|
FUSION CUP 10 HOLE 22MM TRIMED
|
Facility
|
IP
|
$3,111.50
|
|
| Hospital Charge Code |
3002364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.11 |
| Max. Negotiated Rate |
$3,111.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,991.36
|
| Rate for Payer: Altius Commercial |
$2,987.04
|
| Rate for Payer: Beech Street Commercial |
$3,049.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,018.16
|
| Rate for Payer: Cash Price |
$2,178.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.27
|
| Rate for Payer: Entrust Commercial |
$2,955.92
|
| Rate for Payer: First Choice Health Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,898.02
|
| Rate for Payer: HealthUtah PPO |
$3,111.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,803.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.27
|
| Rate for Payer: PacificSource Commercial |
$2,800.35
|
| Rate for Payer: PHCS PPO |
$3,049.27
|
| Rate for Payer: Three Rivers PPO |
$2,333.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,898.02
|
| Rate for Payer: United Healthcare Commercial |
$2,971.48
|
| Rate for Payer: United Healthcare Medicare |
$1,898.02
|
| Rate for Payer: WINHealth Partners Commercial |
$2,955.92
|
| Rate for Payer: Wise Provider Network Commercial |
$2,955.92
|
|
|
FUSION CUP 10 HOLE 22MM TRIMED
|
Facility
|
OP
|
$3,111.50
|
|
| Hospital Charge Code |
3002364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.88 |
| Max. Negotiated Rate |
$3,111.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.27
|
| Rate for Payer: Aetna of WY Medicare |
$2,053.59
|
| Rate for Payer: Altius Commercial |
$2,987.04
|
| Rate for Payer: Beech Street Commercial |
$3,049.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,018.16
|
| Rate for Payer: Cash Price |
$2,178.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.27
|
| Rate for Payer: Entrust Commercial |
$2,955.92
|
| Rate for Payer: First Choice Health Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,773.56
|
| Rate for Payer: HealthUtah PPO |
$3,111.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,684.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.27
|
| Rate for Payer: PacificSource Commercial |
$2,800.35
|
| Rate for Payer: PHCS PPO |
$3,049.27
|
| Rate for Payer: Three Rivers PPO |
$2,333.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,773.56
|
| Rate for Payer: United Healthcare Commercial |
$2,971.48
|
| Rate for Payer: United Healthcare Medicare |
$1,773.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,049.27
|
| Rate for Payer: Wise Provider Network Commercial |
$2,955.92
|
|
|
FUSION CUP 7 HOLE 14MM TRIMED
|
Facility
|
OP
|
$3,111.50
|
|
| Hospital Charge Code |
3001980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.88 |
| Max. Negotiated Rate |
$3,111.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.27
|
| Rate for Payer: Aetna of WY Medicare |
$2,053.59
|
| Rate for Payer: Altius Commercial |
$2,987.04
|
| Rate for Payer: Beech Street Commercial |
$3,049.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,018.16
|
| Rate for Payer: Cash Price |
$2,178.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.27
|
| Rate for Payer: Entrust Commercial |
$2,955.92
|
| Rate for Payer: First Choice Health Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,773.56
|
| Rate for Payer: HealthUtah PPO |
$3,111.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,684.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.27
|
| Rate for Payer: PacificSource Commercial |
$2,800.35
|
| Rate for Payer: PHCS PPO |
$3,049.27
|
| Rate for Payer: Three Rivers PPO |
$2,333.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,773.56
|
| Rate for Payer: United Healthcare Commercial |
$2,971.48
|
| Rate for Payer: United Healthcare Medicare |
$1,773.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,049.27
|
| Rate for Payer: Wise Provider Network Commercial |
$2,955.92
|
|
|
FUSION CUP 7 HOLE 14MM TRIMED
|
Facility
|
IP
|
$3,111.50
|
|
| Hospital Charge Code |
3001980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.11 |
| Max. Negotiated Rate |
$3,111.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.27
|
| Rate for Payer: Aetna of WY Medicare |
$1,991.36
|
| Rate for Payer: Altius Commercial |
$2,987.04
|
| Rate for Payer: Beech Street Commercial |
$3,049.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,018.16
|
| Rate for Payer: Cash Price |
$2,178.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.27
|
| Rate for Payer: Entrust Commercial |
$2,955.92
|
| Rate for Payer: First Choice Health Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,955.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,898.02
|
| Rate for Payer: HealthUtah PPO |
$3,111.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,803.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.27
|
| Rate for Payer: PacificSource Commercial |
$2,800.35
|
| Rate for Payer: PHCS PPO |
$3,049.27
|
| Rate for Payer: Three Rivers PPO |
$2,333.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,898.02
|
| Rate for Payer: United Healthcare Commercial |
$2,971.48
|
| Rate for Payer: United Healthcare Medicare |
$1,898.02
|
| Rate for Payer: WINHealth Partners Commercial |
$2,955.92
|
| Rate for Payer: Wise Provider Network Commercial |
$2,955.92
|
|
|
FUSION CUP REAMER 14 MM TRIMED
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
3003597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.81 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$498.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$473.81
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$498.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$498.75
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
FUSION CUP REAMER 14 MM TRIMED
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
3003597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.06 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$560.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$507.06
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$533.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$533.75
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
FUSION CUP REAMER 18 MM TRIMED
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
3002810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.07 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$816.34
|
| Rate for Payer: Aetna of WY Medicare |
$549.78
|
| Rate for Payer: Altius Commercial |
$799.68
|
| Rate for Payer: Beech Street Commercial |
$816.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$808.01
|
| Rate for Payer: Cash Price |
$583.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$808.01
|
| Rate for Payer: Cigna of WY Commercial |
$816.34
|
| Rate for Payer: Entrust Commercial |
$791.35
|
| Rate for Payer: First Choice Health Commercial |
$791.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$791.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$474.81
|
| Rate for Payer: HealthUtah PPO |
$833.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$808.01
|
| Rate for Payer: Multiplan Medicare/VA |
$451.07
|
| Rate for Payer: One Health Plan of WY PPO |
$816.34
|
| Rate for Payer: PacificSource Commercial |
$749.70
|
| Rate for Payer: PHCS PPO |
$816.34
|
| Rate for Payer: Three Rivers PPO |
$624.75
|
| Rate for Payer: TriWest Veterans Administration |
$474.81
|
| Rate for Payer: United Healthcare Commercial |
$795.52
|
| Rate for Payer: United Healthcare Medicare |
$474.81
|
| Rate for Payer: WINHealth Partners Commercial |
$816.34
|
| Rate for Payer: Wise Provider Network Commercial |
$791.35
|
|
|
FUSION CUP REAMER 18 MM TRIMED
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
3002810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.72 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$816.34
|
| Rate for Payer: Aetna of WY Medicare |
$533.12
|
| Rate for Payer: Altius Commercial |
$799.68
|
| Rate for Payer: Beech Street Commercial |
$816.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$808.01
|
| Rate for Payer: Cash Price |
$583.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$808.01
|
| Rate for Payer: Cigna of WY Commercial |
$816.34
|
| Rate for Payer: Entrust Commercial |
$791.35
|
| Rate for Payer: First Choice Health Commercial |
$791.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$791.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$508.13
|
| Rate for Payer: HealthUtah PPO |
$833.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$808.01
|
| Rate for Payer: Multiplan Medicare/VA |
$482.72
|
| Rate for Payer: One Health Plan of WY PPO |
$816.34
|
| Rate for Payer: PacificSource Commercial |
$749.70
|
| Rate for Payer: PHCS PPO |
$816.34
|
| Rate for Payer: Three Rivers PPO |
$624.75
|
| Rate for Payer: TriWest Veterans Administration |
$508.13
|
| Rate for Payer: United Healthcare Commercial |
$795.52
|
| Rate for Payer: United Healthcare Medicare |
$508.13
|
| Rate for Payer: WINHealth Partners Commercial |
$791.35
|
| Rate for Payer: Wise Provider Network Commercial |
$791.35
|
|
|
FUSION CUP REAMER 22MM TRIMED
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
3002365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.81 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$498.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$473.81
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$498.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$498.75
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
FUSION CUP REAMER 22MM TRIMED
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
3002365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.06 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$560.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$848.75
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.75
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$507.06
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$533.75
|
| Rate for Payer: United Healthcare Commercial |
$835.62
|
| Rate for Payer: United Healthcare Medicare |
$533.75
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
FUSION PACK
|
Facility
|
OP
|
$570.17
|
|
| Hospital Charge Code |
2650833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$570.17 |
| Rate for Payer: United Healthcare Commercial |
$544.51
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.77
|
| Rate for Payer: Aetna of WY Medicare |
$376.31
|
| Rate for Payer: Altius Commercial |
$547.36
|
| Rate for Payer: Beech Street Commercial |
$558.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$553.06
|
| Rate for Payer: Cash Price |
$399.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.06
|
| Rate for Payer: Cigna of WY Commercial |
$558.77
|
| Rate for Payer: Entrust Commercial |
$541.66
|
| Rate for Payer: First Choice Health Commercial |
$541.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.00
|
| Rate for Payer: HealthUtah PPO |
$570.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.06
|
| Rate for Payer: Multiplan Medicare/VA |
$308.75
|
| Rate for Payer: One Health Plan of WY PPO |
$558.77
|
| Rate for Payer: PacificSource Commercial |
$513.15
|
| Rate for Payer: PHCS PPO |
$558.77
|
| Rate for Payer: Three Rivers PPO |
$427.63
|
| Rate for Payer: TriWest Veterans Administration |
$325.00
|
| Rate for Payer: United Healthcare Medicare |
$325.00
|
| Rate for Payer: WINHealth Partners Commercial |
$558.77
|
| Rate for Payer: Wise Provider Network Commercial |
$541.66
|
|
|
FUSION PACK
|
Facility
|
IP
|
$570.17
|
|
| Hospital Charge Code |
2650833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.41 |
| Max. Negotiated Rate |
$570.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.77
|
| Rate for Payer: Aetna of WY Medicare |
$364.91
|
| Rate for Payer: Altius Commercial |
$547.36
|
| Rate for Payer: Beech Street Commercial |
$558.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$553.06
|
| Rate for Payer: Cash Price |
$399.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.06
|
| Rate for Payer: Cigna of WY Commercial |
$558.77
|
| Rate for Payer: Entrust Commercial |
$541.66
|
| Rate for Payer: First Choice Health Commercial |
$541.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$347.80
|
| Rate for Payer: HealthUtah PPO |
$570.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.06
|
| Rate for Payer: Multiplan Medicare/VA |
$330.41
|
| Rate for Payer: One Health Plan of WY PPO |
$558.77
|
| Rate for Payer: PacificSource Commercial |
$513.15
|
| Rate for Payer: PHCS PPO |
$558.77
|
| Rate for Payer: Three Rivers PPO |
$427.63
|
| Rate for Payer: TriWest Veterans Administration |
$347.80
|
| Rate for Payer: United Healthcare Commercial |
$544.51
|
| Rate for Payer: United Healthcare Medicare |
$347.80
|
| Rate for Payer: WINHealth Partners Commercial |
$541.66
|
| Rate for Payer: Wise Provider Network Commercial |
$541.66
|
|
|
FUSION RENTAL CHARGE MEDTRONIC
|
Facility
|
IP
|
$20,650.00
|
|
| Hospital Charge Code |
3002926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,966.68 |
| Max. Negotiated Rate |
$20,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20,237.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,216.00
|
| Rate for Payer: Altius Commercial |
$19,824.00
|
| Rate for Payer: Beech Street Commercial |
$20,237.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20,030.50
|
| Rate for Payer: Cash Price |
$14,455.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$20,030.50
|
| Rate for Payer: Cigna of WY Commercial |
$20,237.00
|
| Rate for Payer: Entrust Commercial |
$19,617.50
|
| Rate for Payer: First Choice Health Commercial |
$19,617.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19,617.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,596.50
|
| Rate for Payer: HealthUtah PPO |
$20,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20,030.50
|
| Rate for Payer: Multiplan Medicare/VA |
$11,966.68
|
| Rate for Payer: One Health Plan of WY PPO |
$20,237.00
|
| Rate for Payer: PacificSource Commercial |
$18,585.00
|
| Rate for Payer: PHCS PPO |
$20,237.00
|
| Rate for Payer: Three Rivers PPO |
$15,487.50
|
| Rate for Payer: TriWest Veterans Administration |
$12,596.50
|
| Rate for Payer: United Healthcare Commercial |
$19,720.75
|
| Rate for Payer: United Healthcare Medicare |
$12,596.50
|
| Rate for Payer: WINHealth Partners Commercial |
$19,617.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19,617.50
|
|
|
FUSION RENTAL CHARGE MEDTRONIC
|
Facility
|
OP
|
$20,650.00
|
|
| Hospital Charge Code |
3002926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,181.98 |
| Max. Negotiated Rate |
$20,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20,237.00
|
| Rate for Payer: Aetna of WY Medicare |
$13,629.00
|
| Rate for Payer: Altius Commercial |
$19,824.00
|
| Rate for Payer: Beech Street Commercial |
$20,237.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20,030.50
|
| Rate for Payer: Cash Price |
$14,455.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$20,030.50
|
| Rate for Payer: Cigna of WY Commercial |
$20,237.00
|
| Rate for Payer: Entrust Commercial |
$19,617.50
|
| Rate for Payer: First Choice Health Commercial |
$19,617.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19,617.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11,770.50
|
| Rate for Payer: HealthUtah PPO |
$20,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20,030.50
|
| Rate for Payer: Multiplan Medicare/VA |
$11,181.98
|
| Rate for Payer: One Health Plan of WY PPO |
$20,237.00
|
| Rate for Payer: PacificSource Commercial |
$18,585.00
|
| Rate for Payer: PHCS PPO |
$20,237.00
|
| Rate for Payer: Three Rivers PPO |
$15,487.50
|
| Rate for Payer: TriWest Veterans Administration |
$11,770.50
|
| Rate for Payer: United Healthcare Commercial |
$19,720.75
|
| Rate for Payer: United Healthcare Medicare |
$11,770.50
|
| Rate for Payer: WINHealth Partners Commercial |
$20,237.00
|
| Rate for Payer: Wise Provider Network Commercial |
$19,617.50
|
|
|
GABAPENTIN 100 MG CAPSULE [16747]
|
Facility
|
OP
|
$15.50
|
|
|
Service Code
|
NDC 6068758011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.19
|
| Rate for Payer: Aetna of WY Medicare |
$10.23
|
| Rate for Payer: Altius Commercial |
$14.88
|
| Rate for Payer: Beech Street Commercial |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.04
|
| Rate for Payer: Cigna of WY Commercial |
$15.19
|
| Rate for Payer: Entrust Commercial |
$14.72
|
| Rate for Payer: First Choice Health Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.39
|
| Rate for Payer: One Health Plan of WY PPO |
$15.19
|
| Rate for Payer: PacificSource Commercial |
$13.95
|
| Rate for Payer: PHCS PPO |
$15.19
|
| Rate for Payer: Three Rivers PPO |
$11.62
|
| Rate for Payer: TriWest Veterans Administration |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$14.80
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.19
|
| Rate for Payer: Wise Provider Network Commercial |
$14.72
|
|
|
GABAPENTIN 100 MG CAPSULE [16747]
|
Facility
|
OP
|
$15.47
|
|
|
Service Code
|
NDC 0904666561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.16
|
| Rate for Payer: Aetna of WY Medicare |
$10.21
|
| Rate for Payer: Altius Commercial |
$14.85
|
| Rate for Payer: Beech Street Commercial |
$15.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.01
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.01
|
| Rate for Payer: Cigna of WY Commercial |
$15.16
|
| Rate for Payer: Entrust Commercial |
$14.70
|
| Rate for Payer: First Choice Health Commercial |
$14.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.82
|
| Rate for Payer: HealthUtah PPO |
$15.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.01
|
| Rate for Payer: Multiplan Medicare/VA |
$8.38
|
| Rate for Payer: One Health Plan of WY PPO |
$15.16
|
| Rate for Payer: PacificSource Commercial |
$13.92
|
| Rate for Payer: PHCS PPO |
$15.16
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.82
|
| Rate for Payer: United Healthcare Commercial |
$14.77
|
| Rate for Payer: United Healthcare Medicare |
$8.82
|
| Rate for Payer: WINHealth Partners Commercial |
$15.16
|
| Rate for Payer: Wise Provider Network Commercial |
$14.70
|
|
|
GABAPENTIN 100 MG CAPSULE [16747]
|
Facility
|
IP
|
$15.50
|
|
|
Service Code
|
NDC 6068758011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.19
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Commercial |
$14.88
|
| Rate for Payer: Beech Street Commercial |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.04
|
| Rate for Payer: Cigna of WY Commercial |
$15.19
|
| Rate for Payer: Entrust Commercial |
$14.72
|
| Rate for Payer: First Choice Health Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.46
|
| Rate for Payer: HealthUtah PPO |
$15.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.98
|
| Rate for Payer: One Health Plan of WY PPO |
$15.19
|
| Rate for Payer: PacificSource Commercial |
$13.95
|
| Rate for Payer: PHCS PPO |
$15.19
|
| Rate for Payer: Three Rivers PPO |
$11.62
|
| Rate for Payer: TriWest Veterans Administration |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$14.80
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.72
|
|
|
GABAPENTIN 100 MG CAPSULE [16747]
|
Facility
|
IP
|
$15.47
|
|
|
Service Code
|
NDC 0904666561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.16
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Commercial |
$14.85
|
| Rate for Payer: Beech Street Commercial |
$15.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.01
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.01
|
| Rate for Payer: Cigna of WY Commercial |
$15.16
|
| Rate for Payer: Entrust Commercial |
$14.70
|
| Rate for Payer: First Choice Health Commercial |
$14.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.44
|
| Rate for Payer: HealthUtah PPO |
$15.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.01
|
| Rate for Payer: Multiplan Medicare/VA |
$8.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.16
|
| Rate for Payer: PacificSource Commercial |
$13.92
|
| Rate for Payer: PHCS PPO |
$15.16
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.44
|
| Rate for Payer: United Healthcare Commercial |
$14.77
|
| Rate for Payer: United Healthcare Medicare |
$9.44
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.70
|
|
|
GABAPENTIN 300 MG CAPSULE [15024]
|
Facility
|
OP
|
$15.65
|
|
|
Service Code
|
NDC 0904666661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.34
|
| Rate for Payer: Aetna of WY Medicare |
$10.33
|
| Rate for Payer: Altius Commercial |
$15.02
|
| Rate for Payer: Beech Street Commercial |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.18
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.18
|
| Rate for Payer: Cigna of WY Commercial |
$15.34
|
| Rate for Payer: Entrust Commercial |
$14.87
|
| Rate for Payer: First Choice Health Commercial |
$14.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.92
|
| Rate for Payer: HealthUtah PPO |
$15.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.18
|
| Rate for Payer: Multiplan Medicare/VA |
$8.47
|
| Rate for Payer: One Health Plan of WY PPO |
$15.34
|
| Rate for Payer: PacificSource Commercial |
$14.08
|
| Rate for Payer: PHCS PPO |
$15.34
|
| Rate for Payer: Three Rivers PPO |
$11.74
|
| Rate for Payer: TriWest Veterans Administration |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
| Rate for Payer: United Healthcare Medicare |
$8.92
|
| Rate for Payer: WINHealth Partners Commercial |
$15.34
|
| Rate for Payer: Wise Provider Network Commercial |
$14.87
|
|
|
GABAPENTIN 300 MG CAPSULE [15024]
|
Facility
|
IP
|
$15.65
|
|
|
Service Code
|
NDC 0904666661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.34
|
| Rate for Payer: Aetna of WY Medicare |
$10.02
|
| Rate for Payer: Altius Commercial |
$15.02
|
| Rate for Payer: Beech Street Commercial |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.18
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.18
|
| Rate for Payer: Cigna of WY Commercial |
$15.34
|
| Rate for Payer: Entrust Commercial |
$14.87
|
| Rate for Payer: First Choice Health Commercial |
$14.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.55
|
| Rate for Payer: HealthUtah PPO |
$15.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.18
|
| Rate for Payer: Multiplan Medicare/VA |
$9.07
|
| Rate for Payer: One Health Plan of WY PPO |
$15.34
|
| Rate for Payer: PacificSource Commercial |
$14.08
|
| Rate for Payer: PHCS PPO |
$15.34
|
| Rate for Payer: Three Rivers PPO |
$11.74
|
| Rate for Payer: TriWest Veterans Administration |
$9.55
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
| Rate for Payer: United Healthcare Medicare |
$9.55
|
| Rate for Payer: WINHealth Partners Commercial |
$14.87
|
| Rate for Payer: Wise Provider Network Commercial |
$14.87
|
|
|
GABAPENTIN 400 MG CAPSULE [5211]
|
Facility
|
IP
|
$15.82
|
|
|
Service Code
|
NDC 0904666761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.50
|
| Rate for Payer: Aetna of WY Medicare |
$10.12
|
| Rate for Payer: Altius Commercial |
$15.19
|
| Rate for Payer: Beech Street Commercial |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.35
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.35
|
| Rate for Payer: Cigna of WY Commercial |
$15.50
|
| Rate for Payer: Entrust Commercial |
$15.03
|
| Rate for Payer: First Choice Health Commercial |
$15.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.65
|
| Rate for Payer: HealthUtah PPO |
$15.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.35
|
| Rate for Payer: Multiplan Medicare/VA |
$9.17
|
| Rate for Payer: One Health Plan of WY PPO |
$15.50
|
| Rate for Payer: PacificSource Commercial |
$14.24
|
| Rate for Payer: PHCS PPO |
$15.50
|
| Rate for Payer: Three Rivers PPO |
$11.86
|
| Rate for Payer: TriWest Veterans Administration |
$9.65
|
| Rate for Payer: United Healthcare Commercial |
$15.11
|
| Rate for Payer: United Healthcare Medicare |
$9.65
|
| Rate for Payer: WINHealth Partners Commercial |
$15.03
|
| Rate for Payer: Wise Provider Network Commercial |
$15.03
|
|
|
GABAPENTIN 400 MG CAPSULE [5211]
|
Facility
|
OP
|
$15.82
|
|
|
Service Code
|
NDC 0904666761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.50
|
| Rate for Payer: Aetna of WY Medicare |
$10.44
|
| Rate for Payer: Altius Commercial |
$15.19
|
| Rate for Payer: Beech Street Commercial |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.35
|
| Rate for Payer: Cash Price |
$11.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.35
|
| Rate for Payer: Cigna of WY Commercial |
$15.50
|
| Rate for Payer: Entrust Commercial |
$15.03
|
| Rate for Payer: First Choice Health Commercial |
$15.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.02
|
| Rate for Payer: HealthUtah PPO |
$15.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.35
|
| Rate for Payer: Multiplan Medicare/VA |
$8.57
|
| Rate for Payer: One Health Plan of WY PPO |
$15.50
|
| Rate for Payer: PacificSource Commercial |
$14.24
|
| Rate for Payer: PHCS PPO |
$15.50
|
| Rate for Payer: Three Rivers PPO |
$11.86
|
| Rate for Payer: TriWest Veterans Administration |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$15.11
|
| Rate for Payer: United Healthcare Medicare |
$9.02
|
| Rate for Payer: WINHealth Partners Commercial |
$15.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15.03
|
|
|
GABAPENTIN 600 MG TABLET [1692]
|
Facility
|
OP
|
$17.62
|
|
|
Service Code
|
NDC 6068750701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.27
|
| Rate for Payer: Aetna of WY Medicare |
$11.63
|
| Rate for Payer: Altius Commercial |
$16.92
|
| Rate for Payer: Beech Street Commercial |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.09
|
| Rate for Payer: Cigna of WY Commercial |
$17.27
|
| Rate for Payer: Entrust Commercial |
$16.74
|
| Rate for Payer: First Choice Health Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.04
|
| Rate for Payer: HealthUtah PPO |
$17.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.09
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$17.27
|
| Rate for Payer: PacificSource Commercial |
$15.86
|
| Rate for Payer: PHCS PPO |
$17.27
|
| Rate for Payer: Three Rivers PPO |
$13.22
|
| Rate for Payer: TriWest Veterans Administration |
$10.04
|
| Rate for Payer: United Healthcare Commercial |
$16.83
|
| Rate for Payer: United Healthcare Medicare |
$10.04
|
| Rate for Payer: WINHealth Partners Commercial |
$17.27
|
| Rate for Payer: Wise Provider Network Commercial |
$16.74
|
|
|
GABAPENTIN 600 MG TABLET [1692]
|
Facility
|
IP
|
$17.62
|
|
|
Service Code
|
NDC 6068750711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.27
|
| Rate for Payer: Aetna of WY Medicare |
$11.28
|
| Rate for Payer: Altius Commercial |
$16.92
|
| Rate for Payer: Beech Street Commercial |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.09
|
| Rate for Payer: Cigna of WY Commercial |
$17.27
|
| Rate for Payer: Entrust Commercial |
$16.74
|
| Rate for Payer: First Choice Health Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.75
|
| Rate for Payer: HealthUtah PPO |
$17.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.09
|
| Rate for Payer: Multiplan Medicare/VA |
$10.21
|
| Rate for Payer: One Health Plan of WY PPO |
$17.27
|
| Rate for Payer: PacificSource Commercial |
$15.86
|
| Rate for Payer: PHCS PPO |
$17.27
|
| Rate for Payer: Three Rivers PPO |
$13.22
|
| Rate for Payer: TriWest Veterans Administration |
$10.75
|
| Rate for Payer: United Healthcare Commercial |
$16.83
|
| Rate for Payer: United Healthcare Medicare |
$10.75
|
| Rate for Payer: WINHealth Partners Commercial |
$16.74
|
| Rate for Payer: Wise Provider Network Commercial |
$16.74
|
|
|
GABAPENTIN 600 MG TABLET [1692]
|
Facility
|
IP
|
$17.62
|
|
|
Service Code
|
NDC 6068750701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.27
|
| Rate for Payer: Aetna of WY Medicare |
$11.28
|
| Rate for Payer: Altius Commercial |
$16.92
|
| Rate for Payer: Beech Street Commercial |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.09
|
| Rate for Payer: Cigna of WY Commercial |
$17.27
|
| Rate for Payer: Entrust Commercial |
$16.74
|
| Rate for Payer: First Choice Health Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.75
|
| Rate for Payer: HealthUtah PPO |
$17.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.09
|
| Rate for Payer: Multiplan Medicare/VA |
$10.21
|
| Rate for Payer: One Health Plan of WY PPO |
$17.27
|
| Rate for Payer: PacificSource Commercial |
$15.86
|
| Rate for Payer: PHCS PPO |
$17.27
|
| Rate for Payer: Three Rivers PPO |
$13.22
|
| Rate for Payer: TriWest Veterans Administration |
$10.75
|
| Rate for Payer: United Healthcare Commercial |
$16.83
|
| Rate for Payer: United Healthcare Medicare |
$10.75
|
| Rate for Payer: WINHealth Partners Commercial |
$16.74
|
| Rate for Payer: Wise Provider Network Commercial |
$16.74
|
|
