|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [137973]
|
Facility
|
IP
|
$189.01
|
|
|
Service Code
|
NDC 0597002402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$118.51 |
| Max. Negotiated Rate |
$189.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$185.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$181.45
|
| Rate for Payer: Altius Commercial |
$181.45
|
| Rate for Payer: Beech Street Commercial |
$185.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.18
|
| Rate for Payer: Cash Price |
$132.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$183.34
|
| Rate for Payer: Cigna of WY Commercial |
$185.23
|
| Rate for Payer: Entrust Commercial |
$179.56
|
| Rate for Payer: First Choice Health Commercial |
$179.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$179.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.75
|
| Rate for Payer: HealthUtah PPO |
$189.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$183.34
|
| Rate for Payer: Multiplan Medicare/VA |
$118.51
|
| Rate for Payer: One Health Plan of WY PPO |
$185.23
|
| Rate for Payer: PacificSource Commercial |
$170.11
|
| Rate for Payer: PHCS PPO |
$185.23
|
| Rate for Payer: Three Rivers PPO |
$141.76
|
| Rate for Payer: TriWest Veterans Administration |
$124.75
|
| Rate for Payer: United Healthcare Commercial |
$164.44
|
| Rate for Payer: United Healthcare Medicare |
$124.75
|
| Rate for Payer: WINHealth Partners Commercial |
$179.56
|
| Rate for Payer: Wise Provider Network Commercial |
$179.56
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [137973]
|
Facility
|
OP
|
$189.01
|
|
|
Service Code
|
NDC 0597002402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$189.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$185.23
|
| Rate for Payer: Aetna of WY Medicare |
$124.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$181.45
|
| Rate for Payer: Altius Commercial |
$181.45
|
| Rate for Payer: Beech Street Commercial |
$185.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.18
|
| Rate for Payer: Cash Price |
$132.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$183.34
|
| Rate for Payer: Cigna of WY Commercial |
$185.23
|
| Rate for Payer: Entrust Commercial |
$179.56
|
| Rate for Payer: First Choice Health Commercial |
$179.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$179.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.63
|
| Rate for Payer: HealthUtah PPO |
$189.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$183.34
|
| Rate for Payer: Multiplan Medicare/VA |
$104.14
|
| Rate for Payer: One Health Plan of WY PPO |
$185.23
|
| Rate for Payer: PacificSource Commercial |
$170.11
|
| Rate for Payer: PHCS PPO |
$185.23
|
| Rate for Payer: Three Rivers PPO |
$141.76
|
| Rate for Payer: TriWest Veterans Administration |
$109.63
|
| Rate for Payer: United Healthcare Commercial |
$164.44
|
| Rate for Payer: United Healthcare Medicare |
$109.63
|
| Rate for Payer: WINHealth Partners Commercial |
$185.23
|
| Rate for Payer: Wise Provider Network Commercial |
$179.56
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 7620410060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Aetna of WY Medicare |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 6068739479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 6068739483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 6068739479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 7620410060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 7620410030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Aetna of WY Medicare |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 6068739483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [19770]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 7620410030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [19480]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 0054004544
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.70
|
| Rate for Payer: Aetna of WY Medicare |
$3.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.61
|
| Rate for Payer: Altius Commercial |
$4.61
|
| Rate for Payer: Beech Street Commercial |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.66
|
| Rate for Payer: Cigna of WY Commercial |
$4.70
|
| Rate for Payer: Entrust Commercial |
$4.56
|
| Rate for Payer: First Choice Health Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.78
|
| Rate for Payer: HealthUtah PPO |
$4.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.66
|
| Rate for Payer: Multiplan Medicare/VA |
$2.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4.70
|
| Rate for Payer: PacificSource Commercial |
$4.32
|
| Rate for Payer: PHCS PPO |
$4.70
|
| Rate for Payer: Three Rivers PPO |
$3.60
|
| Rate for Payer: TriWest Veterans Administration |
$2.78
|
| Rate for Payer: United Healthcare Commercial |
$4.18
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4.70
|
| Rate for Payer: Wise Provider Network Commercial |
$4.56
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [19480]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 0054004544
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.61
|
| Rate for Payer: Altius Commercial |
$4.61
|
| Rate for Payer: Beech Street Commercial |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.66
|
| Rate for Payer: Cigna of WY Commercial |
$4.70
|
| Rate for Payer: Entrust Commercial |
$4.56
|
| Rate for Payer: First Choice Health Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.17
|
| Rate for Payer: HealthUtah PPO |
$4.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.01
|
| Rate for Payer: One Health Plan of WY PPO |
$4.70
|
| Rate for Payer: PacificSource Commercial |
$4.32
|
| Rate for Payer: PHCS PPO |
$4.70
|
| Rate for Payer: Three Rivers PPO |
$3.60
|
| Rate for Payer: TriWest Veterans Administration |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.18
|
| Rate for Payer: United Healthcare Medicare |
$3.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4.56
|
| Rate for Payer: Wise Provider Network Commercial |
$4.56
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [19480]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 6050508261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.61
|
| Rate for Payer: Altius Commercial |
$4.61
|
| Rate for Payer: Beech Street Commercial |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.66
|
| Rate for Payer: Cigna of WY Commercial |
$4.70
|
| Rate for Payer: Entrust Commercial |
$4.56
|
| Rate for Payer: First Choice Health Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.17
|
| Rate for Payer: HealthUtah PPO |
$4.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.01
|
| Rate for Payer: One Health Plan of WY PPO |
$4.70
|
| Rate for Payer: PacificSource Commercial |
$4.32
|
| Rate for Payer: PHCS PPO |
$4.70
|
| Rate for Payer: Three Rivers PPO |
$3.60
|
| Rate for Payer: TriWest Veterans Administration |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.18
|
| Rate for Payer: United Healthcare Medicare |
$3.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4.56
|
| Rate for Payer: Wise Provider Network Commercial |
$4.56
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [19480]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 6050508261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.70
|
| Rate for Payer: Aetna of WY Medicare |
$3.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.61
|
| Rate for Payer: Altius Commercial |
$4.61
|
| Rate for Payer: Beech Street Commercial |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.66
|
| Rate for Payer: Cigna of WY Commercial |
$4.70
|
| Rate for Payer: Entrust Commercial |
$4.56
|
| Rate for Payer: First Choice Health Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.78
|
| Rate for Payer: HealthUtah PPO |
$4.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.66
|
| Rate for Payer: Multiplan Medicare/VA |
$2.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4.70
|
| Rate for Payer: PacificSource Commercial |
$4.32
|
| Rate for Payer: PHCS PPO |
$4.70
|
| Rate for Payer: Three Rivers PPO |
$3.60
|
| Rate for Payer: TriWest Veterans Administration |
$2.78
|
| Rate for Payer: United Healthcare Commercial |
$4.18
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4.70
|
| Rate for Payer: Wise Provider Network Commercial |
$4.56
|
|
|
IPRATROPIUM BROMIDE COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7645
|
| Hospital Charge Code |
J7645
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Beech Street Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PHCS PPO |
$1.90
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
|
|
IRINOTECAN 20 MG/ML INTRAVENOUS SOLUTION (WRAPPER) [4000729]
|
Facility
|
IP
|
$36.46
|
|
|
Service Code
|
HCPCS J9206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.00
|
| Rate for Payer: Altius Commercial |
$35.00
|
| Rate for Payer: Beech Street Commercial |
$35.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.93
|
| Rate for Payer: Cash Price |
$25.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.37
|
| Rate for Payer: Cigna of WY Commercial |
$35.73
|
| Rate for Payer: Entrust Commercial |
$34.64
|
| Rate for Payer: First Choice Health Commercial |
$34.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.06
|
| Rate for Payer: HealthUtah PPO |
$36.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.37
|
| Rate for Payer: Multiplan Medicare/VA |
$22.86
|
| Rate for Payer: One Health Plan of WY PPO |
$35.73
|
| Rate for Payer: PacificSource Commercial |
$32.81
|
| Rate for Payer: PHCS PPO |
$35.73
|
| Rate for Payer: Three Rivers PPO |
$27.34
|
| Rate for Payer: TriWest Veterans Administration |
$24.06
|
| Rate for Payer: United Healthcare Commercial |
$31.72
|
| Rate for Payer: United Healthcare Medicare |
$24.06
|
| Rate for Payer: WINHealth Partners Commercial |
$34.64
|
| Rate for Payer: Wise Provider Network Commercial |
$34.64
|
|
|
IRINOTECAN 20 MG/ML INTRAVENOUS SOLUTION (WRAPPER) [4000729]
|
Facility
|
OP
|
$36.46
|
|
|
Service Code
|
HCPCS J9206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.73
|
| Rate for Payer: Aetna of WY Medicare |
$24.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.00
|
| Rate for Payer: Altius Commercial |
$35.00
|
| Rate for Payer: Beech Street Commercial |
$35.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.93
|
| Rate for Payer: Cash Price |
$25.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.37
|
| Rate for Payer: Cigna of WY Commercial |
$35.73
|
| Rate for Payer: Entrust Commercial |
$34.64
|
| Rate for Payer: First Choice Health Commercial |
$34.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.15
|
| Rate for Payer: HealthUtah PPO |
$36.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.37
|
| Rate for Payer: Multiplan Medicare/VA |
$20.09
|
| Rate for Payer: One Health Plan of WY PPO |
$35.73
|
| Rate for Payer: PacificSource Commercial |
$32.81
|
| Rate for Payer: PHCS PPO |
$35.73
|
| Rate for Payer: Three Rivers PPO |
$27.34
|
| Rate for Payer: TriWest Veterans Administration |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$31.72
|
| Rate for Payer: United Healthcare Medicare |
$21.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.73
|
| Rate for Payer: Wise Provider Network Commercial |
$34.64
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [152485]
|
Facility
|
IP
|
$56.94
|
|
|
Service Code
|
HCPCS J1750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.66
|
| Rate for Payer: Altius Commercial |
$54.66
|
| Rate for Payer: Beech Street Commercial |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.75
|
| Rate for Payer: Cash Price |
$39.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.23
|
| Rate for Payer: Cigna of WY Commercial |
$55.80
|
| Rate for Payer: Entrust Commercial |
$54.09
|
| Rate for Payer: First Choice Health Commercial |
$54.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.58
|
| Rate for Payer: HealthUtah PPO |
$56.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.23
|
| Rate for Payer: Multiplan Medicare/VA |
$35.70
|
| Rate for Payer: One Health Plan of WY PPO |
$55.80
|
| Rate for Payer: PacificSource Commercial |
$51.25
|
| Rate for Payer: PHCS PPO |
$55.80
|
| Rate for Payer: Three Rivers PPO |
$42.70
|
| Rate for Payer: TriWest Veterans Administration |
$37.58
|
| Rate for Payer: United Healthcare Commercial |
$49.54
|
| Rate for Payer: United Healthcare Medicare |
$37.58
|
| Rate for Payer: WINHealth Partners Commercial |
$54.09
|
| Rate for Payer: Wise Provider Network Commercial |
$54.09
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [152485]
|
Facility
|
OP
|
$56.94
|
|
|
Service Code
|
HCPCS J1750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$56.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.80
|
| Rate for Payer: Aetna of WY Medicare |
$37.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.66
|
| Rate for Payer: Altius Commercial |
$54.66
|
| Rate for Payer: Beech Street Commercial |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.75
|
| Rate for Payer: Cash Price |
$39.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.23
|
| Rate for Payer: Cigna of WY Commercial |
$55.80
|
| Rate for Payer: Entrust Commercial |
$54.09
|
| Rate for Payer: First Choice Health Commercial |
$54.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.03
|
| Rate for Payer: HealthUtah PPO |
$56.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.23
|
| Rate for Payer: Multiplan Medicare/VA |
$31.37
|
| Rate for Payer: One Health Plan of WY PPO |
$55.80
|
| Rate for Payer: PacificSource Commercial |
$51.25
|
| Rate for Payer: PHCS PPO |
$55.80
|
| Rate for Payer: Three Rivers PPO |
$42.70
|
| Rate for Payer: TriWest Veterans Administration |
$33.03
|
| Rate for Payer: United Healthcare Commercial |
$49.54
|
| Rate for Payer: United Healthcare Medicare |
$33.03
|
| Rate for Payer: WINHealth Partners Commercial |
$55.80
|
| Rate for Payer: Wise Provider Network Commercial |
$54.09
|
|
|
IRON SUCROSE 20 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000707]
|
Facility
|
IP
|
$49.68
|
|
|
Service Code
|
HCPCS J1756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.69
|
| Rate for Payer: Altius Commercial |
$47.69
|
| Rate for Payer: Beech Street Commercial |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.79
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.19
|
| Rate for Payer: Cigna of WY Commercial |
$48.69
|
| Rate for Payer: Entrust Commercial |
$47.20
|
| Rate for Payer: First Choice Health Commercial |
$47.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.79
|
| Rate for Payer: HealthUtah PPO |
$49.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.19
|
| Rate for Payer: Multiplan Medicare/VA |
$31.15
|
| Rate for Payer: One Health Plan of WY PPO |
$48.69
|
| Rate for Payer: PacificSource Commercial |
$44.71
|
| Rate for Payer: PHCS PPO |
$48.69
|
| Rate for Payer: Three Rivers PPO |
$37.26
|
| Rate for Payer: TriWest Veterans Administration |
$32.79
|
| Rate for Payer: United Healthcare Commercial |
$43.22
|
| Rate for Payer: United Healthcare Medicare |
$32.79
|
| Rate for Payer: WINHealth Partners Commercial |
$47.20
|
| Rate for Payer: Wise Provider Network Commercial |
$47.20
|
|
|
IRON SUCROSE 20 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000707]
|
Facility
|
OP
|
$49.68
|
|
|
Service Code
|
HCPCS J1756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.69
|
| Rate for Payer: Aetna of WY Medicare |
$32.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.69
|
| Rate for Payer: Altius Commercial |
$47.69
|
| Rate for Payer: Beech Street Commercial |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.79
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.19
|
| Rate for Payer: Cigna of WY Commercial |
$48.69
|
| Rate for Payer: Entrust Commercial |
$47.20
|
| Rate for Payer: First Choice Health Commercial |
$47.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.81
|
| Rate for Payer: HealthUtah PPO |
$49.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.19
|
| Rate for Payer: Multiplan Medicare/VA |
$27.37
|
| Rate for Payer: One Health Plan of WY PPO |
$48.69
|
| Rate for Payer: PacificSource Commercial |
$44.71
|
| Rate for Payer: PHCS PPO |
$48.69
|
| Rate for Payer: Three Rivers PPO |
$37.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.81
|
| Rate for Payer: United Healthcare Commercial |
$43.22
|
| Rate for Payer: United Healthcare Medicare |
$28.81
|
| Rate for Payer: WINHealth Partners Commercial |
$48.69
|
| Rate for Payer: Wise Provider Network Commercial |
$47.20
|
|
|
IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
96523
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$24.47
|
| Rate for Payer: Beech Street Commercial |
$87.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: First Choice Health Commercial |
$82.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.47
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$20.80
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$87.40
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.47
|
| Rate for Payer: United Healthcare Commercial |
$80.04
|
| Rate for Payer: United Healthcare Medicare |
$24.47
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
|
|
IRRIG BOTTLE NACL .9% 1L R5200
|
Facility
|
OP
|
$7.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.71
|
| Rate for Payer: Aetna of WY Medicare |
$5.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.56
|
| Rate for Payer: Altius Commercial |
$7.56
|
| Rate for Payer: Beech Street Commercial |
$7.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.63
|
| Rate for Payer: Cigna of WY Commercial |
$7.71
|
| Rate for Payer: Entrust Commercial |
$7.48
|
| Rate for Payer: First Choice Health Commercial |
$7.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.56
|
| Rate for Payer: HealthUtah PPO |
$7.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.63
|
| Rate for Payer: Multiplan Medicare/VA |
$4.34
|
| Rate for Payer: One Health Plan of WY PPO |
$7.71
|
| Rate for Payer: PacificSource Commercial |
$7.08
|
| Rate for Payer: PHCS PPO |
$7.71
|
| Rate for Payer: Three Rivers PPO |
$5.90
|
| Rate for Payer: TriWest Veterans Administration |
$4.56
|
| Rate for Payer: United Healthcare Commercial |
$6.85
|
| Rate for Payer: United Healthcare Medicare |
$4.56
|
| Rate for Payer: WINHealth Partners Commercial |
$7.71
|
| Rate for Payer: Wise Provider Network Commercial |
$7.48
|
|
|
IRRIG BOTTLE NACL .9% 1L R5200
|
Facility
|
IP
|
$7.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.56
|
| Rate for Payer: Altius Commercial |
$7.56
|
| Rate for Payer: Beech Street Commercial |
$7.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.63
|
| Rate for Payer: Cigna of WY Commercial |
$7.71
|
| Rate for Payer: Entrust Commercial |
$7.48
|
| Rate for Payer: First Choice Health Commercial |
$7.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.19
|
| Rate for Payer: HealthUtah PPO |
$7.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.63
|
| Rate for Payer: Multiplan Medicare/VA |
$4.93
|
| Rate for Payer: One Health Plan of WY PPO |
$7.71
|
| Rate for Payer: PacificSource Commercial |
$7.08
|
| Rate for Payer: PHCS PPO |
$7.71
|
| Rate for Payer: Three Rivers PPO |
$5.90
|
| Rate for Payer: TriWest Veterans Administration |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$6.85
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
| Rate for Payer: WINHealth Partners Commercial |
$7.48
|
| Rate for Payer: Wise Provider Network Commercial |
$7.48
|
|
|
IRRIG RANGER WARMING KIT 24750
|
Facility
|
IP
|
$132.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$132.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.43
|
| Rate for Payer: Altius Commercial |
$127.43
|
| Rate for Payer: Beech Street Commercial |
$130.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.98
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.76
|
| Rate for Payer: Cigna of WY Commercial |
$130.09
|
| Rate for Payer: Entrust Commercial |
$126.10
|
| Rate for Payer: First Choice Health Commercial |
$126.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.61
|
| Rate for Payer: HealthUtah PPO |
$132.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.76
|
| Rate for Payer: Multiplan Medicare/VA |
$83.23
|
| Rate for Payer: One Health Plan of WY PPO |
$130.09
|
| Rate for Payer: PacificSource Commercial |
$119.47
|
| Rate for Payer: PHCS PPO |
$130.09
|
| Rate for Payer: Three Rivers PPO |
$99.56
|
| Rate for Payer: TriWest Veterans Administration |
$87.61
|
| Rate for Payer: United Healthcare Commercial |
$115.48
|
| Rate for Payer: United Healthcare Medicare |
$87.61
|
| Rate for Payer: WINHealth Partners Commercial |
$126.10
|
| Rate for Payer: Wise Provider Network Commercial |
$126.10
|
|
