|
MESH PROGRIP ING TEM1208GR
|
Facility
|
IP
|
$744.48
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.79 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$729.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$714.70
|
| Rate for Payer: Altius Commercial |
$714.70
|
| Rate for Payer: Beech Street Commercial |
$729.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.22
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.15
|
| Rate for Payer: Cigna of WY Commercial |
$729.59
|
| Rate for Payer: Entrust Commercial |
$707.26
|
| Rate for Payer: First Choice Health Commercial |
$707.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.36
|
| Rate for Payer: HealthUtah PPO |
$744.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.15
|
| Rate for Payer: Multiplan Medicare/VA |
$466.79
|
| Rate for Payer: One Health Plan of WY PPO |
$729.59
|
| Rate for Payer: PacificSource Commercial |
$670.03
|
| Rate for Payer: PHCS PPO |
$729.59
|
| Rate for Payer: Three Rivers PPO |
$558.36
|
| Rate for Payer: TriWest Veterans Administration |
$491.36
|
| Rate for Payer: United Healthcare Commercial |
$647.70
|
| Rate for Payer: United Healthcare Medicare |
$491.36
|
| Rate for Payer: WINHealth Partners Commercial |
$707.26
|
| Rate for Payer: Wise Provider Network Commercial |
$707.26
|
|
|
MESH PROGRIP LAP 10X15CM LEFT
|
Facility
|
IP
|
$1,223.67
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.24 |
| Max. Negotiated Rate |
$1,223.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,199.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,174.72
|
| Rate for Payer: Altius Commercial |
$1,174.72
|
| Rate for Payer: Beech Street Commercial |
$1,199.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,004.63
|
| Rate for Payer: Cash Price |
$856.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,199.20
|
| Rate for Payer: Entrust Commercial |
$1,162.49
|
| Rate for Payer: First Choice Health Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.62
|
| Rate for Payer: HealthUtah PPO |
$1,223.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.96
|
| Rate for Payer: Multiplan Medicare/VA |
$767.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,199.20
|
| Rate for Payer: PacificSource Commercial |
$1,101.30
|
| Rate for Payer: PHCS PPO |
$1,199.20
|
| Rate for Payer: Three Rivers PPO |
$917.75
|
| Rate for Payer: TriWest Veterans Administration |
$807.62
|
| Rate for Payer: United Healthcare Commercial |
$1,064.59
|
| Rate for Payer: United Healthcare Medicare |
$807.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,162.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,162.49
|
|
|
MESH PROGRIP LAP 10X15CM LEFT
|
Facility
|
OP
|
$1,223.67
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.24 |
| Max. Negotiated Rate |
$1,223.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,199.20
|
| Rate for Payer: Aetna of WY Medicare |
$807.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,174.72
|
| Rate for Payer: Altius Commercial |
$1,174.72
|
| Rate for Payer: Beech Street Commercial |
$1,199.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,004.63
|
| Rate for Payer: Cash Price |
$856.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,199.20
|
| Rate for Payer: Entrust Commercial |
$1,162.49
|
| Rate for Payer: First Choice Health Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$709.73
|
| Rate for Payer: HealthUtah PPO |
$1,223.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.96
|
| Rate for Payer: Multiplan Medicare/VA |
$674.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,199.20
|
| Rate for Payer: PacificSource Commercial |
$1,101.30
|
| Rate for Payer: PHCS PPO |
$1,199.20
|
| Rate for Payer: Three Rivers PPO |
$917.75
|
| Rate for Payer: TriWest Veterans Administration |
$709.73
|
| Rate for Payer: United Healthcare Commercial |
$1,064.59
|
| Rate for Payer: United Healthcare Medicare |
$709.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,199.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,162.49
|
|
|
MESH PROGRIP LAP 10X15CM RIGHT
|
Facility
|
IP
|
$1,223.67
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.24 |
| Max. Negotiated Rate |
$1,223.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,199.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,174.72
|
| Rate for Payer: Altius Commercial |
$1,174.72
|
| Rate for Payer: Beech Street Commercial |
$1,199.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,004.63
|
| Rate for Payer: Cash Price |
$856.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,199.20
|
| Rate for Payer: Entrust Commercial |
$1,162.49
|
| Rate for Payer: First Choice Health Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$807.62
|
| Rate for Payer: HealthUtah PPO |
$1,223.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.96
|
| Rate for Payer: Multiplan Medicare/VA |
$767.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,199.20
|
| Rate for Payer: PacificSource Commercial |
$1,101.30
|
| Rate for Payer: PHCS PPO |
$1,199.20
|
| Rate for Payer: Three Rivers PPO |
$917.75
|
| Rate for Payer: TriWest Veterans Administration |
$807.62
|
| Rate for Payer: United Healthcare Commercial |
$1,064.59
|
| Rate for Payer: United Healthcare Medicare |
$807.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,162.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,162.49
|
|
|
MESH PROGRIP LAP 10X15CM RIGHT
|
Facility
|
OP
|
$1,223.67
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.24 |
| Max. Negotiated Rate |
$1,223.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,199.20
|
| Rate for Payer: Aetna of WY Medicare |
$807.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,174.72
|
| Rate for Payer: Altius Commercial |
$1,174.72
|
| Rate for Payer: Beech Street Commercial |
$1,199.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,004.63
|
| Rate for Payer: Cash Price |
$856.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,199.20
|
| Rate for Payer: Entrust Commercial |
$1,162.49
|
| Rate for Payer: First Choice Health Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,162.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$709.73
|
| Rate for Payer: HealthUtah PPO |
$1,223.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.96
|
| Rate for Payer: Multiplan Medicare/VA |
$674.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,199.20
|
| Rate for Payer: PacificSource Commercial |
$1,101.30
|
| Rate for Payer: PHCS PPO |
$1,199.20
|
| Rate for Payer: Three Rivers PPO |
$917.75
|
| Rate for Payer: TriWest Veterans Administration |
$709.73
|
| Rate for Payer: United Healthcare Commercial |
$1,064.59
|
| Rate for Payer: United Healthcare Medicare |
$709.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,199.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,162.49
|
|
|
MESH VENT 2SIDE 20X15 SYM2015
|
Facility
|
OP
|
$1,528.35
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.12 |
| Max. Negotiated Rate |
$1,528.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,497.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,008.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.22
|
| Rate for Payer: Altius Commercial |
$1,467.22
|
| Rate for Payer: Beech Street Commercial |
$1,497.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,254.78
|
| Rate for Payer: Cash Price |
$1,069.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,497.78
|
| Rate for Payer: Entrust Commercial |
$1,451.93
|
| Rate for Payer: First Choice Health Commercial |
$1,451.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,451.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.44
|
| Rate for Payer: HealthUtah PPO |
$1,528.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.50
|
| Rate for Payer: Multiplan Medicare/VA |
$842.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,497.78
|
| Rate for Payer: PacificSource Commercial |
$1,375.52
|
| Rate for Payer: PHCS PPO |
$1,497.78
|
| Rate for Payer: Three Rivers PPO |
$1,146.26
|
| Rate for Payer: TriWest Veterans Administration |
$886.44
|
| Rate for Payer: United Healthcare Commercial |
$1,329.66
|
| Rate for Payer: United Healthcare Medicare |
$886.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,497.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,451.93
|
|
|
MESH VENT 2SIDE 20X15 SYM2015
|
Facility
|
IP
|
$1,528.35
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.28 |
| Max. Negotiated Rate |
$1,528.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,497.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.22
|
| Rate for Payer: Altius Commercial |
$1,467.22
|
| Rate for Payer: Beech Street Commercial |
$1,497.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,254.78
|
| Rate for Payer: Cash Price |
$1,069.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,497.78
|
| Rate for Payer: Entrust Commercial |
$1,451.93
|
| Rate for Payer: First Choice Health Commercial |
$1,451.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,451.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,008.71
|
| Rate for Payer: HealthUtah PPO |
$1,528.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.50
|
| Rate for Payer: Multiplan Medicare/VA |
$958.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,497.78
|
| Rate for Payer: PacificSource Commercial |
$1,375.52
|
| Rate for Payer: PHCS PPO |
$1,497.78
|
| Rate for Payer: Three Rivers PPO |
$1,146.26
|
| Rate for Payer: TriWest Veterans Administration |
$1,008.71
|
| Rate for Payer: United Healthcare Commercial |
$1,329.66
|
| Rate for Payer: United Healthcare Medicare |
$1,008.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,451.93
|
| Rate for Payer: Wise Provider Network Commercial |
$1,451.93
|
|
|
MESH VENTRAL RECTANGLE 15X10CM
|
Facility
|
IP
|
$974.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.75 |
| Max. Negotiated Rate |
$974.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$954.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$935.12
|
| Rate for Payer: Altius Commercial |
$935.12
|
| Rate for Payer: Beech Street Commercial |
$954.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$799.72
|
| Rate for Payer: Cash Price |
$681.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$944.86
|
| Rate for Payer: Cigna of WY Commercial |
$954.60
|
| Rate for Payer: Entrust Commercial |
$925.38
|
| Rate for Payer: First Choice Health Commercial |
$925.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$925.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$642.89
|
| Rate for Payer: HealthUtah PPO |
$974.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$944.86
|
| Rate for Payer: Multiplan Medicare/VA |
$610.75
|
| Rate for Payer: One Health Plan of WY PPO |
$954.60
|
| Rate for Payer: PacificSource Commercial |
$876.67
|
| Rate for Payer: PHCS PPO |
$954.60
|
| Rate for Payer: Three Rivers PPO |
$730.56
|
| Rate for Payer: TriWest Veterans Administration |
$642.89
|
| Rate for Payer: United Healthcare Commercial |
$847.45
|
| Rate for Payer: United Healthcare Medicare |
$642.89
|
| Rate for Payer: WINHealth Partners Commercial |
$925.38
|
| Rate for Payer: Wise Provider Network Commercial |
$925.38
|
|
|
MESH VENTRAL RECTANGLE 15X10CM
|
Facility
|
OP
|
$974.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.72 |
| Max. Negotiated Rate |
$974.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$954.60
|
| Rate for Payer: Aetna of WY Medicare |
$642.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$935.12
|
| Rate for Payer: Altius Commercial |
$935.12
|
| Rate for Payer: Beech Street Commercial |
$954.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$799.72
|
| Rate for Payer: Cash Price |
$681.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$944.86
|
| Rate for Payer: Cigna of WY Commercial |
$954.60
|
| Rate for Payer: Entrust Commercial |
$925.38
|
| Rate for Payer: First Choice Health Commercial |
$925.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$925.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.97
|
| Rate for Payer: HealthUtah PPO |
$974.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$944.86
|
| Rate for Payer: Multiplan Medicare/VA |
$536.72
|
| Rate for Payer: One Health Plan of WY PPO |
$954.60
|
| Rate for Payer: PacificSource Commercial |
$876.67
|
| Rate for Payer: PHCS PPO |
$954.60
|
| Rate for Payer: Three Rivers PPO |
$730.56
|
| Rate for Payer: TriWest Veterans Administration |
$564.97
|
| Rate for Payer: United Healthcare Commercial |
$847.45
|
| Rate for Payer: United Healthcare Medicare |
$564.97
|
| Rate for Payer: WINHealth Partners Commercial |
$954.60
|
| Rate for Payer: Wise Provider Network Commercial |
$925.38
|
|
|
MESH VERSATEX FLAT 6X4 VTX1510
|
Facility
|
IP
|
$315.38
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.74 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.76
|
| Rate for Payer: Altius Commercial |
$302.76
|
| Rate for Payer: Beech Street Commercial |
$309.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.93
|
| Rate for Payer: Cash Price |
$220.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.92
|
| Rate for Payer: Cigna of WY Commercial |
$309.07
|
| Rate for Payer: Entrust Commercial |
$299.61
|
| Rate for Payer: First Choice Health Commercial |
$299.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.15
|
| Rate for Payer: HealthUtah PPO |
$315.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.92
|
| Rate for Payer: Multiplan Medicare/VA |
$197.74
|
| Rate for Payer: One Health Plan of WY PPO |
$309.07
|
| Rate for Payer: PacificSource Commercial |
$283.84
|
| Rate for Payer: PHCS PPO |
$309.07
|
| Rate for Payer: Three Rivers PPO |
$236.54
|
| Rate for Payer: TriWest Veterans Administration |
$208.15
|
| Rate for Payer: United Healthcare Commercial |
$274.38
|
| Rate for Payer: United Healthcare Medicare |
$208.15
|
| Rate for Payer: WINHealth Partners Commercial |
$299.61
|
| Rate for Payer: Wise Provider Network Commercial |
$299.61
|
|
|
MESH VERSATEX FLAT 6X4 VTX1510
|
Facility
|
OP
|
$315.38
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.77 |
| Max. Negotiated Rate |
$315.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.07
|
| Rate for Payer: Aetna of WY Medicare |
$208.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.76
|
| Rate for Payer: Altius Commercial |
$302.76
|
| Rate for Payer: Beech Street Commercial |
$309.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.93
|
| Rate for Payer: Cash Price |
$220.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.92
|
| Rate for Payer: Cigna of WY Commercial |
$309.07
|
| Rate for Payer: Entrust Commercial |
$299.61
|
| Rate for Payer: First Choice Health Commercial |
$299.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.92
|
| Rate for Payer: HealthUtah PPO |
$315.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.92
|
| Rate for Payer: Multiplan Medicare/VA |
$173.77
|
| Rate for Payer: One Health Plan of WY PPO |
$309.07
|
| Rate for Payer: PacificSource Commercial |
$283.84
|
| Rate for Payer: PHCS PPO |
$309.07
|
| Rate for Payer: Three Rivers PPO |
$236.54
|
| Rate for Payer: TriWest Veterans Administration |
$182.92
|
| Rate for Payer: United Healthcare Commercial |
$274.38
|
| Rate for Payer: United Healthcare Medicare |
$182.92
|
| Rate for Payer: WINHealth Partners Commercial |
$309.07
|
| Rate for Payer: Wise Provider Network Commercial |
$299.61
|
|
|
MESH VERTESSA LITE 26X4X3CM
|
Facility
|
OP
|
$2,887.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,887.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,829.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,905.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,772.00
|
| Rate for Payer: Altius Commercial |
$2,772.00
|
| Rate for Payer: Beech Street Commercial |
$2,829.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,370.64
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,800.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,829.75
|
| Rate for Payer: Entrust Commercial |
$2,743.12
|
| Rate for Payer: First Choice Health Commercial |
$2,743.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,743.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,887.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,800.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,829.75
|
| Rate for Payer: PacificSource Commercial |
$2,598.75
|
| Rate for Payer: PHCS PPO |
$2,829.75
|
| Rate for Payer: Three Rivers PPO |
$2,165.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,512.12
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,829.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,743.12
|
|
|
MESH VERTESSA LITE 26X4X3CM
|
Facility
|
IP
|
$2,887.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,810.46 |
| Max. Negotiated Rate |
$2,887.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,829.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,772.00
|
| Rate for Payer: Altius Commercial |
$2,772.00
|
| Rate for Payer: Beech Street Commercial |
$2,829.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,370.64
|
| Rate for Payer: Cash Price |
$2,021.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,800.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,829.75
|
| Rate for Payer: Entrust Commercial |
$2,743.12
|
| Rate for Payer: First Choice Health Commercial |
$2,743.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,743.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,905.75
|
| Rate for Payer: HealthUtah PPO |
$2,887.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,800.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,810.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,829.75
|
| Rate for Payer: PacificSource Commercial |
$2,598.75
|
| Rate for Payer: PHCS PPO |
$2,829.75
|
| Rate for Payer: Three Rivers PPO |
$2,165.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,905.75
|
| Rate for Payer: United Healthcare Commercial |
$2,512.12
|
| Rate for Payer: United Healthcare Medicare |
$1,905.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,743.12
|
| Rate for Payer: Wise Provider Network Commercial |
$2,743.12
|
|
|
METFORMIN 500 MG TABLET [815]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 6068715511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.51
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
METFORMIN 500 MG TABLET [815]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 6068715511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
METFORMIN 500 MG TABLET [815]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 6068715501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.51
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
METFORMIN 500 MG TABLET [815]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 6068715501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
METFORMIN ER 1,000 MG TABLET,EXTENDED RELEASE 24HR (OSMOTIC) [35081]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 6818033707
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
|
METFORMIN ER 1,000 MG TABLET,EXTENDED RELEASE 24HR (OSMOTIC) [35081]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 6818033707
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Aetna of WY Medicare |
$1.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 6068764011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Aetna of WY Medicare |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 5026855015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.15
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 6275614201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 5026855011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.15
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 5026855011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.31
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 6275614201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
