|
BAIR HUGGER LOWER BODY
|
Facility
|
OP
|
$15.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.45
|
| Rate for Payer: Aetna of WY Medicare |
$10.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.14
|
| Rate for Payer: Altius Commercial |
$15.14
|
| Rate for Payer: Beech Street Commercial |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.30
|
| Rate for Payer: Cigna of WY Commercial |
$15.45
|
| Rate for Payer: Entrust Commercial |
$14.98
|
| Rate for Payer: First Choice Health Commercial |
$14.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.15
|
| Rate for Payer: HealthUtah PPO |
$15.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.30
|
| Rate for Payer: Multiplan Medicare/VA |
$8.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.45
|
| Rate for Payer: PacificSource Commercial |
$14.19
|
| Rate for Payer: PHCS PPO |
$15.45
|
| Rate for Payer: Three Rivers PPO |
$11.83
|
| Rate for Payer: TriWest Veterans Administration |
$9.15
|
| Rate for Payer: United Healthcare Commercial |
$13.72
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WINHealth Partners Commercial |
$15.45
|
| Rate for Payer: Wise Provider Network Commercial |
$14.98
|
|
|
BAIR HUGGER UPPER BODY
|
Facility
|
OP
|
$20.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.18
|
| Rate for Payer: Aetna of WY Medicare |
$13.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.77
|
| Rate for Payer: Altius Commercial |
$19.77
|
| Rate for Payer: Beech Street Commercial |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.90
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.97
|
| Rate for Payer: Cigna of WY Commercial |
$20.18
|
| Rate for Payer: Entrust Commercial |
$19.56
|
| Rate for Payer: First Choice Health Commercial |
$19.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.94
|
| Rate for Payer: HealthUtah PPO |
$20.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.97
|
| Rate for Payer: Multiplan Medicare/VA |
$11.35
|
| Rate for Payer: One Health Plan of WY PPO |
$20.18
|
| Rate for Payer: PacificSource Commercial |
$18.53
|
| Rate for Payer: PHCS PPO |
$20.18
|
| Rate for Payer: Three Rivers PPO |
$15.44
|
| Rate for Payer: TriWest Veterans Administration |
$11.94
|
| Rate for Payer: United Healthcare Commercial |
$17.91
|
| Rate for Payer: United Healthcare Medicare |
$11.94
|
| Rate for Payer: WINHealth Partners Commercial |
$20.18
|
| Rate for Payer: Wise Provider Network Commercial |
$19.56
|
|
|
BAIR HUGGER UPPER BODY
|
Facility
|
IP
|
$20.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.77
|
| Rate for Payer: Altius Commercial |
$19.77
|
| Rate for Payer: Beech Street Commercial |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.90
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.97
|
| Rate for Payer: Cigna of WY Commercial |
$20.18
|
| Rate for Payer: Entrust Commercial |
$19.56
|
| Rate for Payer: First Choice Health Commercial |
$19.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.59
|
| Rate for Payer: HealthUtah PPO |
$20.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.97
|
| Rate for Payer: Multiplan Medicare/VA |
$12.91
|
| Rate for Payer: One Health Plan of WY PPO |
$20.18
|
| Rate for Payer: PacificSource Commercial |
$18.53
|
| Rate for Payer: PHCS PPO |
$20.18
|
| Rate for Payer: Three Rivers PPO |
$15.44
|
| Rate for Payer: TriWest Veterans Administration |
$13.59
|
| Rate for Payer: United Healthcare Commercial |
$17.91
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
| Rate for Payer: WINHealth Partners Commercial |
$19.56
|
| Rate for Payer: Wise Provider Network Commercial |
$19.56
|
|
|
BALLOON EUSTACHIAN EU061655
|
Facility
|
IP
|
$5,867.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,678.73 |
| Max. Negotiated Rate |
$5,867.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,749.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,632.50
|
| Rate for Payer: Altius Commercial |
$5,632.50
|
| Rate for Payer: Beech Street Commercial |
$5,749.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,816.96
|
| Rate for Payer: Cash Price |
$4,107.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,691.17
|
| Rate for Payer: Cigna of WY Commercial |
$5,749.85
|
| Rate for Payer: Entrust Commercial |
$5,573.83
|
| Rate for Payer: First Choice Health Commercial |
$5,573.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,573.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,872.35
|
| Rate for Payer: HealthUtah PPO |
$5,867.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,691.17
|
| Rate for Payer: Multiplan Medicare/VA |
$3,678.73
|
| Rate for Payer: One Health Plan of WY PPO |
$5,749.85
|
| Rate for Payer: PacificSource Commercial |
$5,280.47
|
| Rate for Payer: PHCS PPO |
$5,749.85
|
| Rate for Payer: Three Rivers PPO |
$4,400.39
|
| Rate for Payer: TriWest Veterans Administration |
$3,872.35
|
| Rate for Payer: United Healthcare Commercial |
$5,104.46
|
| Rate for Payer: United Healthcare Medicare |
$3,872.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,573.83
|
| Rate for Payer: Wise Provider Network Commercial |
$5,573.83
|
|
|
BALLOON EUSTACHIAN EU061655
|
Facility
|
OP
|
$5,867.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,232.82 |
| Max. Negotiated Rate |
$5,867.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,749.85
|
| Rate for Payer: Aetna of WY Medicare |
$3,872.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,632.50
|
| Rate for Payer: Altius Commercial |
$5,632.50
|
| Rate for Payer: Beech Street Commercial |
$5,749.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,816.96
|
| Rate for Payer: Cash Price |
$4,107.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,691.17
|
| Rate for Payer: Cigna of WY Commercial |
$5,749.85
|
| Rate for Payer: Entrust Commercial |
$5,573.83
|
| Rate for Payer: First Choice Health Commercial |
$5,573.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,573.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,402.97
|
| Rate for Payer: HealthUtah PPO |
$5,867.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,691.17
|
| Rate for Payer: Multiplan Medicare/VA |
$3,232.82
|
| Rate for Payer: One Health Plan of WY PPO |
$5,749.85
|
| Rate for Payer: PacificSource Commercial |
$5,280.47
|
| Rate for Payer: PHCS PPO |
$5,749.85
|
| Rate for Payer: Three Rivers PPO |
$4,400.39
|
| Rate for Payer: TriWest Veterans Administration |
$3,402.97
|
| Rate for Payer: United Healthcare Commercial |
$5,104.46
|
| Rate for Payer: United Healthcare Medicare |
$3,402.97
|
| Rate for Payer: WINHealth Partners Commercial |
$5,749.85
|
| Rate for Payer: Wise Provider Network Commercial |
$5,573.83
|
|
|
BALLOON EXTRACTOR KATZ BEX7001
|
Facility
|
OP
|
$122.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$122.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.88
|
| Rate for Payer: Aetna of WY Medicare |
$80.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.44
|
| Rate for Payer: Altius Commercial |
$117.44
|
| Rate for Payer: Beech Street Commercial |
$119.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.66
|
| Rate for Payer: Cigna of WY Commercial |
$119.88
|
| Rate for Payer: Entrust Commercial |
$116.21
|
| Rate for Payer: First Choice Health Commercial |
$116.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.95
|
| Rate for Payer: HealthUtah PPO |
$122.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.66
|
| Rate for Payer: Multiplan Medicare/VA |
$67.40
|
| Rate for Payer: One Health Plan of WY PPO |
$119.88
|
| Rate for Payer: PacificSource Commercial |
$110.10
|
| Rate for Payer: PHCS PPO |
$119.88
|
| Rate for Payer: Three Rivers PPO |
$91.75
|
| Rate for Payer: TriWest Veterans Administration |
$70.95
|
| Rate for Payer: United Healthcare Commercial |
$106.43
|
| Rate for Payer: United Healthcare Medicare |
$70.95
|
| Rate for Payer: WINHealth Partners Commercial |
$119.88
|
| Rate for Payer: Wise Provider Network Commercial |
$116.21
|
|
|
BALLOON EXTRACTOR KATZ BEX7001
|
Facility
|
IP
|
$122.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$122.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.44
|
| Rate for Payer: Altius Commercial |
$117.44
|
| Rate for Payer: Beech Street Commercial |
$119.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.66
|
| Rate for Payer: Cigna of WY Commercial |
$119.88
|
| Rate for Payer: Entrust Commercial |
$116.21
|
| Rate for Payer: First Choice Health Commercial |
$116.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.74
|
| Rate for Payer: HealthUtah PPO |
$122.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.66
|
| Rate for Payer: Multiplan Medicare/VA |
$76.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.88
|
| Rate for Payer: PacificSource Commercial |
$110.10
|
| Rate for Payer: PHCS PPO |
$119.88
|
| Rate for Payer: Three Rivers PPO |
$91.75
|
| Rate for Payer: TriWest Veterans Administration |
$80.74
|
| Rate for Payer: United Healthcare Commercial |
$106.43
|
| Rate for Payer: United Healthcare Medicare |
$80.74
|
| Rate for Payer: WINHealth Partners Commercial |
$116.21
|
| Rate for Payer: Wise Provider Network Commercial |
$116.21
|
|
|
BALOXAVIR MARBOXIL 40 MG TABLET [154455]
|
Facility
|
IP
|
$245.86
|
|
|
Service Code
|
NDC 5024286001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.15 |
| Max. Negotiated Rate |
$245.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.03
|
| Rate for Payer: Altius Commercial |
$236.03
|
| Rate for Payer: Beech Street Commercial |
$240.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.85
|
| Rate for Payer: Cash Price |
$172.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.48
|
| Rate for Payer: Cigna of WY Commercial |
$240.94
|
| Rate for Payer: Entrust Commercial |
$233.57
|
| Rate for Payer: First Choice Health Commercial |
$233.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.27
|
| Rate for Payer: HealthUtah PPO |
$245.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.48
|
| Rate for Payer: Multiplan Medicare/VA |
$154.15
|
| Rate for Payer: One Health Plan of WY PPO |
$240.94
|
| Rate for Payer: PacificSource Commercial |
$221.27
|
| Rate for Payer: PHCS PPO |
$240.94
|
| Rate for Payer: Three Rivers PPO |
$184.40
|
| Rate for Payer: TriWest Veterans Administration |
$162.27
|
| Rate for Payer: United Healthcare Commercial |
$213.90
|
| Rate for Payer: United Healthcare Medicare |
$162.27
|
| Rate for Payer: WINHealth Partners Commercial |
$233.57
|
| Rate for Payer: Wise Provider Network Commercial |
$233.57
|
|
|
BALOXAVIR MARBOXIL 40 MG TABLET [154455]
|
Facility
|
OP
|
$245.86
|
|
|
Service Code
|
NDC 5024286001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.47 |
| Max. Negotiated Rate |
$245.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.94
|
| Rate for Payer: Aetna of WY Medicare |
$162.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.03
|
| Rate for Payer: Altius Commercial |
$236.03
|
| Rate for Payer: Beech Street Commercial |
$240.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.85
|
| Rate for Payer: Cash Price |
$172.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.48
|
| Rate for Payer: Cigna of WY Commercial |
$240.94
|
| Rate for Payer: Entrust Commercial |
$233.57
|
| Rate for Payer: First Choice Health Commercial |
$233.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.60
|
| Rate for Payer: HealthUtah PPO |
$245.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.48
|
| Rate for Payer: Multiplan Medicare/VA |
$135.47
|
| Rate for Payer: One Health Plan of WY PPO |
$240.94
|
| Rate for Payer: PacificSource Commercial |
$221.27
|
| Rate for Payer: PHCS PPO |
$240.94
|
| Rate for Payer: Three Rivers PPO |
$184.40
|
| Rate for Payer: TriWest Veterans Administration |
$142.60
|
| Rate for Payer: United Healthcare Commercial |
$213.90
|
| Rate for Payer: United Healthcare Medicare |
$142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$240.94
|
| Rate for Payer: Wise Provider Network Commercial |
$233.57
|
|
|
BANDAGE UNNA BOOT W/CALAMINE
|
Facility
|
OP
|
$13.24
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.98
|
| Rate for Payer: Aetna of WY Medicare |
$8.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.71
|
| Rate for Payer: Altius Commercial |
$12.71
|
| Rate for Payer: Beech Street Commercial |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.87
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.84
|
| Rate for Payer: Cigna of WY Commercial |
$12.98
|
| Rate for Payer: Entrust Commercial |
$12.58
|
| Rate for Payer: First Choice Health Commercial |
$12.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.68
|
| Rate for Payer: HealthUtah PPO |
$13.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.84
|
| Rate for Payer: Multiplan Medicare/VA |
$7.30
|
| Rate for Payer: One Health Plan of WY PPO |
$12.98
|
| Rate for Payer: PacificSource Commercial |
$11.92
|
| Rate for Payer: PHCS PPO |
$12.98
|
| Rate for Payer: Three Rivers PPO |
$9.93
|
| Rate for Payer: TriWest Veterans Administration |
$7.68
|
| Rate for Payer: United Healthcare Commercial |
$11.52
|
| Rate for Payer: United Healthcare Medicare |
$7.68
|
| Rate for Payer: WINHealth Partners Commercial |
$12.98
|
| Rate for Payer: Wise Provider Network Commercial |
$12.58
|
|
|
BANDAGE UNNA BOOT W/CALAMINE
|
Facility
|
IP
|
$13.24
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.71
|
| Rate for Payer: Altius Commercial |
$12.71
|
| Rate for Payer: Beech Street Commercial |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.87
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.84
|
| Rate for Payer: Cigna of WY Commercial |
$12.98
|
| Rate for Payer: Entrust Commercial |
$12.58
|
| Rate for Payer: First Choice Health Commercial |
$12.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.74
|
| Rate for Payer: HealthUtah PPO |
$13.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.30
|
| Rate for Payer: One Health Plan of WY PPO |
$12.98
|
| Rate for Payer: PacificSource Commercial |
$11.92
|
| Rate for Payer: PHCS PPO |
$12.98
|
| Rate for Payer: Three Rivers PPO |
$9.93
|
| Rate for Payer: TriWest Veterans Administration |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$11.52
|
| Rate for Payer: United Healthcare Medicare |
$8.74
|
| Rate for Payer: WINHealth Partners Commercial |
$12.58
|
| Rate for Payer: Wise Provider Network Commercial |
$12.58
|
|
|
BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL SUSPENSION [43229]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 3290916755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL SUSPENSION [43229]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 3290916755
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Aetna of WY Medicare |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
BARIUM SULFATE 40 % (W/V), 30% (W/W) ORAL PASTE [87036]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 3290912522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.85
|
| Rate for Payer: Cigna of WY Commercial |
$0.86
|
| Rate for Payer: Entrust Commercial |
$0.84
|
| Rate for Payer: First Choice Health Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$0.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.85
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.86
|
| Rate for Payer: PacificSource Commercial |
$0.79
|
| Rate for Payer: PHCS PPO |
$0.86
|
| Rate for Payer: Three Rivers PPO |
$0.66
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.84
|
| Rate for Payer: Wise Provider Network Commercial |
$0.84
|
|
|
BARIUM SULFATE 40 % (W/V), 30% (W/W) ORAL PASTE [87036]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 3290912522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.86
|
| Rate for Payer: Aetna of WY Medicare |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.85
|
| Rate for Payer: Cigna of WY Commercial |
$0.86
|
| Rate for Payer: Entrust Commercial |
$0.84
|
| Rate for Payer: First Choice Health Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.85
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.86
|
| Rate for Payer: PacificSource Commercial |
$0.79
|
| Rate for Payer: PHCS PPO |
$0.86
|
| Rate for Payer: Three Rivers PPO |
$0.66
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.86
|
| Rate for Payer: Wise Provider Network Commercial |
$0.84
|
|
|
BARIUM SULFATE 40 % (W/V), 30 % (W/W) ORAL SUSPENSION [39338]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 3290911600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
BARIUM SULFATE 40 % (W/V), 30 % (W/W) ORAL SUSPENSION [39338]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 3290911600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION [18865]
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 3290918702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.85
|
| Rate for Payer: Altius Commercial |
$0.85
|
| Rate for Payer: Beech Street Commercial |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.86
|
| Rate for Payer: Cigna of WY Commercial |
$0.87
|
| Rate for Payer: Entrust Commercial |
$0.85
|
| Rate for Payer: First Choice Health Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.59
|
| Rate for Payer: HealthUtah PPO |
$0.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.86
|
| Rate for Payer: Multiplan Medicare/VA |
$0.56
|
| Rate for Payer: One Health Plan of WY PPO |
$0.87
|
| Rate for Payer: PacificSource Commercial |
$0.80
|
| Rate for Payer: PHCS PPO |
$0.87
|
| Rate for Payer: Three Rivers PPO |
$0.67
|
| Rate for Payer: TriWest Veterans Administration |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.59
|
| Rate for Payer: WINHealth Partners Commercial |
$0.85
|
| Rate for Payer: Wise Provider Network Commercial |
$0.85
|
|
|
BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION [18865]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 3290918602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.06
|
| Rate for Payer: Aetna of WY Medicare |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.06
|
| Rate for Payer: Altius Commercial |
$0.06
|
| Rate for Payer: Beech Street Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.06
|
| Rate for Payer: Cigna of WY Commercial |
$0.06
|
| Rate for Payer: Entrust Commercial |
$0.06
|
| Rate for Payer: First Choice Health Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.06
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.06
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.06
|
| Rate for Payer: Wise Provider Network Commercial |
$0.06
|
|
|
BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION [18865]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 3290918602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.06
|
| Rate for Payer: Altius Commercial |
$0.06
|
| Rate for Payer: Beech Street Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.06
|
| Rate for Payer: Cigna of WY Commercial |
$0.06
|
| Rate for Payer: Entrust Commercial |
$0.06
|
| Rate for Payer: First Choice Health Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$0.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.06
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.06
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.06
|
| Rate for Payer: Wise Provider Network Commercial |
$0.06
|
|
|
BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION [18865]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 3290918702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.87
|
| Rate for Payer: Aetna of WY Medicare |
$0.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.85
|
| Rate for Payer: Altius Commercial |
$0.85
|
| Rate for Payer: Beech Street Commercial |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.73
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.86
|
| Rate for Payer: Cigna of WY Commercial |
$0.87
|
| Rate for Payer: Entrust Commercial |
$0.85
|
| Rate for Payer: First Choice Health Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.52
|
| Rate for Payer: HealthUtah PPO |
$0.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.86
|
| Rate for Payer: Multiplan Medicare/VA |
$0.49
|
| Rate for Payer: One Health Plan of WY PPO |
$0.87
|
| Rate for Payer: PacificSource Commercial |
$0.80
|
| Rate for Payer: PHCS PPO |
$0.87
|
| Rate for Payer: Three Rivers PPO |
$0.67
|
| Rate for Payer: TriWest Veterans Administration |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
| Rate for Payer: WINHealth Partners Commercial |
$0.87
|
| Rate for Payer: Wise Provider Network Commercial |
$0.85
|
|
|
BARIUM SULFATE 700 MG TABLET [88713]
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
NDC 1036177831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.08
|
| Rate for Payer: Aetna of WY Medicare |
$6.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.90
|
| Rate for Payer: Altius Commercial |
$8.90
|
| Rate for Payer: Beech Street Commercial |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.99
|
| Rate for Payer: Cigna of WY Commercial |
$9.08
|
| Rate for Payer: Entrust Commercial |
$8.81
|
| Rate for Payer: First Choice Health Commercial |
$8.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.38
|
| Rate for Payer: HealthUtah PPO |
$9.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.99
|
| Rate for Payer: Multiplan Medicare/VA |
$5.11
|
| Rate for Payer: One Health Plan of WY PPO |
$9.08
|
| Rate for Payer: PacificSource Commercial |
$8.34
|
| Rate for Payer: PHCS PPO |
$9.08
|
| Rate for Payer: Three Rivers PPO |
$6.95
|
| Rate for Payer: TriWest Veterans Administration |
$5.38
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare |
$5.38
|
| Rate for Payer: WINHealth Partners Commercial |
$9.08
|
| Rate for Payer: Wise Provider Network Commercial |
$8.81
|
|
|
BARIUM SULFATE 700 MG TABLET [88713]
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
NDC 1036177831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.90
|
| Rate for Payer: Altius Commercial |
$8.90
|
| Rate for Payer: Beech Street Commercial |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.99
|
| Rate for Payer: Cigna of WY Commercial |
$9.08
|
| Rate for Payer: Entrust Commercial |
$8.81
|
| Rate for Payer: First Choice Health Commercial |
$8.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.12
|
| Rate for Payer: HealthUtah PPO |
$9.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.99
|
| Rate for Payer: Multiplan Medicare/VA |
$5.81
|
| Rate for Payer: One Health Plan of WY PPO |
$9.08
|
| Rate for Payer: PacificSource Commercial |
$8.34
|
| Rate for Payer: PHCS PPO |
$9.08
|
| Rate for Payer: Three Rivers PPO |
$6.95
|
| Rate for Payer: TriWest Veterans Administration |
$6.12
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare |
$6.12
|
| Rate for Payer: WINHealth Partners Commercial |
$8.81
|
| Rate for Payer: Wise Provider Network Commercial |
$8.81
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION [43230]
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
NDC 3290976401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.22
|
| Rate for Payer: Altius Commercial |
$20.22
|
| Rate for Payer: Beech Street Commercial |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.43
|
| Rate for Payer: Cigna of WY Commercial |
$20.64
|
| Rate for Payer: Entrust Commercial |
$20.01
|
| Rate for Payer: First Choice Health Commercial |
$20.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.90
|
| Rate for Payer: HealthUtah PPO |
$21.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.43
|
| Rate for Payer: Multiplan Medicare/VA |
$13.20
|
| Rate for Payer: One Health Plan of WY PPO |
$20.64
|
| Rate for Payer: PacificSource Commercial |
$18.95
|
| Rate for Payer: PHCS PPO |
$20.64
|
| Rate for Payer: Three Rivers PPO |
$15.80
|
| Rate for Payer: TriWest Veterans Administration |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$18.32
|
| Rate for Payer: United Healthcare Medicare |
$13.90
|
| Rate for Payer: WINHealth Partners Commercial |
$20.01
|
| Rate for Payer: Wise Provider Network Commercial |
$20.01
|
|
|
BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION [43230]
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
NDC 3290976401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.64
|
| Rate for Payer: Aetna of WY Medicare |
$13.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.22
|
| Rate for Payer: Altius Commercial |
$20.22
|
| Rate for Payer: Beech Street Commercial |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.43
|
| Rate for Payer: Cigna of WY Commercial |
$20.64
|
| Rate for Payer: Entrust Commercial |
$20.01
|
| Rate for Payer: First Choice Health Commercial |
$20.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.21
|
| Rate for Payer: HealthUtah PPO |
$21.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.60
|
| Rate for Payer: One Health Plan of WY PPO |
$20.64
|
| Rate for Payer: PacificSource Commercial |
$18.95
|
| Rate for Payer: PHCS PPO |
$20.64
|
| Rate for Payer: Three Rivers PPO |
$15.80
|
| Rate for Payer: TriWest Veterans Administration |
$12.21
|
| Rate for Payer: United Healthcare Commercial |
$18.32
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WINHealth Partners Commercial |
$20.64
|
| Rate for Payer: Wise Provider Network Commercial |
$20.01
|
|
