|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
NDC 0409115918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.55
|
| Rate for Payer: Aetna of WY Medicare |
$10.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.03
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.39
|
| Rate for Payer: Cigna of WY Commercial |
$15.55
|
| Rate for Payer: Entrust Commercial |
$15.08
|
| Rate for Payer: First Choice Health Commercial |
$15.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.20
|
| Rate for Payer: HealthUtah PPO |
$15.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.39
|
| Rate for Payer: Multiplan Medicare/VA |
$8.74
|
| Rate for Payer: One Health Plan of WY PPO |
$15.55
|
| Rate for Payer: PacificSource Commercial |
$14.28
|
| Rate for Payer: PHCS PPO |
$15.55
|
| Rate for Payer: Three Rivers PPO |
$11.90
|
| Rate for Payer: TriWest Veterans Administration |
$9.20
|
| Rate for Payer: United Healthcare Commercial |
$13.81
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WINHealth Partners Commercial |
$15.55
|
| Rate for Payer: Wise Provider Network Commercial |
$15.08
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
NDC 0409155919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.37
|
| Rate for Payer: Aetna of WY Medicare |
$10.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.05
|
| Rate for Payer: Altius Commercial |
$15.05
|
| Rate for Payer: Beech Street Commercial |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.21
|
| Rate for Payer: Cigna of WY Commercial |
$15.37
|
| Rate for Payer: Entrust Commercial |
$14.90
|
| Rate for Payer: First Choice Health Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.21
|
| Rate for Payer: Multiplan Medicare/VA |
$8.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.37
|
| Rate for Payer: PacificSource Commercial |
$14.11
|
| Rate for Payer: PHCS PPO |
$15.37
|
| Rate for Payer: Three Rivers PPO |
$11.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.37
|
| Rate for Payer: Wise Provider Network Commercial |
$14.90
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$16.09
|
|
|
Service Code
|
NDC 6332346402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.45
|
| Rate for Payer: Altius Commercial |
$15.45
|
| Rate for Payer: Beech Street Commercial |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.21
|
| Rate for Payer: Cash Price |
$11.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.61
|
| Rate for Payer: Cigna of WY Commercial |
$15.77
|
| Rate for Payer: Entrust Commercial |
$15.29
|
| Rate for Payer: First Choice Health Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.62
|
| Rate for Payer: HealthUtah PPO |
$16.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.61
|
| Rate for Payer: Multiplan Medicare/VA |
$10.09
|
| Rate for Payer: One Health Plan of WY PPO |
$15.77
|
| Rate for Payer: PacificSource Commercial |
$14.48
|
| Rate for Payer: PHCS PPO |
$15.77
|
| Rate for Payer: Three Rivers PPO |
$12.07
|
| Rate for Payer: TriWest Veterans Administration |
$10.62
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
| Rate for Payer: United Healthcare Medicare |
$10.62
|
| Rate for Payer: WINHealth Partners Commercial |
$15.29
|
| Rate for Payer: Wise Provider Network Commercial |
$15.29
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
NDC 0409155919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.05
|
| Rate for Payer: Altius Commercial |
$15.05
|
| Rate for Payer: Beech Street Commercial |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.21
|
| Rate for Payer: Cigna of WY Commercial |
$15.37
|
| Rate for Payer: Entrust Commercial |
$14.90
|
| Rate for Payer: First Choice Health Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.35
|
| Rate for Payer: HealthUtah PPO |
$15.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.21
|
| Rate for Payer: Multiplan Medicare/VA |
$9.83
|
| Rate for Payer: One Health Plan of WY PPO |
$15.37
|
| Rate for Payer: PacificSource Commercial |
$14.11
|
| Rate for Payer: PHCS PPO |
$15.37
|
| Rate for Payer: Three Rivers PPO |
$11.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
| Rate for Payer: United Healthcare Medicare |
$10.35
|
| Rate for Payer: WINHealth Partners Commercial |
$14.90
|
| Rate for Payer: Wise Provider Network Commercial |
$14.90
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 5515016710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$15.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.27
|
| Rate for Payer: Altius Commercial |
$15.27
|
| Rate for Payer: Beech Street Commercial |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.43
|
| Rate for Payer: Cigna of WY Commercial |
$15.59
|
| Rate for Payer: Entrust Commercial |
$15.11
|
| Rate for Payer: First Choice Health Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.50
|
| Rate for Payer: HealthUtah PPO |
$15.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.43
|
| Rate for Payer: Multiplan Medicare/VA |
$9.98
|
| Rate for Payer: One Health Plan of WY PPO |
$15.59
|
| Rate for Payer: PacificSource Commercial |
$14.32
|
| Rate for Payer: PHCS PPO |
$15.59
|
| Rate for Payer: Three Rivers PPO |
$11.93
|
| Rate for Payer: TriWest Veterans Administration |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$13.84
|
| Rate for Payer: United Healthcare Medicare |
$10.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15.11
|
| Rate for Payer: Wise Provider Network Commercial |
$15.11
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 5515016710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$15.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.59
|
| Rate for Payer: Aetna of WY Medicare |
$10.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.27
|
| Rate for Payer: Altius Commercial |
$15.27
|
| Rate for Payer: Beech Street Commercial |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.43
|
| Rate for Payer: Cigna of WY Commercial |
$15.59
|
| Rate for Payer: Entrust Commercial |
$15.11
|
| Rate for Payer: First Choice Health Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: HealthUtah PPO |
$15.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.43
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$15.59
|
| Rate for Payer: PacificSource Commercial |
$14.32
|
| Rate for Payer: PHCS PPO |
$15.59
|
| Rate for Payer: Three Rivers PPO |
$11.93
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$13.84
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: WINHealth Partners Commercial |
$15.59
|
| Rate for Payer: Wise Provider Network Commercial |
$15.11
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$16.09
|
|
|
Service Code
|
NDC 6332346402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.77
|
| Rate for Payer: Aetna of WY Medicare |
$10.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.45
|
| Rate for Payer: Altius Commercial |
$15.45
|
| Rate for Payer: Beech Street Commercial |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.21
|
| Rate for Payer: Cash Price |
$11.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.61
|
| Rate for Payer: Cigna of WY Commercial |
$15.77
|
| Rate for Payer: Entrust Commercial |
$15.29
|
| Rate for Payer: First Choice Health Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.33
|
| Rate for Payer: HealthUtah PPO |
$16.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.61
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: One Health Plan of WY PPO |
$15.77
|
| Rate for Payer: PacificSource Commercial |
$14.48
|
| Rate for Payer: PHCS PPO |
$15.77
|
| Rate for Payer: Three Rivers PPO |
$12.07
|
| Rate for Payer: TriWest Veterans Administration |
$9.33
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
| Rate for Payer: United Healthcare Medicare |
$9.33
|
| Rate for Payer: WINHealth Partners Commercial |
$15.77
|
| Rate for Payer: Wise Provider Network Commercial |
$15.29
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.87
|
|
|
Service Code
|
NDC 0409115918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.03
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.39
|
| Rate for Payer: Cigna of WY Commercial |
$15.55
|
| Rate for Payer: Entrust Commercial |
$15.08
|
| Rate for Payer: First Choice Health Commercial |
$15.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$15.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.55
|
| Rate for Payer: PacificSource Commercial |
$14.28
|
| Rate for Payer: PHCS PPO |
$15.55
|
| Rate for Payer: Three Rivers PPO |
$11.90
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$13.81
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$15.08
|
| Rate for Payer: Wise Provider Network Commercial |
$15.08
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 0143933010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.19
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$8.73
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.19
|
| Rate for Payer: United Healthcare Commercial |
$13.78
|
| Rate for Payer: United Healthcare Medicare |
$9.19
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 0143933010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.45
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$9.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$10.45
|
| Rate for Payer: United Healthcare Commercial |
$13.78
|
| Rate for Payer: United Healthcare Medicare |
$10.45
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 0143933001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.45
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$9.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$10.45
|
| Rate for Payer: United Healthcare Commercial |
$13.78
|
| Rate for Payer: United Healthcare Medicare |
$10.45
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 0143933001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.19
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$8.73
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.19
|
| Rate for Payer: United Healthcare Commercial |
$13.78
|
| Rate for Payer: United Healthcare Medicare |
$9.19
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$16.77
|
|
|
Service Code
|
NDC 0409155918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.43
|
| Rate for Payer: Aetna of WY Medicare |
$11.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.10
|
| Rate for Payer: Altius Commercial |
$16.10
|
| Rate for Payer: Beech Street Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.77
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.27
|
| Rate for Payer: Cigna of WY Commercial |
$16.43
|
| Rate for Payer: Entrust Commercial |
$15.93
|
| Rate for Payer: First Choice Health Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.73
|
| Rate for Payer: HealthUtah PPO |
$16.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.24
|
| Rate for Payer: One Health Plan of WY PPO |
$16.43
|
| Rate for Payer: PacificSource Commercial |
$15.09
|
| Rate for Payer: PHCS PPO |
$16.43
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$14.59
|
| Rate for Payer: United Healthcare Medicare |
$9.73
|
| Rate for Payer: WINHealth Partners Commercial |
$16.43
|
| Rate for Payer: Wise Provider Network Commercial |
$15.93
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.31
|
|
|
Service Code
|
NDC 5515016830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.00
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.70
|
| Rate for Payer: Altius Commercial |
$14.70
|
| Rate for Payer: Beech Street Commercial |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.57
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.85
|
| Rate for Payer: Cigna of WY Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.88
|
| Rate for Payer: HealthUtah PPO |
$15.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.44
|
| Rate for Payer: One Health Plan of WY PPO |
$15.00
|
| Rate for Payer: PacificSource Commercial |
$13.78
|
| Rate for Payer: PHCS PPO |
$15.00
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$8.88
|
| Rate for Payer: United Healthcare Commercial |
$13.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 0409115919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.69
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.87
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.43
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$8.87
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare |
$8.87
|
| Rate for Payer: WINHealth Partners Commercial |
$14.99
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 0409115919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.69
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$16.77
|
|
|
Service Code
|
NDC 0409155918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.10
|
| Rate for Payer: Altius Commercial |
$16.10
|
| Rate for Payer: Beech Street Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.77
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.27
|
| Rate for Payer: Cigna of WY Commercial |
$16.43
|
| Rate for Payer: Entrust Commercial |
$15.93
|
| Rate for Payer: First Choice Health Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.07
|
| Rate for Payer: HealthUtah PPO |
$16.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.27
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.43
|
| Rate for Payer: PacificSource Commercial |
$15.09
|
| Rate for Payer: PHCS PPO |
$16.43
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$14.59
|
| Rate for Payer: United Healthcare Medicare |
$11.07
|
| Rate for Payer: WINHealth Partners Commercial |
$15.93
|
| Rate for Payer: Wise Provider Network Commercial |
$15.93
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$17.08
|
|
|
Service Code
|
NDC 0409156018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$17.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.40
|
| Rate for Payer: Altius Commercial |
$16.40
|
| Rate for Payer: Beech Street Commercial |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.57
|
| Rate for Payer: Cigna of WY Commercial |
$16.74
|
| Rate for Payer: Entrust Commercial |
$16.23
|
| Rate for Payer: First Choice Health Commercial |
$16.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.27
|
| Rate for Payer: HealthUtah PPO |
$17.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.57
|
| Rate for Payer: Multiplan Medicare/VA |
$10.71
|
| Rate for Payer: One Health Plan of WY PPO |
$16.74
|
| Rate for Payer: PacificSource Commercial |
$15.37
|
| Rate for Payer: PHCS PPO |
$16.74
|
| Rate for Payer: Three Rivers PPO |
$12.81
|
| Rate for Payer: TriWest Veterans Administration |
$11.27
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$11.27
|
| Rate for Payer: WINHealth Partners Commercial |
$16.23
|
| Rate for Payer: Wise Provider Network Commercial |
$16.23
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$15.35
|
|
|
Service Code
|
NDC 5515017030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.74
|
| Rate for Payer: Altius Commercial |
$14.74
|
| Rate for Payer: Beech Street Commercial |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$15.04
|
| Rate for Payer: Entrust Commercial |
$14.58
|
| Rate for Payer: First Choice Health Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.13
|
| Rate for Payer: HealthUtah PPO |
$15.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.62
|
| Rate for Payer: One Health Plan of WY PPO |
$15.04
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.04
|
| Rate for Payer: Three Rivers PPO |
$11.51
|
| Rate for Payer: TriWest Veterans Administration |
$10.13
|
| Rate for Payer: United Healthcare Commercial |
$13.35
|
| Rate for Payer: United Healthcare Medicare |
$10.13
|
| Rate for Payer: WINHealth Partners Commercial |
$14.58
|
| Rate for Payer: Wise Provider Network Commercial |
$14.58
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$16.01
|
|
|
Service Code
|
NDC 0409116201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.37
|
| Rate for Payer: Altius Commercial |
$15.37
|
| Rate for Payer: Beech Street Commercial |
$15.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.53
|
| Rate for Payer: Cigna of WY Commercial |
$15.69
|
| Rate for Payer: Entrust Commercial |
$15.21
|
| Rate for Payer: First Choice Health Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.57
|
| Rate for Payer: HealthUtah PPO |
$16.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.53
|
| Rate for Payer: Multiplan Medicare/VA |
$10.04
|
| Rate for Payer: One Health Plan of WY PPO |
$15.69
|
| Rate for Payer: PacificSource Commercial |
$14.41
|
| Rate for Payer: PHCS PPO |
$15.69
|
| Rate for Payer: Three Rivers PPO |
$12.01
|
| Rate for Payer: TriWest Veterans Administration |
$10.57
|
| Rate for Payer: United Healthcare Commercial |
$13.93
|
| Rate for Payer: United Healthcare Medicare |
$10.57
|
| Rate for Payer: WINHealth Partners Commercial |
$15.21
|
| Rate for Payer: Wise Provider Network Commercial |
$15.21
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
OP
|
$17.08
|
|
|
Service Code
|
NDC 0409156018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$17.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.74
|
| Rate for Payer: Aetna of WY Medicare |
$11.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.40
|
| Rate for Payer: Altius Commercial |
$16.40
|
| Rate for Payer: Beech Street Commercial |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.57
|
| Rate for Payer: Cigna of WY Commercial |
$16.74
|
| Rate for Payer: Entrust Commercial |
$16.23
|
| Rate for Payer: First Choice Health Commercial |
$16.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$17.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.57
|
| Rate for Payer: Multiplan Medicare/VA |
$9.41
|
| Rate for Payer: One Health Plan of WY PPO |
$16.74
|
| Rate for Payer: PacificSource Commercial |
$15.37
|
| Rate for Payer: PHCS PPO |
$16.74
|
| Rate for Payer: Three Rivers PPO |
$12.81
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$16.74
|
| Rate for Payer: Wise Provider Network Commercial |
$16.23
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$16.01
|
|
|
Service Code
|
NDC 0409116218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.37
|
| Rate for Payer: Altius Commercial |
$15.37
|
| Rate for Payer: Beech Street Commercial |
$15.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.53
|
| Rate for Payer: Cigna of WY Commercial |
$15.69
|
| Rate for Payer: Entrust Commercial |
$15.21
|
| Rate for Payer: First Choice Health Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.57
|
| Rate for Payer: HealthUtah PPO |
$16.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.53
|
| Rate for Payer: Multiplan Medicare/VA |
$10.04
|
| Rate for Payer: One Health Plan of WY PPO |
$15.69
|
| Rate for Payer: PacificSource Commercial |
$14.41
|
| Rate for Payer: PHCS PPO |
$15.69
|
| Rate for Payer: Three Rivers PPO |
$12.01
|
| Rate for Payer: TriWest Veterans Administration |
$10.57
|
| Rate for Payer: United Healthcare Commercial |
$13.93
|
| Rate for Payer: United Healthcare Medicare |
$10.57
|
| Rate for Payer: WINHealth Partners Commercial |
$15.21
|
| Rate for Payer: Wise Provider Network Commercial |
$15.21
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
OP
|
$16.01
|
|
|
Service Code
|
NDC 0409116218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.69
|
| Rate for Payer: Aetna of WY Medicare |
$10.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.37
|
| Rate for Payer: Altius Commercial |
$15.37
|
| Rate for Payer: Beech Street Commercial |
$15.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.53
|
| Rate for Payer: Cigna of WY Commercial |
$15.69
|
| Rate for Payer: Entrust Commercial |
$15.21
|
| Rate for Payer: First Choice Health Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.29
|
| Rate for Payer: HealthUtah PPO |
$16.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.53
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$15.69
|
| Rate for Payer: PacificSource Commercial |
$14.41
|
| Rate for Payer: PHCS PPO |
$15.69
|
| Rate for Payer: Three Rivers PPO |
$12.01
|
| Rate for Payer: TriWest Veterans Administration |
$9.29
|
| Rate for Payer: United Healthcare Commercial |
$13.93
|
| Rate for Payer: United Healthcare Medicare |
$9.29
|
| Rate for Payer: WINHealth Partners Commercial |
$15.69
|
| Rate for Payer: Wise Provider Network Commercial |
$15.21
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
NDC 0143933401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.78
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.16
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$9.66
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$10.16
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare |
$10.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.63
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 0143933101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| 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: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
