|
MICROPUNCTURE ACCESS SET 5FR
|
Facility
|
OP
|
$129.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$85.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.32
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.11
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$71.35
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$75.11
|
| Rate for Payer: United Healthcare Commercial |
$112.66
|
| Rate for Payer: United Healthcare Medicare |
$75.11
|
| Rate for Payer: WINHealth Partners Commercial |
$126.91
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
MICROPUNCTURE ACCESS SET 5FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.32
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.47
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$81.20
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$85.47
|
| Rate for Payer: United Healthcare Commercial |
$112.66
|
| Rate for Payer: United Healthcare Medicare |
$85.47
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
69990
|
| Min. Negotiated Rate |
$171.30 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Aetna of WY Medicare |
$201.53
|
| Rate for Payer: Beech Street Commercial |
$1,054.50
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: First Choice Health Commercial |
$999.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.53
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$171.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,054.50
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$201.53
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$201.53
|
| Rate for Payer: WINHealth Partners Commercial |
$943.50
|
|
|
MIDAS BURR FLUTED 14CM X 3MM
|
Facility
|
IP
|
$546.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.43 |
| Max. Negotiated Rate |
$546.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$524.29
|
| Rate for Payer: Altius Commercial |
$524.29
|
| Rate for Payer: Beech Street Commercial |
$535.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$448.38
|
| Rate for Payer: Cash Price |
$382.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.76
|
| Rate for Payer: Cigna of WY Commercial |
$535.22
|
| Rate for Payer: Entrust Commercial |
$518.83
|
| Rate for Payer: First Choice Health Commercial |
$518.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.45
|
| Rate for Payer: HealthUtah PPO |
$546.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.76
|
| Rate for Payer: Multiplan Medicare/VA |
$342.43
|
| Rate for Payer: One Health Plan of WY PPO |
$535.22
|
| Rate for Payer: PacificSource Commercial |
$491.53
|
| Rate for Payer: PHCS PPO |
$535.22
|
| Rate for Payer: Three Rivers PPO |
$409.60
|
| Rate for Payer: TriWest Veterans Administration |
$360.45
|
| Rate for Payer: United Healthcare Commercial |
$475.14
|
| Rate for Payer: United Healthcare Medicare |
$360.45
|
| Rate for Payer: WINHealth Partners Commercial |
$518.83
|
| Rate for Payer: Wise Provider Network Commercial |
$518.83
|
|
|
MIDAS BURR FLUTED 14CM X 3MM
|
Facility
|
OP
|
$546.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.92 |
| Max. Negotiated Rate |
$546.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.22
|
| Rate for Payer: Aetna of WY Medicare |
$360.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$524.29
|
| Rate for Payer: Altius Commercial |
$524.29
|
| Rate for Payer: Beech Street Commercial |
$535.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$448.38
|
| Rate for Payer: Cash Price |
$382.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.76
|
| Rate for Payer: Cigna of WY Commercial |
$535.22
|
| Rate for Payer: Entrust Commercial |
$518.83
|
| Rate for Payer: First Choice Health Commercial |
$518.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.76
|
| Rate for Payer: HealthUtah PPO |
$546.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.76
|
| Rate for Payer: Multiplan Medicare/VA |
$300.92
|
| Rate for Payer: One Health Plan of WY PPO |
$535.22
|
| Rate for Payer: PacificSource Commercial |
$491.53
|
| Rate for Payer: PHCS PPO |
$535.22
|
| Rate for Payer: Three Rivers PPO |
$409.60
|
| Rate for Payer: TriWest Veterans Administration |
$316.76
|
| Rate for Payer: United Healthcare Commercial |
$475.14
|
| Rate for Payer: United Healthcare Medicare |
$316.76
|
| Rate for Payer: WINHealth Partners Commercial |
$535.22
|
| Rate for Payer: Wise Provider Network Commercial |
$518.83
|
|
|
MIDAS BURR TELESCOPING 12 X 2.5
|
Facility
|
OP
|
$553.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.05 |
| Max. Negotiated Rate |
$553.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$542.56
|
| Rate for Payer: Aetna of WY Medicare |
$365.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$531.48
|
| Rate for Payer: Altius Commercial |
$531.48
|
| Rate for Payer: Beech Street Commercial |
$542.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$454.53
|
| Rate for Payer: Cash Price |
$387.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$537.02
|
| Rate for Payer: Cigna of WY Commercial |
$542.56
|
| Rate for Payer: Entrust Commercial |
$525.95
|
| Rate for Payer: First Choice Health Commercial |
$525.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.11
|
| Rate for Payer: HealthUtah PPO |
$553.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$537.02
|
| Rate for Payer: Multiplan Medicare/VA |
$305.05
|
| Rate for Payer: One Health Plan of WY PPO |
$542.56
|
| Rate for Payer: PacificSource Commercial |
$498.27
|
| Rate for Payer: PHCS PPO |
$542.56
|
| Rate for Payer: Three Rivers PPO |
$415.22
|
| Rate for Payer: TriWest Veterans Administration |
$321.11
|
| Rate for Payer: United Healthcare Commercial |
$481.66
|
| Rate for Payer: United Healthcare Medicare |
$321.11
|
| Rate for Payer: WINHealth Partners Commercial |
$542.56
|
| Rate for Payer: Wise Provider Network Commercial |
$525.95
|
|
|
MIDAS BURR TELESCOPING 12 X 2.5
|
Facility
|
IP
|
$553.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$553.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$542.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$531.48
|
| Rate for Payer: Altius Commercial |
$531.48
|
| Rate for Payer: Beech Street Commercial |
$542.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$454.53
|
| Rate for Payer: Cash Price |
$387.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$537.02
|
| Rate for Payer: Cigna of WY Commercial |
$542.56
|
| Rate for Payer: Entrust Commercial |
$525.95
|
| Rate for Payer: First Choice Health Commercial |
$525.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.40
|
| Rate for Payer: HealthUtah PPO |
$553.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$537.02
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$542.56
|
| Rate for Payer: PacificSource Commercial |
$498.27
|
| Rate for Payer: PHCS PPO |
$542.56
|
| Rate for Payer: Three Rivers PPO |
$415.22
|
| Rate for Payer: TriWest Veterans Administration |
$365.40
|
| Rate for Payer: United Healthcare Commercial |
$481.66
|
| Rate for Payer: United Healthcare Medicare |
$365.40
|
| Rate for Payer: WINHealth Partners Commercial |
$525.95
|
| Rate for Payer: Wise Provider Network Commercial |
$525.95
|
|
|
MIDAS REX METAL CUTTER 1.6MM
|
Facility
|
OP
|
$805.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.82 |
| Max. Negotiated Rate |
$805.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$789.38
|
| Rate for Payer: Aetna of WY Medicare |
$531.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$773.27
|
| Rate for Payer: Altius Commercial |
$773.27
|
| Rate for Payer: Beech Street Commercial |
$789.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$661.31
|
| Rate for Payer: Cash Price |
$563.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$781.33
|
| Rate for Payer: Cigna of WY Commercial |
$789.38
|
| Rate for Payer: Entrust Commercial |
$765.22
|
| Rate for Payer: First Choice Health Commercial |
$765.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$765.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$467.18
|
| Rate for Payer: HealthUtah PPO |
$805.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$781.33
|
| Rate for Payer: Multiplan Medicare/VA |
$443.82
|
| Rate for Payer: One Health Plan of WY PPO |
$789.38
|
| Rate for Payer: PacificSource Commercial |
$724.94
|
| Rate for Payer: PHCS PPO |
$789.38
|
| Rate for Payer: Three Rivers PPO |
$604.12
|
| Rate for Payer: TriWest Veterans Administration |
$467.18
|
| Rate for Payer: United Healthcare Commercial |
$700.78
|
| Rate for Payer: United Healthcare Medicare |
$467.18
|
| Rate for Payer: WINHealth Partners Commercial |
$789.38
|
| Rate for Payer: Wise Provider Network Commercial |
$765.22
|
|
|
MIDAS REX METAL CUTTER 1.6MM
|
Facility
|
IP
|
$805.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.04 |
| Max. Negotiated Rate |
$805.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$789.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$773.27
|
| Rate for Payer: Altius Commercial |
$773.27
|
| Rate for Payer: Beech Street Commercial |
$789.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$661.31
|
| Rate for Payer: Cash Price |
$563.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$781.33
|
| Rate for Payer: Cigna of WY Commercial |
$789.38
|
| Rate for Payer: Entrust Commercial |
$765.22
|
| Rate for Payer: First Choice Health Commercial |
$765.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$765.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$531.62
|
| Rate for Payer: HealthUtah PPO |
$805.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$781.33
|
| Rate for Payer: Multiplan Medicare/VA |
$505.04
|
| Rate for Payer: One Health Plan of WY PPO |
$789.38
|
| Rate for Payer: PacificSource Commercial |
$724.94
|
| Rate for Payer: PHCS PPO |
$789.38
|
| Rate for Payer: Three Rivers PPO |
$604.12
|
| Rate for Payer: TriWest Veterans Administration |
$531.62
|
| Rate for Payer: United Healthcare Commercial |
$700.78
|
| Rate for Payer: United Healthcare Medicare |
$531.62
|
| Rate for Payer: WINHealth Partners Commercial |
$765.22
|
| Rate for Payer: Wise Provider Network Commercial |
$765.22
|
|
|
MIDAS REX METAL CUTTER 3.0MM
|
Facility
|
OP
|
$784.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.98 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$768.32
|
| Rate for Payer: Aetna of WY Medicare |
$517.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$752.64
|
| Rate for Payer: Altius Commercial |
$752.64
|
| Rate for Payer: Beech Street Commercial |
$768.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$643.66
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$760.48
|
| Rate for Payer: Cigna of WY Commercial |
$768.32
|
| Rate for Payer: Entrust Commercial |
$744.80
|
| Rate for Payer: First Choice Health Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.72
|
| Rate for Payer: HealthUtah PPO |
$784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$760.48
|
| Rate for Payer: Multiplan Medicare/VA |
$431.98
|
| Rate for Payer: One Health Plan of WY PPO |
$768.32
|
| Rate for Payer: PacificSource Commercial |
$705.60
|
| Rate for Payer: PHCS PPO |
$768.32
|
| Rate for Payer: Three Rivers PPO |
$588.00
|
| Rate for Payer: TriWest Veterans Administration |
$454.72
|
| Rate for Payer: United Healthcare Commercial |
$682.08
|
| Rate for Payer: United Healthcare Medicare |
$454.72
|
| Rate for Payer: WINHealth Partners Commercial |
$768.32
|
| Rate for Payer: Wise Provider Network Commercial |
$744.80
|
|
|
MIDAS REX METAL CUTTER 3.0MM
|
Facility
|
IP
|
$784.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.57 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$768.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$752.64
|
| Rate for Payer: Altius Commercial |
$752.64
|
| Rate for Payer: Beech Street Commercial |
$768.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$643.66
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$760.48
|
| Rate for Payer: Cigna of WY Commercial |
$768.32
|
| Rate for Payer: Entrust Commercial |
$744.80
|
| Rate for Payer: First Choice Health Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.44
|
| Rate for Payer: HealthUtah PPO |
$784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$760.48
|
| Rate for Payer: Multiplan Medicare/VA |
$491.57
|
| Rate for Payer: One Health Plan of WY PPO |
$768.32
|
| Rate for Payer: PacificSource Commercial |
$705.60
|
| Rate for Payer: PHCS PPO |
$768.32
|
| Rate for Payer: Three Rivers PPO |
$588.00
|
| Rate for Payer: TriWest Veterans Administration |
$517.44
|
| Rate for Payer: United Healthcare Commercial |
$682.08
|
| Rate for Payer: United Healthcare Medicare |
$517.44
|
| Rate for Payer: WINHealth Partners Commercial |
$744.80
|
| Rate for Payer: Wise Provider Network Commercial |
$744.80
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION [20624]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.97
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.67
|
| Rate for Payer: Altius Commercial |
$15.63
|
| Rate for Payer: Altius Commercial |
$15.65
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Altius Commercial |
$15.46
|
| Rate for Payer: Altius Commercial |
$15.67
|
| Rate for Payer: Beech Street Commercial |
$15.95
|
| Rate for Payer: Beech Street Commercial |
$15.78
|
| Rate for Payer: Beech Street Commercial |
$15.99
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Beech Street Commercial |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.27
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.83
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Cigna of WY Commercial |
$15.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$15.97
|
| Rate for Payer: Cigna of WY Commercial |
$15.78
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.50
|
| Rate for Payer: First Choice Health Commercial |
$15.47
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.50
|
| Rate for Payer: First Choice Health Commercial |
$15.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.76
|
| Rate for Payer: HealthUtah PPO |
$16.32
|
| Rate for Payer: HealthUtah PPO |
$16.10
|
| Rate for Payer: HealthUtah PPO |
$16.28
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: HealthUtah PPO |
$16.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.81
|
| Rate for Payer: Multiplan Medicare/VA |
$10.22
|
| Rate for Payer: Multiplan Medicare/VA |
$10.21
|
| Rate for Payer: Multiplan Medicare/VA |
$10.09
|
| Rate for Payer: Multiplan Medicare/VA |
$10.23
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$15.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.97
|
| Rate for Payer: One Health Plan of WY PPO |
$15.99
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$14.49
|
| Rate for Payer: PacificSource Commercial |
$14.67
|
| Rate for Payer: PacificSource Commercial |
$14.65
|
| Rate for Payer: PacificSource Commercial |
$14.69
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$15.99
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: PHCS PPO |
$15.97
|
| Rate for Payer: PHCS PPO |
$15.78
|
| Rate for Payer: PHCS PPO |
$15.95
|
| Rate for Payer: Three Rivers PPO |
$12.21
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: Three Rivers PPO |
$12.24
|
| Rate for Payer: Three Rivers PPO |
$12.22
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: TriWest Veterans Administration |
$11.06
|
| Rate for Payer: TriWest Veterans Administration |
$10.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.63
|
| Rate for Payer: TriWest Veterans Administration |
$10.74
|
| Rate for Payer: TriWest Veterans Administration |
$10.77
|
| Rate for Payer: United Healthcare Commercial |
$14.20
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Commercial |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$14.16
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$10.76
|
| Rate for Payer: United Healthcare Medicare |
$10.77
|
| Rate for Payer: United Healthcare Medicare |
$10.74
|
| Rate for Payer: United Healthcare Medicare |
$10.63
|
| Rate for Payer: United Healthcare Medicare |
$11.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.47
|
| Rate for Payer: WINHealth Partners Commercial |
$15.50
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: WINHealth Partners Commercial |
$15.48
|
| Rate for Payer: WINHealth Partners Commercial |
$15.30
|
| Rate for Payer: Wise Provider Network Commercial |
$15.47
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.50
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
| Rate for Payer: Wise Provider Network Commercial |
$15.48
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION [20624]
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.95
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.97
|
| Rate for Payer: Aetna of WY Medicare |
$10.77
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Aetna of WY Medicare |
$10.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.74
|
| Rate for Payer: Aetna of WY Medicare |
$10.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Altius Commercial |
$15.63
|
| Rate for Payer: Altius Commercial |
$15.65
|
| Rate for Payer: Altius Commercial |
$15.46
|
| Rate for Payer: Altius Commercial |
$15.67
|
| Rate for Payer: Beech Street Commercial |
$15.99
|
| Rate for Payer: Beech Street Commercial |
$15.78
|
| Rate for Payer: Beech Street Commercial |
$15.97
|
| Rate for Payer: Beech Street Commercial |
$15.95
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.27
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.62
|
| Rate for Payer: Cigna of WY Commercial |
$15.78
|
| Rate for Payer: Cigna of WY Commercial |
$15.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.97
|
| Rate for Payer: Cigna of WY Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: Entrust Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.50
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.50
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.48
|
| Rate for Payer: First Choice Health Commercial |
$15.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.44
|
| Rate for Payer: HealthUtah PPO |
$16.10
|
| Rate for Payer: HealthUtah PPO |
$16.30
|
| Rate for Payer: HealthUtah PPO |
$16.28
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: HealthUtah PPO |
$16.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.81
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: Multiplan Medicare/VA |
$8.98
|
| Rate for Payer: Multiplan Medicare/VA |
$8.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.97
|
| Rate for Payer: One Health Plan of WY PPO |
$15.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.97
|
| Rate for Payer: One Health Plan of WY PPO |
$15.99
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$14.67
|
| Rate for Payer: PacificSource Commercial |
$14.49
|
| Rate for Payer: PacificSource Commercial |
$14.69
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PacificSource Commercial |
$14.65
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: PHCS PPO |
$15.95
|
| Rate for Payer: PHCS PPO |
$15.97
|
| Rate for Payer: PHCS PPO |
$15.99
|
| Rate for Payer: PHCS PPO |
$15.78
|
| Rate for Payer: Three Rivers PPO |
$12.21
|
| Rate for Payer: Three Rivers PPO |
$12.22
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: Three Rivers PPO |
$12.24
|
| Rate for Payer: TriWest Veterans Administration |
$9.44
|
| Rate for Payer: TriWest Veterans Administration |
$9.47
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: TriWest Veterans Administration |
$9.45
|
| Rate for Payer: TriWest Veterans Administration |
$9.34
|
| Rate for Payer: United Healthcare Commercial |
$14.20
|
| Rate for Payer: United Healthcare Commercial |
$14.16
|
| Rate for Payer: United Healthcare Commercial |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.45
|
| Rate for Payer: United Healthcare Medicare |
$9.47
|
| Rate for Payer: United Healthcare Medicare |
$9.34
|
| Rate for Payer: United Healthcare Medicare |
$9.44
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$15.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.99
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: WINHealth Partners Commercial |
$15.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.95
|
| Rate for Payer: Wise Provider Network Commercial |
$15.48
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.47
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
| Rate for Payer: Wise Provider Network Commercial |
$15.50
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP [5092]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 0054356699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.23
|
| Rate for Payer: Altius Commercial |
$4.23
|
| Rate for Payer: Beech Street Commercial |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.28
|
| Rate for Payer: Cigna of WY Commercial |
$4.32
|
| Rate for Payer: Entrust Commercial |
$4.19
|
| Rate for Payer: First Choice Health Commercial |
$4.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.91
|
| Rate for Payer: HealthUtah PPO |
$4.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.28
|
| Rate for Payer: Multiplan Medicare/VA |
$2.77
|
| Rate for Payer: One Health Plan of WY PPO |
$4.32
|
| Rate for Payer: PacificSource Commercial |
$3.97
|
| Rate for Payer: PHCS PPO |
$4.32
|
| Rate for Payer: Three Rivers PPO |
$3.31
|
| Rate for Payer: TriWest Veterans Administration |
$2.91
|
| Rate for Payer: United Healthcare Commercial |
$3.84
|
| Rate for Payer: United Healthcare Medicare |
$2.91
|
| Rate for Payer: WINHealth Partners Commercial |
$4.19
|
| Rate for Payer: Wise Provider Network Commercial |
$4.19
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP [5092]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 0054356699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.32
|
| Rate for Payer: Aetna of WY Medicare |
$2.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.23
|
| Rate for Payer: Altius Commercial |
$4.23
|
| Rate for Payer: Beech Street Commercial |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.28
|
| Rate for Payer: Cigna of WY Commercial |
$4.32
|
| Rate for Payer: Entrust Commercial |
$4.19
|
| Rate for Payer: First Choice Health Commercial |
$4.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.56
|
| Rate for Payer: HealthUtah PPO |
$4.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.28
|
| Rate for Payer: Multiplan Medicare/VA |
$2.43
|
| Rate for Payer: One Health Plan of WY PPO |
$4.32
|
| Rate for Payer: PacificSource Commercial |
$3.97
|
| Rate for Payer: PHCS PPO |
$4.32
|
| Rate for Payer: Three Rivers PPO |
$3.31
|
| Rate for Payer: TriWest Veterans Administration |
$2.56
|
| Rate for Payer: United Healthcare Commercial |
$3.84
|
| Rate for Payer: United Healthcare Medicare |
$2.56
|
| Rate for Payer: WINHealth Partners Commercial |
$4.32
|
| Rate for Payer: Wise Provider Network Commercial |
$4.19
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP (WRAPPED) [4000706]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
NDC 0574015004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.16
|
| Rate for Payer: Aetna of WY Medicare |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.11
|
| Rate for Payer: Altius Commercial |
$2.11
|
| Rate for Payer: Beech Street Commercial |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.13
|
| Rate for Payer: Cigna of WY Commercial |
$2.16
|
| Rate for Payer: Entrust Commercial |
$2.09
|
| Rate for Payer: First Choice Health Commercial |
$2.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.28
|
| Rate for Payer: HealthUtah PPO |
$2.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.13
|
| Rate for Payer: Multiplan Medicare/VA |
$1.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2.16
|
| Rate for Payer: PacificSource Commercial |
$1.98
|
| Rate for Payer: PHCS PPO |
$2.16
|
| Rate for Payer: Three Rivers PPO |
$1.65
|
| Rate for Payer: TriWest Veterans Administration |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2.16
|
| Rate for Payer: Wise Provider Network Commercial |
$2.09
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP (WRAPPED) [4000706]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
NDC 0574015004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.11
|
| Rate for Payer: Altius Commercial |
$2.11
|
| Rate for Payer: Beech Street Commercial |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.13
|
| Rate for Payer: Cigna of WY Commercial |
$2.16
|
| Rate for Payer: Entrust Commercial |
$2.09
|
| Rate for Payer: First Choice Health Commercial |
$2.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.45
|
| Rate for Payer: HealthUtah PPO |
$2.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.13
|
| Rate for Payer: Multiplan Medicare/VA |
$1.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2.16
|
| Rate for Payer: PacificSource Commercial |
$1.98
|
| Rate for Payer: PHCS PPO |
$2.16
|
| Rate for Payer: Three Rivers PPO |
$1.65
|
| Rate for Payer: TriWest Veterans Administration |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2.09
|
| Rate for Payer: Wise Provider Network Commercial |
$2.09
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION [6420]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.69
|
| Rate for Payer: Aetna of WY Medicare |
$11.72
|
| Rate for Payer: Aetna of WY Medicare |
$13.07
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Aetna of WY Medicare |
$17.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$19.01
|
| Rate for Payer: Altius Commercial |
$17.05
|
| Rate for Payer: Altius Commercial |
$26.14
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.40
|
| Rate for Payer: Beech Street Commercial |
$19.40
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Beech Street Commercial |
$26.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.36
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.41
|
| Rate for Payer: Cigna of WY Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$17.40
|
| Rate for Payer: Cigna of WY Commercial |
$26.69
|
| Rate for Payer: Entrust Commercial |
$16.87
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: Entrust Commercial |
$25.87
|
| Rate for Payer: Entrust Commercial |
$18.81
|
| Rate for Payer: First Choice Health Commercial |
$18.81
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.87
|
| Rate for Payer: First Choice Health Commercial |
$25.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$27.23
|
| Rate for Payer: HealthUtah PPO |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$17.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: Multiplan Medicare/VA |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.79
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: One Health Plan of WY PPO |
$26.69
|
| Rate for Payer: One Health Plan of WY PPO |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.40
|
| Rate for Payer: PacificSource Commercial |
$24.51
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.98
|
| Rate for Payer: PacificSource Commercial |
$17.82
|
| Rate for Payer: PHCS PPO |
$26.69
|
| Rate for Payer: PHCS PPO |
$19.40
|
| Rate for Payer: PHCS PPO |
$17.40
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.32
|
| Rate for Payer: Three Rivers PPO |
$20.42
|
| Rate for Payer: Three Rivers PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$10.30
|
| Rate for Payer: TriWest Veterans Administration |
$15.79
|
| Rate for Payer: TriWest Veterans Administration |
$10.09
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: United Healthcare Commercial |
$17.23
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$23.69
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$10.09
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: United Healthcare Medicare |
$15.79
|
| Rate for Payer: WINHealth Partners Commercial |
$26.69
|
| Rate for Payer: WINHealth Partners Commercial |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: WINHealth Partners Commercial |
$19.40
|
| Rate for Payer: Wise Provider Network Commercial |
$16.87
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$25.87
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION [6420]
|
Facility
|
IP
|
$17.76
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.69
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$17.05
|
| Rate for Payer: Altius Commercial |
$26.14
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Altius Commercial |
$19.01
|
| Rate for Payer: Beech Street Commercial |
$26.69
|
| Rate for Payer: Beech Street Commercial |
$19.40
|
| Rate for Payer: Beech Street Commercial |
$17.40
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.36
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.41
|
| Rate for Payer: Cigna of WY Commercial |
$26.69
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.40
|
| Rate for Payer: Entrust Commercial |
$18.81
|
| Rate for Payer: Entrust Commercial |
$25.87
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: Entrust Commercial |
$16.87
|
| Rate for Payer: First Choice Health Commercial |
$16.87
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$25.87
|
| Rate for Payer: First Choice Health Commercial |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.97
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$17.76
|
| Rate for Payer: HealthUtah PPO |
$27.23
|
| Rate for Payer: HealthUtah PPO |
$19.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.21
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: Multiplan Medicare/VA |
$12.41
|
| Rate for Payer: Multiplan Medicare/VA |
$17.07
|
| Rate for Payer: Multiplan Medicare/VA |
$11.14
|
| Rate for Payer: One Health Plan of WY PPO |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: One Health Plan of WY PPO |
$26.69
|
| Rate for Payer: PacificSource Commercial |
$17.82
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.98
|
| Rate for Payer: PacificSource Commercial |
$24.51
|
| Rate for Payer: PHCS PPO |
$26.69
|
| Rate for Payer: PHCS PPO |
$19.40
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: PHCS PPO |
$17.40
|
| Rate for Payer: Three Rivers PPO |
$13.32
|
| Rate for Payer: Three Rivers PPO |
$20.42
|
| Rate for Payer: Three Rivers PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$13.07
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$11.72
|
| Rate for Payer: TriWest Veterans Administration |
$17.97
|
| Rate for Payer: United Healthcare Commercial |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$17.23
|
| Rate for Payer: United Healthcare Commercial |
$15.45
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$17.97
|
| Rate for Payer: United Healthcare Medicare |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$11.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.87
|
| Rate for Payer: WINHealth Partners Commercial |
$16.53
|
| Rate for Payer: WINHealth Partners Commercial |
$25.87
|
| Rate for Payer: WINHealth Partners Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$16.87
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$25.87
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [131324]
|
Facility
|
IP
|
$19.59
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.81
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.93
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12.28
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$12.93
|
| Rate for Payer: WINHealth Partners Commercial |
$18.61
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [131324]
|
Facility
|
OP
|
$19.59
|
|
|
Service Code
|
HCPCS J2250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.81
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.36
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$10.79
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$11.36
|
| Rate for Payer: WINHealth Partners Commercial |
$19.20
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$3,506.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
69440
|
| Min. Negotiated Rate |
$574.46 |
| Max. Negotiated Rate |
$3,506.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,435.88
|
| Rate for Payer: Aetna of WY Medicare |
$675.84
|
| Rate for Payer: Beech Street Commercial |
$3,330.70
|
| Rate for Payer: Cash Price |
$2,454.20
|
| Rate for Payer: Cash Price |
$2,454.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,400.82
|
| Rate for Payer: Cigna of WY Commercial |
$3,435.88
|
| Rate for Payer: First Choice Health Commercial |
$3,155.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,330.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.84
|
| Rate for Payer: HealthUtah PPO |
$3,506.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,400.82
|
| Rate for Payer: Multiplan Medicare/VA |
$574.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,435.88
|
| Rate for Payer: PacificSource Commercial |
$3,155.40
|
| Rate for Payer: PHCS PPO |
$3,330.70
|
| Rate for Payer: Three Rivers PPO |
$2,629.50
|
| Rate for Payer: TriWest Veterans Administration |
$675.84
|
| Rate for Payer: United Healthcare Commercial |
$3,050.22
|
| Rate for Payer: United Healthcare Medicare |
$675.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,980.10
|
|
|
MIDODRINE 10 MG TABLET [24215]
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
NDC 6068740995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.41
|
| Rate for Payer: Altius Commercial |
$5.41
|
| Rate for Payer: Beech Street Commercial |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.47
|
| Rate for Payer: Cigna of WY Commercial |
$5.53
|
| Rate for Payer: Entrust Commercial |
$5.36
|
| Rate for Payer: First Choice Health Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.27
|
| Rate for Payer: HealthUtah PPO |
$5.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.47
|
| Rate for Payer: Multiplan Medicare/VA |
$3.11
|
| Rate for Payer: One Health Plan of WY PPO |
$5.53
|
| Rate for Payer: PacificSource Commercial |
$5.08
|
| Rate for Payer: PHCS PPO |
$5.53
|
| Rate for Payer: Three Rivers PPO |
$4.23
|
| Rate for Payer: TriWest Veterans Administration |
$3.27
|
| Rate for Payer: United Healthcare Commercial |
$4.91
|
| Rate for Payer: United Healthcare Medicare |
$3.27
|
| Rate for Payer: WINHealth Partners Commercial |
$5.53
|
| Rate for Payer: Wise Provider Network Commercial |
$5.36
|
|
|
MIDODRINE 10 MG TABLET [24215]
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
NDC 6068740925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.41
|
| Rate for Payer: Altius Commercial |
$5.41
|
| Rate for Payer: Beech Street Commercial |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.47
|
| Rate for Payer: Cigna of WY Commercial |
$5.53
|
| Rate for Payer: Entrust Commercial |
$5.36
|
| Rate for Payer: First Choice Health Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.27
|
| Rate for Payer: HealthUtah PPO |
$5.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.47
|
| Rate for Payer: Multiplan Medicare/VA |
$3.11
|
| Rate for Payer: One Health Plan of WY PPO |
$5.53
|
| Rate for Payer: PacificSource Commercial |
$5.08
|
| Rate for Payer: PHCS PPO |
$5.53
|
| Rate for Payer: Three Rivers PPO |
$4.23
|
| Rate for Payer: TriWest Veterans Administration |
$3.27
|
| Rate for Payer: United Healthcare Commercial |
$4.91
|
| Rate for Payer: United Healthcare Medicare |
$3.27
|
| Rate for Payer: WINHealth Partners Commercial |
$5.53
|
| Rate for Payer: Wise Provider Network Commercial |
$5.36
|
|
|
MIDODRINE 10 MG TABLET [24215]
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
NDC 6068740995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.41
|
| Rate for Payer: Altius Commercial |
$5.41
|
| Rate for Payer: Beech Street Commercial |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.47
|
| Rate for Payer: Cigna of WY Commercial |
$5.53
|
| Rate for Payer: Entrust Commercial |
$5.36
|
| Rate for Payer: First Choice Health Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.72
|
| Rate for Payer: HealthUtah PPO |
$5.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.47
|
| Rate for Payer: Multiplan Medicare/VA |
$3.54
|
| Rate for Payer: One Health Plan of WY PPO |
$5.53
|
| Rate for Payer: PacificSource Commercial |
$5.08
|
| Rate for Payer: PHCS PPO |
$5.53
|
| Rate for Payer: Three Rivers PPO |
$4.23
|
| Rate for Payer: TriWest Veterans Administration |
$3.72
|
| Rate for Payer: United Healthcare Commercial |
$4.91
|
| Rate for Payer: United Healthcare Medicare |
$3.72
|
| Rate for Payer: WINHealth Partners Commercial |
$5.36
|
| Rate for Payer: Wise Provider Network Commercial |
$5.36
|
|
