|
FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90847
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$462.56
|
| Rate for Payer: Aetna of WY Medicare |
$99.27
|
| Rate for Payer: Beech Street Commercial |
$448.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$457.84
|
| Rate for Payer: Cigna of WY Commercial |
$462.56
|
| Rate for Payer: First Choice Health Commercial |
$424.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$448.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.27
|
| Rate for Payer: HealthUtah PPO |
$472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$457.84
|
| Rate for Payer: Multiplan Medicare/VA |
$84.38
|
| Rate for Payer: One Health Plan of WY PPO |
$462.56
|
| Rate for Payer: PacificSource Commercial |
$424.80
|
| Rate for Payer: PHCS PPO |
$448.40
|
| Rate for Payer: Three Rivers PPO |
$354.00
|
| Rate for Payer: TriWest Veterans Administration |
$99.27
|
| Rate for Payer: United Healthcare Commercial |
$410.64
|
| Rate for Payer: United Healthcare Medicare |
$99.27
|
| Rate for Payer: WINHealth Partners Commercial |
$448.40
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 6068759511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6373964510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| 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 |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 5026829911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.53
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0904719361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 0904719361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 6068759501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 5026829911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 6068759501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 6068759511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 6373964510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
OP
|
$16.78
|
|
|
Service Code
|
NDC 6745743300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.44
|
| Rate for Payer: Aetna of WY Medicare |
$11.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.11
|
| Rate for Payer: Altius Commercial |
$16.11
|
| Rate for Payer: Beech Street Commercial |
$16.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.78
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.28
|
| Rate for Payer: Cigna of WY Commercial |
$16.44
|
| Rate for Payer: Entrust Commercial |
$15.94
|
| Rate for Payer: First Choice Health Commercial |
$15.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.73
|
| Rate for Payer: HealthUtah PPO |
$16.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$16.44
|
| Rate for Payer: PacificSource Commercial |
$15.10
|
| Rate for Payer: PHCS PPO |
$16.44
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare |
$9.73
|
| Rate for Payer: WINHealth Partners Commercial |
$16.44
|
| Rate for Payer: Wise Provider Network Commercial |
$15.94
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6332373911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.13
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.79
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.26
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6332373912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.13
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.79
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.09
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$10.53
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$11.09
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare |
$11.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6332373912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.13
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.79
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.26
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.78
|
|
|
Service Code
|
NDC 6745743300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.11
|
| Rate for Payer: Altius Commercial |
$16.11
|
| Rate for Payer: Beech Street Commercial |
$16.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.78
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.28
|
| Rate for Payer: Cigna of WY Commercial |
$16.44
|
| Rate for Payer: Entrust Commercial |
$15.94
|
| Rate for Payer: First Choice Health Commercial |
$15.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.07
|
| Rate for Payer: HealthUtah PPO |
$16.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.28
|
| Rate for Payer: Multiplan Medicare/VA |
$10.52
|
| Rate for Payer: One Health Plan of WY PPO |
$16.44
|
| Rate for Payer: PacificSource Commercial |
$15.10
|
| Rate for Payer: PHCS PPO |
$16.44
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare |
$11.07
|
| Rate for Payer: WINHealth Partners Commercial |
$15.94
|
| Rate for Payer: Wise Provider Network Commercial |
$15.94
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6332373911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.13
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.79
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.09
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$10.53
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$11.09
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare |
$11.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION [157895]
|
Facility
|
OP
|
$2,663.89
|
|
|
Service Code
|
HCPCS J9358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,467.80 |
| Max. Negotiated Rate |
$2,663.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,610.61
|
| Rate for Payer: Aetna of WY Medicare |
$1,758.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,557.33
|
| Rate for Payer: Altius Commercial |
$2,557.33
|
| Rate for Payer: Beech Street Commercial |
$2,610.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,187.05
|
| Rate for Payer: Cash Price |
$1,864.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,583.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,610.61
|
| Rate for Payer: Entrust Commercial |
$2,530.70
|
| Rate for Payer: First Choice Health Commercial |
$2,530.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,530.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,545.06
|
| Rate for Payer: HealthUtah PPO |
$2,663.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,583.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,467.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,610.61
|
| Rate for Payer: PacificSource Commercial |
$2,397.50
|
| Rate for Payer: PHCS PPO |
$2,610.61
|
| Rate for Payer: Three Rivers PPO |
$1,997.92
|
| Rate for Payer: TriWest Veterans Administration |
$1,545.06
|
| Rate for Payer: United Healthcare Commercial |
$2,317.58
|
| Rate for Payer: United Healthcare Medicare |
$1,545.06
|
| Rate for Payer: WINHealth Partners Commercial |
$2,610.61
|
| Rate for Payer: Wise Provider Network Commercial |
$2,530.70
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION [157895]
|
Facility
|
IP
|
$2,663.89
|
|
|
Service Code
|
HCPCS J9358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,670.26 |
| Max. Negotiated Rate |
$2,663.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,610.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,557.33
|
| Rate for Payer: Altius Commercial |
$2,557.33
|
| Rate for Payer: Beech Street Commercial |
$2,610.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,187.05
|
| Rate for Payer: Cash Price |
$1,864.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,583.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,610.61
|
| Rate for Payer: Entrust Commercial |
$2,530.70
|
| Rate for Payer: First Choice Health Commercial |
$2,530.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,530.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,758.17
|
| Rate for Payer: HealthUtah PPO |
$2,663.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,583.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,670.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,610.61
|
| Rate for Payer: PacificSource Commercial |
$2,397.50
|
| Rate for Payer: PHCS PPO |
$2,610.61
|
| Rate for Payer: Three Rivers PPO |
$1,997.92
|
| Rate for Payer: TriWest Veterans Administration |
$1,758.17
|
| Rate for Payer: United Healthcare Commercial |
$2,317.58
|
| Rate for Payer: United Healthcare Medicare |
$1,758.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,530.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,530.70
|
|
|
FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
28060
|
| Min. Negotiated Rate |
$299.72 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Aetna of WY Medicare |
$352.61
|
| Rate for Payer: Beech Street Commercial |
$1,767.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: First Choice Health Commercial |
$1,674.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.61
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$299.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,767.00
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$352.61
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$352.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,581.00
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
26045
|
| Min. Negotiated Rate |
$395.64 |
| Max. Negotiated Rate |
$2,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,379.44
|
| Rate for Payer: Aetna of WY Medicare |
$465.46
|
| Rate for Payer: Beech Street Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,355.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,379.44
|
| Rate for Payer: First Choice Health Commercial |
$2,185.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,306.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.46
|
| Rate for Payer: HealthUtah PPO |
$2,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,355.16
|
| Rate for Payer: Multiplan Medicare/VA |
$395.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,379.44
|
| Rate for Payer: PacificSource Commercial |
$2,185.20
|
| Rate for Payer: PHCS PPO |
$2,306.60
|
| Rate for Payer: Three Rivers PPO |
$1,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$465.46
|
| Rate for Payer: United Healthcare Commercial |
$2,112.36
|
| Rate for Payer: United Healthcare Medicare |
$465.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,063.80
|
|
|
FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$7,604.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
26123
|
| Min. Negotiated Rate |
$695.95 |
| Max. Negotiated Rate |
$7,604.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,451.92
|
| Rate for Payer: Aetna of WY Medicare |
$818.77
|
| Rate for Payer: Beech Street Commercial |
$7,223.80
|
| Rate for Payer: Cash Price |
$5,322.80
|
| Rate for Payer: Cash Price |
$5,322.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,375.88
|
| Rate for Payer: Cigna of WY Commercial |
$7,451.92
|
| Rate for Payer: First Choice Health Commercial |
$6,843.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,223.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$818.77
|
| Rate for Payer: HealthUtah PPO |
$7,604.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,375.88
|
| Rate for Payer: Multiplan Medicare/VA |
$695.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7,451.92
|
| Rate for Payer: PacificSource Commercial |
$6,843.60
|
| Rate for Payer: PHCS PPO |
$7,223.80
|
| Rate for Payer: Three Rivers PPO |
$5,703.00
|
| Rate for Payer: TriWest Veterans Administration |
$818.77
|
| Rate for Payer: United Healthcare Commercial |
$6,615.48
|
| Rate for Payer: United Healthcare Medicare |
$818.77
|
| Rate for Payer: WINHealth Partners Commercial |
$6,463.40
|
|
|
FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$3,614.00
|
|
|
Service Code
|
HCPCS 26125
|
| Hospital Charge Code |
26125
|
| Min. Negotiated Rate |
$216.34 |
| Max. Negotiated Rate |
$3,614.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,541.72
|
| Rate for Payer: Aetna of WY Medicare |
$254.52
|
| Rate for Payer: Beech Street Commercial |
$3,433.30
|
| Rate for Payer: Cash Price |
$2,529.80
|
| Rate for Payer: Cash Price |
$2,529.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,505.58
|
| Rate for Payer: Cigna of WY Commercial |
$3,541.72
|
| Rate for Payer: First Choice Health Commercial |
$3,252.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,433.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.52
|
| Rate for Payer: HealthUtah PPO |
$3,614.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,505.58
|
| Rate for Payer: Multiplan Medicare/VA |
$216.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,541.72
|
| Rate for Payer: PacificSource Commercial |
$3,252.60
|
| Rate for Payer: PHCS PPO |
$3,433.30
|
| Rate for Payer: Three Rivers PPO |
$2,710.50
|
| Rate for Payer: TriWest Veterans Administration |
$254.52
|
| Rate for Payer: United Healthcare Commercial |
$3,144.18
|
| Rate for Payer: United Healthcare Medicare |
$254.52
|
| Rate for Payer: WINHealth Partners Commercial |
$3,071.90
|
|
|
FAT EMULSION 20 % INTRAVENOUS [2318]
|
Facility
|
IP
|
$15.43
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.81
|
| Rate for Payer: Altius Commercial |
$14.81
|
| Rate for Payer: Beech Street Commercial |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.67
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.97
|
| Rate for Payer: Cigna of WY Commercial |
$15.12
|
| Rate for Payer: Entrust Commercial |
$14.66
|
| Rate for Payer: First Choice Health Commercial |
$14.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.18
|
| Rate for Payer: HealthUtah PPO |
$15.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.97
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$15.12
|
| Rate for Payer: PacificSource Commercial |
$13.89
|
| Rate for Payer: PHCS PPO |
$15.12
|
| Rate for Payer: Three Rivers PPO |
$11.57
|
| Rate for Payer: TriWest Veterans Administration |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Medicare |
$10.18
|
| Rate for Payer: WINHealth Partners Commercial |
$14.66
|
| Rate for Payer: Wise Provider Network Commercial |
$14.66
|
|
|
FAT EMULSION 20 % INTRAVENOUS [2318]
|
Facility
|
OP
|
$15.43
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.81
|
| Rate for Payer: Altius Commercial |
$14.81
|
| Rate for Payer: Beech Street Commercial |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.67
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.97
|
| Rate for Payer: Cigna of WY Commercial |
$15.12
|
| Rate for Payer: Entrust Commercial |
$14.66
|
| Rate for Payer: First Choice Health Commercial |
$14.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.95
|
| Rate for Payer: HealthUtah PPO |
$15.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.97
|
| Rate for Payer: Multiplan Medicare/VA |
$8.50
|
| Rate for Payer: One Health Plan of WY PPO |
$15.12
|
| Rate for Payer: PacificSource Commercial |
$13.89
|
| Rate for Payer: PHCS PPO |
$15.12
|
| Rate for Payer: Three Rivers PPO |
$11.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Medicare |
$8.95
|
| Rate for Payer: WINHealth Partners Commercial |
$15.12
|
| Rate for Payer: Wise Provider Network Commercial |
$14.66
|
|
