|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 4778142311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 0378911916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 0406911276
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
OP
|
$55.60
|
|
|
Service Code
|
NDC 0406911276
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$36.70
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.69
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$30.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$31.69
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$31.69
|
| Rate for Payer: WINHealth Partners Commercial |
$54.49
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 0378911998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
OP
|
$55.60
|
|
|
Service Code
|
NDC 0378911998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$36.70
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.69
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$30.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$31.69
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$31.69
|
| Rate for Payer: WINHealth Partners Commercial |
$54.49
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
IP
|
$55.60
|
|
|
Service Code
|
NDC 4778142347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.92
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.22
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.92
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$33.92
|
| Rate for Payer: WINHealth Partners Commercial |
$52.82
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
OP
|
$55.60
|
|
|
Service Code
|
NDC 4778142311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$36.70
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.69
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$30.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$31.69
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$31.69
|
| Rate for Payer: WINHealth Partners Commercial |
$54.49
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [38542]
|
Facility
|
OP
|
$55.60
|
|
|
Service Code
|
NDC 0378911916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.49
|
| Rate for Payer: Aetna of WY Medicare |
$36.70
|
| Rate for Payer: Altius Commercial |
$53.38
|
| Rate for Payer: Beech Street Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.93
|
| Rate for Payer: Cigna of WY Commercial |
$54.49
|
| Rate for Payer: Entrust Commercial |
$52.82
|
| Rate for Payer: First Choice Health Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.69
|
| Rate for Payer: HealthUtah PPO |
$55.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.93
|
| Rate for Payer: Multiplan Medicare/VA |
$30.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.49
|
| Rate for Payer: PacificSource Commercial |
$50.04
|
| Rate for Payer: PHCS PPO |
$54.49
|
| Rate for Payer: Three Rivers PPO |
$41.70
|
| Rate for Payer: TriWest Veterans Administration |
$31.69
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Medicare |
$31.69
|
| Rate for Payer: WINHealth Partners Commercial |
$54.49
|
| Rate for Payer: Wise Provider Network Commercial |
$52.82
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 0378912198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$26.37
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.77
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$21.63
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$22.77
|
| Rate for Payer: WINHealth Partners Commercial |
$39.15
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 0406912576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$25.57
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.37
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$23.15
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$24.37
|
| Rate for Payer: WINHealth Partners Commercial |
$37.95
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 0378912116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$25.57
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.37
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$23.15
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$24.37
|
| Rate for Payer: WINHealth Partners Commercial |
$37.95
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 0378912116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$26.37
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.77
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$21.63
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$22.77
|
| Rate for Payer: WINHealth Partners Commercial |
$39.15
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 0378912198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$25.57
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.37
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$23.15
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$24.37
|
| Rate for Payer: WINHealth Partners Commercial |
$37.95
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH [17570]
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 0406912576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.15
|
| Rate for Payer: Aetna of WY Medicare |
$26.37
|
| Rate for Payer: Altius Commercial |
$38.35
|
| Rate for Payer: Beech Street Commercial |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.75
|
| Rate for Payer: Cigna of WY Commercial |
$39.15
|
| Rate for Payer: Entrust Commercial |
$37.95
|
| Rate for Payer: First Choice Health Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.77
|
| Rate for Payer: HealthUtah PPO |
$39.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.75
|
| Rate for Payer: Multiplan Medicare/VA |
$21.63
|
| Rate for Payer: One Health Plan of WY PPO |
$39.15
|
| Rate for Payer: PacificSource Commercial |
$35.96
|
| Rate for Payer: PHCS PPO |
$39.15
|
| Rate for Payer: Three Rivers PPO |
$29.96
|
| Rate for Payer: TriWest Veterans Administration |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare |
$22.77
|
| Rate for Payer: WINHealth Partners Commercial |
$39.15
|
| Rate for Payer: Wise Provider Network Commercial |
$37.95
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
OP
|
$49.83
|
|
|
Service Code
|
NDC 0378912216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$49.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.83
|
| Rate for Payer: Aetna of WY Medicare |
$32.89
|
| Rate for Payer: Altius Commercial |
$47.84
|
| Rate for Payer: Beech Street Commercial |
$48.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.34
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.34
|
| Rate for Payer: Cigna of WY Commercial |
$48.83
|
| Rate for Payer: Entrust Commercial |
$47.34
|
| Rate for Payer: First Choice Health Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$49.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.34
|
| Rate for Payer: Multiplan Medicare/VA |
$26.98
|
| Rate for Payer: One Health Plan of WY PPO |
$48.83
|
| Rate for Payer: PacificSource Commercial |
$44.85
|
| Rate for Payer: PHCS PPO |
$48.83
|
| Rate for Payer: Three Rivers PPO |
$37.37
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$47.59
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$48.83
|
| Rate for Payer: Wise Provider Network Commercial |
$47.34
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
OP
|
$49.83
|
|
|
Service Code
|
NDC 0378912298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$49.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.83
|
| Rate for Payer: Aetna of WY Medicare |
$32.89
|
| Rate for Payer: Altius Commercial |
$47.84
|
| Rate for Payer: Beech Street Commercial |
$48.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.34
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.34
|
| Rate for Payer: Cigna of WY Commercial |
$48.83
|
| Rate for Payer: Entrust Commercial |
$47.34
|
| Rate for Payer: First Choice Health Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$49.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.34
|
| Rate for Payer: Multiplan Medicare/VA |
$26.98
|
| Rate for Payer: One Health Plan of WY PPO |
$48.83
|
| Rate for Payer: PacificSource Commercial |
$44.85
|
| Rate for Payer: PHCS PPO |
$48.83
|
| Rate for Payer: Three Rivers PPO |
$37.37
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$47.59
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$48.83
|
| Rate for Payer: Wise Provider Network Commercial |
$47.34
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
IP
|
$49.83
|
|
|
Service Code
|
NDC 0378912298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$49.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.83
|
| Rate for Payer: Aetna of WY Medicare |
$31.89
|
| Rate for Payer: Altius Commercial |
$47.84
|
| Rate for Payer: Beech Street Commercial |
$48.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.34
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.34
|
| Rate for Payer: Cigna of WY Commercial |
$48.83
|
| Rate for Payer: Entrust Commercial |
$47.34
|
| Rate for Payer: First Choice Health Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.40
|
| Rate for Payer: HealthUtah PPO |
$49.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.34
|
| Rate for Payer: Multiplan Medicare/VA |
$28.88
|
| Rate for Payer: One Health Plan of WY PPO |
$48.83
|
| Rate for Payer: PacificSource Commercial |
$44.85
|
| Rate for Payer: PHCS PPO |
$48.83
|
| Rate for Payer: Three Rivers PPO |
$37.37
|
| Rate for Payer: TriWest Veterans Administration |
$30.40
|
| Rate for Payer: United Healthcare Commercial |
$47.59
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
| Rate for Payer: WINHealth Partners Commercial |
$47.34
|
| Rate for Payer: Wise Provider Network Commercial |
$47.34
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [852]
|
Facility
|
IP
|
$49.83
|
|
|
Service Code
|
NDC 0378912216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$49.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.83
|
| Rate for Payer: Aetna of WY Medicare |
$31.89
|
| Rate for Payer: Altius Commercial |
$47.84
|
| Rate for Payer: Beech Street Commercial |
$48.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.34
|
| Rate for Payer: Cash Price |
$34.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.34
|
| Rate for Payer: Cigna of WY Commercial |
$48.83
|
| Rate for Payer: Entrust Commercial |
$47.34
|
| Rate for Payer: First Choice Health Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.40
|
| Rate for Payer: HealthUtah PPO |
$49.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.34
|
| Rate for Payer: Multiplan Medicare/VA |
$28.88
|
| Rate for Payer: One Health Plan of WY PPO |
$48.83
|
| Rate for Payer: PacificSource Commercial |
$44.85
|
| Rate for Payer: PHCS PPO |
$48.83
|
| Rate for Payer: Three Rivers PPO |
$37.37
|
| Rate for Payer: TriWest Veterans Administration |
$30.40
|
| Rate for Payer: United Healthcare Commercial |
$47.59
|
| Rate for Payer: United Healthcare Medicare |
$30.40
|
| Rate for Payer: WINHealth Partners Commercial |
$47.34
|
| Rate for Payer: Wise Provider Network Commercial |
$47.34
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$55.04
|
|
|
Service Code
|
NDC 0378912316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$35.23
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.57
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$31.90
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$33.57
|
| Rate for Payer: WINHealth Partners Commercial |
$52.29
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$55.04
|
|
|
Service Code
|
NDC 4778142711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$35.23
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.57
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$31.90
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$33.57
|
| Rate for Payer: WINHealth Partners Commercial |
$52.29
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$55.04
|
|
|
Service Code
|
NDC 0378912398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$35.23
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.57
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$31.90
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$33.57
|
| Rate for Payer: WINHealth Partners Commercial |
$52.29
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
IP
|
$55.04
|
|
|
Service Code
|
NDC 4778142747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$35.23
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.57
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$31.90
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$33.57
|
| Rate for Payer: WINHealth Partners Commercial |
$52.29
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$55.04
|
|
|
Service Code
|
NDC 4778142747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$36.33
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.37
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$29.80
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$31.37
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$31.37
|
| Rate for Payer: WINHealth Partners Commercial |
$53.94
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [18521]
|
Facility
|
OP
|
$55.04
|
|
|
Service Code
|
NDC 4778142711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.94
|
| Rate for Payer: Aetna of WY Medicare |
$36.33
|
| Rate for Payer: Altius Commercial |
$52.84
|
| Rate for Payer: Beech Street Commercial |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.39
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.39
|
| Rate for Payer: Cigna of WY Commercial |
$53.94
|
| Rate for Payer: Entrust Commercial |
$52.29
|
| Rate for Payer: First Choice Health Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.37
|
| Rate for Payer: HealthUtah PPO |
$55.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.39
|
| Rate for Payer: Multiplan Medicare/VA |
$29.80
|
| Rate for Payer: One Health Plan of WY PPO |
$53.94
|
| Rate for Payer: PacificSource Commercial |
$49.54
|
| Rate for Payer: PHCS PPO |
$53.94
|
| Rate for Payer: Three Rivers PPO |
$41.28
|
| Rate for Payer: TriWest Veterans Administration |
$31.37
|
| Rate for Payer: United Healthcare Commercial |
$52.56
|
| Rate for Payer: United Healthcare Medicare |
$31.37
|
| Rate for Payer: WINHealth Partners Commercial |
$53.94
|
| Rate for Payer: Wise Provider Network Commercial |
$52.29
|
|
