|
INSPIRE RESPIRATORY SENSING LEAD
|
Facility
|
IP
|
$11,812.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,406.44 |
| Max. Negotiated Rate |
$11,812.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,576.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,340.00
|
| Rate for Payer: Altius Commercial |
$11,340.00
|
| Rate for Payer: Beech Street Commercial |
$11,576.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,698.06
|
| Rate for Payer: Cash Price |
$8,268.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,458.12
|
| Rate for Payer: Cigna of WY Commercial |
$11,576.25
|
| Rate for Payer: Entrust Commercial |
$11,221.88
|
| Rate for Payer: First Choice Health Commercial |
$11,221.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,221.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,796.25
|
| Rate for Payer: HealthUtah PPO |
$11,812.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,458.12
|
| Rate for Payer: Multiplan Medicare/VA |
$7,406.44
|
| Rate for Payer: One Health Plan of WY PPO |
$11,576.25
|
| Rate for Payer: PacificSource Commercial |
$10,631.25
|
| Rate for Payer: PHCS PPO |
$11,576.25
|
| Rate for Payer: Three Rivers PPO |
$8,859.38
|
| Rate for Payer: TriWest Veterans Administration |
$7,796.25
|
| Rate for Payer: United Healthcare Commercial |
$10,276.88
|
| Rate for Payer: United Healthcare Medicare |
$7,796.25
|
| Rate for Payer: WINHealth Partners Commercial |
$11,221.88
|
| Rate for Payer: Wise Provider Network Commercial |
$11,221.88
|
|
|
INSPIRE SLEEP REMOTE
|
Facility
|
IP
|
$4,900.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,072.30 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,802.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,704.00
|
| Rate for Payer: Altius Commercial |
$4,704.00
|
| Rate for Payer: Beech Street Commercial |
$4,802.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,022.90
|
| Rate for Payer: Cash Price |
$3,430.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,753.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,802.00
|
| Rate for Payer: Entrust Commercial |
$4,655.00
|
| Rate for Payer: First Choice Health Commercial |
$4,655.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,655.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,234.00
|
| Rate for Payer: HealthUtah PPO |
$4,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,753.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,072.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4,802.00
|
| Rate for Payer: PacificSource Commercial |
$4,410.00
|
| Rate for Payer: PHCS PPO |
$4,802.00
|
| Rate for Payer: Three Rivers PPO |
$3,675.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,234.00
|
| Rate for Payer: United Healthcare Commercial |
$4,263.00
|
| Rate for Payer: United Healthcare Medicare |
$3,234.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,655.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,655.00
|
|
|
INSPIRE SLEEP REMOTE
|
Facility
|
OP
|
$4,900.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,699.90 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,802.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,234.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,704.00
|
| Rate for Payer: Altius Commercial |
$4,704.00
|
| Rate for Payer: Beech Street Commercial |
$4,802.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,022.90
|
| Rate for Payer: Cash Price |
$3,430.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,753.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,802.00
|
| Rate for Payer: Entrust Commercial |
$4,655.00
|
| Rate for Payer: First Choice Health Commercial |
$4,655.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,655.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,842.00
|
| Rate for Payer: HealthUtah PPO |
$4,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,753.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,699.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4,802.00
|
| Rate for Payer: PacificSource Commercial |
$4,410.00
|
| Rate for Payer: PHCS PPO |
$4,802.00
|
| Rate for Payer: Three Rivers PPO |
$3,675.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,842.00
|
| Rate for Payer: United Healthcare Commercial |
$4,263.00
|
| Rate for Payer: United Healthcare Medicare |
$2,842.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,802.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,655.00
|
|
|
INSPIRE STIMULATION LEAD
|
Facility
|
OP
|
$6,825.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,760.58 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,504.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,552.00
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,603.32
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,958.50
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,760.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,958.50
|
| Rate for Payer: United Healthcare Commercial |
$5,937.75
|
| Rate for Payer: United Healthcare Medicare |
$3,958.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
INSPIRE STIMULATION LEAD
|
Facility
|
IP
|
$6,825.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,279.28 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,552.00
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,603.32
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,504.50
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$4,279.28
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,504.50
|
| Rate for Payer: United Healthcare Commercial |
$5,937.75
|
| Rate for Payer: United Healthcare Medicare |
$4,504.50
|
| Rate for Payer: WINHealth Partners Commercial |
$6,483.75
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
INSTRUMENT TRACKER MEDTRONIC
|
Facility
|
IP
|
$554.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$554.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.56
|
| Rate for Payer: Altius Commercial |
$532.56
|
| Rate for Payer: Beech Street Commercial |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$388.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.11
|
| Rate for Payer: Cigna of WY Commercial |
$543.66
|
| Rate for Payer: Entrust Commercial |
$527.01
|
| Rate for Payer: First Choice Health Commercial |
$527.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$366.14
|
| Rate for Payer: HealthUtah PPO |
$554.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.11
|
| Rate for Payer: Multiplan Medicare/VA |
$347.83
|
| Rate for Payer: One Health Plan of WY PPO |
$543.66
|
| Rate for Payer: PacificSource Commercial |
$499.28
|
| Rate for Payer: PHCS PPO |
$543.66
|
| Rate for Payer: Three Rivers PPO |
$416.06
|
| Rate for Payer: TriWest Veterans Administration |
$366.14
|
| Rate for Payer: United Healthcare Commercial |
$482.63
|
| Rate for Payer: United Healthcare Medicare |
$366.14
|
| Rate for Payer: WINHealth Partners Commercial |
$527.01
|
| Rate for Payer: Wise Provider Network Commercial |
$527.01
|
|
|
INSTRUMENT TRACKER MEDTRONIC
|
Facility
|
OP
|
$554.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.67 |
| Max. Negotiated Rate |
$554.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.66
|
| Rate for Payer: Aetna of WY Medicare |
$366.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.56
|
| Rate for Payer: Altius Commercial |
$532.56
|
| Rate for Payer: Beech Street Commercial |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$388.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.11
|
| Rate for Payer: Cigna of WY Commercial |
$543.66
|
| Rate for Payer: Entrust Commercial |
$527.01
|
| Rate for Payer: First Choice Health Commercial |
$527.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.76
|
| Rate for Payer: HealthUtah PPO |
$554.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.11
|
| Rate for Payer: Multiplan Medicare/VA |
$305.67
|
| Rate for Payer: One Health Plan of WY PPO |
$543.66
|
| Rate for Payer: PacificSource Commercial |
$499.28
|
| Rate for Payer: PHCS PPO |
$543.66
|
| Rate for Payer: Three Rivers PPO |
$416.06
|
| Rate for Payer: TriWest Veterans Administration |
$321.76
|
| Rate for Payer: United Healthcare Commercial |
$482.63
|
| Rate for Payer: United Healthcare Medicare |
$321.76
|
| Rate for Payer: WINHealth Partners Commercial |
$543.66
|
| Rate for Payer: Wise Provider Network Commercial |
$527.01
|
|
|
INSUFFLATION DEVICE ENDO BALLOON
|
Facility
|
OP
|
$126.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.82
|
| Rate for Payer: Aetna of WY Medicare |
$83.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.30
|
| Rate for Payer: Altius Commercial |
$121.30
|
| Rate for Payer: Beech Street Commercial |
$123.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.73
|
| Rate for Payer: Cash Price |
$88.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.56
|
| Rate for Payer: Cigna of WY Commercial |
$123.82
|
| Rate for Payer: Entrust Commercial |
$120.03
|
| Rate for Payer: First Choice Health Commercial |
$120.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.28
|
| Rate for Payer: HealthUtah PPO |
$126.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.56
|
| Rate for Payer: Multiplan Medicare/VA |
$69.62
|
| Rate for Payer: One Health Plan of WY PPO |
$123.82
|
| Rate for Payer: PacificSource Commercial |
$113.72
|
| Rate for Payer: PHCS PPO |
$123.82
|
| Rate for Payer: Three Rivers PPO |
$94.76
|
| Rate for Payer: TriWest Veterans Administration |
$73.28
|
| Rate for Payer: United Healthcare Commercial |
$109.92
|
| Rate for Payer: United Healthcare Medicare |
$73.28
|
| Rate for Payer: WINHealth Partners Commercial |
$123.82
|
| Rate for Payer: Wise Provider Network Commercial |
$120.03
|
|
|
INSUFFLATION DEVICE ENDO BALLOON
|
Facility
|
IP
|
$126.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.30
|
| Rate for Payer: Altius Commercial |
$121.30
|
| Rate for Payer: Beech Street Commercial |
$123.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.73
|
| Rate for Payer: Cash Price |
$88.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.56
|
| Rate for Payer: Cigna of WY Commercial |
$123.82
|
| Rate for Payer: Entrust Commercial |
$120.03
|
| Rate for Payer: First Choice Health Commercial |
$120.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.39
|
| Rate for Payer: HealthUtah PPO |
$126.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.56
|
| Rate for Payer: Multiplan Medicare/VA |
$79.22
|
| Rate for Payer: One Health Plan of WY PPO |
$123.82
|
| Rate for Payer: PacificSource Commercial |
$113.72
|
| Rate for Payer: PHCS PPO |
$123.82
|
| Rate for Payer: Three Rivers PPO |
$94.76
|
| Rate for Payer: TriWest Veterans Administration |
$83.39
|
| Rate for Payer: United Healthcare Commercial |
$109.92
|
| Rate for Payer: United Healthcare Medicare |
$83.39
|
| Rate for Payer: WINHealth Partners Commercial |
$120.03
|
| Rate for Payer: Wise Provider Network Commercial |
$120.03
|
|
|
INSULIN DEGLUDEC (U-200) 200 UNIT/ML (3 ML) SUBCUTANEOUS PEN [142575]
|
Facility
|
IP
|
$133.63
|
|
|
Service Code
|
NDC 0169255013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.28
|
| Rate for Payer: Altius Commercial |
$128.28
|
| Rate for Payer: Beech Street Commercial |
$130.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.71
|
| Rate for Payer: Cash Price |
$93.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.62
|
| Rate for Payer: Cigna of WY Commercial |
$130.96
|
| Rate for Payer: Entrust Commercial |
$126.95
|
| Rate for Payer: First Choice Health Commercial |
$126.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.20
|
| Rate for Payer: HealthUtah PPO |
$133.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.62
|
| Rate for Payer: Multiplan Medicare/VA |
$83.79
|
| Rate for Payer: One Health Plan of WY PPO |
$130.96
|
| Rate for Payer: PacificSource Commercial |
$120.27
|
| Rate for Payer: PHCS PPO |
$130.96
|
| Rate for Payer: Three Rivers PPO |
$100.22
|
| Rate for Payer: TriWest Veterans Administration |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$116.26
|
| Rate for Payer: United Healthcare Medicare |
$88.20
|
| Rate for Payer: WINHealth Partners Commercial |
$126.95
|
| Rate for Payer: Wise Provider Network Commercial |
$126.95
|
|
|
INSULIN DEGLUDEC (U-200) 200 UNIT/ML (3 ML) SUBCUTANEOUS PEN [142575]
|
Facility
|
OP
|
$133.63
|
|
|
Service Code
|
NDC 0169255013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.96
|
| Rate for Payer: Aetna of WY Medicare |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.28
|
| Rate for Payer: Altius Commercial |
$128.28
|
| Rate for Payer: Beech Street Commercial |
$130.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.71
|
| Rate for Payer: Cash Price |
$93.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.62
|
| Rate for Payer: Cigna of WY Commercial |
$130.96
|
| Rate for Payer: Entrust Commercial |
$126.95
|
| Rate for Payer: First Choice Health Commercial |
$126.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.51
|
| Rate for Payer: HealthUtah PPO |
$133.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.62
|
| Rate for Payer: Multiplan Medicare/VA |
$73.63
|
| Rate for Payer: One Health Plan of WY PPO |
$130.96
|
| Rate for Payer: PacificSource Commercial |
$120.27
|
| Rate for Payer: PHCS PPO |
$130.96
|
| Rate for Payer: Three Rivers PPO |
$100.22
|
| Rate for Payer: TriWest Veterans Administration |
$77.51
|
| Rate for Payer: United Healthcare Commercial |
$116.26
|
| Rate for Payer: United Healthcare Medicare |
$77.51
|
| Rate for Payer: WINHealth Partners Commercial |
$130.96
|
| Rate for Payer: Wise Provider Network Commercial |
$126.95
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [40581]
|
Facility
|
OP
|
$47.35
|
|
|
Service Code
|
NDC 0169643255
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.40
|
| Rate for Payer: Aetna of WY Medicare |
$31.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.46
|
| Rate for Payer: Altius Commercial |
$45.46
|
| Rate for Payer: Beech Street Commercial |
$46.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.87
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.93
|
| Rate for Payer: Cigna of WY Commercial |
$46.40
|
| Rate for Payer: Entrust Commercial |
$44.98
|
| Rate for Payer: First Choice Health Commercial |
$44.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.46
|
| Rate for Payer: HealthUtah PPO |
$47.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.93
|
| Rate for Payer: Multiplan Medicare/VA |
$26.09
|
| Rate for Payer: One Health Plan of WY PPO |
$46.40
|
| Rate for Payer: PacificSource Commercial |
$42.62
|
| Rate for Payer: PHCS PPO |
$46.40
|
| Rate for Payer: Three Rivers PPO |
$35.51
|
| Rate for Payer: TriWest Veterans Administration |
$27.46
|
| Rate for Payer: United Healthcare Commercial |
$41.19
|
| Rate for Payer: United Healthcare Medicare |
$27.46
|
| Rate for Payer: WINHealth Partners Commercial |
$46.40
|
| Rate for Payer: Wise Provider Network Commercial |
$44.98
|
|
|
INSULIN DETEMIR (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [40581]
|
Facility
|
IP
|
$47.35
|
|
|
Service Code
|
NDC 0169643255
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.46
|
| Rate for Payer: Altius Commercial |
$45.46
|
| Rate for Payer: Beech Street Commercial |
$46.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.87
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.93
|
| Rate for Payer: Cigna of WY Commercial |
$46.40
|
| Rate for Payer: Entrust Commercial |
$44.98
|
| Rate for Payer: First Choice Health Commercial |
$44.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.25
|
| Rate for Payer: HealthUtah PPO |
$47.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.93
|
| Rate for Payer: Multiplan Medicare/VA |
$29.69
|
| Rate for Payer: One Health Plan of WY PPO |
$46.40
|
| Rate for Payer: PacificSource Commercial |
$42.62
|
| Rate for Payer: PHCS PPO |
$46.40
|
| Rate for Payer: Three Rivers PPO |
$35.51
|
| Rate for Payer: TriWest Veterans Administration |
$31.25
|
| Rate for Payer: United Healthcare Commercial |
$41.19
|
| Rate for Payer: United Healthcare Medicare |
$31.25
|
| Rate for Payer: WINHealth Partners Commercial |
$44.98
|
| Rate for Payer: Wise Provider Network Commercial |
$44.98
|
|
|
INSULIN GLARGINE 100 UNIT-LIXISENATIDE 33 MCG/ML SUBCUTANEOUS PEN [147186]
|
Facility
|
IP
|
$118.93
|
|
|
Service Code
|
NDC 0024576105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$118.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.17
|
| Rate for Payer: Altius Commercial |
$114.17
|
| Rate for Payer: Beech Street Commercial |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.64
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.36
|
| Rate for Payer: Cigna of WY Commercial |
$116.55
|
| Rate for Payer: Entrust Commercial |
$112.98
|
| Rate for Payer: First Choice Health Commercial |
$112.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.49
|
| Rate for Payer: HealthUtah PPO |
$118.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.36
|
| Rate for Payer: Multiplan Medicare/VA |
$74.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.55
|
| Rate for Payer: PacificSource Commercial |
$107.04
|
| Rate for Payer: PHCS PPO |
$116.55
|
| Rate for Payer: Three Rivers PPO |
$89.20
|
| Rate for Payer: TriWest Veterans Administration |
$78.49
|
| Rate for Payer: United Healthcare Commercial |
$103.47
|
| Rate for Payer: United Healthcare Medicare |
$78.49
|
| Rate for Payer: WINHealth Partners Commercial |
$112.98
|
| Rate for Payer: Wise Provider Network Commercial |
$112.98
|
|
|
INSULIN GLARGINE 100 UNIT-LIXISENATIDE 33 MCG/ML SUBCUTANEOUS PEN [147186]
|
Facility
|
OP
|
$113.99
|
|
|
Service Code
|
NDC 0024576102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$113.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.71
|
| Rate for Payer: Aetna of WY Medicare |
$75.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.43
|
| Rate for Payer: Altius Commercial |
$109.43
|
| Rate for Payer: Beech Street Commercial |
$111.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.59
|
| Rate for Payer: Cash Price |
$79.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.57
|
| Rate for Payer: Cigna of WY Commercial |
$111.71
|
| Rate for Payer: Entrust Commercial |
$108.29
|
| Rate for Payer: First Choice Health Commercial |
$108.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.11
|
| Rate for Payer: HealthUtah PPO |
$113.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.57
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$111.71
|
| Rate for Payer: PacificSource Commercial |
$102.59
|
| Rate for Payer: PHCS PPO |
$111.71
|
| Rate for Payer: Three Rivers PPO |
$85.49
|
| Rate for Payer: TriWest Veterans Administration |
$66.11
|
| Rate for Payer: United Healthcare Commercial |
$99.17
|
| Rate for Payer: United Healthcare Medicare |
$66.11
|
| Rate for Payer: WINHealth Partners Commercial |
$111.71
|
| Rate for Payer: Wise Provider Network Commercial |
$108.29
|
|
|
INSULIN GLARGINE 100 UNIT-LIXISENATIDE 33 MCG/ML SUBCUTANEOUS PEN [147186]
|
Facility
|
OP
|
$118.93
|
|
|
Service Code
|
NDC 0024576105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$118.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.55
|
| Rate for Payer: Aetna of WY Medicare |
$78.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.17
|
| Rate for Payer: Altius Commercial |
$114.17
|
| Rate for Payer: Beech Street Commercial |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.64
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.36
|
| Rate for Payer: Cigna of WY Commercial |
$116.55
|
| Rate for Payer: Entrust Commercial |
$112.98
|
| Rate for Payer: First Choice Health Commercial |
$112.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.98
|
| Rate for Payer: HealthUtah PPO |
$118.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.36
|
| Rate for Payer: Multiplan Medicare/VA |
$65.53
|
| Rate for Payer: One Health Plan of WY PPO |
$116.55
|
| Rate for Payer: PacificSource Commercial |
$107.04
|
| Rate for Payer: PHCS PPO |
$116.55
|
| Rate for Payer: Three Rivers PPO |
$89.20
|
| Rate for Payer: TriWest Veterans Administration |
$68.98
|
| Rate for Payer: United Healthcare Commercial |
$103.47
|
| Rate for Payer: United Healthcare Medicare |
$68.98
|
| Rate for Payer: WINHealth Partners Commercial |
$116.55
|
| Rate for Payer: Wise Provider Network Commercial |
$112.98
|
|
|
INSULIN GLARGINE 100 UNIT-LIXISENATIDE 33 MCG/ML SUBCUTANEOUS PEN [147186]
|
Facility
|
IP
|
$113.99
|
|
|
Service Code
|
NDC 0024576102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$113.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.43
|
| Rate for Payer: Altius Commercial |
$109.43
|
| Rate for Payer: Beech Street Commercial |
$111.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.59
|
| Rate for Payer: Cash Price |
$79.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.57
|
| Rate for Payer: Cigna of WY Commercial |
$111.71
|
| Rate for Payer: Entrust Commercial |
$108.29
|
| Rate for Payer: First Choice Health Commercial |
$108.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.23
|
| Rate for Payer: HealthUtah PPO |
$113.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.57
|
| Rate for Payer: Multiplan Medicare/VA |
$71.47
|
| Rate for Payer: One Health Plan of WY PPO |
$111.71
|
| Rate for Payer: PacificSource Commercial |
$102.59
|
| Rate for Payer: PHCS PPO |
$111.71
|
| Rate for Payer: Three Rivers PPO |
$85.49
|
| Rate for Payer: TriWest Veterans Administration |
$75.23
|
| Rate for Payer: United Healthcare Commercial |
$99.17
|
| Rate for Payer: United Healthcare Medicare |
$75.23
|
| Rate for Payer: WINHealth Partners Commercial |
$108.29
|
| Rate for Payer: Wise Provider Network Commercial |
$108.29
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
IP
|
$58.51
|
|
|
Service Code
|
NDC 0002771559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$58.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.17
|
| Rate for Payer: Altius Commercial |
$56.17
|
| Rate for Payer: Beech Street Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.04
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.75
|
| Rate for Payer: Cigna of WY Commercial |
$57.34
|
| Rate for Payer: Entrust Commercial |
$55.58
|
| Rate for Payer: First Choice Health Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.62
|
| Rate for Payer: HealthUtah PPO |
$58.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.75
|
| Rate for Payer: Multiplan Medicare/VA |
$36.69
|
| Rate for Payer: One Health Plan of WY PPO |
$57.34
|
| Rate for Payer: PacificSource Commercial |
$52.66
|
| Rate for Payer: PHCS PPO |
$57.34
|
| Rate for Payer: Three Rivers PPO |
$43.88
|
| Rate for Payer: TriWest Veterans Administration |
$38.62
|
| Rate for Payer: United Healthcare Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare |
$38.62
|
| Rate for Payer: WINHealth Partners Commercial |
$55.58
|
| Rate for Payer: Wise Provider Network Commercial |
$55.58
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
IP
|
$37.49
|
|
|
Service Code
|
NDC 0088221901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$37.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.99
|
| Rate for Payer: Altius Commercial |
$35.99
|
| Rate for Payer: Beech Street Commercial |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.78
|
| Rate for Payer: Cash Price |
$26.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.37
|
| Rate for Payer: Cigna of WY Commercial |
$36.74
|
| Rate for Payer: Entrust Commercial |
$35.62
|
| Rate for Payer: First Choice Health Commercial |
$35.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.74
|
| Rate for Payer: HealthUtah PPO |
$37.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.37
|
| Rate for Payer: Multiplan Medicare/VA |
$23.51
|
| Rate for Payer: One Health Plan of WY PPO |
$36.74
|
| Rate for Payer: PacificSource Commercial |
$33.74
|
| Rate for Payer: PHCS PPO |
$36.74
|
| Rate for Payer: Three Rivers PPO |
$28.12
|
| Rate for Payer: TriWest Veterans Administration |
$24.74
|
| Rate for Payer: United Healthcare Commercial |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$24.74
|
| Rate for Payer: WINHealth Partners Commercial |
$35.62
|
| Rate for Payer: Wise Provider Network Commercial |
$35.62
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
OP
|
$37.49
|
|
|
Service Code
|
NDC 0088221901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$37.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.74
|
| Rate for Payer: Aetna of WY Medicare |
$24.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.99
|
| Rate for Payer: Altius Commercial |
$35.99
|
| Rate for Payer: Beech Street Commercial |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.78
|
| Rate for Payer: Cash Price |
$26.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.37
|
| Rate for Payer: Cigna of WY Commercial |
$36.74
|
| Rate for Payer: Entrust Commercial |
$35.62
|
| Rate for Payer: First Choice Health Commercial |
$35.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.74
|
| Rate for Payer: HealthUtah PPO |
$37.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.37
|
| Rate for Payer: Multiplan Medicare/VA |
$20.66
|
| Rate for Payer: One Health Plan of WY PPO |
$36.74
|
| Rate for Payer: PacificSource Commercial |
$33.74
|
| Rate for Payer: PHCS PPO |
$36.74
|
| Rate for Payer: Three Rivers PPO |
$28.12
|
| Rate for Payer: TriWest Veterans Administration |
$21.74
|
| Rate for Payer: United Healthcare Commercial |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$21.74
|
| Rate for Payer: WINHealth Partners Commercial |
$36.74
|
| Rate for Payer: Wise Provider Network Commercial |
$35.62
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
OP
|
$58.51
|
|
|
Service Code
|
NDC 0002771559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$58.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.34
|
| Rate for Payer: Aetna of WY Medicare |
$38.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.17
|
| Rate for Payer: Altius Commercial |
$56.17
|
| Rate for Payer: Beech Street Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.04
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.75
|
| Rate for Payer: Cigna of WY Commercial |
$57.34
|
| Rate for Payer: Entrust Commercial |
$55.58
|
| Rate for Payer: First Choice Health Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.94
|
| Rate for Payer: HealthUtah PPO |
$58.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.75
|
| Rate for Payer: Multiplan Medicare/VA |
$32.24
|
| Rate for Payer: One Health Plan of WY PPO |
$57.34
|
| Rate for Payer: PacificSource Commercial |
$52.66
|
| Rate for Payer: PHCS PPO |
$57.34
|
| Rate for Payer: Three Rivers PPO |
$43.88
|
| Rate for Payer: TriWest Veterans Administration |
$33.94
|
| Rate for Payer: United Healthcare Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare |
$33.94
|
| Rate for Payer: WINHealth Partners Commercial |
$57.34
|
| Rate for Payer: Wise Provider Network Commercial |
$55.58
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
OP
|
$58.51
|
|
|
Service Code
|
NDC 0002771501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$58.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.34
|
| Rate for Payer: Aetna of WY Medicare |
$38.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.17
|
| Rate for Payer: Altius Commercial |
$56.17
|
| Rate for Payer: Beech Street Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.04
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.75
|
| Rate for Payer: Cigna of WY Commercial |
$57.34
|
| Rate for Payer: Entrust Commercial |
$55.58
|
| Rate for Payer: First Choice Health Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.94
|
| Rate for Payer: HealthUtah PPO |
$58.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.75
|
| Rate for Payer: Multiplan Medicare/VA |
$32.24
|
| Rate for Payer: One Health Plan of WY PPO |
$57.34
|
| Rate for Payer: PacificSource Commercial |
$52.66
|
| Rate for Payer: PHCS PPO |
$57.34
|
| Rate for Payer: Three Rivers PPO |
$43.88
|
| Rate for Payer: TriWest Veterans Administration |
$33.94
|
| Rate for Payer: United Healthcare Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare |
$33.94
|
| Rate for Payer: WINHealth Partners Commercial |
$57.34
|
| Rate for Payer: Wise Provider Network Commercial |
$55.58
|
|
|
INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [44267]
|
Facility
|
IP
|
$58.51
|
|
|
Service Code
|
NDC 0002771501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$58.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.17
|
| Rate for Payer: Altius Commercial |
$56.17
|
| Rate for Payer: Beech Street Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.04
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.75
|
| Rate for Payer: Cigna of WY Commercial |
$57.34
|
| Rate for Payer: Entrust Commercial |
$55.58
|
| Rate for Payer: First Choice Health Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.62
|
| Rate for Payer: HealthUtah PPO |
$58.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.75
|
| Rate for Payer: Multiplan Medicare/VA |
$36.69
|
| Rate for Payer: One Health Plan of WY PPO |
$57.34
|
| Rate for Payer: PacificSource Commercial |
$52.66
|
| Rate for Payer: PHCS PPO |
$57.34
|
| Rate for Payer: Three Rivers PPO |
$43.88
|
| Rate for Payer: TriWest Veterans Administration |
$38.62
|
| Rate for Payer: United Healthcare Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare |
$38.62
|
| Rate for Payer: WINHealth Partners Commercial |
$55.58
|
| Rate for Payer: Wise Provider Network Commercial |
$55.58
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
NDC 8325701532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.07
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$22.87
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$24.07
|
| Rate for Payer: WINHealth Partners Commercial |
$34.65
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
NDC 4950239471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.07
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$22.87
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$24.07
|
| Rate for Payer: WINHealth Partners Commercial |
$34.65
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
