|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 5026833015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 5026833011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 5026833011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.10
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 5026833015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.10
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
FLUID FIGHTER SUCTION DISC
|
Facility
|
IP
|
$30.64
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.41
|
| Rate for Payer: Altius Commercial |
$29.41
|
| Rate for Payer: Beech Street Commercial |
$30.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.72
|
| Rate for Payer: Cigna of WY Commercial |
$30.03
|
| Rate for Payer: Entrust Commercial |
$29.11
|
| Rate for Payer: First Choice Health Commercial |
$29.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.22
|
| Rate for Payer: HealthUtah PPO |
$30.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.72
|
| Rate for Payer: Multiplan Medicare/VA |
$19.21
|
| Rate for Payer: One Health Plan of WY PPO |
$30.03
|
| Rate for Payer: PacificSource Commercial |
$27.58
|
| Rate for Payer: PHCS PPO |
$30.03
|
| Rate for Payer: Three Rivers PPO |
$22.98
|
| Rate for Payer: TriWest Veterans Administration |
$20.22
|
| Rate for Payer: United Healthcare Commercial |
$26.66
|
| Rate for Payer: United Healthcare Medicare |
$20.22
|
| Rate for Payer: WINHealth Partners Commercial |
$29.11
|
| Rate for Payer: Wise Provider Network Commercial |
$29.11
|
|
|
FLUID FIGHTER SUCTION DISC
|
Facility
|
OP
|
$30.64
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.03
|
| Rate for Payer: Aetna of WY Medicare |
$20.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.41
|
| Rate for Payer: Altius Commercial |
$29.41
|
| Rate for Payer: Beech Street Commercial |
$30.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.72
|
| Rate for Payer: Cigna of WY Commercial |
$30.03
|
| Rate for Payer: Entrust Commercial |
$29.11
|
| Rate for Payer: First Choice Health Commercial |
$29.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.77
|
| Rate for Payer: HealthUtah PPO |
$30.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.72
|
| Rate for Payer: Multiplan Medicare/VA |
$16.88
|
| Rate for Payer: One Health Plan of WY PPO |
$30.03
|
| Rate for Payer: PacificSource Commercial |
$27.58
|
| Rate for Payer: PHCS PPO |
$30.03
|
| Rate for Payer: Three Rivers PPO |
$22.98
|
| Rate for Payer: TriWest Veterans Administration |
$17.77
|
| Rate for Payer: United Healthcare Commercial |
$26.66
|
| Rate for Payer: United Healthcare Medicare |
$17.77
|
| Rate for Payer: WINHealth Partners Commercial |
$30.03
|
| Rate for Payer: Wise Provider Network Commercial |
$29.11
|
|
|
FLUID STICK USA-FS1
|
Facility
|
OP
|
$87.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.21 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$57.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.84
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.75
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$48.21
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$50.75
|
| Rate for Payer: United Healthcare Commercial |
$76.12
|
| Rate for Payer: United Healthcare Medicare |
$50.75
|
| Rate for Payer: WINHealth Partners Commercial |
$85.75
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
FLUID STICK USA-FS1
|
Facility
|
IP
|
$87.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.84
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.75
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$54.86
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$76.12
|
| Rate for Payer: United Healthcare Medicare |
$57.75
|
| Rate for Payer: WINHealth Partners Commercial |
$83.12
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [20638]
|
Facility
|
OP
|
$20.94
|
|
|
Service Code
|
NDC 6332342405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.52
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.10
|
| Rate for Payer: Altius Commercial |
$20.10
|
| Rate for Payer: Beech Street Commercial |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.31
|
| Rate for Payer: Cigna of WY Commercial |
$20.52
|
| Rate for Payer: Entrust Commercial |
$19.89
|
| Rate for Payer: First Choice Health Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.15
|
| Rate for Payer: HealthUtah PPO |
$20.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.31
|
| Rate for Payer: Multiplan Medicare/VA |
$11.54
|
| Rate for Payer: One Health Plan of WY PPO |
$20.52
|
| Rate for Payer: PacificSource Commercial |
$18.85
|
| Rate for Payer: PHCS PPO |
$20.52
|
| Rate for Payer: Three Rivers PPO |
$15.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.15
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare |
$12.15
|
| Rate for Payer: WINHealth Partners Commercial |
$20.52
|
| Rate for Payer: Wise Provider Network Commercial |
$19.89
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [20638]
|
Facility
|
IP
|
$20.94
|
|
|
Service Code
|
NDC 6332342405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.10
|
| Rate for Payer: Altius Commercial |
$20.10
|
| Rate for Payer: Beech Street Commercial |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.31
|
| Rate for Payer: Cigna of WY Commercial |
$20.52
|
| Rate for Payer: Entrust Commercial |
$19.89
|
| Rate for Payer: First Choice Health Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$20.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.31
|
| Rate for Payer: Multiplan Medicare/VA |
$13.13
|
| Rate for Payer: One Health Plan of WY PPO |
$20.52
|
| Rate for Payer: PacificSource Commercial |
$18.85
|
| Rate for Payer: PHCS PPO |
$20.52
|
| Rate for Payer: Three Rivers PPO |
$15.70
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
| Rate for Payer: WINHealth Partners Commercial |
$19.89
|
| Rate for Payer: Wise Provider Network Commercial |
$19.89
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 1723890099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.80
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 1723890011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Aetna of WY Medicare |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.82
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 1723890011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.80
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 1723890099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Aetna of WY Medicare |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.82
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Hospital Charge Code |
77003
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$851.62
|
| Rate for Payer: Aetna of WY Medicare |
$27.49
|
| Rate for Payer: Beech Street Commercial |
$825.55
|
| Rate for Payer: Cash Price |
$608.30
|
| Rate for Payer: Cash Price |
$608.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$842.93
|
| Rate for Payer: Cigna of WY Commercial |
$851.62
|
| Rate for Payer: First Choice Health Commercial |
$782.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$825.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.49
|
| Rate for Payer: HealthUtah PPO |
$869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$842.93
|
| Rate for Payer: Multiplan Medicare/VA |
$23.37
|
| Rate for Payer: One Health Plan of WY PPO |
$851.62
|
| Rate for Payer: PacificSource Commercial |
$782.10
|
| Rate for Payer: PHCS PPO |
$825.55
|
| Rate for Payer: Three Rivers PPO |
$651.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.49
|
| Rate for Payer: United Healthcare Commercial |
$756.03
|
| Rate for Payer: United Healthcare Medicare |
$27.49
|
| Rate for Payer: WINHealth Partners Commercial |
$825.55
|
|
|
FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
77001
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$96.50
|
| Rate for Payer: Beech Street Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: First Choice Health Commercial |
$450.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.50
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$82.02
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$475.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$96.50
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$96.50
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
|
|
FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 77002 26
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Medicare |
$25.61
|
| Rate for Payer: Beech Street Commercial |
$74.10
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: First Choice Health Commercial |
$70.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.61
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Multiplan Medicare/VA |
$21.77
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$74.10
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.61
|
| Rate for Payer: United Healthcare Commercial |
$67.86
|
| Rate for Payer: United Healthcare Medicare |
$25.61
|
| Rate for Payer: WINHealth Partners Commercial |
$74.10
|
|
|
FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$979.02
|
| Rate for Payer: Aetna of WY Medicare |
$113.61
|
| Rate for Payer: Beech Street Commercial |
$949.05
|
| Rate for Payer: Cash Price |
$699.30
|
| Rate for Payer: Cash Price |
$699.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$969.03
|
| Rate for Payer: Cigna of WY Commercial |
$979.02
|
| Rate for Payer: First Choice Health Commercial |
$899.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$949.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.61
|
| Rate for Payer: HealthUtah PPO |
$999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$969.03
|
| Rate for Payer: Multiplan Medicare/VA |
$96.57
|
| Rate for Payer: One Health Plan of WY PPO |
$979.02
|
| Rate for Payer: PacificSource Commercial |
$899.10
|
| Rate for Payer: PHCS PPO |
$949.05
|
| Rate for Payer: Three Rivers PPO |
$749.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.61
|
| Rate for Payer: United Healthcare Commercial |
$869.13
|
| Rate for Payer: United Healthcare Medicare |
$113.61
|
| Rate for Payer: WINHealth Partners Commercial |
$949.05
|
|
|
FLUOROURACIL 50 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000719]
|
Facility
|
IP
|
$17.40
|
|
|
Service Code
|
HCPCS J9190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.38
|
| Rate for Payer: Altius Commercial |
$16.38
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Beech Street Commercial |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.72
|
| Rate for Payer: Entrust Commercial |
$16.21
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.21
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.26
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$17.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: Multiplan Medicare/VA |
$10.70
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: One Health Plan of WY PPO |
$16.72
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.35
|
| Rate for Payer: PHCS PPO |
$16.72
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$12.80
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$14.84
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$11.26
|
| Rate for Payer: WINHealth Partners Commercial |
$16.21
|
| Rate for Payer: WINHealth Partners Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$16.21
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
FLUOROURACIL 50 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000719]
|
Facility
|
OP
|
$17.40
|
|
|
Service Code
|
HCPCS J9190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.72
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.38
|
| Rate for Payer: Beech Street Commercial |
$16.72
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.55
|
| Rate for Payer: Cigna of WY Commercial |
$16.72
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: Entrust Commercial |
$16.21
|
| Rate for Payer: First Choice Health Commercial |
$16.21
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$17.06
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$16.72
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.35
|
| Rate for Payer: PHCS PPO |
$16.72
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$12.80
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$10.09
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$14.84
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$10.09
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$16.72
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: Wise Provider Network Commercial |
$16.21
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
FLUOXETINE 10 MG CAPSULE [14508]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5011164701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
FLUOXETINE 10 MG CAPSULE [14508]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 5011164701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
FLUOXETINE 10 MG CAPSULE [14508]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 4254372501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
FLUOXETINE 10 MG CAPSULE [14508]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 4254372501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
FLUOXETINE 10 MG CAPSULE [14508]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904578461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
