|
INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$3,847.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,770.06
|
| Rate for Payer: Aetna of WY Medicare |
$128.88
|
| Rate for Payer: Beech Street Commercial |
$3,654.65
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,731.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,770.06
|
| Rate for Payer: First Choice Health Commercial |
$3,462.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,654.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.88
|
| Rate for Payer: HealthUtah PPO |
$3,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,731.59
|
| Rate for Payer: Multiplan Medicare/VA |
$109.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,770.06
|
| Rate for Payer: PacificSource Commercial |
$3,462.30
|
| Rate for Payer: PHCS PPO |
$3,654.65
|
| Rate for Payer: Three Rivers PPO |
$2,885.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.88
|
| Rate for Payer: United Healthcare Commercial |
$3,346.89
|
| Rate for Payer: United Healthcare Medicare |
$128.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,269.95
|
|
|
INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
J7300
|
| Min. Negotiated Rate |
$1,104.00 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Beech Street Commercial |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: First Choice Health Commercial |
$1,324.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,398.40
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.40
|
|
|
INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 57180
|
| Hospital Charge Code |
57180
|
| Min. Negotiated Rate |
$99.98 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$567.42
|
| Rate for Payer: Aetna of WY Medicare |
$117.62
|
| Rate for Payer: Beech Street Commercial |
$550.05
|
| Rate for Payer: Cash Price |
$405.30
|
| Rate for Payer: Cash Price |
$405.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$561.63
|
| Rate for Payer: Cigna of WY Commercial |
$567.42
|
| Rate for Payer: First Choice Health Commercial |
$521.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$550.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.62
|
| Rate for Payer: HealthUtah PPO |
$579.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$561.63
|
| Rate for Payer: Multiplan Medicare/VA |
$99.98
|
| Rate for Payer: One Health Plan of WY PPO |
$567.42
|
| Rate for Payer: PacificSource Commercial |
$521.10
|
| Rate for Payer: PHCS PPO |
$550.05
|
| Rate for Payer: Three Rivers PPO |
$434.25
|
| Rate for Payer: TriWest Veterans Administration |
$117.62
|
| Rate for Payer: United Healthcare Commercial |
$503.73
|
| Rate for Payer: United Healthcare Medicare |
$117.62
|
| Rate for Payer: WINHealth Partners Commercial |
$492.15
|
|
|
INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
36000
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Beech Street Commercial |
$313.50
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: First Choice Health Commercial |
$297.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$313.50
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$280.50
|
|
|
INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
36140
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$2,416.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,367.68
|
| Rate for Payer: Aetna of WY Medicare |
$82.06
|
| Rate for Payer: Beech Street Commercial |
$2,295.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,343.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,367.68
|
| Rate for Payer: First Choice Health Commercial |
$2,174.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,295.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.06
|
| Rate for Payer: HealthUtah PPO |
$2,416.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,343.52
|
| Rate for Payer: Multiplan Medicare/VA |
$69.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,367.68
|
| Rate for Payer: PacificSource Commercial |
$2,174.40
|
| Rate for Payer: PHCS PPO |
$2,295.20
|
| Rate for Payer: Three Rivers PPO |
$1,812.00
|
| Rate for Payer: TriWest Veterans Administration |
$82.06
|
| Rate for Payer: United Healthcare Commercial |
$2,101.92
|
| Rate for Payer: United Healthcare Medicare |
$82.06
|
| Rate for Payer: WINHealth Partners Commercial |
$2,053.60
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
31500
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$132.87
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.87
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Multiplan Medicare/VA |
$112.94
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.87
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Medicare |
$132.87
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 3877905988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.27
|
| Rate for Payer: Altius Commercial |
$1.27
|
| Rate for Payer: Beech Street Commercial |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.28
|
| Rate for Payer: Cigna of WY Commercial |
$1.29
|
| Rate for Payer: Entrust Commercial |
$1.25
|
| Rate for Payer: First Choice Health Commercial |
$1.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.87
|
| Rate for Payer: HealthUtah PPO |
$1.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1.29
|
| Rate for Payer: PacificSource Commercial |
$1.19
|
| Rate for Payer: PHCS PPO |
$1.29
|
| Rate for Payer: Three Rivers PPO |
$0.99
|
| Rate for Payer: TriWest Veterans Administration |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Medicare |
$0.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1.25
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
IP
|
$9.21
|
|
|
Service Code
|
NDC 4843323015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.84
|
| Rate for Payer: Altius Commercial |
$8.84
|
| Rate for Payer: Beech Street Commercial |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.56
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.93
|
| Rate for Payer: Cigna of WY Commercial |
$9.03
|
| Rate for Payer: Entrust Commercial |
$8.75
|
| Rate for Payer: First Choice Health Commercial |
$8.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.08
|
| Rate for Payer: HealthUtah PPO |
$9.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.93
|
| Rate for Payer: Multiplan Medicare/VA |
$5.77
|
| Rate for Payer: One Health Plan of WY PPO |
$9.03
|
| Rate for Payer: PacificSource Commercial |
$8.29
|
| Rate for Payer: PHCS PPO |
$9.03
|
| Rate for Payer: Three Rivers PPO |
$6.91
|
| Rate for Payer: TriWest Veterans Administration |
$6.08
|
| Rate for Payer: United Healthcare Commercial |
$8.01
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
| Rate for Payer: WINHealth Partners Commercial |
$8.75
|
| Rate for Payer: Wise Provider Network Commercial |
$8.75
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 0395277516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.58
|
| Rate for Payer: Altius Commercial |
$0.58
|
| Rate for Payer: Beech Street Commercial |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.58
|
| Rate for Payer: Cigna of WY Commercial |
$0.59
|
| Rate for Payer: Entrust Commercial |
$0.57
|
| Rate for Payer: First Choice Health Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.40
|
| Rate for Payer: HealthUtah PPO |
$0.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.58
|
| Rate for Payer: Multiplan Medicare/VA |
$0.38
|
| Rate for Payer: One Health Plan of WY PPO |
$0.59
|
| Rate for Payer: PacificSource Commercial |
$0.54
|
| Rate for Payer: PHCS PPO |
$0.59
|
| Rate for Payer: Three Rivers PPO |
$0.45
|
| Rate for Payer: TriWest Veterans Administration |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.52
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.57
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 0395277516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.59
|
| Rate for Payer: Aetna of WY Medicare |
$0.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.58
|
| Rate for Payer: Altius Commercial |
$0.58
|
| Rate for Payer: Beech Street Commercial |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.58
|
| Rate for Payer: Cigna of WY Commercial |
$0.59
|
| Rate for Payer: Entrust Commercial |
$0.57
|
| Rate for Payer: First Choice Health Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.58
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.59
|
| Rate for Payer: PacificSource Commercial |
$0.54
|
| Rate for Payer: PHCS PPO |
$0.59
|
| Rate for Payer: Three Rivers PPO |
$0.45
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.52
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.59
|
| Rate for Payer: Wise Provider Network Commercial |
$0.57
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 3877905988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.29
|
| Rate for Payer: Aetna of WY Medicare |
$0.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.27
|
| Rate for Payer: Altius Commercial |
$1.27
|
| Rate for Payer: Beech Street Commercial |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.28
|
| Rate for Payer: Cigna of WY Commercial |
$1.29
|
| Rate for Payer: Entrust Commercial |
$1.25
|
| Rate for Payer: First Choice Health Commercial |
$1.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.29
|
| Rate for Payer: PacificSource Commercial |
$1.19
|
| Rate for Payer: PHCS PPO |
$1.29
|
| Rate for Payer: Three Rivers PPO |
$0.99
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.29
|
| Rate for Payer: Wise Provider Network Commercial |
$1.25
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION [1716]
|
Facility
|
OP
|
$9.21
|
|
|
Service Code
|
NDC 4843323015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.03
|
| Rate for Payer: Aetna of WY Medicare |
$6.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.84
|
| Rate for Payer: Altius Commercial |
$8.84
|
| Rate for Payer: Beech Street Commercial |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.56
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.93
|
| Rate for Payer: Cigna of WY Commercial |
$9.03
|
| Rate for Payer: Entrust Commercial |
$8.75
|
| Rate for Payer: First Choice Health Commercial |
$8.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.34
|
| Rate for Payer: HealthUtah PPO |
$9.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.93
|
| Rate for Payer: Multiplan Medicare/VA |
$5.07
|
| Rate for Payer: One Health Plan of WY PPO |
$9.03
|
| Rate for Payer: PacificSource Commercial |
$8.29
|
| Rate for Payer: PHCS PPO |
$9.03
|
| Rate for Payer: Three Rivers PPO |
$6.91
|
| Rate for Payer: TriWest Veterans Administration |
$5.34
|
| Rate for Payer: United Healthcare Commercial |
$8.01
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WINHealth Partners Commercial |
$9.03
|
| Rate for Payer: Wise Provider Network Commercial |
$8.75
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [4572]
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS Q9967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.97
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.60
|
| Rate for Payer: Aetna of WY Medicare |
$12.30
|
| Rate for Payer: Aetna of WY Medicare |
$12.53
|
| Rate for Payer: Aetna of WY Medicare |
$12.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.22
|
| Rate for Payer: Altius Commercial |
$17.88
|
| Rate for Payer: Altius Commercial |
$18.22
|
| Rate for Payer: Altius Commercial |
$17.61
|
| Rate for Payer: Beech Street Commercial |
$18.26
|
| Rate for Payer: Beech Street Commercial |
$18.60
|
| Rate for Payer: Beech Street Commercial |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.79
|
| Rate for Payer: Cigna of WY Commercial |
$18.60
|
| Rate for Payer: Cigna of WY Commercial |
$17.97
|
| Rate for Payer: Cigna of WY Commercial |
$18.26
|
| Rate for Payer: Entrust Commercial |
$18.03
|
| Rate for Payer: Entrust Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.42
|
| Rate for Payer: First Choice Health Commercial |
$17.70
|
| Rate for Payer: First Choice Health Commercial |
$17.42
|
| Rate for Payer: First Choice Health Commercial |
$18.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.01
|
| Rate for Payer: HealthUtah PPO |
$18.34
|
| Rate for Payer: HealthUtah PPO |
$18.98
|
| Rate for Payer: HealthUtah PPO |
$18.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.07
|
| Rate for Payer: Multiplan Medicare/VA |
$10.11
|
| Rate for Payer: Multiplan Medicare/VA |
$10.27
|
| Rate for Payer: Multiplan Medicare/VA |
$10.46
|
| Rate for Payer: One Health Plan of WY PPO |
$17.97
|
| Rate for Payer: One Health Plan of WY PPO |
$18.60
|
| Rate for Payer: One Health Plan of WY PPO |
$18.26
|
| Rate for Payer: PacificSource Commercial |
$17.08
|
| Rate for Payer: PacificSource Commercial |
$16.77
|
| Rate for Payer: PacificSource Commercial |
$16.51
|
| Rate for Payer: PHCS PPO |
$18.26
|
| Rate for Payer: PHCS PPO |
$17.97
|
| Rate for Payer: PHCS PPO |
$18.60
|
| Rate for Payer: Three Rivers PPO |
$13.97
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: Three Rivers PPO |
$14.24
|
| Rate for Payer: TriWest Veterans Administration |
$11.01
|
| Rate for Payer: TriWest Veterans Administration |
$10.81
|
| Rate for Payer: TriWest Veterans Administration |
$10.64
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$16.21
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare |
$11.01
|
| Rate for Payer: United Healthcare Medicare |
$10.64
|
| Rate for Payer: United Healthcare Medicare |
$10.81
|
| Rate for Payer: WINHealth Partners Commercial |
$18.60
|
| Rate for Payer: WINHealth Partners Commercial |
$17.97
|
| Rate for Payer: WINHealth Partners Commercial |
$18.26
|
| Rate for Payer: Wise Provider Network Commercial |
$17.42
|
| Rate for Payer: Wise Provider Network Commercial |
$18.03
|
| Rate for Payer: Wise Provider Network Commercial |
$17.70
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION [4572]
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
HCPCS Q9967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.97
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.22
|
| Rate for Payer: Altius Commercial |
$17.88
|
| Rate for Payer: Altius Commercial |
$17.61
|
| Rate for Payer: Altius Commercial |
$18.22
|
| Rate for Payer: Beech Street Commercial |
$18.60
|
| Rate for Payer: Beech Street Commercial |
$18.26
|
| Rate for Payer: Beech Street Commercial |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.07
|
| Rate for Payer: Cigna of WY Commercial |
$18.26
|
| Rate for Payer: Cigna of WY Commercial |
$18.60
|
| Rate for Payer: Cigna of WY Commercial |
$17.97
|
| Rate for Payer: Entrust Commercial |
$18.03
|
| Rate for Payer: Entrust Commercial |
$17.42
|
| Rate for Payer: Entrust Commercial |
$17.70
|
| Rate for Payer: First Choice Health Commercial |
$17.70
|
| Rate for Payer: First Choice Health Commercial |
$18.03
|
| Rate for Payer: First Choice Health Commercial |
$17.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.53
|
| Rate for Payer: HealthUtah PPO |
$18.34
|
| Rate for Payer: HealthUtah PPO |
$18.63
|
| Rate for Payer: HealthUtah PPO |
$18.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.79
|
| Rate for Payer: Multiplan Medicare/VA |
$11.90
|
| Rate for Payer: Multiplan Medicare/VA |
$11.50
|
| Rate for Payer: Multiplan Medicare/VA |
$11.68
|
| Rate for Payer: One Health Plan of WY PPO |
$17.97
|
| Rate for Payer: One Health Plan of WY PPO |
$18.26
|
| Rate for Payer: One Health Plan of WY PPO |
$18.60
|
| Rate for Payer: PacificSource Commercial |
$17.08
|
| Rate for Payer: PacificSource Commercial |
$16.51
|
| Rate for Payer: PacificSource Commercial |
$16.77
|
| Rate for Payer: PHCS PPO |
$18.26
|
| Rate for Payer: PHCS PPO |
$17.97
|
| Rate for Payer: PHCS PPO |
$18.60
|
| Rate for Payer: Three Rivers PPO |
$13.97
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: Three Rivers PPO |
$14.24
|
| Rate for Payer: TriWest Veterans Administration |
$12.30
|
| Rate for Payer: TriWest Veterans Administration |
$12.10
|
| Rate for Payer: TriWest Veterans Administration |
$12.53
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Commercial |
$16.21
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: United Healthcare Medicare |
$12.53
|
| Rate for Payer: United Healthcare Medicare |
$12.30
|
| Rate for Payer: WINHealth Partners Commercial |
$17.70
|
| Rate for Payer: WINHealth Partners Commercial |
$17.42
|
| Rate for Payer: WINHealth Partners Commercial |
$18.03
|
| Rate for Payer: Wise Provider Network Commercial |
$18.03
|
| Rate for Payer: Wise Provider Network Commercial |
$17.42
|
| Rate for Payer: Wise Provider Network Commercial |
$17.70
|
|
|
IOVERA CARTRIDGES
|
Facility
|
IP
|
$66.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.89
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$41.70
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$43.89
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
| Rate for Payer: WINHealth Partners Commercial |
$63.18
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
IOVERA CARTRIDGES
|
Facility
|
OP
|
$66.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Aetna of WY Medicare |
$43.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.57
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$36.64
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$38.57
|
| Rate for Payer: WINHealth Partners Commercial |
$65.17
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
IOVERA SMART TIP 3 X 8.5MM
|
Facility
|
OP
|
$2,098.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.14 |
| Max. Negotiated Rate |
$2,098.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,056.28
|
| Rate for Payer: Aetna of WY Medicare |
$1,384.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,014.32
|
| Rate for Payer: Altius Commercial |
$2,014.32
|
| Rate for Payer: Beech Street Commercial |
$2,056.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,722.66
|
| Rate for Payer: Cash Price |
$1,468.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,035.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,056.28
|
| Rate for Payer: Entrust Commercial |
$1,993.34
|
| Rate for Payer: First Choice Health Commercial |
$1,993.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,993.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,216.98
|
| Rate for Payer: HealthUtah PPO |
$2,098.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,035.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,156.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,056.28
|
| Rate for Payer: PacificSource Commercial |
$1,888.42
|
| Rate for Payer: PHCS PPO |
$2,056.28
|
| Rate for Payer: Three Rivers PPO |
$1,573.69
|
| Rate for Payer: TriWest Veterans Administration |
$1,216.98
|
| Rate for Payer: United Healthcare Commercial |
$1,825.48
|
| Rate for Payer: United Healthcare Medicare |
$1,216.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,056.28
|
| Rate for Payer: Wise Provider Network Commercial |
$1,993.34
|
|
|
IOVERA SMART TIP 3 X 8.5MM
|
Facility
|
IP
|
$2,098.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,315.60 |
| Max. Negotiated Rate |
$2,098.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,056.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,014.32
|
| Rate for Payer: Altius Commercial |
$2,014.32
|
| Rate for Payer: Beech Street Commercial |
$2,056.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,722.66
|
| Rate for Payer: Cash Price |
$1,468.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,035.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,056.28
|
| Rate for Payer: Entrust Commercial |
$1,993.34
|
| Rate for Payer: First Choice Health Commercial |
$1,993.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,993.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,384.84
|
| Rate for Payer: HealthUtah PPO |
$2,098.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,035.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,315.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,056.28
|
| Rate for Payer: PacificSource Commercial |
$1,888.42
|
| Rate for Payer: PHCS PPO |
$2,056.28
|
| Rate for Payer: Three Rivers PPO |
$1,573.69
|
| Rate for Payer: TriWest Veterans Administration |
$1,384.84
|
| Rate for Payer: United Healthcare Commercial |
$1,825.48
|
| Rate for Payer: United Healthcare Medicare |
$1,384.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,993.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1,993.34
|
|
|
IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 99253
|
| Hospital Charge Code |
99253
|
| Min. Negotiated Rate |
$120.57 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$383.18
|
| Rate for Payer: Beech Street Commercial |
$371.45
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$379.27
|
| Rate for Payer: Cigna of WY Commercial |
$383.18
|
| Rate for Payer: First Choice Health Commercial |
$351.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$371.45
|
| Rate for Payer: HealthUtah PPO |
$120.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$379.27
|
| Rate for Payer: One Health Plan of WY PPO |
$383.18
|
| Rate for Payer: PacificSource Commercial |
$351.90
|
| Rate for Payer: PHCS PPO |
$371.45
|
| Rate for Payer: Three Rivers PPO |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$340.17
|
| Rate for Payer: WINHealth Partners Commercial |
$371.45
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 6068740579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.84
|
| Rate for Payer: Cigna of WY Commercial |
$0.85
|
| Rate for Payer: Entrust Commercial |
$0.83
|
| Rate for Payer: First Choice Health Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: HealthUtah PPO |
$0.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.84
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.85
|
| Rate for Payer: PacificSource Commercial |
$0.78
|
| Rate for Payer: PHCS PPO |
$0.85
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.76
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: WINHealth Partners Commercial |
$0.83
|
| Rate for Payer: Wise Provider Network Commercial |
$0.83
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 7620460030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.80
|
| Rate for Payer: Altius Commercial |
$2.80
|
| Rate for Payer: Beech Street Commercial |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.83
|
| Rate for Payer: Cigna of WY Commercial |
$2.86
|
| Rate for Payer: Entrust Commercial |
$2.77
|
| Rate for Payer: First Choice Health Commercial |
$2.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.69
|
| Rate for Payer: HealthUtah PPO |
$2.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.83
|
| Rate for Payer: Multiplan Medicare/VA |
$1.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2.86
|
| Rate for Payer: PacificSource Commercial |
$2.63
|
| Rate for Payer: PHCS PPO |
$2.86
|
| Rate for Payer: Three Rivers PPO |
$2.19
|
| Rate for Payer: TriWest Veterans Administration |
$1.69
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Medicare |
$1.69
|
| Rate for Payer: WINHealth Partners Commercial |
$2.86
|
| Rate for Payer: Wise Provider Network Commercial |
$2.77
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 6068740583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.84
|
| Rate for Payer: Cigna of WY Commercial |
$0.85
|
| Rate for Payer: Entrust Commercial |
$0.83
|
| Rate for Payer: First Choice Health Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: HealthUtah PPO |
$0.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.84
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.85
|
| Rate for Payer: PacificSource Commercial |
$0.78
|
| Rate for Payer: PHCS PPO |
$0.85
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.76
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: WINHealth Partners Commercial |
$0.83
|
| Rate for Payer: Wise Provider Network Commercial |
$0.83
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 7620460030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.80
|
| Rate for Payer: Altius Commercial |
$2.80
|
| Rate for Payer: Beech Street Commercial |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.83
|
| Rate for Payer: Cigna of WY Commercial |
$2.86
|
| Rate for Payer: Entrust Commercial |
$2.77
|
| Rate for Payer: First Choice Health Commercial |
$2.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.93
|
| Rate for Payer: HealthUtah PPO |
$2.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.83
|
| Rate for Payer: Multiplan Medicare/VA |
$1.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2.86
|
| Rate for Payer: PacificSource Commercial |
$2.63
|
| Rate for Payer: PHCS PPO |
$2.86
|
| Rate for Payer: Three Rivers PPO |
$2.19
|
| Rate for Payer: TriWest Veterans Administration |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Medicare |
$1.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2.77
|
| Rate for Payer: Wise Provider Network Commercial |
$2.77
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 6068740583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.85
|
| Rate for Payer: Aetna of WY Medicare |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.84
|
| Rate for Payer: Cigna of WY Commercial |
$0.85
|
| Rate for Payer: Entrust Commercial |
$0.83
|
| Rate for Payer: First Choice Health Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.50
|
| Rate for Payer: HealthUtah PPO |
$0.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.84
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.85
|
| Rate for Payer: PacificSource Commercial |
$0.78
|
| Rate for Payer: PHCS PPO |
$0.85
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.50
|
| Rate for Payer: United Healthcare Commercial |
$0.76
|
| Rate for Payer: United Healthcare Medicare |
$0.50
|
| Rate for Payer: WINHealth Partners Commercial |
$0.85
|
| Rate for Payer: Wise Provider Network Commercial |
$0.83
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [1964]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 6068740579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.85
|
| Rate for Payer: Aetna of WY Medicare |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.84
|
| Rate for Payer: Cigna of WY Commercial |
$0.85
|
| Rate for Payer: Entrust Commercial |
$0.83
|
| Rate for Payer: First Choice Health Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.50
|
| Rate for Payer: HealthUtah PPO |
$0.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.84
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.85
|
| Rate for Payer: PacificSource Commercial |
$0.78
|
| Rate for Payer: PHCS PPO |
$0.85
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.50
|
| Rate for Payer: United Healthcare Commercial |
$0.76
|
| Rate for Payer: United Healthcare Medicare |
$0.50
|
| Rate for Payer: WINHealth Partners Commercial |
$0.85
|
| Rate for Payer: Wise Provider Network Commercial |
$0.83
|
|
