|
ATHLETIC SUPP MD ADLT
|
Facility
|
OP
|
$23.66
|
|
| Hospital Charge Code |
3000273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$23.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.19
|
| Rate for Payer: Aetna of WY Medicare |
$15.62
|
| Rate for Payer: Altius Commercial |
$22.71
|
| Rate for Payer: Beech Street Commercial |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.95
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.95
|
| Rate for Payer: Cigna of WY Commercial |
$23.19
|
| Rate for Payer: Entrust Commercial |
$22.48
|
| Rate for Payer: First Choice Health Commercial |
$22.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.49
|
| Rate for Payer: HealthUtah PPO |
$23.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.95
|
| Rate for Payer: Multiplan Medicare/VA |
$12.81
|
| Rate for Payer: One Health Plan of WY PPO |
$23.19
|
| Rate for Payer: PacificSource Commercial |
$21.29
|
| Rate for Payer: PHCS PPO |
$23.19
|
| Rate for Payer: Three Rivers PPO |
$17.74
|
| Rate for Payer: TriWest Veterans Administration |
$13.49
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$13.49
|
| Rate for Payer: WINHealth Partners Commercial |
$23.19
|
| Rate for Payer: Wise Provider Network Commercial |
$22.48
|
|
|
ATHLETIC SUPP MD ADLT
|
Facility
|
IP
|
$23.66
|
|
| Hospital Charge Code |
3000273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$23.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.19
|
| Rate for Payer: Aetna of WY Medicare |
$15.14
|
| Rate for Payer: Altius Commercial |
$22.71
|
| Rate for Payer: Beech Street Commercial |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.95
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.95
|
| Rate for Payer: Cigna of WY Commercial |
$23.19
|
| Rate for Payer: Entrust Commercial |
$22.48
|
| Rate for Payer: First Choice Health Commercial |
$22.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.43
|
| Rate for Payer: HealthUtah PPO |
$23.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.95
|
| Rate for Payer: Multiplan Medicare/VA |
$13.71
|
| Rate for Payer: One Health Plan of WY PPO |
$23.19
|
| Rate for Payer: PacificSource Commercial |
$21.29
|
| Rate for Payer: PHCS PPO |
$23.19
|
| Rate for Payer: Three Rivers PPO |
$17.74
|
| Rate for Payer: TriWest Veterans Administration |
$14.43
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$14.43
|
| Rate for Payer: WINHealth Partners Commercial |
$22.48
|
| Rate for Payer: Wise Provider Network Commercial |
$22.48
|
|
|
ATHLETIC SUPP SM ADLT
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
3000330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Aetna of WY Medicare |
$13.44
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.81
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$12.17
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$12.81
|
| Rate for Payer: United Healthcare Commercial |
$20.06
|
| Rate for Payer: United Healthcare Medicare |
$12.81
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
ATHLETIC SUPP SM ADLT
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
3000330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Aetna of WY Medicare |
$13.86
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.97
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.37
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.97
|
| Rate for Payer: United Healthcare Commercial |
$20.06
|
| Rate for Payer: United Healthcare Medicare |
$11.97
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
ATHLETIC SUPP XLG ADLT
|
Facility
|
OP
|
$11.87
|
|
| Hospital Charge Code |
2650349
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.63
|
| Rate for Payer: Aetna of WY Medicare |
$7.83
|
| Rate for Payer: Altius Commercial |
$11.40
|
| Rate for Payer: Beech Street Commercial |
$11.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$8.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.51
|
| Rate for Payer: Cigna of WY Commercial |
$11.63
|
| Rate for Payer: Entrust Commercial |
$11.28
|
| Rate for Payer: First Choice Health Commercial |
$11.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.77
|
| Rate for Payer: HealthUtah PPO |
$11.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.51
|
| Rate for Payer: Multiplan Medicare/VA |
$6.43
|
| Rate for Payer: One Health Plan of WY PPO |
$11.63
|
| Rate for Payer: PacificSource Commercial |
$10.68
|
| Rate for Payer: PHCS PPO |
$11.63
|
| Rate for Payer: Three Rivers PPO |
$8.90
|
| Rate for Payer: TriWest Veterans Administration |
$6.77
|
| Rate for Payer: United Healthcare Commercial |
$11.34
|
| Rate for Payer: United Healthcare Medicare |
$6.77
|
| Rate for Payer: WINHealth Partners Commercial |
$11.63
|
| Rate for Payer: Wise Provider Network Commercial |
$11.28
|
|
|
ATHLETIC SUPP XLG ADLT
|
Facility
|
IP
|
$11.87
|
|
| Hospital Charge Code |
2650349
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.63
|
| Rate for Payer: Aetna of WY Medicare |
$7.60
|
| Rate for Payer: Altius Commercial |
$11.40
|
| Rate for Payer: Beech Street Commercial |
$11.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$8.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.51
|
| Rate for Payer: Cigna of WY Commercial |
$11.63
|
| Rate for Payer: Entrust Commercial |
$11.28
|
| Rate for Payer: First Choice Health Commercial |
$11.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.24
|
| Rate for Payer: HealthUtah PPO |
$11.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.51
|
| Rate for Payer: Multiplan Medicare/VA |
$6.88
|
| Rate for Payer: One Health Plan of WY PPO |
$11.63
|
| Rate for Payer: PacificSource Commercial |
$10.68
|
| Rate for Payer: PHCS PPO |
$11.63
|
| Rate for Payer: Three Rivers PPO |
$8.90
|
| Rate for Payer: TriWest Veterans Administration |
$7.24
|
| Rate for Payer: United Healthcare Commercial |
$11.34
|
| Rate for Payer: United Healthcare Medicare |
$7.24
|
| Rate for Payer: WINHealth Partners Commercial |
$11.28
|
| Rate for Payer: Wise Provider Network Commercial |
$11.28
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
NDC 6050525789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.37
|
| Rate for Payer: Aetna of WY Medicare |
$10.04
|
| Rate for Payer: Altius Commercial |
$15.05
|
| Rate for Payer: Beech Street Commercial |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.21
|
| Rate for Payer: Cash Price |
$10.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.21
|
| Rate for Payer: Cigna of WY Commercial |
$15.37
|
| Rate for Payer: Entrust Commercial |
$14.90
|
| Rate for Payer: First Choice Health Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.56
|
| Rate for Payer: HealthUtah PPO |
$15.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.21
|
| Rate for Payer: Multiplan Medicare/VA |
$9.09
|
| Rate for Payer: One Health Plan of WY PPO |
$15.37
|
| Rate for Payer: PacificSource Commercial |
$14.11
|
| Rate for Payer: PHCS PPO |
$15.37
|
| Rate for Payer: Three Rivers PPO |
$11.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$14.97
|
| Rate for Payer: United Healthcare Medicare |
$9.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.90
|
| Rate for Payer: Wise Provider Network Commercial |
$14.90
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
NDC 6808409711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.55
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$9.55
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.66
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
NDC 6050525789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.37
|
| Rate for Payer: Aetna of WY Medicare |
$10.35
|
| Rate for Payer: Altius Commercial |
$15.05
|
| Rate for Payer: Beech Street Commercial |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.21
|
| Rate for Payer: Cash Price |
$10.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.21
|
| Rate for Payer: Cigna of WY Commercial |
$15.37
|
| Rate for Payer: Entrust Commercial |
$14.90
|
| Rate for Payer: First Choice Health Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.94
|
| Rate for Payer: HealthUtah PPO |
$15.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.21
|
| Rate for Payer: Multiplan Medicare/VA |
$8.49
|
| Rate for Payer: One Health Plan of WY PPO |
$15.37
|
| Rate for Payer: PacificSource Commercial |
$14.11
|
| Rate for Payer: PHCS PPO |
$15.37
|
| Rate for Payer: Three Rivers PPO |
$11.76
|
| Rate for Payer: TriWest Veterans Administration |
$8.94
|
| Rate for Payer: United Healthcare Commercial |
$14.97
|
| Rate for Payer: United Healthcare Medicare |
$8.94
|
| Rate for Payer: WINHealth Partners Commercial |
$15.37
|
| Rate for Payer: Wise Provider Network Commercial |
$14.90
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
NDC 6808409711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6808409801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.58
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.10
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
IP
|
$15.96
|
|
|
Service Code
|
NDC 6050525798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$15.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.64
|
| Rate for Payer: Aetna of WY Medicare |
$10.21
|
| Rate for Payer: Altius Commercial |
$15.32
|
| Rate for Payer: Beech Street Commercial |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.48
|
| Rate for Payer: Cigna of WY Commercial |
$15.64
|
| Rate for Payer: Entrust Commercial |
$15.16
|
| Rate for Payer: First Choice Health Commercial |
$15.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$15.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.48
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$15.64
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.64
|
| Rate for Payer: Three Rivers PPO |
$11.97
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$15.24
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$15.16
|
| Rate for Payer: Wise Provider Network Commercial |
$15.16
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
OP
|
$15.96
|
|
|
Service Code
|
NDC 6050525798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$15.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.64
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.32
|
| Rate for Payer: Beech Street Commercial |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.48
|
| Rate for Payer: Cigna of WY Commercial |
$15.64
|
| Rate for Payer: Entrust Commercial |
$15.16
|
| Rate for Payer: First Choice Health Commercial |
$15.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.10
|
| Rate for Payer: HealthUtah PPO |
$15.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.48
|
| Rate for Payer: Multiplan Medicare/VA |
$8.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.64
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.64
|
| Rate for Payer: Three Rivers PPO |
$11.97
|
| Rate for Payer: TriWest Veterans Administration |
$9.10
|
| Rate for Payer: United Healthcare Commercial |
$15.24
|
| Rate for Payer: United Healthcare Medicare |
$9.10
|
| Rate for Payer: WINHealth Partners Commercial |
$15.64
|
| Rate for Payer: Wise Provider Network Commercial |
$15.16
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6808409801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6808409901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6808409901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.58
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.10
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6808409911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.58
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.10
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6808409911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
OP
|
$16.73
|
|
|
Service Code
|
NDC 0904629304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.40
|
| Rate for Payer: Aetna of WY Medicare |
$11.04
|
| Rate for Payer: Altius Commercial |
$16.06
|
| Rate for Payer: Beech Street Commercial |
$16.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.23
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.23
|
| Rate for Payer: Cigna of WY Commercial |
$16.40
|
| Rate for Payer: Entrust Commercial |
$15.89
|
| Rate for Payer: First Choice Health Commercial |
$15.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.54
|
| Rate for Payer: HealthUtah PPO |
$16.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.23
|
| Rate for Payer: Multiplan Medicare/VA |
$9.06
|
| Rate for Payer: One Health Plan of WY PPO |
$16.40
|
| Rate for Payer: PacificSource Commercial |
$15.06
|
| Rate for Payer: PHCS PPO |
$16.40
|
| Rate for Payer: Three Rivers PPO |
$12.55
|
| Rate for Payer: TriWest Veterans Administration |
$9.54
|
| Rate for Payer: United Healthcare Commercial |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.40
|
| Rate for Payer: Wise Provider Network Commercial |
$15.89
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
NDC 0904629304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.40
|
| Rate for Payer: Aetna of WY Medicare |
$10.71
|
| Rate for Payer: Altius Commercial |
$16.06
|
| Rate for Payer: Beech Street Commercial |
$16.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.23
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.23
|
| Rate for Payer: Cigna of WY Commercial |
$16.40
|
| Rate for Payer: Entrust Commercial |
$15.89
|
| Rate for Payer: First Choice Health Commercial |
$15.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.21
|
| Rate for Payer: HealthUtah PPO |
$16.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.23
|
| Rate for Payer: Multiplan Medicare/VA |
$9.70
|
| Rate for Payer: One Health Plan of WY PPO |
$16.40
|
| Rate for Payer: PacificSource Commercial |
$15.06
|
| Rate for Payer: PHCS PPO |
$16.40
|
| Rate for Payer: Three Rivers PPO |
$12.55
|
| Rate for Payer: TriWest Veterans Administration |
$10.21
|
| Rate for Payer: United Healthcare Commercial |
$15.98
|
| Rate for Payer: United Healthcare Medicare |
$10.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.89
|
| Rate for Payer: Wise Provider Network Commercial |
$15.89
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [13079]
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.28
|
| Rate for Payer: Aetna of WY Medicare |
$12.53
|
| Rate for Payer: Aetna of WY Medicare |
$13.89
|
| Rate for Payer: Altius Commercial |
$20.84
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.06
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Cigna of WY Commercial |
$21.28
|
| Rate for Payer: Entrust Commercial |
$20.62
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$20.62
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.24
|
| Rate for Payer: HealthUtah PPO |
$21.71
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Multiplan Medicare/VA |
$11.35
|
| Rate for Payer: Multiplan Medicare/VA |
$12.58
|
| Rate for Payer: One Health Plan of WY PPO |
$21.28
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PacificSource Commercial |
$19.54
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: PHCS PPO |
$21.28
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$16.28
|
| Rate for Payer: TriWest Veterans Administration |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$20.73
|
| Rate for Payer: United Healthcare Commercial |
$18.70
|
| Rate for Payer: United Healthcare Medicare |
$13.24
|
| Rate for Payer: United Healthcare Medicare |
$11.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.60
|
| Rate for Payer: WINHealth Partners Commercial |
$20.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
| Rate for Payer: Wise Provider Network Commercial |
$20.62
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [13079]
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.28
|
| Rate for Payer: Aetna of WY Medicare |
$14.33
|
| Rate for Payer: Aetna of WY Medicare |
$12.92
|
| Rate for Payer: Altius Commercial |
$20.84
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Cigna of WY Commercial |
$21.28
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: Entrust Commercial |
$20.62
|
| Rate for Payer: First Choice Health Commercial |
$20.62
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.37
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$21.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.06
|
| Rate for Payer: Multiplan Medicare/VA |
$11.76
|
| Rate for Payer: Multiplan Medicare/VA |
$10.60
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$21.28
|
| Rate for Payer: PacificSource Commercial |
$19.54
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: PHCS PPO |
$21.28
|
| Rate for Payer: Three Rivers PPO |
$16.28
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: TriWest Veterans Administration |
$12.37
|
| Rate for Payer: TriWest Veterans Administration |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$20.73
|
| Rate for Payer: United Healthcare Medicare |
$12.37
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
| Rate for Payer: WINHealth Partners Commercial |
$19.19
|
| Rate for Payer: WINHealth Partners Commercial |
$21.28
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
| Rate for Payer: Wise Provider Network Commercial |
$20.62
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [160316]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.47
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.07
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$27.62
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.07
|
| Rate for Payer: United Healthcare Commercial |
$48.70
|
| Rate for Payer: United Healthcare Medicare |
$29.07
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [160316]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$32.64
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.47
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.11
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$29.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.11
|
| Rate for Payer: United Healthcare Commercial |
$48.70
|
| Rate for Payer: United Healthcare Medicare |
$31.11
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Aetna of WY Medicare |
$69.55
|
| Rate for Payer: Beech Street Commercial |
$364.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$372.48
|
| Rate for Payer: Cigna of WY Commercial |
$376.32
|
| Rate for Payer: First Choice Health Commercial |
$345.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.55
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$59.12
|
| Rate for Payer: One Health Plan of WY PPO |
$376.32
|
| Rate for Payer: PacificSource Commercial |
$345.60
|
| Rate for Payer: PHCS PPO |
$364.80
|
| Rate for Payer: Three Rivers PPO |
$288.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.55
|
| Rate for Payer: United Healthcare Commercial |
$364.80
|
| Rate for Payer: WINHealth Partners Commercial |
$364.80
|
|
