payer: HealthUtah PPO |
$269.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.73
|
| Rate for Payer: Multiplan Medicare/VA |
$169.18
|
| Rate for Payer: One Health Plan of WY PPO |
$264.42
|
| Rate for Payer: PacificSource Commercial |
$242.84
|
| Rate for Payer: PHCS PPO |
$264.42
|
| Rate for Payer: Three Rivers PPO |
$202.36
|
| Rate for Payer: TriWest Veterans Administration |
$178.08
|
| Rate for Payer: United Healthcare Commercial |
$234.74
|
| Rate for Payer: United Healthcare Medicare |
$178.08
|
| Rate for Payer: WINHealth Partners Commercial |
$256.33
|
| Rate for Payer: Wise Provider Network Commercial |
$256.33
|
|
|
BURR ROUND 10FLUTE 3MM 9300RBT
|
Facility
|
OP
|
$269.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.42
|
| Rate for Payer: Aetna of WY Medicare |
$178.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.03
|
| Rate for Payer: Altius Commercial |
$259.03
|
| Rate for Payer: Beech Street Commercial |
$264.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.52
|
| Rate for Payer: Cash Price |
$188.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.73
|
| Rate for Payer: Cigna of WY Commercial |
$264.42
|
| Rate for Payer: Entrust Commercial |
$256.33
|
| Rate for Payer: First Choice Health Commercial |
$256.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.50
|
| Rate for Payer: HealthUtah PPO |
$269.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.73
|
| Rate for Payer: Multiplan Medicare/VA |
$148.67
|
| Rate for Payer: One Health Plan of WY PPO |
$264.42
|
| Rate for Payer: PacificSource Commercial |
$242.84
|
| Rate for Payer: PHCS PPO |
$264.42
|
| Rate for Payer: Three Rivers PPO |
$202.36
|
| Rate for Payer: TriWest Veterans Administration |
$156.50
|
| Rate for Payer: United Healthcare Commercial |
$234.74
|
| Rate for Payer: United Healthcare Medicare |
$156.50
|
| Rate for Payer: WINHealth Partners Commercial |
$264.42
|
| Rate for Payer: Wise Provider Network Commercial |
$256.33
|
|
|
BURR ROUND 8 FLUTE 4MM 8400RBE
|
Facility
|
OP
|
$241.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$241.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.36
|
| Rate for Payer: Aetna of WY Medicare |
$159.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.53
|
| Rate for Payer: Altius Commercial |
$231.53
|
| Rate for Payer: Beech Street Commercial |
$236.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.01
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.94
|
| Rate for Payer: Cigna of WY Commercial |
$236.36
|
| Rate for Payer: Entrust Commercial |
$229.12
|
| Rate for Payer: First Choice Health Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.88
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$132.89
|
| Rate for Payer: One Health Plan of WY PPO |
$236.36
|
| Rate for Payer: PacificSource Commercial |
$217.06
|
| Rate for Payer: PHCS PPO |
$236.36
|
| Rate for Payer: Three Rivers PPO |
$180.88
|
| Rate for Payer: TriWest Veterans Administration |
$139.88
|
| Rate for Payer: United Healthcare Commercial |
$209.83
|
| Rate for Payer: United Healthcare Medicare |
$139.88
|
| Rate for Payer: WINHealth Partners Commercial |
$236.36
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
|
BURR ROUND 8 FLUTE 4MM 8400RBE
|
Facility
|
IP
|
$241.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.22 |
| Max. Negotiated Rate |
$241.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.53
|
| Rate for Payer: Altius Commercial |
$231.53
|
| Rate for Payer: Beech Street Commercial |
$236.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.01
|
| Rate for Payer: Cash Price |
$168.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.94
|
| Rate for Payer: Cigna of WY Commercial |
$236.36
|
| Rate for Payer: Entrust Commercial |
$229.12
|
| Rate for Payer: First Choice Health Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.18
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$151.22
|
| Rate for Payer: One Health Plan of WY PPO |
$236.36
|
| Rate for Payer: PacificSource Commercial |
$217.06
|
| Rate for Payer: PHCS PPO |
$236.36
|
| Rate for Payer: Three Rivers PPO |
$180.88
|
| Rate for Payer: TriWest Veterans Administration |
$159.18
|
| Rate for Payer: United Healthcare Commercial |
$209.83
|
| Rate for Payer: United Healthcare Medicare |
$159.18
|
| Rate for Payer: WINHealth Partners Commercial |
$229.12
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
