|
BUR 6.0 EGG 14 FLU 1607-2-3
|
Facility
|
OP
|
$111.30
|
|
| Hospital Charge Code |
2650573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.07
|
| Rate for Payer: Aetna of WY Medicare |
$73.46
|
| 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 |
$107.96
|
| 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 |
$63.44
|
| Rate for Payer: HealthUtah PPO |
$111.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.96
|
| Rate for Payer: Multiplan Medicare/VA |
$60.27
|
| 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 |
$63.44
|
| Rate for Payer: United Healthcare Commercial |
$106.29
|
| Rate for Payer: United Healthcare Medicare |
$63.44
|
| Rate for Payer: WINHealth Partners Commercial |
$109.07
|
| Rate for Payer: Wise Provider Network Commercial |
$105.74
|
|
|
BUR 6.0 EGG 14 FLU 1607-2-3
|
Facility
|
IP
|
$111.30
|
|
| Hospital Charge Code |
2650573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.07
|
| Rate for Payer: Aetna of WY Medicare |
$71.23
|
| 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 |
$107.96
|
| 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 |
$67.89
|
| Rate for Payer: HealthUtah PPO |
$111.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.96
|
| Rate for Payer: Multiplan Medicare/VA |
$64.50
|
| 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 |
$67.89
|
| Rate for Payer: United Healthcare Commercial |
$106.29
|
| Rate for Payer: United Healthcare Medicare |
$67.89
|
| Rate for Payer: WINHealth Partners Commercial |
$105.74
|
| Rate for Payer: Wise Provider Network Commercial |
$105.74
|
|
|
BUR BAR 12 FLU 4.0 375-941-012
|
Facility
|
IP
|
$77.32
|
|
| Hospital Charge Code |
2650548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.81 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.77
|
| Rate for Payer: Aetna of WY Medicare |
$49.48
|
| Rate for Payer: Altius Commercial |
$74.23
|
| Rate for Payer: Beech Street Commercial |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.00
|
| Rate for Payer: Cigna of WY Commercial |
$75.77
|
| Rate for Payer: Entrust Commercial |
$73.45
|
| Rate for Payer: First Choice Health Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.17
|
| Rate for Payer: HealthUtah PPO |
$77.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.00
|
| Rate for Payer: Multiplan Medicare/VA |
$44.81
|
| Rate for Payer: One Health Plan of WY PPO |
$75.77
|
| Rate for Payer: PacificSource Commercial |
$69.59
|
| Rate for Payer: PHCS PPO |
$75.77
|
| Rate for Payer: Three Rivers PPO |
$57.99
|
| Rate for Payer: TriWest Veterans Administration |
$47.17
|
| Rate for Payer: United Healthcare Commercial |
$73.84
|
| Rate for Payer: United Healthcare Medicare |
$47.17
|
| Rate for Payer: WINHealth Partners Commercial |
$73.45
|
| Rate for Payer: Wise Provider Network Commercial |
$73.45
|
|
|
BUR BAR 12 FLU 4.0 375-941-012
|
Facility
|
OP
|
$77.32
|
|
| Hospital Charge Code |
2650548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.77
|
| Rate for Payer: Aetna of WY Medicare |
$51.03
|
| Rate for Payer: Altius Commercial |
$74.23
|
| Rate for Payer: Beech Street Commercial |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.00
|
| Rate for Payer: Cigna of WY Commercial |
$75.77
|
| Rate for Payer: Entrust Commercial |
$73.45
|
| Rate for Payer: First Choice Health Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.07
|
| Rate for Payer: HealthUtah PPO |
$77.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.00
|
| Rate for Payer: Multiplan Medicare/VA |
$41.87
|
| Rate for Payer: One Health Plan of WY PPO |
$75.77
|
| Rate for Payer: PacificSource Commercial |
$69.59
|
| Rate for Payer: PHCS PPO |
$75.77
|
| Rate for Payer: Three Rivers PPO |
$57.99
|
| Rate for Payer: TriWest Veterans Administration |
$44.07
|
| Rate for Payer: United Healthcare Commercial |
$73.84
|
| Rate for Payer: United Healthcare Medicare |
$44.07
|
| Rate for Payer: WINHealth Partners Commercial |
$75.77
|
| Rate for Payer: Wise Provider Network Commercial |
$73.45
|
|
|
BUR BAR 12 FLU 5.0 375-951-112
|
Facility
|
IP
|
$77.32
|
|
| Hospital Charge Code |
2650549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.81 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.77
|
| Rate for Payer: Aetna of WY Medicare |
$49.48
|
| Rate for Payer: Altius Commercial |
$74.23
|
| Rate for Payer: Beech Street Commercial |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.00
|
| Rate for Payer: Cigna of WY Commercial |
$75.77
|
| Rate for Payer: Entrust Commercial |
$73.45
|
| Rate for Payer: First Choice Health Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.17
|
| Rate for Payer: HealthUtah PPO |
$77.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.00
|
| Rate for Payer: Multiplan Medicare/VA |
$44.81
|
| Rate for Payer: One Health Plan of WY PPO |
$75.77
|
| Rate for Payer: PacificSource Commercial |
$69.59
|
| Rate for Payer: PHCS PPO |
$75.77
|
| Rate for Payer: Three Rivers PPO |
$57.99
|
| Rate for Payer: TriWest Veterans Administration |
$47.17
|
| Rate for Payer: United Healthcare Commercial |
$73.84
|
| Rate for Payer: United Healthcare Medicare |
$47.17
|
| Rate for Payer: WINHealth Partners Commercial |
$73.45
|
| Rate for Payer: Wise Provider Network Commercial |
$73.45
|
|
|
BUR BAR 12 FLU 5.0 375-951-112
|
Facility
|
OP
|
$77.32
|
|
| Hospital Charge Code |
2650549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.77
|
| Rate for Payer: Aetna of WY Medicare |
$51.03
|
| Rate for Payer: Altius Commercial |
$74.23
|
| Rate for Payer: Beech Street Commercial |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.00
|
| Rate for Payer: Cigna of WY Commercial |
$75.77
|
| Rate for Payer: Entrust Commercial |
$73.45
|
| Rate for Payer: First Choice Health Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.07
|
| Rate for Payer: HealthUtah PPO |
$77.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.00
|
| Rate for Payer: Multiplan Medicare/VA |
$41.87
|
| Rate for Payer: One Health Plan of WY PPO |
$75.77
|
| Rate for Payer: PacificSource Commercial |
$69.59
|
| Rate for Payer: PHCS PPO |
$75.77
|
| Rate for Payer: Three Rivers PPO |
$57.99
|
| Rate for Payer: TriWest Veterans Administration |
$44.07
|
| Rate for Payer: United Healthcare Commercial |
$73.84
|
| Rate for Payer: United Healthcare Medicare |
$44.07
|
| Rate for Payer: WINHealth Partners Commercial |
$75.77
|
| Rate for Payer: Wise Provider Network Commercial |
$73.45
|
|
|
BURETTE INLINE 150ML
|
Facility
|
IP
|
$6.55
|
|
| Hospital Charge Code |
2050017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$6.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.42
|
| Rate for Payer: Aetna of WY Medicare |
$4.19
|
| Rate for Payer: Altius Commercial |
$6.29
|
| Rate for Payer: Beech Street Commercial |
$6.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.35
|
| Rate for Payer: Cigna of WY Commercial |
$6.42
|
| Rate for Payer: Entrust Commercial |
$6.22
|
| Rate for Payer: First Choice Health Commercial |
$6.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.00
|
| Rate for Payer: HealthUtah PPO |
$6.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.35
|
| Rate for Payer: Multiplan Medicare/VA |
$3.80
|
| Rate for Payer: One Health Plan of WY PPO |
$6.42
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.42
|
| Rate for Payer: Three Rivers PPO |
$4.91
|
| Rate for Payer: TriWest Veterans Administration |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6.22
|
| Rate for Payer: Wise Provider Network Commercial |
$6.22
|
|
|
BURETTE INLINE 150ML
|
Facility
|
OP
|
$6.55
|
|
| Hospital Charge Code |
2050017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$6.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.42
|
| Rate for Payer: Aetna of WY Medicare |
$4.32
|
| Rate for Payer: Altius Commercial |
$6.29
|
| Rate for Payer: Beech Street Commercial |
$6.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.35
|
| Rate for Payer: Cigna of WY Commercial |
$6.42
|
| Rate for Payer: Entrust Commercial |
$6.22
|
| Rate for Payer: First Choice Health Commercial |
$6.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.73
|
| Rate for Payer: HealthUtah PPO |
$6.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.35
|
| Rate for Payer: Multiplan Medicare/VA |
$3.55
|
| Rate for Payer: One Health Plan of WY PPO |
$6.42
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.42
|
| Rate for Payer: Three Rivers PPO |
$4.91
|
| Rate for Payer: TriWest Veterans Administration |
$3.73
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$3.73
|
| Rate for Payer: WINHealth Partners Commercial |
$6.42
|
| Rate for Payer: Wise Provider Network Commercial |
$6.22
|
|
|
BURR 3MM 1.75" 0277-010-230
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2650828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$22.40
|
| 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 |
$33.95
|
| 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 |
$21.35
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.28
|
| 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 |
$21.35
|
| Rate for Payer: United Healthcare Commercial |
$33.42
|
| Rate for Payer: United Healthcare Medicare |
$21.35
|
| 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 |
2650828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.95 |
| 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 Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.95
|
| 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 |
$19.95
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$18.95
|
| 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 |
$19.95
|
| Rate for Payer: United Healthcare Commercial |
$33.42
|
| Rate for Payer: United Healthcare Medicare |
$19.95
|
| 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
|
$116.02
|
|
| Hospital Charge Code |
2650061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.23 |
| Max. Negotiated Rate |
$116.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.70
|
| Rate for Payer: Aetna of WY Medicare |
$74.25
|
| Rate for Payer: Altius Commercial |
$111.38
|
| Rate for Payer: Beech Street Commercial |
$113.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.54
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.54
|
| Rate for Payer: Cigna of WY Commercial |
$113.70
|
| Rate for Payer: Entrust Commercial |
$110.22
|
| Rate for Payer: First Choice Health Commercial |
$110.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.77
|
| Rate for Payer: HealthUtah PPO |
$116.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.54
|
| Rate for Payer: Multiplan Medicare/VA |
$67.23
|
| Rate for Payer: One Health Plan of WY PPO |
$113.70
|
| Rate for Payer: PacificSource Commercial |
$104.42
|
| Rate for Payer: PHCS PPO |
$113.70
|
| Rate for Payer: Three Rivers PPO |
$87.02
|
| Rate for Payer: TriWest Veterans Administration |
$70.77
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
| Rate for Payer: United Healthcare Medicare |
$70.77
|
| Rate for Payer: WINHealth Partners Commercial |
$110.22
|
| Rate for Payer: Wise Provider Network Commercial |
$110.22
|
|
|
BUR RD FAST CUT 5.5 1608-6-141
|
Facility
|
OP
|
$116.02
|
|
| Hospital Charge Code |
2650061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.82 |
| Max. Negotiated Rate |
$116.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.70
|
| Rate for Payer: Aetna of WY Medicare |
$76.57
|
| Rate for Payer: Altius Commercial |
$111.38
|
| Rate for Payer: Beech Street Commercial |
$113.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.54
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.54
|
| Rate for Payer: Cigna of WY Commercial |
$113.70
|
| Rate for Payer: Entrust Commercial |
$110.22
|
| Rate for Payer: First Choice Health Commercial |
$110.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.13
|
| Rate for Payer: HealthUtah PPO |
$116.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.54
|
| Rate for Payer: Multiplan Medicare/VA |
$62.82
|
| Rate for Payer: One Health Plan of WY PPO |
$113.70
|
| Rate for Payer: PacificSource Commercial |
$104.42
|
| Rate for Payer: PHCS PPO |
$113.70
|
| Rate for Payer: Three Rivers PPO |
$87.02
|
| Rate for Payer: TriWest Veterans Administration |
$66.13
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
| Rate for Payer: United Healthcare Medicare |
$66.13
|
| Rate for Payer: WINHealth Partners Commercial |
$113.70
|
| Rate for Payer: Wise Provider Network Commercial |
$110.22
|
|
|
BURR DR. CLYDE 3.0 5820-107-30
|
Facility
|
IP
|
$370.20
|
|
| Hospital Charge Code |
2650060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.53 |
| Max. Negotiated Rate |
$370.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.80
|
| Rate for Payer: Aetna of WY Medicare |
$236.93
|
| 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 |
$359.09
|
| 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 |
$225.82
|
| Rate for Payer: HealthUtah PPO |
$370.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.09
|
| Rate for Payer: Multiplan Medicare/VA |
$214.53
|
| 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 |
$225.82
|
| Rate for Payer: United Healthcare Commercial |
$353.54
|
| Rate for Payer: United Healthcare Medicare |
$225.82
|
| Rate for Payer: WINHealth Partners Commercial |
$351.69
|
| Rate for Payer: Wise Provider Network Commercial |
$351.69
|
|
|
BURR DR. CLYDE 3.0 5820-107-30
|
Facility
|
OP
|
$370.20
|
|
| Hospital Charge Code |
2650060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.46 |
| 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 Commercial |
$355.39
|
| Rate for Payer: Beech Street Commercial |
$362.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.09
|
| 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 |
$211.01
|
| Rate for Payer: HealthUtah PPO |
$370.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$359.09
|
| Rate for Payer: Multiplan Medicare/VA |
$200.46
|
| 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 |
$211.01
|
| Rate for Payer: United Healthcare Commercial |
$353.54
|
| Rate for Payer: United Healthcare Medicare |
$211.01
|
| Rate for Payer: WINHealth Partners Commercial |
$362.80
|
| Rate for Payer: Wise Provider Network Commercial |
$351.69
|
|
|
BURR DRIL PIL PT3.0 1608-2-133
|
Facility
|
IP
|
$120.96
|
|
| Hospital Charge Code |
2650058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.54
|
| Rate for Payer: Aetna of WY Medicare |
$77.41
|
| 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 |
$117.33
|
| 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 |
$73.79
|
| Rate for Payer: HealthUtah PPO |
$120.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.33
|
| Rate for Payer: Multiplan Medicare/VA |
$70.10
|
| 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 |
$73.79
|
| Rate for Payer: United Healthcare Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare |
$73.79
|
| 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 |
2650058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.50 |
| 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 Commercial |
$116.12
|
| Rate for Payer: Beech Street Commercial |
$118.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.33
|
| 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 |
$68.95
|
| Rate for Payer: HealthUtah PPO |
$120.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.33
|
| Rate for Payer: Multiplan Medicare/VA |
$65.50
|
| 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 |
$68.95
|
| Rate for Payer: United Healthcare Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare |
$68.95
|
| 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 |
2650059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.96 |
| 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 Commercial |
$125.80
|
| Rate for Payer: Beech Street Commercial |
$128.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.11
|
| 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 |
$74.69
|
| Rate for Payer: HealthUtah PPO |
$131.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.11
|
| Rate for Payer: Multiplan Medicare/VA |
$70.96
|
| 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 |
$74.69
|
| Rate for Payer: United Healthcare Commercial |
$125.14
|
| Rate for Payer: United Healthcare Medicare |
$74.69
|
| 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 |
2650059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.94 |
| Max. Negotiated Rate |
$131.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.42
|
| Rate for Payer: Aetna of WY Medicare |
$83.87
|
| 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 |
$127.11
|
| 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 |
$79.93
|
| Rate for Payer: HealthUtah PPO |
$131.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.11
|
| Rate for Payer: Multiplan Medicare/VA |
$75.94
|
| 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 |
$79.93
|
| Rate for Payer: United Healthcare Commercial |
$125.14
|
| Rate for Payer: United Healthcare Medicare |
$79.93
|
| Rate for Payer: WINHealth Partners Commercial |
$124.49
|
| Rate for Payer: Wise Provider Network Commercial |
$124.49
|
|
|
BURR OPTHALMIC TIP 1MM 0001
|
Facility
|
OP
|
$30.97
|
|
| Hospital Charge Code |
2400072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$30.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.35
|
| Rate for Payer: Aetna of WY Medicare |
$20.44
|
| Rate for Payer: Altius Commercial |
$29.73
|
| Rate for Payer: Beech Street Commercial |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.04
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.04
|
| Rate for Payer: Cigna of WY Commercial |
$30.35
|
| Rate for Payer: Entrust Commercial |
$29.42
|
| Rate for Payer: First Choice Health Commercial |
$29.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.65
|
| Rate for Payer: HealthUtah PPO |
$30.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.04
|
| Rate for Payer: Multiplan Medicare/VA |
$16.77
|
| Rate for Payer: One Health Plan of WY PPO |
$30.35
|
| Rate for Payer: PacificSource Commercial |
$27.87
|
| Rate for Payer: PHCS PPO |
$30.35
|
| Rate for Payer: Three Rivers PPO |
$23.23
|
| Rate for Payer: TriWest Veterans Administration |
$17.65
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$17.65
|
| Rate for Payer: WINHealth Partners Commercial |
$30.35
|
| Rate for Payer: Wise Provider Network Commercial |
$29.42
|
|
|
BURR OPTHALMIC TIP 1MM 0001
|
Facility
|
IP
|
$30.97
|
|
| Hospital Charge Code |
2400072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$30.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.35
|
| Rate for Payer: Aetna of WY Medicare |
$19.82
|
| Rate for Payer: Altius Commercial |
$29.73
|
| Rate for Payer: Beech Street Commercial |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.04
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.04
|
| Rate for Payer: Cigna of WY Commercial |
$30.35
|
| Rate for Payer: Entrust Commercial |
$29.42
|
| Rate for Payer: First Choice Health Commercial |
$29.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.89
|
| Rate for Payer: HealthUtah PPO |
$30.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.04
|
| Rate for Payer: Multiplan Medicare/VA |
$17.95
|
| Rate for Payer: One Health Plan of WY PPO |
$30.35
|
| Rate for Payer: PacificSource Commercial |
$27.87
|
| Rate for Payer: PHCS PPO |
$30.35
|
| Rate for Payer: Three Rivers PPO |
$23.23
|
| Rate for Payer: TriWest Veterans Administration |
$18.89
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$18.89
|
| Rate for Payer: WINHealth Partners Commercial |
$29.42
|
| Rate for Payer: Wise Provider Network Commercial |
$29.42
|
|
|
BUR ROUND 12 FLUTE 4.0MM
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
2650550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$82.88
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.00
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$75.05
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
BUR ROUND 12 FLUTE 4.0MM
|
Facility
|
OP
|
$129.50
|
|
| Hospital Charge Code |
2650550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.12 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$85.47
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.82
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$70.12
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$73.82
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$73.82
|
| Rate for Payer: WINHealth Partners Commercial |
$126.91
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
BURR OVAL 8 FLUTE 4MM 8400OBE
|
Facility
|
OP
|
$241.18
|
|
| Hospital Charge Code |
2650866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.60 |
| 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 Commercial |
$231.53
|
| Rate for Payer: Beech Street Commercial |
$236.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.94
|
| 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 |
$137.47
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$130.60
|
| 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 |
$137.47
|
| Rate for Payer: United Healthcare Commercial |
$230.33
|
| Rate for Payer: United Healthcare Medicare |
$137.47
|
| Rate for Payer: WINHealth Partners Commercial |
$236.36
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
|
BURR OVAL 8 FLUTE 4MM 8400OBE
|
Facility
|
IP
|
$241.18
|
|
| Hospital Charge Code |
2650866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.76 |
| Max. Negotiated Rate |
$241.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.36
|
| Rate for Payer: Aetna of WY Medicare |
$154.36
|
| 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 |
$233.94
|
| 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 |
$147.12
|
| Rate for Payer: HealthUtah PPO |
$241.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.94
|
| Rate for Payer: Multiplan Medicare/VA |
$139.76
|
| 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 |
$147.12
|
| Rate for Payer: United Healthcare Commercial |
$230.33
|
| Rate for Payer: United Healthcare Medicare |
$147.12
|
| Rate for Payer: WINHealth Partners Commercial |
$229.12
|
| Rate for Payer: Wise Provider Network Commercial |
$229.12
|
|
|
BURR OVAL 8 FLUTE 5MM 8500OBE
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
2650865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.86 |
| 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 Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| 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 |
$59.85
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$56.86
|
| 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 |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$59.85
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
