|
KYLEENA, 19.5 MG
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS Q9984
|
| Hospital Charge Code |
Q9984
|
| Min. Negotiated Rate |
$930.75 |
| Max. Negotiated Rate |
$1,241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,216.18
|
| Rate for Payer: Beech Street Commercial |
$1,178.95
|
| Rate for Payer: Cash Price |
$868.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,203.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,216.18
|
| Rate for Payer: First Choice Health Commercial |
$1,116.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,178.95
|
| Rate for Payer: HealthUtah PPO |
$1,241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,203.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,216.18
|
| Rate for Payer: PacificSource Commercial |
$1,116.90
|
| Rate for Payer: PHCS PPO |
$1,178.95
|
| Rate for Payer: Three Rivers PPO |
$930.75
|
| Rate for Payer: United Healthcare Commercial |
$1,079.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,178.95
|
|
|
LABETALOL 100 MG TABLET [17843]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 6068743911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.74
|
| Rate for Payer: Altius Commercial |
$1.74
|
| Rate for Payer: Beech Street Commercial |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.76
|
| Rate for Payer: Cigna of WY Commercial |
$1.77
|
| Rate for Payer: Entrust Commercial |
$1.72
|
| Rate for Payer: First Choice Health Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.77
|
| Rate for Payer: PacificSource Commercial |
$1.63
|
| Rate for Payer: PHCS PPO |
$1.77
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.72
|
|
|
LABETALOL 100 MG TABLET [17843]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 6068743911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.77
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.74
|
| Rate for Payer: Altius Commercial |
$1.74
|
| Rate for Payer: Beech Street Commercial |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.76
|
| Rate for Payer: Cigna of WY Commercial |
$1.77
|
| Rate for Payer: Entrust Commercial |
$1.72
|
| Rate for Payer: First Choice Health Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.05
|
| Rate for Payer: HealthUtah PPO |
$1.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.77
|
| Rate for Payer: PacificSource Commercial |
$1.63
|
| Rate for Payer: PHCS PPO |
$1.77
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1.77
|
| Rate for Payer: Wise Provider Network Commercial |
$1.72
|
|
|
LABETALOL 100 MG TABLET [17843]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 6068743901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.77
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.74
|
| Rate for Payer: Altius Commercial |
$1.74
|
| Rate for Payer: Beech Street Commercial |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.76
|
| Rate for Payer: Cigna of WY Commercial |
$1.77
|
| Rate for Payer: Entrust Commercial |
$1.72
|
| Rate for Payer: First Choice Health Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.05
|
| Rate for Payer: HealthUtah PPO |
$1.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.77
|
| Rate for Payer: PacificSource Commercial |
$1.63
|
| Rate for Payer: PHCS PPO |
$1.77
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1.77
|
| Rate for Payer: Wise Provider Network Commercial |
$1.72
|
|
|
LABETALOL 100 MG TABLET [17843]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 6068743901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.74
|
| Rate for Payer: Altius Commercial |
$1.74
|
| Rate for Payer: Beech Street Commercial |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.76
|
| Rate for Payer: Cigna of WY Commercial |
$1.77
|
| Rate for Payer: Entrust Commercial |
$1.72
|
| Rate for Payer: First Choice Health Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.77
|
| Rate for Payer: PacificSource Commercial |
$1.63
|
| Rate for Payer: PHCS PPO |
$1.77
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.72
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION [18335]
|
Facility
|
OP
|
$16.40
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.41
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Medicare |
$10.82
|
| Rate for Payer: Aetna of WY Medicare |
$12.69
|
| Rate for Payer: Aetna of WY Medicare |
$10.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.38
|
| Rate for Payer: Aetna of WY Medicare |
$10.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.45
|
| Rate for Payer: Altius Commercial |
$18.45
|
| Rate for Payer: Altius Commercial |
$15.09
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Altius Commercial |
$14.80
|
| Rate for Payer: Altius Commercial |
$15.74
|
| Rate for Payer: Beech Street Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.41
|
| Rate for Payer: Beech Street Commercial |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.96
|
| Rate for Payer: Cigna of WY Commercial |
$15.11
|
| Rate for Payer: Cigna of WY Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$16.07
|
| Rate for Payer: Cigna of WY Commercial |
$18.84
|
| Rate for Payer: Entrust Commercial |
$14.65
|
| Rate for Payer: Entrust Commercial |
$14.93
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$18.26
|
| Rate for Payer: Entrust Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$14.65
|
| Rate for Payer: First Choice Health Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$18.26
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$14.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.12
|
| Rate for Payer: HealthUtah PPO |
$15.42
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: HealthUtah PPO |
$15.72
|
| Rate for Payer: HealthUtah PPO |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$16.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Multiplan Medicare/VA |
$10.59
|
| Rate for Payer: Multiplan Medicare/VA |
$8.50
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: Multiplan Medicare/VA |
$9.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.66
|
| Rate for Payer: One Health Plan of WY PPO |
$15.41
|
| Rate for Payer: One Health Plan of WY PPO |
$15.11
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$18.84
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$14.76
|
| Rate for Payer: PacificSource Commercial |
$17.30
|
| Rate for Payer: PacificSource Commercial |
$14.15
|
| Rate for Payer: PHCS PPO |
$18.84
|
| Rate for Payer: PHCS PPO |
$15.41
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: PHCS PPO |
$16.07
|
| Rate for Payer: PHCS PPO |
$15.11
|
| Rate for Payer: Three Rivers PPO |
$11.79
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: Three Rivers PPO |
$14.42
|
| Rate for Payer: Three Rivers PPO |
$12.30
|
| Rate for Payer: TriWest Veterans Administration |
$9.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.51
|
| Rate for Payer: TriWest Veterans Administration |
$11.15
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: TriWest Veterans Administration |
$8.94
|
| Rate for Payer: United Healthcare Commercial |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: United Healthcare Medicare |
$9.51
|
| Rate for Payer: United Healthcare Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$11.15
|
| Rate for Payer: WINHealth Partners Commercial |
$15.11
|
| Rate for Payer: WINHealth Partners Commercial |
$16.07
|
| Rate for Payer: WINHealth Partners Commercial |
$18.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.47
|
| Rate for Payer: WINHealth Partners Commercial |
$15.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$18.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.93
|
| Rate for Payer: Wise Provider Network Commercial |
$14.65
|
| Rate for Payer: Wise Provider Network Commercial |
$15.58
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION [18335]
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$19.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.74
|
| Rate for Payer: Altius Commercial |
$15.09
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Altius Commercial |
$18.45
|
| Rate for Payer: Altius Commercial |
$14.80
|
| Rate for Payer: Altius Commercial |
$15.74
|
| Rate for Payer: Beech Street Commercial |
$15.41
|
| Rate for Payer: Beech Street Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$18.84
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.91
|
| Rate for Payer: Cigna of WY Commercial |
$18.84
|
| Rate for Payer: Cigna of WY Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$16.07
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.11
|
| Rate for Payer: Entrust Commercial |
$14.65
|
| Rate for Payer: Entrust Commercial |
$18.26
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.93
|
| Rate for Payer: Entrust Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$14.93
|
| Rate for Payer: First Choice Health Commercial |
$14.65
|
| Rate for Payer: First Choice Health Commercial |
$18.26
|
| Rate for Payer: First Choice Health Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.42
|
| Rate for Payer: HealthUtah PPO |
$16.40
|
| Rate for Payer: HealthUtah PPO |
$15.42
|
| Rate for Payer: HealthUtah PPO |
$15.72
|
| Rate for Payer: HealthUtah PPO |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.90
|
| Rate for Payer: Multiplan Medicare/VA |
$9.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.05
|
| Rate for Payer: One Health Plan of WY PPO |
$15.11
|
| Rate for Payer: One Health Plan of WY PPO |
$15.41
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$18.84
|
| Rate for Payer: PacificSource Commercial |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$14.15
|
| Rate for Payer: PacificSource Commercial |
$14.76
|
| Rate for Payer: PacificSource Commercial |
$17.30
|
| Rate for Payer: PHCS PPO |
$16.07
|
| Rate for Payer: PHCS PPO |
$18.84
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: PHCS PPO |
$15.11
|
| Rate for Payer: PHCS PPO |
$15.41
|
| Rate for Payer: Three Rivers PPO |
$11.79
|
| Rate for Payer: Three Rivers PPO |
$14.42
|
| Rate for Payer: Three Rivers PPO |
$12.30
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$12.69
|
| Rate for Payer: TriWest Veterans Administration |
$10.42
|
| Rate for Payer: TriWest Veterans Administration |
$10.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.38
|
| Rate for Payer: TriWest Veterans Administration |
$10.82
|
| Rate for Payer: United Healthcare Commercial |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$13.74
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
| Rate for Payer: United Healthcare Medicare |
$10.82
|
| Rate for Payer: United Healthcare Medicare |
$10.38
|
| Rate for Payer: United Healthcare Medicare |
$10.18
|
| Rate for Payer: United Healthcare Medicare |
$12.69
|
| Rate for Payer: WINHealth Partners Commercial |
$14.93
|
| Rate for Payer: WINHealth Partners Commercial |
$15.58
|
| Rate for Payer: WINHealth Partners Commercial |
$18.26
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: WINHealth Partners Commercial |
$14.65
|
| Rate for Payer: Wise Provider Network Commercial |
$14.93
|
| Rate for Payer: Wise Provider Network Commercial |
$18.26
|
| Rate for Payer: Wise Provider Network Commercial |
$15.58
|
| Rate for Payer: Wise Provider Network Commercial |
$14.65
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SYR/SOLN (WRAPPER) [4080000502]
|
Facility
|
OP
|
$16.40
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.82
|
| Rate for Payer: Aetna of WY Medicare |
$10.18
|
| Rate for Payer: Aetna of WY Medicare |
$12.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.80
|
| Rate for Payer: Altius Commercial |
$15.74
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Altius Commercial |
$18.45
|
| Rate for Payer: Altius Commercial |
$14.80
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.64
|
| Rate for Payer: Cigna of WY Commercial |
$16.07
|
| Rate for Payer: Cigna of WY Commercial |
$15.11
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$18.84
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.65
|
| Rate for Payer: Entrust Commercial |
$18.26
|
| Rate for Payer: Entrust Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$15.58
|
| Rate for Payer: First Choice Health Commercial |
$14.65
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$18.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.51
|
| Rate for Payer: HealthUtah PPO |
$15.42
|
| Rate for Payer: HealthUtah PPO |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$16.40
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.96
|
| Rate for Payer: Multiplan Medicare/VA |
$9.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.50
|
| Rate for Payer: Multiplan Medicare/VA |
$10.59
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$15.11
|
| Rate for Payer: One Health Plan of WY PPO |
$18.84
|
| Rate for Payer: One Health Plan of WY PPO |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: PacificSource Commercial |
$17.30
|
| Rate for Payer: PacificSource Commercial |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$14.76
|
| Rate for Payer: PHCS PPO |
$18.84
|
| Rate for Payer: PHCS PPO |
$16.07
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: PHCS PPO |
$15.11
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$14.42
|
| Rate for Payer: Three Rivers PPO |
$12.30
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: TriWest Veterans Administration |
$11.15
|
| Rate for Payer: TriWest Veterans Administration |
$8.94
|
| Rate for Payer: TriWest Veterans Administration |
$9.51
|
| Rate for Payer: United Healthcare Commercial |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Medicare |
$9.51
|
| Rate for Payer: United Healthcare Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: United Healthcare Medicare |
$11.15
|
| Rate for Payer: WINHealth Partners Commercial |
$18.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.47
|
| Rate for Payer: WINHealth Partners Commercial |
$15.11
|
| Rate for Payer: WINHealth Partners Commercial |
$16.07
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14.65
|
| Rate for Payer: Wise Provider Network Commercial |
$15.58
|
| Rate for Payer: Wise Provider Network Commercial |
$18.26
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SYR/SOLN (WRAPPER) [4080000502]
|
Facility
|
IP
|
$15.79
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.80
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Altius Commercial |
$18.45
|
| Rate for Payer: Altius Commercial |
$14.80
|
| Rate for Payer: Altius Commercial |
$15.74
|
| Rate for Payer: Beech Street Commercial |
$18.84
|
| Rate for Payer: Beech Street Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$13.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.64
|
| Rate for Payer: Cigna of WY Commercial |
$18.84
|
| Rate for Payer: Cigna of WY Commercial |
$15.11
|
| Rate for Payer: Cigna of WY Commercial |
$16.07
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.58
|
| Rate for Payer: Entrust Commercial |
$18.26
|
| Rate for Payer: Entrust Commercial |
$14.65
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$14.65
|
| Rate for Payer: First Choice Health Commercial |
$18.26
|
| Rate for Payer: First Choice Health Commercial |
$15.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.69
|
| Rate for Payer: HealthUtah PPO |
$15.42
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: HealthUtah PPO |
$19.22
|
| Rate for Payer: HealthUtah PPO |
$16.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.91
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.05
|
| Rate for Payer: Multiplan Medicare/VA |
$9.90
|
| Rate for Payer: One Health Plan of WY PPO |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$15.11
|
| Rate for Payer: One Health Plan of WY PPO |
$18.84
|
| Rate for Payer: PacificSource Commercial |
$14.76
|
| Rate for Payer: PacificSource Commercial |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$17.30
|
| Rate for Payer: PHCS PPO |
$18.84
|
| Rate for Payer: PHCS PPO |
$16.07
|
| Rate for Payer: PHCS PPO |
$15.11
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$14.42
|
| Rate for Payer: Three Rivers PPO |
$12.30
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$10.82
|
| Rate for Payer: TriWest Veterans Administration |
$10.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.42
|
| Rate for Payer: TriWest Veterans Administration |
$12.69
|
| Rate for Payer: United Healthcare Commercial |
$16.72
|
| Rate for Payer: United Healthcare Commercial |
$14.27
|
| Rate for Payer: United Healthcare Commercial |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$13.42
|
| Rate for Payer: United Healthcare Medicare |
$10.18
|
| Rate for Payer: United Healthcare Medicare |
$12.69
|
| Rate for Payer: United Healthcare Medicare |
$10.82
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: WINHealth Partners Commercial |
$14.65
|
| Rate for Payer: WINHealth Partners Commercial |
$18.26
|
| Rate for Payer: WINHealth Partners Commercial |
$15.58
|
| Rate for Payer: Wise Provider Network Commercial |
$15.58
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14.65
|
| Rate for Payer: Wise Provider Network Commercial |
$18.26
|
|
|
L.ACIDOPHIL,SALIVARI-BIFIDO BIFIDUM-STREP THERMOPH 175 MG CAPSULE [53105]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 8770140808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
L.ACIDOPHIL,SALIVARI-BIFIDO BIFIDUM-STREP THERMOPH 175 MG CAPSULE [53105]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 8770140808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.18
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
LACTASE 3,000 UNIT TABLET [14718]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 8770128810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
LACTASE 3,000 UNIT TABLET [14718]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 8770128810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
LACTASE 9,000 UNIT TABLET [11111]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 0045091032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$0.86
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
LACTASE 9,000 UNIT TABLET [11111]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 0045091032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Aetna of WY Medicare |
$0.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.89
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION [5808]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
NDC 0264775010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION [5808]
|
Facility
|
IP
|
$15.01
|
|
|
Service Code
|
NDC 0264775000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.41
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$9.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION [5808]
|
Facility
|
OP
|
$15.01
|
|
|
Service Code
|
NDC 0264775000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.41
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.27
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION [5808]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
NDC 0264775010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
LACTATED RINGERS IRRIGATION SOLUTION [5747]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0264738960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
LACTATED RINGERS IRRIGATION SOLUTION [5747]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0264738960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
LACTATED RINGERS IV BOLUS [400296]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0264775010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
LACTATED RINGERS IV BOLUS [400296]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264775000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
LACTATED RINGERS IV BOLUS [400296]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264775000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
LACTATED RINGERS IV BOLUS [400296]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0264775010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
