|
FEMOR NAIL 13X340MM 1825-1334S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X340MM 1825-1334S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X360MM 1825-1336S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X360MM 1825-1336S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X380MM 1825-1338S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X380MM 1825-1338S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X400MM 1825-1340S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X400MM 1825-1340S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X420MM 1825-1342S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X420MM 1825-1342S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X440MM 1825-1344S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X440MM 1825-1344S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X460MM 1825-1346S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X460MM 1825-1346S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X480MM 1825-1348S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 13X480MM 1825-1348S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 14X420MM 1825-1342S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMOR NAIL 14X420MM 1825-1342S
|
Facility
|
OP
|
$3,879.61
|
|
| Hospital Charge Code |
3100497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.81 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,560.54
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,211.38
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,100.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,211.38
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,211.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3,802.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
|
FEMUR PLATE FF MED
|
Facility
|
IP
|
$3,115.00
|
|
| Hospital Charge Code |
3003471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,805.14 |
| Max. Negotiated Rate |
$3,115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,052.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,993.60
|
| Rate for Payer: Altius Commercial |
$2,990.40
|
| Rate for Payer: Beech Street Commercial |
$3,052.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,021.55
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,021.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,052.70
|
| Rate for Payer: Entrust Commercial |
$2,959.25
|
| Rate for Payer: First Choice Health Commercial |
$2,959.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,959.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,900.15
|
| Rate for Payer: HealthUtah PPO |
$3,115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,021.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,805.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3,052.70
|
| Rate for Payer: PacificSource Commercial |
$2,803.50
|
| Rate for Payer: PHCS PPO |
$3,052.70
|
| Rate for Payer: Three Rivers PPO |
$2,336.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,900.15
|
| Rate for Payer: United Healthcare Commercial |
$2,974.82
|
| Rate for Payer: United Healthcare Medicare |
$1,900.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,959.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,959.25
|
|
|
FEMUR PLATE FF MED
|
Facility
|
OP
|
$3,115.00
|
|
| Hospital Charge Code |
3003471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,686.77 |
| Max. Negotiated Rate |
$3,115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,052.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,055.90
|
| Rate for Payer: Altius Commercial |
$2,990.40
|
| Rate for Payer: Beech Street Commercial |
$3,052.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,021.55
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,021.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,052.70
|
| Rate for Payer: Entrust Commercial |
$2,959.25
|
| Rate for Payer: First Choice Health Commercial |
$2,959.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,959.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,775.55
|
| Rate for Payer: HealthUtah PPO |
$3,115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,021.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,686.77
|
| Rate for Payer: One Health Plan of WY PPO |
$3,052.70
|
| Rate for Payer: PacificSource Commercial |
$2,803.50
|
| Rate for Payer: PHCS PPO |
$3,052.70
|
| Rate for Payer: Three Rivers PPO |
$2,336.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,775.55
|
| Rate for Payer: United Healthcare Commercial |
$2,974.82
|
| Rate for Payer: United Healthcare Medicare |
$1,775.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,052.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,959.25
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [41966]
|
Facility
|
IP
|
$17.61
|
|
|
Service Code
|
NDC 0378306677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.26
|
| Rate for Payer: Aetna of WY Medicare |
$11.27
|
| Rate for Payer: Altius Commercial |
$16.91
|
| Rate for Payer: Beech Street Commercial |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.08
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.08
|
| Rate for Payer: Cigna of WY Commercial |
$17.26
|
| Rate for Payer: Entrust Commercial |
$16.73
|
| Rate for Payer: First Choice Health Commercial |
$16.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.74
|
| Rate for Payer: HealthUtah PPO |
$17.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.08
|
| Rate for Payer: Multiplan Medicare/VA |
$10.20
|
| Rate for Payer: One Health Plan of WY PPO |
$17.26
|
| Rate for Payer: PacificSource Commercial |
$15.85
|
| Rate for Payer: PHCS PPO |
$17.26
|
| Rate for Payer: Three Rivers PPO |
$13.21
|
| Rate for Payer: TriWest Veterans Administration |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.82
|
| Rate for Payer: United Healthcare Medicare |
$10.74
|
| Rate for Payer: WINHealth Partners Commercial |
$16.73
|
| Rate for Payer: Wise Provider Network Commercial |
$16.73
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [41966]
|
Facility
|
IP
|
$27.37
|
|
|
Service Code
|
NDC 6068762911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.82
|
| Rate for Payer: Aetna of WY Medicare |
$17.52
|
| Rate for Payer: Altius Commercial |
$26.28
|
| Rate for Payer: Beech Street Commercial |
$26.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.55
|
| Rate for Payer: Cash Price |
$19.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.55
|
| Rate for Payer: Cigna of WY Commercial |
$26.82
|
| Rate for Payer: Entrust Commercial |
$26.00
|
| Rate for Payer: First Choice Health Commercial |
$26.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.70
|
| Rate for Payer: HealthUtah PPO |
$27.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.55
|
| Rate for Payer: Multiplan Medicare/VA |
$15.86
|
| Rate for Payer: One Health Plan of WY PPO |
$26.82
|
| Rate for Payer: PacificSource Commercial |
$24.63
|
| Rate for Payer: PHCS PPO |
$26.82
|
| Rate for Payer: Three Rivers PPO |
$20.53
|
| Rate for Payer: TriWest Veterans Administration |
$16.70
|
| Rate for Payer: United Healthcare Commercial |
$26.14
|
| Rate for Payer: United Healthcare Medicare |
$16.70
|
| Rate for Payer: WINHealth Partners Commercial |
$26.00
|
| Rate for Payer: Wise Provider Network Commercial |
$26.00
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [41966]
|
Facility
|
OP
|
$27.37
|
|
|
Service Code
|
NDC 6068762911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.82
|
| Rate for Payer: Aetna of WY Medicare |
$18.06
|
| Rate for Payer: Altius Commercial |
$26.28
|
| Rate for Payer: Beech Street Commercial |
$26.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.55
|
| Rate for Payer: Cash Price |
$19.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.55
|
| Rate for Payer: Cigna of WY Commercial |
$26.82
|
| Rate for Payer: Entrust Commercial |
$26.00
|
| Rate for Payer: First Choice Health Commercial |
$26.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.60
|
| Rate for Payer: HealthUtah PPO |
$27.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.55
|
| Rate for Payer: Multiplan Medicare/VA |
$14.82
|
| Rate for Payer: One Health Plan of WY PPO |
$26.82
|
| Rate for Payer: PacificSource Commercial |
$24.63
|
| Rate for Payer: PHCS PPO |
$26.82
|
| Rate for Payer: Three Rivers PPO |
$20.53
|
| Rate for Payer: TriWest Veterans Administration |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$26.14
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WINHealth Partners Commercial |
$26.82
|
| Rate for Payer: Wise Provider Network Commercial |
$26.00
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET [41966]
|
Facility
|
OP
|
$17.61
|
|
|
Service Code
|
NDC 0378306677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.26
|
| Rate for Payer: Aetna of WY Medicare |
$11.62
|
| Rate for Payer: Altius Commercial |
$16.91
|
| Rate for Payer: Beech Street Commercial |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.08
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.08
|
| Rate for Payer: Cigna of WY Commercial |
$17.26
|
| Rate for Payer: Entrust Commercial |
$16.73
|
| Rate for Payer: First Choice Health Commercial |
$16.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.04
|
| Rate for Payer: HealthUtah PPO |
$17.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.08
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$17.26
|
| Rate for Payer: PacificSource Commercial |
$15.85
|
| Rate for Payer: PHCS PPO |
$17.26
|
| Rate for Payer: Three Rivers PPO |
$13.21
|
| Rate for Payer: TriWest Veterans Administration |
$10.04
|
| Rate for Payer: United Healthcare Commercial |
$16.82
|
| Rate for Payer: United Healthcare Medicare |
$10.04
|
| Rate for Payer: WINHealth Partners Commercial |
$17.26
|
| Rate for Payer: Wise Provider Network Commercial |
$16.73
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 4778142347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
