|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
IP
|
$24.95
|
|
|
Service Code
|
NDC 0378912116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.95
|
| Rate for Payer: Altius Commercial |
$23.95
|
| Rate for Payer: Beech Street Commercial |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.20
|
| Rate for Payer: Cigna of WY Commercial |
$24.45
|
| Rate for Payer: Entrust Commercial |
$23.70
|
| Rate for Payer: First Choice Health Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.47
|
| Rate for Payer: HealthUtah PPO |
$24.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$15.64
|
| Rate for Payer: One Health Plan of WY PPO |
$24.45
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.45
|
| Rate for Payer: Three Rivers PPO |
$18.71
|
| Rate for Payer: TriWest Veterans Administration |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$16.47
|
| Rate for Payer: WINHealth Partners Commercial |
$23.70
|
| Rate for Payer: Wise Provider Network Commercial |
$23.70
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
IP
|
$24.95
|
|
|
Service Code
|
NDC 0378912198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.95
|
| Rate for Payer: Altius Commercial |
$23.95
|
| Rate for Payer: Beech Street Commercial |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.20
|
| Rate for Payer: Cigna of WY Commercial |
$24.45
|
| Rate for Payer: Entrust Commercial |
$23.70
|
| Rate for Payer: First Choice Health Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.47
|
| Rate for Payer: HealthUtah PPO |
$24.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$15.64
|
| Rate for Payer: One Health Plan of WY PPO |
$24.45
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.45
|
| Rate for Payer: Three Rivers PPO |
$18.71
|
| Rate for Payer: TriWest Veterans Administration |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$16.47
|
| Rate for Payer: WINHealth Partners Commercial |
$23.70
|
| Rate for Payer: Wise Provider Network Commercial |
$23.70
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$24.95
|
|
|
Service Code
|
NDC 0378912198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.45
|
| Rate for Payer: Aetna of WY Medicare |
$16.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.95
|
| Rate for Payer: Altius Commercial |
$23.95
|
| Rate for Payer: Beech Street Commercial |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.20
|
| Rate for Payer: Cigna of WY Commercial |
$24.45
|
| Rate for Payer: Entrust Commercial |
$23.70
|
| Rate for Payer: First Choice Health Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.47
|
| Rate for Payer: HealthUtah PPO |
$24.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$13.75
|
| Rate for Payer: One Health Plan of WY PPO |
$24.45
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.45
|
| Rate for Payer: Three Rivers PPO |
$18.71
|
| Rate for Payer: TriWest Veterans Administration |
$14.47
|
| Rate for Payer: United Healthcare Commercial |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$14.47
|
| Rate for Payer: WINHealth Partners Commercial |
$24.45
|
| Rate for Payer: Wise Provider Network Commercial |
$23.70
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$24.95
|
|
|
Service Code
|
NDC 0378912116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.45
|
| Rate for Payer: Aetna of WY Medicare |
$16.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.95
|
| Rate for Payer: Altius Commercial |
$23.95
|
| Rate for Payer: Beech Street Commercial |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.20
|
| Rate for Payer: Cigna of WY Commercial |
$24.45
|
| Rate for Payer: Entrust Commercial |
$23.70
|
| Rate for Payer: First Choice Health Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.47
|
| Rate for Payer: HealthUtah PPO |
$24.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$13.75
|
| Rate for Payer: One Health Plan of WY PPO |
$24.45
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.45
|
| Rate for Payer: Three Rivers PPO |
$18.71
|
| Rate for Payer: TriWest Veterans Administration |
$14.47
|
| Rate for Payer: United Healthcare Commercial |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$14.47
|
| Rate for Payer: WINHealth Partners Commercial |
$24.45
|
| Rate for Payer: Wise Provider Network Commercial |
$23.70
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$24.95
|
|
|
Service Code
|
NDC 0406912576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.45
|
| Rate for Payer: Aetna of WY Medicare |
$16.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.95
|
| Rate for Payer: Altius Commercial |
$23.95
|
| Rate for Payer: Beech Street Commercial |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.20
|
| Rate for Payer: Cigna of WY Commercial |
$24.45
|
| Rate for Payer: Entrust Commercial |
$23.70
|
| Rate for Payer: First Choice Health Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.47
|
| Rate for Payer: HealthUtah PPO |
$24.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$13.75
|
| Rate for Payer: One Health Plan of WY PPO |
$24.45
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.45
|
| Rate for Payer: Three Rivers PPO |
$18.71
|
| Rate for Payer: TriWest Veterans Administration |
$14.47
|
| Rate for Payer: United Healthcare Commercial |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$14.47
|
| Rate for Payer: WINHealth Partners Commercial |
$24.45
|
| Rate for Payer: Wise Provider Network Commercial |
$23.70
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
IP
|
$34.83
|
|
|
Service Code
|
NDC 0406915076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.99
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$21.84
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$22.99
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$22.99
|
| Rate for Payer: WINHealth Partners Commercial |
$33.09
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
OP
|
$34.83
|
|
|
Service Code
|
NDC 0406915076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Aetna of WY Medicare |
$22.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.20
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WINHealth Partners Commercial |
$34.13
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
OP
|
$34.83
|
|
|
Service Code
|
NDC 0378912216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Aetna of WY Medicare |
$22.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.20
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WINHealth Partners Commercial |
$34.13
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
IP
|
$34.83
|
|
|
Service Code
|
NDC 0378912216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.99
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$21.84
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$22.99
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$22.99
|
| Rate for Payer: WINHealth Partners Commercial |
$33.09
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
IP
|
$34.83
|
|
|
Service Code
|
NDC 0378912298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.99
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$21.84
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$22.99
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$22.99
|
| Rate for Payer: WINHealth Partners Commercial |
$33.09
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
OP
|
$34.83
|
|
|
Service Code
|
NDC 0378912298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Aetna of WY Medicare |
$22.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.20
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WINHealth Partners Commercial |
$34.13
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$40.04
|
|
|
Service Code
|
NDC 0378912316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.43
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$25.11
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$26.43
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
| Rate for Payer: WINHealth Partners Commercial |
$38.04
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$40.04
|
|
|
Service Code
|
NDC 4778142711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Aetna of WY Medicare |
$26.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.22
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.06
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$23.22
|
| Rate for Payer: WINHealth Partners Commercial |
$39.24
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$40.04
|
|
|
Service Code
|
NDC 0378912398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.43
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$25.11
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$26.43
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
| Rate for Payer: WINHealth Partners Commercial |
$38.04
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$40.04
|
|
|
Service Code
|
NDC 0378912398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Aetna of WY Medicare |
$26.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.22
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.06
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$23.22
|
| Rate for Payer: WINHealth Partners Commercial |
$39.24
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$40.04
|
|
|
Service Code
|
NDC 4778142711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.43
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$25.11
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$26.43
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
| Rate for Payer: WINHealth Partners Commercial |
$38.04
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$40.04
|
|
|
Service Code
|
NDC 0406917576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Aetna of WY Medicare |
$26.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.22
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.06
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$23.22
|
| Rate for Payer: WINHealth Partners Commercial |
$39.24
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$40.04
|
|
|
Service Code
|
NDC 4778142747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Aetna of WY Medicare |
$26.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.22
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.06
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$23.22
|
| Rate for Payer: WINHealth Partners Commercial |
$39.24
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$40.04
|
|
|
Service Code
|
NDC 4778142747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.43
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$25.11
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$26.43
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
| Rate for Payer: WINHealth Partners Commercial |
$38.04
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$40.04
|
|
|
Service Code
|
NDC 0406917576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.43
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$25.11
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$26.43
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
| Rate for Payer: WINHealth Partners Commercial |
$38.04
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$40.04
|
|
|
Service Code
|
NDC 0378912316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$40.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.24
|
| Rate for Payer: Aetna of WY Medicare |
$26.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.44
|
| Rate for Payer: Altius Commercial |
$38.44
|
| Rate for Payer: Beech Street Commercial |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.84
|
| Rate for Payer: Cigna of WY Commercial |
$39.24
|
| Rate for Payer: Entrust Commercial |
$38.04
|
| Rate for Payer: First Choice Health Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.22
|
| Rate for Payer: HealthUtah PPO |
$40.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.06
|
| Rate for Payer: One Health Plan of WY PPO |
$39.24
|
| Rate for Payer: PacificSource Commercial |
$36.04
|
| Rate for Payer: PHCS PPO |
$39.24
|
| Rate for Payer: Three Rivers PPO |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$34.83
|
| Rate for Payer: United Healthcare Medicare |
$23.22
|
| Rate for Payer: WINHealth Partners Commercial |
$39.24
|
| Rate for Payer: Wise Provider Network Commercial |
$38.04
|
|
|
FENTANYL CITRATE INJECTION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
J3010
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Aetna of WY Medicare |
$0.99
|
| Rate for Payer: Beech Street Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: First Choice Health Commercial |
$10.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.99
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.40
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$0.99
|
| Rate for Payer: WINHealth Partners Commercial |
$11.40
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [14425]
|
Facility
|
IP
|
$19.25
|
|
|
Service Code
|
HCPCS J3010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Altius Commercial |
$18.07
|
| Rate for Payer: Altius Commercial |
$18.48
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$18.86
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Beech Street Commercial |
$18.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.26
|
| Rate for Payer: Cigna of WY Commercial |
$18.44
|
| Rate for Payer: Cigna of WY Commercial |
$18.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$17.88
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$18.29
|
| Rate for Payer: First Choice Health Commercial |
$18.29
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$17.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.92
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: HealthUtah PPO |
$19.25
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$18.82
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.66
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: Multiplan Medicare/VA |
$11.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.56
|
| Rate for Payer: Multiplan Medicare/VA |
$12.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.07
|
| Rate for Payer: One Health Plan of WY PPO |
$18.44
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: One Health Plan of WY PPO |
$18.86
|
| Rate for Payer: PacificSource Commercial |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$16.94
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$18.86
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: PHCS PPO |
$18.44
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$14.12
|
| Rate for Payer: Three Rivers PPO |
$14.44
|
| Rate for Payer: TriWest Veterans Administration |
$11.22
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$12.42
|
| Rate for Payer: TriWest Veterans Administration |
$11.12
|
| Rate for Payer: TriWest Veterans Administration |
$12.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Commercial |
$16.37
|
| Rate for Payer: United Healthcare Commercial |
$16.75
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Medicare |
$12.92
|
| Rate for Payer: United Healthcare Medicare |
$11.22
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
| Rate for Payer: United Healthcare Medicare |
$12.70
|
| Rate for Payer: United Healthcare Medicare |
$12.42
|
| Rate for Payer: WINHealth Partners Commercial |
$18.29
|
| Rate for Payer: WINHealth Partners Commercial |
$17.88
|
| Rate for Payer: WINHealth Partners Commercial |
$18.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: WINHealth Partners Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
| Rate for Payer: Wise Provider Network Commercial |
$17.88
|
| Rate for Payer: Wise Provider Network Commercial |
$18.29
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION [14425]
|
Facility
|
OP
|
$19.25
|
|
|
Service Code
|
HCPCS J3010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.44
|
| Rate for Payer: Aetna of WY Medicare |
$11.22
|
| Rate for Payer: Aetna of WY Medicare |
$12.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.12
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Aetna of WY Medicare |
$12.42
|
| Rate for Payer: Aetna of WY Medicare |
$12.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.48
|
| Rate for Payer: Altius Commercial |
$18.07
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Altius Commercial |
$18.48
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$18.86
|
| Rate for Payer: Beech Street Commercial |
$18.44
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$18.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Cigna of WY Commercial |
$18.44
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$18.29
|
| Rate for Payer: Entrust Commercial |
$17.88
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$17.88
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$18.29
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.77
|
| Rate for Payer: HealthUtah PPO |
$19.25
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: HealthUtah PPO |
$18.82
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.26
|
| Rate for Payer: Multiplan Medicare/VA |
$10.61
|
| Rate for Payer: Multiplan Medicare/VA |
$10.79
|
| Rate for Payer: Multiplan Medicare/VA |
$10.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$18.44
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: One Health Plan of WY PPO |
$18.86
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PacificSource Commercial |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$16.94
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: PHCS PPO |
$18.44
|
| Rate for Payer: PHCS PPO |
$18.86
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$14.12
|
| Rate for Payer: Three Rivers PPO |
$14.44
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: TriWest Veterans Administration |
$11.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.77
|
| Rate for Payer: TriWest Veterans Administration |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$10.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: TriWest Veterans Administration |
$10.09
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$16.37
|
| Rate for Payer: United Healthcare Commercial |
$16.75
|
| Rate for Payer: United Healthcare Commercial |
$14.66
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: United Healthcare Medicare |
$9.77
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
| Rate for Payer: United Healthcare Medicare |
$11.36
|
| Rate for Payer: United Healthcare Medicare |
$10.09
|
| Rate for Payer: United Healthcare Medicare |
$10.92
|
| Rate for Payer: WINHealth Partners Commercial |
$19.19
|
| Rate for Payer: WINHealth Partners Commercial |
$18.44
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: WINHealth Partners Commercial |
$18.86
|
| Rate for Payer: WINHealth Partners Commercial |
$16.66
|
| Rate for Payer: WINHealth Partners Commercial |
$16.51
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$17.88
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$18.29
|
|
|
FERN TEST
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Hospital Charge Code |
Q0114
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Beech Street Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: First Choice Health Commercial |
$93.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$98.80
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$98.80
|
|
