|
MECLIZINE 25 MG TABLET [11572]
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 5026852311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.61
|
| Rate for Payer: Altius Commercial |
$2.61
|
| Rate for Payer: Beech Street Commercial |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.64
|
| Rate for Payer: Cigna of WY Commercial |
$2.67
|
| Rate for Payer: Entrust Commercial |
$2.58
|
| Rate for Payer: First Choice Health Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.80
|
| Rate for Payer: HealthUtah PPO |
$2.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2.67
|
| Rate for Payer: PacificSource Commercial |
$2.45
|
| Rate for Payer: PHCS PPO |
$2.67
|
| Rate for Payer: Three Rivers PPO |
$2.04
|
| Rate for Payer: TriWest Veterans Administration |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2.58
|
| Rate for Payer: Wise Provider Network Commercial |
$2.58
|
|
|
MECLIZINE 25 MG TABLET [11572]
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 5026852311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.67
|
| Rate for Payer: Aetna of WY Medicare |
$1.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.61
|
| Rate for Payer: Altius Commercial |
$2.61
|
| Rate for Payer: Beech Street Commercial |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.64
|
| Rate for Payer: Cigna of WY Commercial |
$2.67
|
| Rate for Payer: Entrust Commercial |
$2.58
|
| Rate for Payer: First Choice Health Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.58
|
| Rate for Payer: HealthUtah PPO |
$2.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2.67
|
| Rate for Payer: PacificSource Commercial |
$2.45
|
| Rate for Payer: PHCS PPO |
$2.67
|
| Rate for Payer: Three Rivers PPO |
$2.04
|
| Rate for Payer: TriWest Veterans Administration |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Medicare |
$1.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2.67
|
| Rate for Payer: Wise Provider Network Commercial |
$2.58
|
|
|
MECLIZINE 25 MG TABLET [11572]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 6808449111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.33
|
| Rate for Payer: Aetna of WY Medicare |
$1.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.28
|
| Rate for Payer: Altius Commercial |
$2.28
|
| Rate for Payer: Beech Street Commercial |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.31
|
| Rate for Payer: Cigna of WY Commercial |
$2.33
|
| Rate for Payer: Entrust Commercial |
$2.26
|
| Rate for Payer: First Choice Health Commercial |
$2.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.38
|
| Rate for Payer: HealthUtah PPO |
$2.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2.33
|
| Rate for Payer: PacificSource Commercial |
$2.14
|
| Rate for Payer: PHCS PPO |
$2.33
|
| Rate for Payer: Three Rivers PPO |
$1.78
|
| Rate for Payer: TriWest Veterans Administration |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$2.07
|
| Rate for Payer: United Healthcare Medicare |
$1.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2.33
|
| Rate for Payer: Wise Provider Network Commercial |
$2.26
|
|
|
MECLIZINE 25 MG TABLET [11572]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 6808449111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.28
|
| Rate for Payer: Altius Commercial |
$2.28
|
| Rate for Payer: Beech Street Commercial |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.31
|
| Rate for Payer: Cigna of WY Commercial |
$2.33
|
| Rate for Payer: Entrust Commercial |
$2.26
|
| Rate for Payer: First Choice Health Commercial |
$2.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.57
|
| Rate for Payer: HealthUtah PPO |
$2.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1.49
|
| Rate for Payer: One Health Plan of WY PPO |
$2.33
|
| Rate for Payer: PacificSource Commercial |
$2.14
|
| Rate for Payer: PHCS PPO |
$2.33
|
| Rate for Payer: Three Rivers PPO |
$1.78
|
| Rate for Payer: TriWest Veterans Administration |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$2.07
|
| Rate for Payer: United Healthcare Medicare |
$1.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2.26
|
| Rate for Payer: Wise Provider Network Commercial |
$2.26
|
|
|
MECONIUM ASPIRATOR N0101
|
Facility
|
OP
|
$13.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.58
|
| Rate for Payer: Aetna of WY Medicare |
$9.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.31
|
| Rate for Payer: Altius Commercial |
$13.31
|
| Rate for Payer: Beech Street Commercial |
$13.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.38
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.44
|
| Rate for Payer: Cigna of WY Commercial |
$13.58
|
| Rate for Payer: Entrust Commercial |
$13.17
|
| Rate for Payer: First Choice Health Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.04
|
| Rate for Payer: HealthUtah PPO |
$13.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.44
|
| Rate for Payer: Multiplan Medicare/VA |
$7.64
|
| Rate for Payer: One Health Plan of WY PPO |
$13.58
|
| Rate for Payer: PacificSource Commercial |
$12.47
|
| Rate for Payer: PHCS PPO |
$13.58
|
| Rate for Payer: Three Rivers PPO |
$10.40
|
| Rate for Payer: TriWest Veterans Administration |
$8.04
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare |
$8.04
|
| Rate for Payer: WINHealth Partners Commercial |
$13.58
|
| Rate for Payer: Wise Provider Network Commercial |
$13.17
|
|
|
MECONIUM ASPIRATOR N0101
|
Facility
|
IP
|
$13.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.31
|
| Rate for Payer: Altius Commercial |
$13.31
|
| Rate for Payer: Beech Street Commercial |
$13.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.38
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.44
|
| Rate for Payer: Cigna of WY Commercial |
$13.58
|
| Rate for Payer: Entrust Commercial |
$13.17
|
| Rate for Payer: First Choice Health Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.15
|
| Rate for Payer: HealthUtah PPO |
$13.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.44
|
| Rate for Payer: Multiplan Medicare/VA |
$8.69
|
| Rate for Payer: One Health Plan of WY PPO |
$13.58
|
| Rate for Payer: PacificSource Commercial |
$12.47
|
| Rate for Payer: PHCS PPO |
$13.58
|
| Rate for Payer: Three Rivers PPO |
$10.40
|
| Rate for Payer: TriWest Veterans Administration |
$9.15
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WINHealth Partners Commercial |
$13.17
|
| Rate for Payer: Wise Provider Network Commercial |
$13.17
|
|
|
MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
97802
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.02
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$26.37
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$31.02
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19258]
|
Facility
|
OP
|
$83.79
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$83.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$55.30
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.44
|
| Rate for Payer: Altius Commercial |
$80.44
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Beech Street Commercial |
$82.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$58.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Cigna of WY Commercial |
$82.11
|
| Rate for Payer: Entrust Commercial |
$79.60
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$79.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: HealthUtah PPO |
$83.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.28
|
| Rate for Payer: Multiplan Medicare/VA |
$46.17
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: One Health Plan of WY PPO |
$82.11
|
| Rate for Payer: PacificSource Commercial |
$75.41
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: PHCS PPO |
$82.11
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: Three Rivers PPO |
$62.84
|
| Rate for Payer: TriWest Veterans Administration |
$48.60
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
| Rate for Payer: United Healthcare Medicare |
$48.60
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: WINHealth Partners Commercial |
$82.11
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$79.60
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19258]
|
Facility
|
IP
|
$83.79
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.54 |
| Max. Negotiated Rate |
$83.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Altius Commercial |
$80.44
|
| Rate for Payer: Beech Street Commercial |
$82.11
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.79
|
| Rate for Payer: Cash Price |
$58.65
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.28
|
| Rate for Payer: Cigna of WY Commercial |
$82.11
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: Entrust Commercial |
$79.60
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$79.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$83.79
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.28
|
| Rate for Payer: Multiplan Medicare/VA |
$52.54
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$82.11
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$75.41
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: PHCS PPO |
$82.11
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: Three Rivers PPO |
$62.84
|
| Rate for Payer: TriWest Veterans Administration |
$55.30
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Commercial |
$72.90
|
| Rate for Payer: United Healthcare Medicare |
$55.30
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: WINHealth Partners Commercial |
$79.60
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$79.60
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [25743]
|
Facility
|
OP
|
$137.50
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.75
|
| Rate for Payer: Aetna of WY Medicare |
$90.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$132.00
|
| Rate for Payer: Altius Commercial |
$132.00
|
| Rate for Payer: Beech Street Commercial |
$134.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.89
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.38
|
| Rate for Payer: Cigna of WY Commercial |
$134.75
|
| Rate for Payer: Entrust Commercial |
$130.62
|
| Rate for Payer: First Choice Health Commercial |
$130.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.75
|
| Rate for Payer: HealthUtah PPO |
$137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.38
|
| Rate for Payer: Multiplan Medicare/VA |
$75.76
|
| Rate for Payer: One Health Plan of WY PPO |
$134.75
|
| Rate for Payer: PacificSource Commercial |
$123.75
|
| Rate for Payer: PHCS PPO |
$134.75
|
| Rate for Payer: Three Rivers PPO |
$103.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.75
|
| Rate for Payer: United Healthcare Commercial |
$119.62
|
| Rate for Payer: United Healthcare Medicare |
$79.75
|
| Rate for Payer: WINHealth Partners Commercial |
$134.75
|
| Rate for Payer: Wise Provider Network Commercial |
$130.62
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SYRINGE [25743]
|
Facility
|
IP
|
$137.50
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.21 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$132.00
|
| Rate for Payer: Altius Commercial |
$132.00
|
| Rate for Payer: Beech Street Commercial |
$134.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.89
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.38
|
| Rate for Payer: Cigna of WY Commercial |
$134.75
|
| Rate for Payer: Entrust Commercial |
$130.62
|
| Rate for Payer: First Choice Health Commercial |
$130.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.75
|
| Rate for Payer: HealthUtah PPO |
$137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.38
|
| Rate for Payer: Multiplan Medicare/VA |
$86.21
|
| Rate for Payer: One Health Plan of WY PPO |
$134.75
|
| Rate for Payer: PacificSource Commercial |
$123.75
|
| Rate for Payer: PHCS PPO |
$134.75
|
| Rate for Payer: Three Rivers PPO |
$103.12
|
| Rate for Payer: TriWest Veterans Administration |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$119.62
|
| Rate for Payer: United Healthcare Medicare |
$90.75
|
| Rate for Payer: WINHealth Partners Commercial |
$130.62
|
| Rate for Payer: Wise Provider Network Commercial |
$130.62
|
|
|
MELATONIN 10 MG SUBLINGUAL TABLET [142576]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 8770142634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
MELATONIN 10 MG SUBLINGUAL TABLET [142576]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 8770142634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
MELATONIN 3 MG TABLET [6962]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 2055503601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.53
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
MELATONIN 3 MG TABLET [6962]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 2055503601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
MELATONIN 3 MG TABLET [6962]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 8770140813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
MELATONIN 3 MG TABLET [6962]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 8770140813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
MELKER CRICOTHYROTOMY CATH SET
|
Facility
|
OP
|
$803.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.78 |
| Max. Negotiated Rate |
$803.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$787.53
|
| Rate for Payer: Aetna of WY Medicare |
$530.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$771.46
|
| Rate for Payer: Altius Commercial |
$771.46
|
| Rate for Payer: Beech Street Commercial |
$787.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$659.76
|
| Rate for Payer: Cash Price |
$562.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$779.49
|
| Rate for Payer: Cigna of WY Commercial |
$787.53
|
| Rate for Payer: Entrust Commercial |
$763.42
|
| Rate for Payer: First Choice Health Commercial |
$763.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$763.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.09
|
| Rate for Payer: HealthUtah PPO |
$803.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$779.49
|
| Rate for Payer: Multiplan Medicare/VA |
$442.78
|
| Rate for Payer: One Health Plan of WY PPO |
$787.53
|
| Rate for Payer: PacificSource Commercial |
$723.24
|
| Rate for Payer: PHCS PPO |
$787.53
|
| Rate for Payer: Three Rivers PPO |
$602.70
|
| Rate for Payer: TriWest Veterans Administration |
$466.09
|
| Rate for Payer: United Healthcare Commercial |
$699.13
|
| Rate for Payer: United Healthcare Medicare |
$466.09
|
| Rate for Payer: WINHealth Partners Commercial |
$787.53
|
| Rate for Payer: Wise Provider Network Commercial |
$763.42
|
|
|
MELKER CRICOTHYROTOMY CATH SET
|
Facility
|
IP
|
$803.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.86 |
| Max. Negotiated Rate |
$803.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$787.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$771.46
|
| Rate for Payer: Altius Commercial |
$771.46
|
| Rate for Payer: Beech Street Commercial |
$787.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$659.76
|
| Rate for Payer: Cash Price |
$562.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$779.49
|
| Rate for Payer: Cigna of WY Commercial |
$787.53
|
| Rate for Payer: Entrust Commercial |
$763.42
|
| Rate for Payer: First Choice Health Commercial |
$763.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$763.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.38
|
| Rate for Payer: HealthUtah PPO |
$803.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$779.49
|
| Rate for Payer: Multiplan Medicare/VA |
$503.86
|
| Rate for Payer: One Health Plan of WY PPO |
$787.53
|
| Rate for Payer: PacificSource Commercial |
$723.24
|
| Rate for Payer: PHCS PPO |
$787.53
|
| Rate for Payer: Three Rivers PPO |
$602.70
|
| Rate for Payer: TriWest Veterans Administration |
$530.38
|
| Rate for Payer: United Healthcare Commercial |
$699.13
|
| Rate for Payer: United Healthcare Medicare |
$530.38
|
| Rate for Payer: WINHealth Partners Commercial |
$763.42
|
| Rate for Payer: Wise Provider Network Commercial |
$763.42
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 6838205101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.19
|
| Rate for Payer: Altius Commercial |
$0.19
|
| Rate for Payer: Beech Street Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.19
|
| Rate for Payer: Cigna of WY Commercial |
$0.20
|
| Rate for Payer: Entrust Commercial |
$0.19
|
| Rate for Payer: First Choice Health Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.20
|
| Rate for Payer: PacificSource Commercial |
$0.18
|
| Rate for Payer: PHCS PPO |
$0.20
|
| Rate for Payer: Three Rivers PPO |
$0.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.20
|
| Rate for Payer: Wise Provider Network Commercial |
$0.19
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 5026852611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 5026852615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 5026852611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 6838205101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.19
|
| Rate for Payer: Altius Commercial |
$0.19
|
| Rate for Payer: Beech Street Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.19
|
| Rate for Payer: Cigna of WY Commercial |
$0.20
|
| Rate for Payer: Entrust Commercial |
$0.19
|
| Rate for Payer: First Choice Health Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.20
|
| Rate for Payer: PacificSource Commercial |
$0.18
|
| Rate for Payer: PHCS PPO |
$0.20
|
| Rate for Payer: Three Rivers PPO |
$0.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.19
|
| Rate for Payer: Wise Provider Network Commercial |
$0.19
|
|
|
MELOXICAM 15 MG TABLET [4471]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 5026852615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
