|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [9400]
|
Facility
|
IP
|
$59.46
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$59.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.27
|
| 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 |
$39.24
|
| Rate for Payer: HealthUtah PPO |
$59.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.68
|
| Rate for Payer: Multiplan Medicare/VA |
$37.28
|
| 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 |
$39.24
|
| Rate for Payer: United Healthcare Commercial |
$51.73
|
| Rate for Payer: United Healthcare Medicare |
$39.24
|
| Rate for Payer: WINHealth Partners Commercial |
$56.49
|
| Rate for Payer: Wise Provider Network Commercial |
$56.49
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS (WRAPPER) [4000709]
|
Facility
|
OP
|
$369.02
|
|
|
Service Code
|
NDC 6564955107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$203.33 |
| Max. Negotiated Rate |
$369.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$361.64
|
| Rate for Payer: Aetna of WY Medicare |
$243.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$354.26
|
| Rate for Payer: Altius Commercial |
$354.26
|
| Rate for Payer: Beech Street Commercial |
$361.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$302.97
|
| Rate for Payer: Cash Price |
$258.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$357.95
|
| Rate for Payer: Cigna of WY Commercial |
$361.64
|
| Rate for Payer: Entrust Commercial |
$350.57
|
| Rate for Payer: First Choice Health Commercial |
$350.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$350.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.03
|
| Rate for Payer: HealthUtah PPO |
$369.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$357.95
|
| Rate for Payer: Multiplan Medicare/VA |
$203.33
|
| Rate for Payer: One Health Plan of WY PPO |
$361.64
|
| Rate for Payer: PacificSource Commercial |
$332.12
|
| Rate for Payer: PHCS PPO |
$361.64
|
| Rate for Payer: Three Rivers PPO |
$276.76
|
| Rate for Payer: TriWest Veterans Administration |
$214.03
|
| Rate for Payer: United Healthcare Commercial |
$321.05
|
| Rate for Payer: United Healthcare Medicare |
$214.03
|
| Rate for Payer: WINHealth Partners Commercial |
$361.64
|
| Rate for Payer: Wise Provider Network Commercial |
$350.57
|
|
|
METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS (WRAPPER) [4000709]
|
Facility
|
IP
|
$369.02
|
|
|
Service Code
|
NDC 6564955107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$231.38 |
| Max. Negotiated Rate |
$369.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$361.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$354.26
|
| Rate for Payer: Altius Commercial |
$354.26
|
| Rate for Payer: Beech Street Commercial |
$361.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$302.97
|
| Rate for Payer: Cash Price |
$258.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$357.95
|
| Rate for Payer: Cigna of WY Commercial |
$361.64
|
| Rate for Payer: Entrust Commercial |
$350.57
|
| Rate for Payer: First Choice Health Commercial |
$350.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$350.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.55
|
| Rate for Payer: HealthUtah PPO |
$369.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$357.95
|
| Rate for Payer: Multiplan Medicare/VA |
$231.38
|
| Rate for Payer: One Health Plan of WY PPO |
$361.64
|
| Rate for Payer: PacificSource Commercial |
$332.12
|
| Rate for Payer: PHCS PPO |
$361.64
|
| Rate for Payer: Three Rivers PPO |
$276.76
|
| Rate for Payer: TriWest Veterans Administration |
$243.55
|
| Rate for Payer: United Healthcare Commercial |
$321.05
|
| Rate for Payer: United Healthcare Medicare |
$243.55
|
| Rate for Payer: WINHealth Partners Commercial |
$350.57
|
| Rate for Payer: Wise Provider Network Commercial |
$350.57
|
|
|
METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
J1020
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Beech Street Commercial |
$14.25
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: First Choice Health Commercial |
$13.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.25
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
|
|
METHYLPREDNISOLONE 40 MG INJ
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
J1030
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.05
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
|
|
METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [17789]
|
Facility
|
IP
|
$0.86
|
|
|
Service Code
|
HCPCS J7509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.59
|
| Rate for Payer: Altius Commercial |
$0.59
|
| Rate for Payer: Altius Commercial |
$0.83
|
| Rate for Payer: Beech Street Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.83
|
| Rate for Payer: Cigna of WY Commercial |
$0.84
|
| Rate for Payer: Cigna of WY Commercial |
$0.60
|
| Rate for Payer: Entrust Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.82
|
| Rate for Payer: First Choice Health Commercial |
$0.58
|
| Rate for Payer: First Choice Health Commercial |
$0.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.40
|
| Rate for Payer: HealthUtah PPO |
$0.86
|
| Rate for Payer: HealthUtah PPO |
$0.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.83
|
| Rate for Payer: Multiplan Medicare/VA |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.38
|
| Rate for Payer: One Health Plan of WY PPO |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$0.60
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.55
|
| Rate for Payer: PHCS PPO |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.84
|
| Rate for Payer: Three Rivers PPO |
$0.46
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: TriWest Veterans Administration |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.75
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.82
|
| Rate for Payer: Wise Provider Network Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.82
|
|
|
METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [17789]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
HCPCS J7509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.84
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.60
|
| Rate for Payer: Aetna of WY Medicare |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.83
|
| Rate for Payer: Altius Commercial |
$0.83
|
| Rate for Payer: Altius Commercial |
$0.59
|
| Rate for Payer: Beech Street Commercial |
$0.60
|
| Rate for Payer: Beech Street Commercial |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.59
|
| Rate for Payer: Cigna of WY Commercial |
$0.60
|
| Rate for Payer: Cigna of WY Commercial |
$0.84
|
| Rate for Payer: Entrust Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.58
|
| Rate for Payer: First Choice Health Commercial |
$0.58
|
| Rate for Payer: First Choice Health Commercial |
$0.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.61
|
| Rate for Payer: HealthUtah PPO |
$0.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.83
|
| Rate for Payer: Multiplan Medicare/VA |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.34
|
| Rate for Payer: One Health Plan of WY PPO |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$0.84
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.55
|
| Rate for Payer: PHCS PPO |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.84
|
| Rate for Payer: Three Rivers PPO |
$0.46
|
| Rate for Payer: Three Rivers PPO |
$0.65
|
| Rate for Payer: TriWest Veterans Administration |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.75
|
| Rate for Payer: United Healthcare Medicare |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$0.84
|
| Rate for Payer: Wise Provider Network Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.82
|
|
|
METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
J1040
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Beech Street Commercial |
$44.65
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: First Choice Health Commercial |
$42.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$44.65
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [12246]
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.38
|
| Rate for Payer: Altius Commercial |
$44.48
|
| Rate for Payer: Altius Commercial |
$44.46
|
| Rate for Payer: Altius Commercial |
$50.38
|
| Rate for Payer: Beech Street Commercial |
$51.43
|
| Rate for Payer: Beech Street Commercial |
$45.40
|
| Rate for Payer: Beech Street Commercial |
$45.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.04
|
| Rate for Payer: Cash Price |
$32.43
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.94
|
| Rate for Payer: Cigna of WY Commercial |
$45.40
|
| Rate for Payer: Cigna of WY Commercial |
$51.43
|
| Rate for Payer: Cigna of WY Commercial |
$45.38
|
| Rate for Payer: Entrust Commercial |
$49.86
|
| Rate for Payer: Entrust Commercial |
$43.99
|
| Rate for Payer: Entrust Commercial |
$44.01
|
| Rate for Payer: First Choice Health Commercial |
$44.01
|
| Rate for Payer: First Choice Health Commercial |
$49.86
|
| Rate for Payer: First Choice Health Commercial |
$43.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.64
|
| Rate for Payer: HealthUtah PPO |
$46.31
|
| Rate for Payer: HealthUtah PPO |
$46.33
|
| Rate for Payer: HealthUtah PPO |
$52.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.92
|
| Rate for Payer: Multiplan Medicare/VA |
$32.90
|
| Rate for Payer: Multiplan Medicare/VA |
$29.04
|
| Rate for Payer: Multiplan Medicare/VA |
$29.05
|
| Rate for Payer: One Health Plan of WY PPO |
$45.38
|
| Rate for Payer: One Health Plan of WY PPO |
$45.40
|
| Rate for Payer: One Health Plan of WY PPO |
$51.43
|
| Rate for Payer: PacificSource Commercial |
$47.23
|
| Rate for Payer: PacificSource Commercial |
$41.68
|
| Rate for Payer: PacificSource Commercial |
$41.70
|
| Rate for Payer: PHCS PPO |
$45.40
|
| Rate for Payer: PHCS PPO |
$45.38
|
| Rate for Payer: PHCS PPO |
$51.43
|
| Rate for Payer: Three Rivers PPO |
$34.75
|
| Rate for Payer: Three Rivers PPO |
$34.73
|
| Rate for Payer: Three Rivers PPO |
$39.36
|
| Rate for Payer: TriWest Veterans Administration |
$30.58
|
| Rate for Payer: TriWest Veterans Administration |
$30.56
|
| Rate for Payer: TriWest Veterans Administration |
$34.64
|
| Rate for Payer: United Healthcare Commercial |
$40.29
|
| Rate for Payer: United Healthcare Commercial |
$45.66
|
| Rate for Payer: United Healthcare Commercial |
$40.31
|
| Rate for Payer: United Healthcare Medicare |
$30.56
|
| Rate for Payer: United Healthcare Medicare |
$34.64
|
| Rate for Payer: United Healthcare Medicare |
$30.58
|
| Rate for Payer: WINHealth Partners Commercial |
$44.01
|
| Rate for Payer: WINHealth Partners Commercial |
$43.99
|
| Rate for Payer: WINHealth Partners Commercial |
$49.86
|
| Rate for Payer: Wise Provider Network Commercial |
$49.86
|
| Rate for Payer: Wise Provider Network Commercial |
$43.99
|
| Rate for Payer: Wise Provider Network Commercial |
$44.01
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [12246]
|
Facility
|
OP
|
$46.33
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$46.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.38
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.43
|
| Rate for Payer: Aetna of WY Medicare |
$30.58
|
| Rate for Payer: Aetna of WY Medicare |
$34.64
|
| Rate for Payer: Aetna of WY Medicare |
$30.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.38
|
| Rate for Payer: Altius Commercial |
$44.48
|
| Rate for Payer: Altius Commercial |
$50.38
|
| Rate for Payer: Altius Commercial |
$44.46
|
| Rate for Payer: Beech Street Commercial |
$45.40
|
| Rate for Payer: Beech Street Commercial |
$51.43
|
| Rate for Payer: Beech Street Commercial |
$45.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.09
|
| Rate for Payer: Cash Price |
$32.43
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.92
|
| Rate for Payer: Cigna of WY Commercial |
$51.43
|
| Rate for Payer: Cigna of WY Commercial |
$45.38
|
| Rate for Payer: Cigna of WY Commercial |
$45.40
|
| Rate for Payer: Entrust Commercial |
$49.86
|
| Rate for Payer: Entrust Commercial |
$44.01
|
| Rate for Payer: Entrust Commercial |
$43.99
|
| Rate for Payer: First Choice Health Commercial |
$44.01
|
| Rate for Payer: First Choice Health Commercial |
$43.99
|
| Rate for Payer: First Choice Health Commercial |
$49.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.44
|
| Rate for Payer: HealthUtah PPO |
$46.31
|
| Rate for Payer: HealthUtah PPO |
$52.48
|
| Rate for Payer: HealthUtah PPO |
$46.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.94
|
| Rate for Payer: Multiplan Medicare/VA |
$25.52
|
| Rate for Payer: Multiplan Medicare/VA |
$25.53
|
| Rate for Payer: Multiplan Medicare/VA |
$28.92
|
| Rate for Payer: One Health Plan of WY PPO |
$45.38
|
| Rate for Payer: One Health Plan of WY PPO |
$51.43
|
| Rate for Payer: One Health Plan of WY PPO |
$45.40
|
| Rate for Payer: PacificSource Commercial |
$47.23
|
| Rate for Payer: PacificSource Commercial |
$41.70
|
| Rate for Payer: PacificSource Commercial |
$41.68
|
| Rate for Payer: PHCS PPO |
$45.40
|
| Rate for Payer: PHCS PPO |
$45.38
|
| Rate for Payer: PHCS PPO |
$51.43
|
| Rate for Payer: Three Rivers PPO |
$34.75
|
| Rate for Payer: Three Rivers PPO |
$34.73
|
| Rate for Payer: Three Rivers PPO |
$39.36
|
| Rate for Payer: TriWest Veterans Administration |
$30.44
|
| Rate for Payer: TriWest Veterans Administration |
$26.87
|
| Rate for Payer: TriWest Veterans Administration |
$26.86
|
| Rate for Payer: United Healthcare Commercial |
$40.29
|
| Rate for Payer: United Healthcare Commercial |
$40.31
|
| Rate for Payer: United Healthcare Commercial |
$45.66
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
| Rate for Payer: United Healthcare Medicare |
$26.86
|
| Rate for Payer: United Healthcare Medicare |
$26.87
|
| Rate for Payer: WINHealth Partners Commercial |
$51.43
|
| Rate for Payer: WINHealth Partners Commercial |
$45.38
|
| Rate for Payer: WINHealth Partners Commercial |
$45.40
|
| Rate for Payer: Wise Provider Network Commercial |
$43.99
|
| Rate for Payer: Wise Provider Network Commercial |
$49.86
|
| Rate for Payer: Wise Provider Network Commercial |
$44.01
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [9106]
|
Facility
|
OP
|
$55.80
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.68
|
| Rate for Payer: Aetna of WY Medicare |
$36.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.57
|
| Rate for Payer: Altius Commercial |
$53.57
|
| Rate for Payer: Beech Street Commercial |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.81
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.13
|
| Rate for Payer: Cigna of WY Commercial |
$54.68
|
| Rate for Payer: Entrust Commercial |
$53.01
|
| Rate for Payer: First Choice Health Commercial |
$53.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.36
|
| Rate for Payer: HealthUtah PPO |
$55.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.13
|
| Rate for Payer: Multiplan Medicare/VA |
$30.75
|
| Rate for Payer: One Health Plan of WY PPO |
$54.68
|
| Rate for Payer: PacificSource Commercial |
$50.22
|
| Rate for Payer: PHCS PPO |
$54.68
|
| Rate for Payer: Three Rivers PPO |
$41.85
|
| Rate for Payer: TriWest Veterans Administration |
$32.36
|
| Rate for Payer: United Healthcare Commercial |
$48.55
|
| Rate for Payer: United Healthcare Medicare |
$32.36
|
| Rate for Payer: WINHealth Partners Commercial |
$54.68
|
| Rate for Payer: Wise Provider Network Commercial |
$53.01
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [9106]
|
Facility
|
IP
|
$55.80
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.57
|
| Rate for Payer: Altius Commercial |
$53.57
|
| Rate for Payer: Beech Street Commercial |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.81
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.13
|
| Rate for Payer: Cigna of WY Commercial |
$54.68
|
| Rate for Payer: Entrust Commercial |
$53.01
|
| Rate for Payer: First Choice Health Commercial |
$53.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.83
|
| Rate for Payer: HealthUtah PPO |
$55.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.13
|
| Rate for Payer: Multiplan Medicare/VA |
$34.99
|
| Rate for Payer: One Health Plan of WY PPO |
$54.68
|
| Rate for Payer: PacificSource Commercial |
$50.22
|
| Rate for Payer: PHCS PPO |
$54.68
|
| Rate for Payer: Three Rivers PPO |
$41.85
|
| Rate for Payer: TriWest Veterans Administration |
$36.83
|
| Rate for Payer: United Healthcare Commercial |
$48.55
|
| Rate for Payer: United Healthcare Medicare |
$36.83
|
| Rate for Payer: WINHealth Partners Commercial |
$53.01
|
| Rate for Payer: Wise Provider Network Commercial |
$53.01
|
|
|
METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
J2920
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.05
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
|
|
METHYLPREDNISOLONE INJECTION
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
J2930
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.05
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [12177]
|
Facility
|
IP
|
$102.96
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.10
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Altius Commercial |
$98.84
|
| Rate for Payer: Altius Commercial |
$80.10
|
| Rate for Payer: Beech Street Commercial |
$81.77
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Beech Street Commercial |
$100.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$72.07
|
| Rate for Payer: Cash Price |
$58.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Cigna of WY Commercial |
$81.77
|
| Rate for Payer: Cigna of WY Commercial |
$100.90
|
| Rate for Payer: Entrust Commercial |
$79.27
|
| Rate for Payer: Entrust Commercial |
$97.81
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$79.27
|
| Rate for Payer: First Choice Health Commercial |
$97.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.07
|
| Rate for Payer: HealthUtah PPO |
$102.96
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: HealthUtah PPO |
$83.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.87
|
| Rate for Payer: Multiplan Medicare/VA |
$52.32
|
| Rate for Payer: Multiplan Medicare/VA |
$64.56
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$100.90
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: One Health Plan of WY PPO |
$81.77
|
| Rate for Payer: PacificSource Commercial |
$75.10
|
| Rate for Payer: PacificSource Commercial |
$92.66
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: PHCS PPO |
$100.90
|
| Rate for Payer: PHCS PPO |
$81.77
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: Three Rivers PPO |
$77.22
|
| Rate for Payer: Three Rivers PPO |
$62.58
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: TriWest Veterans Administration |
$67.95
|
| Rate for Payer: TriWest Veterans Administration |
$55.07
|
| Rate for Payer: United Healthcare Commercial |
$89.58
|
| Rate for Payer: United Healthcare Commercial |
$72.59
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$67.95
|
| Rate for Payer: United Healthcare Medicare |
$55.07
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: WINHealth Partners Commercial |
$97.81
|
| Rate for Payer: WINHealth Partners Commercial |
$79.27
|
| Rate for Payer: Wise Provider Network Commercial |
$79.27
|
| Rate for Payer: Wise Provider Network Commercial |
$97.81
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [12177]
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.77
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Aetna of WY Medicare |
$55.07
|
| Rate for Payer: Aetna of WY Medicare |
$67.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.10
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Altius Commercial |
$80.10
|
| Rate for Payer: Altius Commercial |
$98.84
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Beech Street Commercial |
$81.77
|
| Rate for Payer: Beech Street Commercial |
$100.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$72.07
|
| Rate for Payer: Cash Price |
$58.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.87
|
| Rate for Payer: Cigna of WY Commercial |
$81.77
|
| Rate for Payer: Cigna of WY Commercial |
$100.90
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$79.27
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: Entrust Commercial |
$97.81
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$97.81
|
| Rate for Payer: First Choice Health Commercial |
$79.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.40
|
| Rate for Payer: HealthUtah PPO |
$102.96
|
| Rate for Payer: HealthUtah PPO |
$83.44
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$56.73
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: Multiplan Medicare/VA |
$45.98
|
| Rate for Payer: One Health Plan of WY PPO |
$100.90
|
| Rate for Payer: One Health Plan of WY PPO |
$81.77
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$75.10
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PacificSource Commercial |
$92.66
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: PHCS PPO |
$100.90
|
| Rate for Payer: PHCS PPO |
$81.77
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: Three Rivers PPO |
$77.22
|
| Rate for Payer: Three Rivers PPO |
$62.58
|
| Rate for Payer: TriWest Veterans Administration |
$48.40
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: TriWest Veterans Administration |
$59.72
|
| Rate for Payer: United Healthcare Commercial |
$89.58
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$72.59
|
| Rate for Payer: United Healthcare Medicare |
$48.40
|
| Rate for Payer: United Healthcare Medicare |
$59.72
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$81.77
|
| Rate for Payer: WINHealth Partners Commercial |
$100.90
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$97.81
|
| Rate for Payer: Wise Provider Network Commercial |
$79.27
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [88804]
|
Facility
|
IP
|
$46.25
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$46.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.40
|
| Rate for Payer: Altius Commercial |
$44.40
|
| Rate for Payer: Beech Street Commercial |
$45.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.97
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.86
|
| Rate for Payer: Cigna of WY Commercial |
$45.32
|
| Rate for Payer: Entrust Commercial |
$43.94
|
| Rate for Payer: First Choice Health Commercial |
$43.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.52
|
| Rate for Payer: HealthUtah PPO |
$46.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.86
|
| Rate for Payer: Multiplan Medicare/VA |
$29.00
|
| Rate for Payer: One Health Plan of WY PPO |
$45.32
|
| Rate for Payer: PacificSource Commercial |
$41.62
|
| Rate for Payer: PHCS PPO |
$45.32
|
| Rate for Payer: Three Rivers PPO |
$34.69
|
| Rate for Payer: TriWest Veterans Administration |
$30.52
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Medicare |
$30.52
|
| Rate for Payer: WINHealth Partners Commercial |
$43.94
|
| Rate for Payer: Wise Provider Network Commercial |
$43.94
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [88804]
|
Facility
|
OP
|
$46.25
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$46.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.32
|
| Rate for Payer: Aetna of WY Medicare |
$30.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.40
|
| Rate for Payer: Altius Commercial |
$44.40
|
| Rate for Payer: Beech Street Commercial |
$45.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.97
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.86
|
| Rate for Payer: Cigna of WY Commercial |
$45.32
|
| Rate for Payer: Entrust Commercial |
$43.94
|
| Rate for Payer: First Choice Health Commercial |
$43.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.82
|
| Rate for Payer: HealthUtah PPO |
$46.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.86
|
| Rate for Payer: Multiplan Medicare/VA |
$25.48
|
| Rate for Payer: One Health Plan of WY PPO |
$45.32
|
| Rate for Payer: PacificSource Commercial |
$41.62
|
| Rate for Payer: PHCS PPO |
$45.32
|
| Rate for Payer: Three Rivers PPO |
$34.69
|
| Rate for Payer: TriWest Veterans Administration |
$26.82
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Medicare |
$26.82
|
| Rate for Payer: WINHealth Partners Commercial |
$45.32
|
| Rate for Payer: Wise Provider Network Commercial |
$43.94
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [88803]
|
Facility
|
IP
|
$37.64
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.13
|
| Rate for Payer: Altius Commercial |
$36.13
|
| Rate for Payer: Beech Street Commercial |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.90
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.51
|
| Rate for Payer: Cigna of WY Commercial |
$36.89
|
| Rate for Payer: Entrust Commercial |
$35.76
|
| Rate for Payer: First Choice Health Commercial |
$35.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.84
|
| Rate for Payer: HealthUtah PPO |
$37.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.51
|
| Rate for Payer: Multiplan Medicare/VA |
$23.60
|
| Rate for Payer: One Health Plan of WY PPO |
$36.89
|
| Rate for Payer: PacificSource Commercial |
$33.88
|
| Rate for Payer: PHCS PPO |
$36.89
|
| Rate for Payer: Three Rivers PPO |
$28.23
|
| Rate for Payer: TriWest Veterans Administration |
$24.84
|
| Rate for Payer: United Healthcare Commercial |
$32.75
|
| Rate for Payer: United Healthcare Medicare |
$24.84
|
| Rate for Payer: WINHealth Partners Commercial |
$35.76
|
| Rate for Payer: Wise Provider Network Commercial |
$35.76
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [88803]
|
Facility
|
OP
|
$37.64
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.89
|
| Rate for Payer: Aetna of WY Medicare |
$24.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.13
|
| Rate for Payer: Altius Commercial |
$36.13
|
| Rate for Payer: Beech Street Commercial |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.90
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.51
|
| Rate for Payer: Cigna of WY Commercial |
$36.89
|
| Rate for Payer: Entrust Commercial |
$35.76
|
| Rate for Payer: First Choice Health Commercial |
$35.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.83
|
| Rate for Payer: HealthUtah PPO |
$37.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.51
|
| Rate for Payer: Multiplan Medicare/VA |
$20.74
|
| Rate for Payer: One Health Plan of WY PPO |
$36.89
|
| Rate for Payer: PacificSource Commercial |
$33.88
|
| Rate for Payer: PHCS PPO |
$36.89
|
| Rate for Payer: Three Rivers PPO |
$28.23
|
| Rate for Payer: TriWest Veterans Administration |
$21.83
|
| Rate for Payer: United Healthcare Commercial |
$32.75
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
| Rate for Payer: WINHealth Partners Commercial |
$36.89
|
| Rate for Payer: Wise Provider Network Commercial |
$35.76
|
|
|
METOCLOPRAMIDE 10 MG TABLET [20124]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 6068763111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.35
|
| Rate for Payer: Aetna of WY Medicare |
$1.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.30
|
| Rate for Payer: Altius Commercial |
$2.30
|
| Rate for Payer: Beech Street Commercial |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.33
|
| Rate for Payer: Cigna of WY Commercial |
$2.35
|
| Rate for Payer: Entrust Commercial |
$2.28
|
| Rate for Payer: First Choice Health Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.35
|
| Rate for Payer: PacificSource Commercial |
$2.16
|
| Rate for Payer: PHCS PPO |
$2.35
|
| Rate for Payer: Three Rivers PPO |
$1.80
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2.28
|
|
|
METOCLOPRAMIDE 10 MG TABLET [20124]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 6068763101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.30
|
| Rate for Payer: Altius Commercial |
$2.30
|
| Rate for Payer: Beech Street Commercial |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.33
|
| Rate for Payer: Cigna of WY Commercial |
$2.35
|
| Rate for Payer: Entrust Commercial |
$2.28
|
| Rate for Payer: First Choice Health Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.58
|
| Rate for Payer: HealthUtah PPO |
$2.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2.35
|
| Rate for Payer: PacificSource Commercial |
$2.16
|
| Rate for Payer: PHCS PPO |
$2.35
|
| Rate for Payer: Three Rivers PPO |
$1.80
|
| Rate for Payer: TriWest Veterans Administration |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Medicare |
$1.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2.28
|
| Rate for Payer: Wise Provider Network Commercial |
$2.28
|
|
|
METOCLOPRAMIDE 10 MG TABLET [20124]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 6068763111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.30
|
| Rate for Payer: Altius Commercial |
$2.30
|
| Rate for Payer: Beech Street Commercial |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.33
|
| Rate for Payer: Cigna of WY Commercial |
$2.35
|
| Rate for Payer: Entrust Commercial |
$2.28
|
| Rate for Payer: First Choice Health Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.58
|
| Rate for Payer: HealthUtah PPO |
$2.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2.35
|
| Rate for Payer: PacificSource Commercial |
$2.16
|
| Rate for Payer: PHCS PPO |
$2.35
|
| Rate for Payer: Three Rivers PPO |
$1.80
|
| Rate for Payer: TriWest Veterans Administration |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Medicare |
$1.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2.28
|
| Rate for Payer: Wise Provider Network Commercial |
$2.28
|
|
|
METOCLOPRAMIDE 10 MG TABLET [20124]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 6068763101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.35
|
| Rate for Payer: Aetna of WY Medicare |
$1.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.30
|
| Rate for Payer: Altius Commercial |
$2.30
|
| Rate for Payer: Beech Street Commercial |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.33
|
| Rate for Payer: Cigna of WY Commercial |
$2.35
|
| Rate for Payer: Entrust Commercial |
$2.28
|
| Rate for Payer: First Choice Health Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.35
|
| Rate for Payer: PacificSource Commercial |
$2.16
|
| Rate for Payer: PHCS PPO |
$2.35
|
| Rate for Payer: Three Rivers PPO |
$1.80
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2.28
|
|
|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [1874]
|
Facility
|
IP
|
$19.40
|
|
|
Service Code
|
HCPCS J2765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.01
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.78
|
| Rate for Payer: Altius Commercial |
$16.78
|
| Rate for Payer: Altius Commercial |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$19.01
|
| Rate for Payer: Beech Street Commercial |
$17.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.93
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.82
|
| Rate for Payer: Cigna of WY Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$17.13
|
| Rate for Payer: Entrust Commercial |
$16.61
|
| Rate for Payer: Entrust Commercial |
$18.43
|
| Rate for Payer: First Choice Health Commercial |
$16.61
|
| Rate for Payer: First Choice Health Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.54
|
| Rate for Payer: HealthUtah PPO |
$19.40
|
| Rate for Payer: HealthUtah PPO |
$17.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.82
|
| Rate for Payer: Multiplan Medicare/VA |
$12.16
|
| Rate for Payer: Multiplan Medicare/VA |
$10.96
|
| Rate for Payer: One Health Plan of WY PPO |
$19.01
|
| Rate for Payer: One Health Plan of WY PPO |
$17.13
|
| Rate for Payer: PacificSource Commercial |
$17.46
|
| Rate for Payer: PacificSource Commercial |
$15.73
|
| Rate for Payer: PHCS PPO |
$17.13
|
| Rate for Payer: PHCS PPO |
$19.01
|
| Rate for Payer: Three Rivers PPO |
$13.11
|
| Rate for Payer: Three Rivers PPO |
$14.55
|
| Rate for Payer: TriWest Veterans Administration |
$12.80
|
| Rate for Payer: TriWest Veterans Administration |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$15.21
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.61
|
| Rate for Payer: WINHealth Partners Commercial |
$18.43
|
| Rate for Payer: Wise Provider Network Commercial |
$16.61
|
| Rate for Payer: Wise Provider Network Commercial |
$18.43
|
|
