|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 5026855015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.31
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR [18966]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 6068764011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.37
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [159775]
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS J7674
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Aetna of WY Medicare |
$17.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.22
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Multiplan Medicare/VA |
$14.46
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$15.22
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare |
$15.22
|
| Rate for Payer: WINHealth Partners Commercial |
$25.72
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
|
|
METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [159775]
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J7674
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.32
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Multiplan Medicare/VA |
$16.46
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$17.32
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare |
$17.32
|
| Rate for Payer: WINHealth Partners Commercial |
$24.94
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
|
|
METHADONE 5 MG TABLET [18508]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 0054070920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
METHADONE 5 MG TABLET [18508]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 0054070920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [9975]
|
Facility
|
IP
|
$9.85
|
|
|
Service Code
|
NDC 6068769411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.46
|
| Rate for Payer: Altius Commercial |
$9.46
|
| Rate for Payer: Beech Street Commercial |
$9.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.09
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.55
|
| Rate for Payer: Cigna of WY Commercial |
$9.65
|
| Rate for Payer: Entrust Commercial |
$9.36
|
| Rate for Payer: First Choice Health Commercial |
$9.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.50
|
| Rate for Payer: HealthUtah PPO |
$9.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.55
|
| Rate for Payer: Multiplan Medicare/VA |
$6.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9.65
|
| Rate for Payer: PacificSource Commercial |
$8.86
|
| Rate for Payer: PHCS PPO |
$9.65
|
| Rate for Payer: Three Rivers PPO |
$7.39
|
| Rate for Payer: TriWest Veterans Administration |
$6.50
|
| Rate for Payer: United Healthcare Commercial |
$8.57
|
| Rate for Payer: United Healthcare Medicare |
$6.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9.36
|
| Rate for Payer: Wise Provider Network Commercial |
$9.36
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [9975]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 3069847701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [9975]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 3069847701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
METHENAMINE HIPPURATE 1 GRAM TABLET [9975]
|
Facility
|
OP
|
$9.85
|
|
|
Service Code
|
NDC 6068769411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.65
|
| Rate for Payer: Aetna of WY Medicare |
$6.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.46
|
| Rate for Payer: Altius Commercial |
$9.46
|
| Rate for Payer: Beech Street Commercial |
$9.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.09
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.55
|
| Rate for Payer: Cigna of WY Commercial |
$9.65
|
| Rate for Payer: Entrust Commercial |
$9.36
|
| Rate for Payer: First Choice Health Commercial |
$9.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.71
|
| Rate for Payer: HealthUtah PPO |
$9.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.55
|
| Rate for Payer: Multiplan Medicare/VA |
$5.43
|
| Rate for Payer: One Health Plan of WY PPO |
$9.65
|
| Rate for Payer: PacificSource Commercial |
$8.86
|
| Rate for Payer: PHCS PPO |
$9.65
|
| Rate for Payer: Three Rivers PPO |
$7.39
|
| Rate for Payer: TriWest Veterans Administration |
$5.71
|
| Rate for Payer: United Healthcare Commercial |
$8.57
|
| Rate for Payer: United Healthcare Medicare |
$5.71
|
| Rate for Payer: WINHealth Partners Commercial |
$9.65
|
| Rate for Payer: Wise Provider Network Commercial |
$9.36
|
|
|
METHIMAZOLE 10 MG TABLET [17910]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 2315507101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
METHIMAZOLE 10 MG TABLET [17910]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 2315507101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$0.99
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [7830]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J2800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.17
|
| Rate for Payer: Aetna of WY Medicare |
$14.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.74
|
| Rate for Payer: Altius Commercial |
$20.74
|
| Rate for Payer: Beech Street Commercial |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.73
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.95
|
| Rate for Payer: Cigna of WY Commercial |
$21.17
|
| Rate for Payer: Entrust Commercial |
$20.52
|
| Rate for Payer: First Choice Health Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.53
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$11.90
|
| Rate for Payer: One Health Plan of WY PPO |
$21.17
|
| Rate for Payer: PacificSource Commercial |
$19.44
|
| Rate for Payer: PHCS PPO |
$21.17
|
| Rate for Payer: Three Rivers PPO |
$16.20
|
| Rate for Payer: TriWest Veterans Administration |
$12.53
|
| Rate for Payer: United Healthcare Commercial |
$18.79
|
| Rate for Payer: United Healthcare Medicare |
$12.53
|
| Rate for Payer: WINHealth Partners Commercial |
$21.17
|
| Rate for Payer: Wise Provider Network Commercial |
$20.52
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [7830]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J2800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.74
|
| Rate for Payer: Altius Commercial |
$20.74
|
| Rate for Payer: Beech Street Commercial |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.73
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.95
|
| Rate for Payer: Cigna of WY Commercial |
$21.17
|
| Rate for Payer: Entrust Commercial |
$20.52
|
| Rate for Payer: First Choice Health Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.26
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$13.54
|
| Rate for Payer: One Health Plan of WY PPO |
$21.17
|
| Rate for Payer: PacificSource Commercial |
$19.44
|
| Rate for Payer: PHCS PPO |
$21.17
|
| Rate for Payer: Three Rivers PPO |
$16.20
|
| Rate for Payer: TriWest Veterans Administration |
$14.26
|
| Rate for Payer: United Healthcare Commercial |
$18.79
|
| Rate for Payer: United Healthcare Medicare |
$14.26
|
| Rate for Payer: WINHealth Partners Commercial |
$20.52
|
| Rate for Payer: Wise Provider Network Commercial |
$20.52
|
|
|
METHOCARBAMOL 500 MG TABLET [734]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6068755911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
METHOCARBAMOL 500 MG TABLET [734]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6068755911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [7531]
|
Facility
|
IP
|
$28.63
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.48
|
| Rate for Payer: Altius Commercial |
$27.48
|
| Rate for Payer: Beech Street Commercial |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.51
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.77
|
| Rate for Payer: Cigna of WY Commercial |
$28.06
|
| Rate for Payer: Entrust Commercial |
$27.20
|
| Rate for Payer: First Choice Health Commercial |
$27.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.90
|
| Rate for Payer: HealthUtah PPO |
$28.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.77
|
| Rate for Payer: Multiplan Medicare/VA |
$17.95
|
| Rate for Payer: One Health Plan of WY PPO |
$28.06
|
| Rate for Payer: PacificSource Commercial |
$25.77
|
| Rate for Payer: PHCS PPO |
$28.06
|
| Rate for Payer: Three Rivers PPO |
$21.47
|
| Rate for Payer: TriWest Veterans Administration |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$24.91
|
| Rate for Payer: United Healthcare Medicare |
$18.90
|
| Rate for Payer: WINHealth Partners Commercial |
$27.20
|
| Rate for Payer: Wise Provider Network Commercial |
$27.20
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [7531]
|
Facility
|
OP
|
$28.63
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.06
|
| Rate for Payer: Aetna of WY Medicare |
$18.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.48
|
| Rate for Payer: Altius Commercial |
$27.48
|
| Rate for Payer: Beech Street Commercial |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.51
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.77
|
| Rate for Payer: Cigna of WY Commercial |
$28.06
|
| Rate for Payer: Entrust Commercial |
$27.20
|
| Rate for Payer: First Choice Health Commercial |
$27.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.61
|
| Rate for Payer: HealthUtah PPO |
$28.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.77
|
| Rate for Payer: Multiplan Medicare/VA |
$15.78
|
| Rate for Payer: One Health Plan of WY PPO |
$28.06
|
| Rate for Payer: PacificSource Commercial |
$25.77
|
| Rate for Payer: PHCS PPO |
$28.06
|
| Rate for Payer: Three Rivers PPO |
$21.47
|
| Rate for Payer: TriWest Veterans Administration |
$16.61
|
| Rate for Payer: United Healthcare Commercial |
$24.91
|
| Rate for Payer: United Healthcare Medicare |
$16.61
|
| Rate for Payer: WINHealth Partners Commercial |
$28.06
|
| Rate for Payer: Wise Provider Network Commercial |
$27.20
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [27657]
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.79
|
| Rate for Payer: Altius Commercial |
$31.79
|
| Rate for Payer: Beech Street Commercial |
$32.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.12
|
| Rate for Payer: Cigna of WY Commercial |
$32.45
|
| Rate for Payer: Entrust Commercial |
$31.45
|
| Rate for Payer: First Choice Health Commercial |
$31.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.85
|
| Rate for Payer: HealthUtah PPO |
$33.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.12
|
| Rate for Payer: Multiplan Medicare/VA |
$20.76
|
| Rate for Payer: One Health Plan of WY PPO |
$32.45
|
| Rate for Payer: PacificSource Commercial |
$29.80
|
| Rate for Payer: PHCS PPO |
$32.45
|
| Rate for Payer: Three Rivers PPO |
$24.83
|
| Rate for Payer: TriWest Veterans Administration |
$21.85
|
| Rate for Payer: United Healthcare Commercial |
$28.81
|
| Rate for Payer: United Healthcare Medicare |
$21.85
|
| Rate for Payer: WINHealth Partners Commercial |
$31.45
|
| Rate for Payer: Wise Provider Network Commercial |
$31.45
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [27657]
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.45
|
| Rate for Payer: Aetna of WY Medicare |
$21.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.79
|
| Rate for Payer: Altius Commercial |
$31.79
|
| Rate for Payer: Beech Street Commercial |
$32.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.12
|
| Rate for Payer: Cigna of WY Commercial |
$32.45
|
| Rate for Payer: Entrust Commercial |
$31.45
|
| Rate for Payer: First Choice Health Commercial |
$31.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.20
|
| Rate for Payer: HealthUtah PPO |
$33.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.12
|
| Rate for Payer: Multiplan Medicare/VA |
$18.24
|
| Rate for Payer: One Health Plan of WY PPO |
$32.45
|
| Rate for Payer: PacificSource Commercial |
$29.80
|
| Rate for Payer: PHCS PPO |
$32.45
|
| Rate for Payer: Three Rivers PPO |
$24.83
|
| Rate for Payer: TriWest Veterans Administration |
$19.20
|
| Rate for Payer: United Healthcare Commercial |
$28.81
|
| Rate for Payer: United Healthcare Medicare |
$19.20
|
| Rate for Payer: WINHealth Partners Commercial |
$32.45
|
| Rate for Payer: Wise Provider Network Commercial |
$31.45
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [13586]
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
NDC 5428814701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Aetna of WY Medicare |
$37.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.72
|
| Rate for Payer: Altius Commercial |
$54.72
|
| Rate for Payer: Beech Street Commercial |
$55.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: Entrust Commercial |
$54.15
|
| Rate for Payer: First Choice Health Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.06
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$31.41
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$55.86
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.06
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$33.06
|
| Rate for Payer: WINHealth Partners Commercial |
$55.86
|
| Rate for Payer: Wise Provider Network Commercial |
$54.15
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION [13586]
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
NDC 5428814701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.72
|
| Rate for Payer: Altius Commercial |
$54.72
|
| Rate for Payer: Beech Street Commercial |
$55.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: Entrust Commercial |
$54.15
|
| Rate for Payer: First Choice Health Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.62
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$35.74
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$55.86
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.62
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$37.62
|
| Rate for Payer: WINHealth Partners Commercial |
$54.15
|
| Rate for Payer: Wise Provider Network Commercial |
$54.15
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [146504]
|
Facility
|
IP
|
$61.88
|
|
|
Service Code
|
HCPCS Q9968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$61.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.40
|
| Rate for Payer: Altius Commercial |
$59.40
|
| Rate for Payer: Beech Street Commercial |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.02
|
| Rate for Payer: Cigna of WY Commercial |
$60.64
|
| Rate for Payer: Entrust Commercial |
$58.79
|
| Rate for Payer: First Choice Health Commercial |
$58.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.84
|
| Rate for Payer: HealthUtah PPO |
$61.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.02
|
| Rate for Payer: Multiplan Medicare/VA |
$38.80
|
| Rate for Payer: One Health Plan of WY PPO |
$60.64
|
| Rate for Payer: PacificSource Commercial |
$55.69
|
| Rate for Payer: PHCS PPO |
$60.64
|
| Rate for Payer: Three Rivers PPO |
$46.41
|
| Rate for Payer: TriWest Veterans Administration |
$40.84
|
| Rate for Payer: United Healthcare Commercial |
$53.84
|
| Rate for Payer: United Healthcare Medicare |
$40.84
|
| Rate for Payer: WINHealth Partners Commercial |
$58.79
|
| Rate for Payer: Wise Provider Network Commercial |
$58.79
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [146504]
|
Facility
|
OP
|
$61.88
|
|
|
Service Code
|
HCPCS Q9968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$61.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.64
|
| Rate for Payer: Aetna of WY Medicare |
$40.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.40
|
| Rate for Payer: Altius Commercial |
$59.40
|
| Rate for Payer: Beech Street Commercial |
$60.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.02
|
| Rate for Payer: Cigna of WY Commercial |
$60.64
|
| Rate for Payer: Entrust Commercial |
$58.79
|
| Rate for Payer: First Choice Health Commercial |
$58.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$61.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.02
|
| Rate for Payer: Multiplan Medicare/VA |
$34.10
|
| Rate for Payer: One Health Plan of WY PPO |
$60.64
|
| Rate for Payer: PacificSource Commercial |
$55.69
|
| Rate for Payer: PHCS PPO |
$60.64
|
| Rate for Payer: Three Rivers PPO |
$46.41
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$53.84
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$60.64
|
| Rate for Payer: Wise Provider Network Commercial |
$58.79
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [9400]
|
Facility
|
OP
|
$59.46
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$59.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.27
|
| Rate for Payer: Aetna of WY Medicare |
$39.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.08
|
| Rate for Payer: Altius Commercial |
$57.08
|
| Rate for Payer: Beech Street Commercial |
$58.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.82
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.68
|
| Rate for Payer: Cigna of WY Commercial |
$58.27
|
| Rate for Payer: Entrust Commercial |
$56.49
|
| Rate for Payer: First Choice Health Commercial |
$56.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.49
|
| Rate for Payer: HealthUtah PPO |
$59.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.68
|
| Rate for Payer: Multiplan Medicare/VA |
$32.76
|
| Rate for Payer: One Health Plan of WY PPO |
$58.27
|
| Rate for Payer: PacificSource Commercial |
$53.51
|
| Rate for Payer: PHCS PPO |
$58.27
|
| Rate for Payer: Three Rivers PPO |
$44.60
|
| Rate for Payer: TriWest Veterans Administration |
$34.49
|
| Rate for Payer: United Healthcare Commercial |
$51.73
|
| Rate for Payer: United Healthcare Medicare |
$34.49
|
| Rate for Payer: WINHealth Partners Commercial |
$58.27
|
| Rate for Payer: Wise Provider Network Commercial |
$56.49
|
|
