|
BURR OVAL 8 FLUTE 5MM 8500OBE
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
2650865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$67.20
|
| 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 |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$60.85
|
| 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 |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| 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 |
2650062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$99.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.07
|
| Rate for Payer: Aetna of WY Medicare |
$63.39
|
| 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 |
$96.08
|
| 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 |
$60.42
|
| Rate for Payer: HealthUtah PPO |
$99.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.08
|
| Rate for Payer: Multiplan Medicare/VA |
$57.40
|
| 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 |
$60.42
|
| Rate for Payer: United Healthcare Commercial |
$94.59
|
| Rate for Payer: United Healthcare Medicare |
$60.42
|
| 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 |
2650062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.64 |
| 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 Commercial |
$95.09
|
| Rate for Payer: Beech Street Commercial |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.08
|
| 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 |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$99.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.08
|
| Rate for Payer: Multiplan Medicare/VA |
$53.64
|
| 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 |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$94.59
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| 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 |
2650063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.30 |
| 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 Commercial |
$101.58
|
| Rate for Payer: Beech Street Commercial |
$103.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.64
|
| 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 |
$60.31
|
| Rate for Payer: HealthUtah PPO |
$105.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.64
|
| Rate for Payer: Multiplan Medicare/VA |
$57.30
|
| 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 |
$60.31
|
| Rate for Payer: United Healthcare Commercial |
$101.05
|
| Rate for Payer: United Healthcare Medicare |
$60.31
|
| 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 |
2650063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.32 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.69
|
| Rate for Payer: Aetna of WY Medicare |
$67.72
|
| 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 |
$102.64
|
| 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 |
$64.54
|
| Rate for Payer: HealthUtah PPO |
$105.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.64
|
| Rate for Payer: Multiplan Medicare/VA |
$61.32
|
| 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 |
$64.54
|
| Rate for Payer: United Healthcare Commercial |
$101.05
|
| Rate for Payer: United Healthcare Medicare |
$64.54
|
| Rate for Payer: WINHealth Partners Commercial |
$100.52
|
| Rate for Payer: Wise Provider Network Commercial |
$100.52
|
|
|
BURR ROUND 10FLUTE 3MM 9300RBT
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2650864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
BURR ROUND 10FLUTE 3MM 9300RBT
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2650864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
BURR ROUND 8 FLUTE 4MM 8400RBE
|
Facility
|
IP
|
$241.18
|
|
| Hospital Charge Code |
2650870
|
|
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 ROUND 8 FLUTE 4MM 8400RBE
|
Facility
|
OP
|
$241.18
|
|
| Hospital Charge Code |
2650870
|
|
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
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
OP
|
$15.55
|
|
|
Service Code
|
NDC 5107998601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.24
|
| Rate for Payer: Aetna of WY Medicare |
$10.26
|
| Rate for Payer: Altius Commercial |
$14.93
|
| Rate for Payer: Beech Street Commercial |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.08
|
| Rate for Payer: Cigna of WY Commercial |
$15.24
|
| Rate for Payer: Entrust Commercial |
$14.77
|
| Rate for Payer: First Choice Health Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.86
|
| Rate for Payer: HealthUtah PPO |
$15.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.08
|
| Rate for Payer: Multiplan Medicare/VA |
$8.42
|
| Rate for Payer: One Health Plan of WY PPO |
$15.24
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.24
|
| Rate for Payer: Three Rivers PPO |
$11.66
|
| Rate for Payer: TriWest Veterans Administration |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.85
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WINHealth Partners Commercial |
$15.24
|
| Rate for Payer: Wise Provider Network Commercial |
$14.77
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
OP
|
$15.55
|
|
|
Service Code
|
NDC 5107998620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.24
|
| Rate for Payer: Aetna of WY Medicare |
$10.26
|
| Rate for Payer: Altius Commercial |
$14.93
|
| Rate for Payer: Beech Street Commercial |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.08
|
| Rate for Payer: Cigna of WY Commercial |
$15.24
|
| Rate for Payer: Entrust Commercial |
$14.77
|
| Rate for Payer: First Choice Health Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.86
|
| Rate for Payer: HealthUtah PPO |
$15.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.08
|
| Rate for Payer: Multiplan Medicare/VA |
$8.42
|
| Rate for Payer: One Health Plan of WY PPO |
$15.24
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.24
|
| Rate for Payer: Three Rivers PPO |
$11.66
|
| Rate for Payer: TriWest Veterans Administration |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.85
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WINHealth Partners Commercial |
$15.24
|
| Rate for Payer: Wise Provider Network Commercial |
$14.77
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
IP
|
$15.55
|
|
|
Service Code
|
NDC 5107998601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.24
|
| Rate for Payer: Aetna of WY Medicare |
$9.95
|
| Rate for Payer: Altius Commercial |
$14.93
|
| Rate for Payer: Beech Street Commercial |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.08
|
| Rate for Payer: Cigna of WY Commercial |
$15.24
|
| Rate for Payer: Entrust Commercial |
$14.77
|
| Rate for Payer: First Choice Health Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$15.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.08
|
| Rate for Payer: Multiplan Medicare/VA |
$9.01
|
| Rate for Payer: One Health Plan of WY PPO |
$15.24
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.24
|
| Rate for Payer: Three Rivers PPO |
$11.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$14.85
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$14.77
|
| Rate for Payer: Wise Provider Network Commercial |
$14.77
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
IP
|
$15.55
|
|
|
Service Code
|
NDC 5107998620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.24
|
| Rate for Payer: Aetna of WY Medicare |
$9.95
|
| Rate for Payer: Altius Commercial |
$14.93
|
| Rate for Payer: Beech Street Commercial |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.08
|
| Rate for Payer: Cigna of WY Commercial |
$15.24
|
| Rate for Payer: Entrust Commercial |
$14.77
|
| Rate for Payer: First Choice Health Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$15.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.08
|
| Rate for Payer: Multiplan Medicare/VA |
$9.01
|
| Rate for Payer: One Health Plan of WY PPO |
$15.24
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.24
|
| Rate for Payer: Three Rivers PPO |
$11.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$14.85
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$14.77
|
| Rate for Payer: Wise Provider Network Commercial |
$14.77
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$15.35
|
|
|
Service Code
|
NDC 2930024601
|
|
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
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$15.35
|
|
|
Service Code
|
NDC 2930024601
|
|
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
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$16.82
|
|
|
Service Code
|
NDC 5026813511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.10
|
| Rate for Payer: Altius Commercial |
$16.15
|
| Rate for Payer: Beech Street Commercial |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.32
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.32
|
| Rate for Payer: Cigna of WY Commercial |
$16.48
|
| Rate for Payer: Entrust Commercial |
$15.98
|
| Rate for Payer: First Choice Health Commercial |
$15.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.59
|
| Rate for Payer: HealthUtah PPO |
$16.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.11
|
| Rate for Payer: One Health Plan of WY PPO |
$16.48
|
| Rate for Payer: PacificSource Commercial |
$15.14
|
| Rate for Payer: PHCS PPO |
$16.48
|
| Rate for Payer: Three Rivers PPO |
$12.62
|
| Rate for Payer: TriWest Veterans Administration |
$9.59
|
| Rate for Payer: United Healthcare Commercial |
$16.06
|
| Rate for Payer: United Healthcare Medicare |
$9.59
|
| Rate for Payer: WINHealth Partners Commercial |
$16.48
|
| Rate for Payer: Wise Provider Network Commercial |
$15.98
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$17.29
|
|
|
Service Code
|
NDC 5107996001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$17.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.94
|
| Rate for Payer: Aetna of WY Medicare |
$11.41
|
| Rate for Payer: Altius Commercial |
$16.60
|
| Rate for Payer: Beech Street Commercial |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.77
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.77
|
| Rate for Payer: Cigna of WY Commercial |
$16.94
|
| Rate for Payer: Entrust Commercial |
$16.43
|
| Rate for Payer: First Choice Health Commercial |
$16.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: HealthUtah PPO |
$17.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.77
|
| Rate for Payer: Multiplan Medicare/VA |
$9.36
|
| Rate for Payer: One Health Plan of WY PPO |
$16.94
|
| Rate for Payer: PacificSource Commercial |
$15.56
|
| Rate for Payer: PHCS PPO |
$16.94
|
| Rate for Payer: Three Rivers PPO |
$12.97
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: WINHealth Partners Commercial |
$16.94
|
| Rate for Payer: Wise Provider Network Commercial |
$16.43
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$16.82
|
|
|
Service Code
|
NDC 5026813511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.48
|
| Rate for Payer: Aetna of WY Medicare |
$10.76
|
| Rate for Payer: Altius Commercial |
$16.15
|
| Rate for Payer: Beech Street Commercial |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.32
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.32
|
| Rate for Payer: Cigna of WY Commercial |
$16.48
|
| Rate for Payer: Entrust Commercial |
$15.98
|
| Rate for Payer: First Choice Health Commercial |
$15.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.26
|
| Rate for Payer: HealthUtah PPO |
$16.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.75
|
| Rate for Payer: One Health Plan of WY PPO |
$16.48
|
| Rate for Payer: PacificSource Commercial |
$15.14
|
| Rate for Payer: PHCS PPO |
$16.48
|
| Rate for Payer: Three Rivers PPO |
$12.62
|
| Rate for Payer: TriWest Veterans Administration |
$10.26
|
| Rate for Payer: United Healthcare Commercial |
$16.06
|
| Rate for Payer: United Healthcare Medicare |
$10.26
|
| Rate for Payer: WINHealth Partners Commercial |
$15.98
|
| Rate for Payer: Wise Provider Network Commercial |
$15.98
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$17.29
|
|
|
Service Code
|
NDC 5107996001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$17.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.94
|
| Rate for Payer: Aetna of WY Medicare |
$11.07
|
| Rate for Payer: Altius Commercial |
$16.60
|
| Rate for Payer: Beech Street Commercial |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.77
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.77
|
| Rate for Payer: Cigna of WY Commercial |
$16.94
|
| Rate for Payer: Entrust Commercial |
$16.43
|
| Rate for Payer: First Choice Health Commercial |
$16.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.55
|
| Rate for Payer: HealthUtah PPO |
$17.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.77
|
| Rate for Payer: Multiplan Medicare/VA |
$10.02
|
| Rate for Payer: One Health Plan of WY PPO |
$16.94
|
| Rate for Payer: PacificSource Commercial |
$15.56
|
| Rate for Payer: PHCS PPO |
$16.94
|
| Rate for Payer: Three Rivers PPO |
$12.97
|
| Rate for Payer: TriWest Veterans Administration |
$10.55
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare |
$10.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.43
|
| Rate for Payer: Wise Provider Network Commercial |
$16.43
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8141]
|
Facility
|
OP
|
$15.74
|
|
|
Service Code
|
NDC 0527169501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.39
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8141]
|
Facility
|
IP
|
$15.74
|
|
|
Service Code
|
NDC 0527169501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY [5766]
|
Facility
|
IP
|
$35.83
|
|
|
Service Code
|
NDC 1022302013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$35.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.11
|
| Rate for Payer: Aetna of WY Medicare |
$22.93
|
| Rate for Payer: Altius Commercial |
$34.40
|
| Rate for Payer: Beech Street Commercial |
$35.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.76
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.76
|
| Rate for Payer: Cigna of WY Commercial |
$35.11
|
| Rate for Payer: Entrust Commercial |
$34.04
|
| Rate for Payer: First Choice Health Commercial |
$34.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.86
|
| Rate for Payer: HealthUtah PPO |
$35.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.76
|
| Rate for Payer: Multiplan Medicare/VA |
$20.76
|
| Rate for Payer: One Health Plan of WY PPO |
$35.11
|
| Rate for Payer: PacificSource Commercial |
$32.25
|
| Rate for Payer: PHCS PPO |
$35.11
|
| Rate for Payer: Three Rivers PPO |
$26.87
|
| Rate for Payer: TriWest Veterans Administration |
$21.86
|
| Rate for Payer: United Healthcare Commercial |
$34.22
|
| Rate for Payer: United Healthcare Medicare |
$21.86
|
| Rate for Payer: WINHealth Partners Commercial |
$34.04
|
| Rate for Payer: Wise Provider Network Commercial |
$34.04
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY [5766]
|
Facility
|
OP
|
$35.83
|
|
|
Service Code
|
NDC 1022302013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$35.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.11
|
| Rate for Payer: Aetna of WY Medicare |
$23.65
|
| Rate for Payer: Altius Commercial |
$34.40
|
| Rate for Payer: Beech Street Commercial |
$35.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.76
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.76
|
| Rate for Payer: Cigna of WY Commercial |
$35.11
|
| Rate for Payer: Entrust Commercial |
$34.04
|
| Rate for Payer: First Choice Health Commercial |
$34.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.42
|
| Rate for Payer: HealthUtah PPO |
$35.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.76
|
| Rate for Payer: Multiplan Medicare/VA |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$35.11
|
| Rate for Payer: PacificSource Commercial |
$32.25
|
| Rate for Payer: PHCS PPO |
$35.11
|
| Rate for Payer: Three Rivers PPO |
$26.87
|
| Rate for Payer: TriWest Veterans Administration |
$20.42
|
| Rate for Payer: United Healthcare Commercial |
$34.22
|
| Rate for Payer: United Healthcare Medicare |
$20.42
|
| Rate for Payer: WINHealth Partners Commercial |
$35.11
|
| Rate for Payer: Wise Provider Network Commercial |
$34.04
|
|
|
BUTTON DOG BONE AR-2270
|
Facility
|
IP
|
$1,225.00
|
|
| Hospital Charge Code |
3002025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.89 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.50
|
| Rate for Payer: Aetna of WY Medicare |
$784.00
|
| Rate for Payer: Altius Commercial |
$1,176.00
|
| Rate for Payer: Beech Street Commercial |
$1,200.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,188.25
|
| Rate for Payer: Cash Price |
$857.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.50
|
| Rate for Payer: Entrust Commercial |
$1,163.75
|
| Rate for Payer: First Choice Health Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.25
|
| Rate for Payer: HealthUtah PPO |
$1,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.25
|
| Rate for Payer: Multiplan Medicare/VA |
$709.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.50
|
| Rate for Payer: PacificSource Commercial |
$1,102.50
|
| Rate for Payer: PHCS PPO |
$1,200.50
|
| Rate for Payer: Three Rivers PPO |
$918.75
|
| Rate for Payer: TriWest Veterans Administration |
$747.25
|
| Rate for Payer: United Healthcare Commercial |
$1,169.88
|
| Rate for Payer: United Healthcare Medicare |
$747.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,163.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.75
|
|
|
BUTTON DOG BONE AR-2270
|
Facility
|
OP
|
$1,225.00
|
|
| Hospital Charge Code |
3002025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.34 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: United Healthcare Commercial |
$1,169.88
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.50
|
| Rate for Payer: Aetna of WY Medicare |
$808.50
|
| Rate for Payer: Altius Commercial |
$1,176.00
|
| Rate for Payer: Beech Street Commercial |
$1,200.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,188.25
|
| Rate for Payer: Cash Price |
$857.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.50
|
| Rate for Payer: Entrust Commercial |
$1,163.75
|
| Rate for Payer: First Choice Health Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.25
|
| Rate for Payer: HealthUtah PPO |
$1,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.25
|
| Rate for Payer: Multiplan Medicare/VA |
$663.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.50
|
| Rate for Payer: PacificSource Commercial |
$1,102.50
|
| Rate for Payer: PHCS PPO |
$1,200.50
|
| Rate for Payer: Three Rivers PPO |
$918.75
|
| Rate for Payer: TriWest Veterans Administration |
$698.25
|
| Rate for Payer: United Healthcare Medicare |
$698.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,200.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.75
|
|
