|
KETAMINE 50 MG/ML INJECTION SOLUTION [16220]
|
Facility
|
OP
|
$17.81
|
|
|
Service Code
|
NDC 4202311410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$17.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.45
|
| Rate for Payer: Aetna of WY Medicare |
$11.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.10
|
| Rate for Payer: Altius Commercial |
$17.10
|
| Rate for Payer: Beech Street Commercial |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.28
|
| Rate for Payer: Cigna of WY Commercial |
$17.45
|
| Rate for Payer: Entrust Commercial |
$16.92
|
| Rate for Payer: First Choice Health Commercial |
$16.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.33
|
| Rate for Payer: HealthUtah PPO |
$17.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.81
|
| Rate for Payer: One Health Plan of WY PPO |
$17.45
|
| Rate for Payer: PacificSource Commercial |
$16.03
|
| Rate for Payer: PHCS PPO |
$17.45
|
| Rate for Payer: Three Rivers PPO |
$13.36
|
| Rate for Payer: TriWest Veterans Administration |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$10.33
|
| Rate for Payer: WINHealth Partners Commercial |
$17.45
|
| Rate for Payer: Wise Provider Network Commercial |
$16.92
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION [16220]
|
Facility
|
IP
|
$17.81
|
|
|
Service Code
|
NDC 4202311410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$17.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.10
|
| Rate for Payer: Altius Commercial |
$17.10
|
| Rate for Payer: Beech Street Commercial |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.62
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.28
|
| Rate for Payer: Cigna of WY Commercial |
$17.45
|
| Rate for Payer: Entrust Commercial |
$16.92
|
| Rate for Payer: First Choice Health Commercial |
$16.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.75
|
| Rate for Payer: HealthUtah PPO |
$17.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.28
|
| Rate for Payer: Multiplan Medicare/VA |
$11.17
|
| Rate for Payer: One Health Plan of WY PPO |
$17.45
|
| Rate for Payer: PacificSource Commercial |
$16.03
|
| Rate for Payer: PHCS PPO |
$17.45
|
| Rate for Payer: Three Rivers PPO |
$13.36
|
| Rate for Payer: TriWest Veterans Administration |
$11.75
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$11.75
|
| Rate for Payer: WINHealth Partners Commercial |
$16.92
|
| Rate for Payer: Wise Provider Network Commercial |
$16.92
|
|
|
KETOROLAC 0.5 % EYE DROPS [8819]
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
NDC 6050510031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.99
|
| Rate for Payer: Aetna of WY Medicare |
$14.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.54
|
| Rate for Payer: Altius Commercial |
$21.54
|
| Rate for Payer: Beech Street Commercial |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.42
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.77
|
| Rate for Payer: Cigna of WY Commercial |
$21.99
|
| Rate for Payer: Entrust Commercial |
$21.32
|
| Rate for Payer: First Choice Health Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.02
|
| Rate for Payer: HealthUtah PPO |
$22.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.77
|
| Rate for Payer: Multiplan Medicare/VA |
$12.36
|
| Rate for Payer: One Health Plan of WY PPO |
$21.99
|
| Rate for Payer: PacificSource Commercial |
$20.20
|
| Rate for Payer: PHCS PPO |
$21.99
|
| Rate for Payer: Three Rivers PPO |
$16.83
|
| Rate for Payer: TriWest Veterans Administration |
$13.02
|
| Rate for Payer: United Healthcare Commercial |
$19.52
|
| Rate for Payer: United Healthcare Medicare |
$13.02
|
| Rate for Payer: WINHealth Partners Commercial |
$21.99
|
| Rate for Payer: Wise Provider Network Commercial |
$21.32
|
|
|
KETOROLAC 0.5 % EYE DROPS [8819]
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
NDC 6050510031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.54
|
| Rate for Payer: Altius Commercial |
$21.54
|
| Rate for Payer: Beech Street Commercial |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.42
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.77
|
| Rate for Payer: Cigna of WY Commercial |
$21.99
|
| Rate for Payer: Entrust Commercial |
$21.32
|
| Rate for Payer: First Choice Health Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.81
|
| Rate for Payer: HealthUtah PPO |
$22.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.77
|
| Rate for Payer: Multiplan Medicare/VA |
$14.07
|
| Rate for Payer: One Health Plan of WY PPO |
$21.99
|
| Rate for Payer: PacificSource Commercial |
$20.20
|
| Rate for Payer: PHCS PPO |
$21.99
|
| Rate for Payer: Three Rivers PPO |
$16.83
|
| Rate for Payer: TriWest Veterans Administration |
$14.81
|
| Rate for Payer: United Healthcare Commercial |
$19.52
|
| Rate for Payer: United Healthcare Medicare |
$14.81
|
| Rate for Payer: WINHealth Partners Commercial |
$21.32
|
| Rate for Payer: Wise Provider Network Commercial |
$21.32
|
|
|
KETOROLAC 0.5 % EYE DROPS [8819]
|
Facility
|
OP
|
$19.60
|
|
|
Service Code
|
NDC 6131412605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.21
|
| Rate for Payer: Aetna of WY Medicare |
$12.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.82
|
| Rate for Payer: Altius Commercial |
$18.82
|
| Rate for Payer: Beech Street Commercial |
$19.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.09
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$19.21
|
| Rate for Payer: Entrust Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.37
|
| Rate for Payer: HealthUtah PPO |
$19.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.01
|
| Rate for Payer: Multiplan Medicare/VA |
$10.80
|
| Rate for Payer: One Health Plan of WY PPO |
$19.21
|
| Rate for Payer: PacificSource Commercial |
$17.64
|
| Rate for Payer: PHCS PPO |
$19.21
|
| Rate for Payer: Three Rivers PPO |
$14.70
|
| Rate for Payer: TriWest Veterans Administration |
$11.37
|
| Rate for Payer: United Healthcare Commercial |
$17.05
|
| Rate for Payer: United Healthcare Medicare |
$11.37
|
| Rate for Payer: WINHealth Partners Commercial |
$19.21
|
| Rate for Payer: Wise Provider Network Commercial |
$18.62
|
|
|
KETOROLAC 0.5 % EYE DROPS [8819]
|
Facility
|
IP
|
$19.60
|
|
|
Service Code
|
NDC 6131412605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.82
|
| Rate for Payer: Altius Commercial |
$18.82
|
| Rate for Payer: Beech Street Commercial |
$19.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.09
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$19.21
|
| Rate for Payer: Entrust Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.94
|
| Rate for Payer: HealthUtah PPO |
$19.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.01
|
| Rate for Payer: Multiplan Medicare/VA |
$12.29
|
| Rate for Payer: One Health Plan of WY PPO |
$19.21
|
| Rate for Payer: PacificSource Commercial |
$17.64
|
| Rate for Payer: PHCS PPO |
$19.21
|
| Rate for Payer: Three Rivers PPO |
$14.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$17.05
|
| Rate for Payer: United Healthcare Medicare |
$12.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.62
|
|
|
KETOROLAC 10 MG TABLET [8756]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 0093031401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.50
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4.22
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
KETOROLAC 10 MG TABLET [8756]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 0093031401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.09
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
KETOROLAC 10 MG TABLET [8756]
|
Facility
|
OP
|
$7.25
|
|
|
Service Code
|
NDC 0378113401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.10
|
| Rate for Payer: Aetna of WY Medicare |
$4.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.96
|
| Rate for Payer: Altius Commercial |
$6.96
|
| Rate for Payer: Beech Street Commercial |
$7.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.03
|
| Rate for Payer: Cigna of WY Commercial |
$7.10
|
| Rate for Payer: Entrust Commercial |
$6.89
|
| Rate for Payer: First Choice Health Commercial |
$6.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.20
|
| Rate for Payer: HealthUtah PPO |
$7.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.03
|
| Rate for Payer: Multiplan Medicare/VA |
$3.99
|
| Rate for Payer: One Health Plan of WY PPO |
$7.10
|
| Rate for Payer: PacificSource Commercial |
$6.52
|
| Rate for Payer: PHCS PPO |
$7.10
|
| Rate for Payer: Three Rivers PPO |
$5.44
|
| Rate for Payer: TriWest Veterans Administration |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$6.31
|
| Rate for Payer: United Healthcare Medicare |
$4.20
|
| Rate for Payer: WINHealth Partners Commercial |
$7.10
|
| Rate for Payer: Wise Provider Network Commercial |
$6.89
|
|
|
KETOROLAC 10 MG TABLET [8756]
|
Facility
|
IP
|
$7.25
|
|
|
Service Code
|
NDC 0378113401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.96
|
| Rate for Payer: Altius Commercial |
$6.96
|
| Rate for Payer: Beech Street Commercial |
$7.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.03
|
| Rate for Payer: Cigna of WY Commercial |
$7.10
|
| Rate for Payer: Entrust Commercial |
$6.89
|
| Rate for Payer: First Choice Health Commercial |
$6.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.78
|
| Rate for Payer: HealthUtah PPO |
$7.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.03
|
| Rate for Payer: Multiplan Medicare/VA |
$4.55
|
| Rate for Payer: One Health Plan of WY PPO |
$7.10
|
| Rate for Payer: PacificSource Commercial |
$6.52
|
| Rate for Payer: PHCS PPO |
$7.10
|
| Rate for Payer: Three Rivers PPO |
$5.44
|
| Rate for Payer: TriWest Veterans Administration |
$4.78
|
| Rate for Payer: United Healthcare Commercial |
$6.31
|
| Rate for Payer: United Healthcare Medicare |
$4.78
|
| Rate for Payer: WINHealth Partners Commercial |
$6.89
|
| Rate for Payer: Wise Provider Network Commercial |
$6.89
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION [199]
|
Facility
|
OP
|
$29.02
|
|
|
Service Code
|
HCPCS J1885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.61
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.48
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.75
|
| Rate for Payer: Aetna of WY Medicare |
$19.15
|
| Rate for Payer: Aetna of WY Medicare |
$19.18
|
| Rate for Payer: Aetna of WY Medicare |
$17.34
|
| Rate for Payer: Aetna of WY Medicare |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$13.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.90
|
| Rate for Payer: Altius Commercial |
$27.90
|
| Rate for Payer: Altius Commercial |
$21.62
|
| Rate for Payer: Altius Commercial |
$25.23
|
| Rate for Payer: Altius Commercial |
$19.21
|
| Rate for Payer: Altius Commercial |
$27.86
|
| Rate for Payer: Beech Street Commercial |
$28.44
|
| Rate for Payer: Beech Street Commercial |
$19.61
|
| Rate for Payer: Beech Street Commercial |
$25.75
|
| Rate for Payer: Beech Street Commercial |
$22.07
|
| Rate for Payer: Beech Street Commercial |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.41
|
| Rate for Payer: Cigna of WY Commercial |
$19.61
|
| Rate for Payer: Cigna of WY Commercial |
$22.07
|
| Rate for Payer: Cigna of WY Commercial |
$25.75
|
| Rate for Payer: Cigna of WY Commercial |
$28.44
|
| Rate for Payer: Cigna of WY Commercial |
$28.48
|
| Rate for Payer: Entrust Commercial |
$19.01
|
| Rate for Payer: Entrust Commercial |
$21.39
|
| Rate for Payer: Entrust Commercial |
$24.97
|
| Rate for Payer: Entrust Commercial |
$27.61
|
| Rate for Payer: Entrust Commercial |
$27.57
|
| Rate for Payer: First Choice Health Commercial |
$19.01
|
| Rate for Payer: First Choice Health Commercial |
$27.57
|
| Rate for Payer: First Choice Health Commercial |
$27.61
|
| Rate for Payer: First Choice Health Commercial |
$24.97
|
| Rate for Payer: First Choice Health Commercial |
$21.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.06
|
| Rate for Payer: HealthUtah PPO |
$20.01
|
| Rate for Payer: HealthUtah PPO |
$26.28
|
| Rate for Payer: HealthUtah PPO |
$22.52
|
| Rate for Payer: HealthUtah PPO |
$29.06
|
| Rate for Payer: HealthUtah PPO |
$29.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.49
|
| Rate for Payer: Multiplan Medicare/VA |
$16.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.03
|
| Rate for Payer: Multiplan Medicare/VA |
$14.48
|
| Rate for Payer: Multiplan Medicare/VA |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$12.41
|
| Rate for Payer: One Health Plan of WY PPO |
$22.07
|
| Rate for Payer: One Health Plan of WY PPO |
$19.61
|
| Rate for Payer: One Health Plan of WY PPO |
$25.75
|
| Rate for Payer: One Health Plan of WY PPO |
$28.44
|
| Rate for Payer: One Health Plan of WY PPO |
$28.48
|
| Rate for Payer: PacificSource Commercial |
$23.65
|
| Rate for Payer: PacificSource Commercial |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$26.12
|
| Rate for Payer: PacificSource Commercial |
$26.15
|
| Rate for Payer: PacificSource Commercial |
$20.27
|
| Rate for Payer: PHCS PPO |
$28.48
|
| Rate for Payer: PHCS PPO |
$22.07
|
| Rate for Payer: PHCS PPO |
$25.75
|
| Rate for Payer: PHCS PPO |
$28.44
|
| Rate for Payer: PHCS PPO |
$19.61
|
| Rate for Payer: Three Rivers PPO |
$16.89
|
| Rate for Payer: Three Rivers PPO |
$19.71
|
| Rate for Payer: Three Rivers PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$21.80
|
| Rate for Payer: Three Rivers PPO |
$21.76
|
| Rate for Payer: TriWest Veterans Administration |
$13.06
|
| Rate for Payer: TriWest Veterans Administration |
$16.83
|
| Rate for Payer: TriWest Veterans Administration |
$16.85
|
| Rate for Payer: TriWest Veterans Administration |
$15.24
|
| Rate for Payer: TriWest Veterans Administration |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Commercial |
$17.41
|
| Rate for Payer: United Healthcare Commercial |
$22.86
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Medicare |
$15.24
|
| Rate for Payer: United Healthcare Medicare |
$16.83
|
| Rate for Payer: United Healthcare Medicare |
$11.61
|
| Rate for Payer: United Healthcare Medicare |
$13.06
|
| Rate for Payer: United Healthcare Medicare |
$16.85
|
| Rate for Payer: WINHealth Partners Commercial |
$19.61
|
| Rate for Payer: WINHealth Partners Commercial |
$28.44
|
| Rate for Payer: WINHealth Partners Commercial |
$28.48
|
| Rate for Payer: WINHealth Partners Commercial |
$25.75
|
| Rate for Payer: WINHealth Partners Commercial |
$22.07
|
| Rate for Payer: Wise Provider Network Commercial |
$24.97
|
| Rate for Payer: Wise Provider Network Commercial |
$27.61
|
| Rate for Payer: Wise Provider Network Commercial |
$21.39
|
| Rate for Payer: Wise Provider Network Commercial |
$19.01
|
| Rate for Payer: Wise Provider Network Commercial |
$27.57
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION [199]
|
Facility
|
IP
|
$29.06
|
|
|
Service Code
|
HCPCS J1885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$29.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.48
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.75
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.44
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.61
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.86
|
| Rate for Payer: Altius Commercial |
$21.62
|
| Rate for Payer: Altius Commercial |
$25.23
|
| Rate for Payer: Altius Commercial |
$27.90
|
| Rate for Payer: Altius Commercial |
$19.21
|
| Rate for Payer: Altius Commercial |
$27.86
|
| Rate for Payer: Beech Street Commercial |
$22.07
|
| Rate for Payer: Beech Street Commercial |
$19.61
|
| Rate for Payer: Beech Street Commercial |
$28.44
|
| Rate for Payer: Beech Street Commercial |
$28.48
|
| Rate for Payer: Beech Street Commercial |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.15
|
| Rate for Payer: Cigna of WY Commercial |
$28.48
|
| Rate for Payer: Cigna of WY Commercial |
$22.07
|
| Rate for Payer: Cigna of WY Commercial |
$28.44
|
| Rate for Payer: Cigna of WY Commercial |
$25.75
|
| Rate for Payer: Cigna of WY Commercial |
$19.61
|
| Rate for Payer: Entrust Commercial |
$19.01
|
| Rate for Payer: Entrust Commercial |
$27.61
|
| Rate for Payer: Entrust Commercial |
$24.97
|
| Rate for Payer: Entrust Commercial |
$21.39
|
| Rate for Payer: Entrust Commercial |
$27.57
|
| Rate for Payer: First Choice Health Commercial |
$21.39
|
| Rate for Payer: First Choice Health Commercial |
$19.01
|
| Rate for Payer: First Choice Health Commercial |
$27.61
|
| Rate for Payer: First Choice Health Commercial |
$27.57
|
| Rate for Payer: First Choice Health Commercial |
$24.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.34
|
| Rate for Payer: HealthUtah PPO |
$29.02
|
| Rate for Payer: HealthUtah PPO |
$20.01
|
| Rate for Payer: HealthUtah PPO |
$22.52
|
| Rate for Payer: HealthUtah PPO |
$29.06
|
| Rate for Payer: HealthUtah PPO |
$26.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.49
|
| Rate for Payer: Multiplan Medicare/VA |
$16.48
|
| Rate for Payer: Multiplan Medicare/VA |
$14.12
|
| Rate for Payer: Multiplan Medicare/VA |
$12.55
|
| Rate for Payer: Multiplan Medicare/VA |
$18.20
|
| Rate for Payer: Multiplan Medicare/VA |
$18.22
|
| Rate for Payer: One Health Plan of WY PPO |
$19.61
|
| Rate for Payer: One Health Plan of WY PPO |
$22.07
|
| Rate for Payer: One Health Plan of WY PPO |
$25.75
|
| Rate for Payer: One Health Plan of WY PPO |
$28.44
|
| Rate for Payer: One Health Plan of WY PPO |
$28.48
|
| Rate for Payer: PacificSource Commercial |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$23.65
|
| Rate for Payer: PacificSource Commercial |
$20.27
|
| Rate for Payer: PacificSource Commercial |
$26.12
|
| Rate for Payer: PacificSource Commercial |
$26.15
|
| Rate for Payer: PHCS PPO |
$28.44
|
| Rate for Payer: PHCS PPO |
$28.48
|
| Rate for Payer: PHCS PPO |
$25.75
|
| Rate for Payer: PHCS PPO |
$19.61
|
| Rate for Payer: PHCS PPO |
$22.07
|
| Rate for Payer: Three Rivers PPO |
$16.89
|
| Rate for Payer: Three Rivers PPO |
$21.80
|
| Rate for Payer: Three Rivers PPO |
$21.76
|
| Rate for Payer: Three Rivers PPO |
$19.71
|
| Rate for Payer: Three Rivers PPO |
$15.01
|
| Rate for Payer: TriWest Veterans Administration |
$19.18
|
| Rate for Payer: TriWest Veterans Administration |
$17.34
|
| Rate for Payer: TriWest Veterans Administration |
$13.21
|
| Rate for Payer: TriWest Veterans Administration |
$14.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.15
|
| Rate for Payer: United Healthcare Commercial |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Commercial |
$17.41
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Commercial |
$22.86
|
| Rate for Payer: United Healthcare Medicare |
$17.34
|
| Rate for Payer: United Healthcare Medicare |
$19.15
|
| Rate for Payer: United Healthcare Medicare |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$19.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.39
|
| Rate for Payer: WINHealth Partners Commercial |
$27.57
|
| Rate for Payer: WINHealth Partners Commercial |
$27.61
|
| Rate for Payer: WINHealth Partners Commercial |
$24.97
|
| Rate for Payer: WINHealth Partners Commercial |
$19.01
|
| Rate for Payer: Wise Provider Network Commercial |
$21.39
|
| Rate for Payer: Wise Provider Network Commercial |
$27.61
|
| Rate for Payer: Wise Provider Network Commercial |
$27.57
|
| Rate for Payer: Wise Provider Network Commercial |
$19.01
|
| Rate for Payer: Wise Provider Network Commercial |
$24.97
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [8097]
|
Facility
|
IP
|
$37.85
|
|
|
Service Code
|
HCPCS J1885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.09
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.36
|
| Rate for Payer: Altius Commercial |
$32.36
|
| Rate for Payer: Altius Commercial |
$21.12
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Altius Commercial |
$24.66
|
| Rate for Payer: Altius Commercial |
$36.34
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Altius Commercial |
$33.55
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Beech Street Commercial |
$33.04
|
| Rate for Payer: Beech Street Commercial |
$37.09
|
| Rate for Payer: Beech Street Commercial |
$34.25
|
| Rate for Payer: Beech Street Commercial |
$25.18
|
| Rate for Payer: Beech Street Commercial |
$21.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.07
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
| Rate for Payer: Cigna of WY Commercial |
$21.56
|
| Rate for Payer: Cigna of WY Commercial |
$25.18
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Cigna of WY Commercial |
$33.04
|
| Rate for Payer: Cigna of WY Commercial |
$34.25
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Cigna of WY Commercial |
$37.09
|
| Rate for Payer: Entrust Commercial |
$24.41
|
| Rate for Payer: Entrust Commercial |
$35.96
|
| Rate for Payer: Entrust Commercial |
$32.02
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: Entrust Commercial |
$20.90
|
| Rate for Payer: Entrust Commercial |
$33.20
|
| Rate for Payer: First Choice Health Commercial |
$20.90
|
| Rate for Payer: First Choice Health Commercial |
$35.96
|
| Rate for Payer: First Choice Health Commercial |
$32.02
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$24.41
|
| Rate for Payer: First Choice Health Commercial |
$33.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.07
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: HealthUtah PPO |
$37.85
|
| Rate for Payer: HealthUtah PPO |
$33.71
|
| Rate for Payer: HealthUtah PPO |
$25.69
|
| Rate for Payer: HealthUtah PPO |
$34.95
|
| Rate for Payer: HealthUtah PPO |
$22.00
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.92
|
| Rate for Payer: Multiplan Medicare/VA |
$13.79
|
| Rate for Payer: Multiplan Medicare/VA |
$13.32
|
| Rate for Payer: Multiplan Medicare/VA |
$16.11
|
| Rate for Payer: Multiplan Medicare/VA |
$22.57
|
| Rate for Payer: Multiplan Medicare/VA |
$23.73
|
| Rate for Payer: Multiplan Medicare/VA |
$21.14
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: One Health Plan of WY PPO |
$21.56
|
| Rate for Payer: One Health Plan of WY PPO |
$34.25
|
| Rate for Payer: One Health Plan of WY PPO |
$37.09
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: One Health Plan of WY PPO |
$25.18
|
| Rate for Payer: One Health Plan of WY PPO |
$33.04
|
| Rate for Payer: PacificSource Commercial |
$34.06
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PacificSource Commercial |
$23.12
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PacificSource Commercial |
$19.80
|
| Rate for Payer: PacificSource Commercial |
$31.46
|
| Rate for Payer: PacificSource Commercial |
$30.34
|
| Rate for Payer: PHCS PPO |
$25.18
|
| Rate for Payer: PHCS PPO |
$21.56
|
| Rate for Payer: PHCS PPO |
$34.25
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: PHCS PPO |
$37.09
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: PHCS PPO |
$33.04
|
| Rate for Payer: Three Rivers PPO |
$26.21
|
| Rate for Payer: Three Rivers PPO |
$25.28
|
| Rate for Payer: Three Rivers PPO |
$28.39
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: Three Rivers PPO |
$16.50
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: Three Rivers PPO |
$19.27
|
| Rate for Payer: TriWest Veterans Administration |
$14.52
|
| Rate for Payer: TriWest Veterans Administration |
$16.96
|
| Rate for Payer: TriWest Veterans Administration |
$22.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.07
|
| Rate for Payer: TriWest Veterans Administration |
$23.76
|
| Rate for Payer: TriWest Veterans Administration |
$24.98
|
| Rate for Payer: TriWest Veterans Administration |
$14.02
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$30.41
|
| Rate for Payer: United Healthcare Commercial |
$29.33
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Commercial |
$22.35
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare |
$24.98
|
| Rate for Payer: United Healthcare Medicare |
$22.25
|
| Rate for Payer: United Healthcare Medicare |
$14.02
|
| Rate for Payer: United Healthcare Medicare |
$16.96
|
| Rate for Payer: United Healthcare Medicare |
$23.76
|
| Rate for Payer: United Healthcare Medicare |
$23.07
|
| Rate for Payer: United Healthcare Medicare |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$34.20
|
| Rate for Payer: WINHealth Partners Commercial |
$24.41
|
| Rate for Payer: WINHealth Partners Commercial |
$35.96
|
| Rate for Payer: WINHealth Partners Commercial |
$20.90
|
| Rate for Payer: WINHealth Partners Commercial |
$20.19
|
| Rate for Payer: WINHealth Partners Commercial |
$32.02
|
| Rate for Payer: WINHealth Partners Commercial |
$33.20
|
| Rate for Payer: Wise Provider Network Commercial |
$35.96
|
| Rate for Payer: Wise Provider Network Commercial |
$32.02
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
| Rate for Payer: Wise Provider Network Commercial |
$33.20
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
| Rate for Payer: Wise Provider Network Commercial |
$20.90
|
| Rate for Payer: Wise Provider Network Commercial |
$24.41
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [8097]
|
Facility
|
OP
|
$37.85
|
|
|
Service Code
|
HCPCS J1885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.09
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Aetna of WY Medicare |
$24.98
|
| Rate for Payer: Aetna of WY Medicare |
$14.52
|
| Rate for Payer: Aetna of WY Medicare |
$23.76
|
| Rate for Payer: Aetna of WY Medicare |
$23.07
|
| Rate for Payer: Aetna of WY Medicare |
$16.96
|
| Rate for Payer: Aetna of WY Medicare |
$14.02
|
| Rate for Payer: Aetna of WY Medicare |
$22.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.55
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Altius Commercial |
$32.36
|
| Rate for Payer: Altius Commercial |
$36.34
|
| Rate for Payer: Altius Commercial |
$33.55
|
| Rate for Payer: Altius Commercial |
$21.12
|
| Rate for Payer: Altius Commercial |
$24.66
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Beech Street Commercial |
$21.56
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Beech Street Commercial |
$25.18
|
| Rate for Payer: Beech Street Commercial |
$33.04
|
| Rate for Payer: Beech Street Commercial |
$34.25
|
| Rate for Payer: Beech Street Commercial |
$37.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.69
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$14.87
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.71
|
| Rate for Payer: Cigna of WY Commercial |
$33.04
|
| Rate for Payer: Cigna of WY Commercial |
$25.18
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Cigna of WY Commercial |
$37.09
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Cigna of WY Commercial |
$21.56
|
| Rate for Payer: Cigna of WY Commercial |
$34.25
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: Entrust Commercial |
$33.20
|
| Rate for Payer: Entrust Commercial |
$24.41
|
| Rate for Payer: Entrust Commercial |
$20.90
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: Entrust Commercial |
$35.96
|
| Rate for Payer: Entrust Commercial |
$32.02
|
| Rate for Payer: First Choice Health Commercial |
$35.96
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$24.41
|
| Rate for Payer: First Choice Health Commercial |
$20.90
|
| Rate for Payer: First Choice Health Commercial |
$33.20
|
| Rate for Payer: First Choice Health Commercial |
$32.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.90
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: HealthUtah PPO |
$37.85
|
| Rate for Payer: HealthUtah PPO |
$22.00
|
| Rate for Payer: HealthUtah PPO |
$25.69
|
| Rate for Payer: HealthUtah PPO |
$34.95
|
| Rate for Payer: HealthUtah PPO |
$33.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.90
|
| Rate for Payer: Multiplan Medicare/VA |
$14.16
|
| Rate for Payer: Multiplan Medicare/VA |
$18.57
|
| Rate for Payer: Multiplan Medicare/VA |
$12.12
|
| Rate for Payer: Multiplan Medicare/VA |
$19.84
|
| Rate for Payer: Multiplan Medicare/VA |
$19.26
|
| Rate for Payer: Multiplan Medicare/VA |
$11.71
|
| Rate for Payer: Multiplan Medicare/VA |
$20.86
|
| Rate for Payer: One Health Plan of WY PPO |
$21.56
|
| Rate for Payer: One Health Plan of WY PPO |
$25.18
|
| Rate for Payer: One Health Plan of WY PPO |
$37.09
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: One Health Plan of WY PPO |
$33.04
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.25
|
| Rate for Payer: PacificSource Commercial |
$34.06
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PacificSource Commercial |
$31.46
|
| Rate for Payer: PacificSource Commercial |
$19.80
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PacificSource Commercial |
$30.34
|
| Rate for Payer: PacificSource Commercial |
$23.12
|
| Rate for Payer: PHCS PPO |
$25.18
|
| Rate for Payer: PHCS PPO |
$37.09
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: PHCS PPO |
$33.04
|
| Rate for Payer: PHCS PPO |
$34.25
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: PHCS PPO |
$21.56
|
| Rate for Payer: Three Rivers PPO |
$16.50
|
| Rate for Payer: Three Rivers PPO |
$26.21
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: Three Rivers PPO |
$19.27
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: Three Rivers PPO |
$28.39
|
| Rate for Payer: Three Rivers PPO |
$25.28
|
| Rate for Payer: TriWest Veterans Administration |
$12.76
|
| Rate for Payer: TriWest Veterans Administration |
$14.90
|
| Rate for Payer: TriWest Veterans Administration |
$19.55
|
| Rate for Payer: TriWest Veterans Administration |
$20.27
|
| Rate for Payer: TriWest Veterans Administration |
$20.88
|
| Rate for Payer: TriWest Veterans Administration |
$21.95
|
| Rate for Payer: TriWest Veterans Administration |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Commercial |
$29.33
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Commercial |
$22.35
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$30.41
|
| Rate for Payer: United Healthcare Medicare |
$20.88
|
| Rate for Payer: United Healthcare Medicare |
$20.27
|
| Rate for Payer: United Healthcare Medicare |
$21.95
|
| Rate for Payer: United Healthcare Medicare |
$19.55
|
| Rate for Payer: United Healthcare Medicare |
$14.90
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: United Healthcare Medicare |
$12.76
|
| Rate for Payer: WINHealth Partners Commercial |
$20.82
|
| Rate for Payer: WINHealth Partners Commercial |
$34.25
|
| Rate for Payer: WINHealth Partners Commercial |
$25.18
|
| Rate for Payer: WINHealth Partners Commercial |
$37.09
|
| Rate for Payer: WINHealth Partners Commercial |
$35.28
|
| Rate for Payer: WINHealth Partners Commercial |
$33.04
|
| Rate for Payer: WINHealth Partners Commercial |
$21.56
|
| Rate for Payer: Wise Provider Network Commercial |
$32.02
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
| Rate for Payer: Wise Provider Network Commercial |
$20.90
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
| Rate for Payer: Wise Provider Network Commercial |
$33.20
|
| Rate for Payer: Wise Provider Network Commercial |
$35.96
|
| Rate for Payer: Wise Provider Network Commercial |
$24.41
|
|
|
KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
J1885
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.20
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
|
|
KETOTIFEN 0.025 % (0.035 %) EYE DROPS [3719]
|
Facility
|
IP
|
$8.48
|
|
|
Service Code
|
NDC 0536125240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.14
|
| Rate for Payer: Altius Commercial |
$8.14
|
| Rate for Payer: Beech Street Commercial |
$8.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.23
|
| Rate for Payer: Cigna of WY Commercial |
$8.31
|
| Rate for Payer: Entrust Commercial |
$8.06
|
| Rate for Payer: First Choice Health Commercial |
$8.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.60
|
| Rate for Payer: HealthUtah PPO |
$8.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.23
|
| Rate for Payer: Multiplan Medicare/VA |
$5.32
|
| Rate for Payer: One Health Plan of WY PPO |
$8.31
|
| Rate for Payer: PacificSource Commercial |
$7.63
|
| Rate for Payer: PHCS PPO |
$8.31
|
| Rate for Payer: Three Rivers PPO |
$6.36
|
| Rate for Payer: TriWest Veterans Administration |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$5.60
|
| Rate for Payer: WINHealth Partners Commercial |
$8.06
|
| Rate for Payer: Wise Provider Network Commercial |
$8.06
|
|
|
KETOTIFEN 0.025 % (0.035 %) EYE DROPS [3719]
|
Facility
|
OP
|
$9.98
|
|
|
Service Code
|
NDC 0065401105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.78
|
| Rate for Payer: Aetna of WY Medicare |
$6.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.58
|
| Rate for Payer: Altius Commercial |
$9.58
|
| Rate for Payer: Beech Street Commercial |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.19
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.68
|
| Rate for Payer: Cigna of WY Commercial |
$9.78
|
| Rate for Payer: Entrust Commercial |
$9.48
|
| Rate for Payer: First Choice Health Commercial |
$9.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.79
|
| Rate for Payer: HealthUtah PPO |
$9.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5.50
|
| Rate for Payer: One Health Plan of WY PPO |
$9.78
|
| Rate for Payer: PacificSource Commercial |
$8.98
|
| Rate for Payer: PHCS PPO |
$9.78
|
| Rate for Payer: Three Rivers PPO |
$7.48
|
| Rate for Payer: TriWest Veterans Administration |
$5.79
|
| Rate for Payer: United Healthcare Commercial |
$8.68
|
| Rate for Payer: United Healthcare Medicare |
$5.79
|
| Rate for Payer: WINHealth Partners Commercial |
$9.78
|
| Rate for Payer: Wise Provider Network Commercial |
$9.48
|
|
|
KETOTIFEN 0.025 % (0.035 %) EYE DROPS [3719]
|
Facility
|
OP
|
$8.48
|
|
|
Service Code
|
NDC 0536125240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.31
|
| Rate for Payer: Aetna of WY Medicare |
$5.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.14
|
| Rate for Payer: Altius Commercial |
$8.14
|
| Rate for Payer: Beech Street Commercial |
$8.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.23
|
| Rate for Payer: Cigna of WY Commercial |
$8.31
|
| Rate for Payer: Entrust Commercial |
$8.06
|
| Rate for Payer: First Choice Health Commercial |
$8.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.92
|
| Rate for Payer: HealthUtah PPO |
$8.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.23
|
| Rate for Payer: Multiplan Medicare/VA |
$4.67
|
| Rate for Payer: One Health Plan of WY PPO |
$8.31
|
| Rate for Payer: PacificSource Commercial |
$7.63
|
| Rate for Payer: PHCS PPO |
$8.31
|
| Rate for Payer: Three Rivers PPO |
$6.36
|
| Rate for Payer: TriWest Veterans Administration |
$4.92
|
| Rate for Payer: United Healthcare Commercial |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$4.92
|
| Rate for Payer: WINHealth Partners Commercial |
$8.31
|
| Rate for Payer: Wise Provider Network Commercial |
$8.06
|
|
|
KETOTIFEN 0.025 % (0.035 %) EYE DROPS [3719]
|
Facility
|
IP
|
$9.98
|
|
|
Service Code
|
NDC 0065401105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.58
|
| Rate for Payer: Altius Commercial |
$9.58
|
| Rate for Payer: Beech Street Commercial |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.19
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.68
|
| Rate for Payer: Cigna of WY Commercial |
$9.78
|
| Rate for Payer: Entrust Commercial |
$9.48
|
| Rate for Payer: First Choice Health Commercial |
$9.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.59
|
| Rate for Payer: HealthUtah PPO |
$9.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.68
|
| Rate for Payer: Multiplan Medicare/VA |
$6.26
|
| Rate for Payer: One Health Plan of WY PPO |
$9.78
|
| Rate for Payer: PacificSource Commercial |
$8.98
|
| Rate for Payer: PHCS PPO |
$9.78
|
| Rate for Payer: Three Rivers PPO |
$7.48
|
| Rate for Payer: TriWest Veterans Administration |
$6.59
|
| Rate for Payer: United Healthcare Commercial |
$8.68
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WINHealth Partners Commercial |
$9.48
|
| Rate for Payer: Wise Provider Network Commercial |
$9.48
|
|
|
KING SUPRAGLOTTIC SZ 3 KLTD213
|
Facility
|
OP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
KING SUPRAGLOTTIC SZ 3 KLTD213
|
Facility
|
IP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
KING SUPRAGLOTTIC SZ 4 KLTD214
|
Facility
|
OP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
KING SUPRAGLOTTIC SZ 4 KLTD214
|
Facility
|
IP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
KING SUPRAGLOTTIC SZ 5 KLTD215
|
Facility
|
OP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
KING SUPRAGLOTTIC SZ 5 KLTD215
|
Facility
|
IP
|
$119.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
