|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [101294]
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 5464356491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.30
|
| Rate for Payer: Altius Commercial |
$20.30
|
| Rate for Payer: Beech Street Commercial |
$20.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.36
|
| Rate for Payer: Cash Price |
$14.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.52
|
| Rate for Payer: Cigna of WY Commercial |
$20.73
|
| Rate for Payer: Entrust Commercial |
$20.09
|
| Rate for Payer: First Choice Health Commercial |
$20.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.96
|
| Rate for Payer: HealthUtah PPO |
$21.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.52
|
| Rate for Payer: Multiplan Medicare/VA |
$13.26
|
| Rate for Payer: One Health Plan of WY PPO |
$20.73
|
| Rate for Payer: PacificSource Commercial |
$19.04
|
| Rate for Payer: PHCS PPO |
$20.73
|
| Rate for Payer: Three Rivers PPO |
$15.86
|
| Rate for Payer: TriWest Veterans Administration |
$13.96
|
| Rate for Payer: United Healthcare Commercial |
$18.40
|
| Rate for Payer: United Healthcare Medicare |
$13.96
|
| Rate for Payer: WINHealth Partners Commercial |
$20.09
|
| Rate for Payer: Wise Provider Network Commercial |
$20.09
|
|
|
MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 78452 26
|
| Hospital Charge Code |
78452
|
| Min. Negotiated Rate |
$61.63 |
| Max. Negotiated Rate |
$1,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,524.88
|
| Rate for Payer: Aetna of WY Medicare |
$72.51
|
| Rate for Payer: Beech Street Commercial |
$1,478.20
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,509.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,524.88
|
| Rate for Payer: First Choice Health Commercial |
$1,400.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,478.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.51
|
| Rate for Payer: HealthUtah PPO |
$1,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,509.32
|
| Rate for Payer: Multiplan Medicare/VA |
$61.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,524.88
|
| Rate for Payer: PacificSource Commercial |
$1,400.40
|
| Rate for Payer: PHCS PPO |
$1,478.20
|
| Rate for Payer: Three Rivers PPO |
$1,167.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.51
|
| Rate for Payer: United Healthcare Commercial |
$1,353.72
|
| Rate for Payer: United Healthcare Medicare |
$72.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,478.20
|
|
|
MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 58140 80
|
| Hospital Charge Code |
58140
|
| Min. Negotiated Rate |
$753.72 |
| Max. Negotiated Rate |
$4,655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,561.90
|
| Rate for Payer: Aetna of WY Medicare |
$886.73
|
| Rate for Payer: Beech Street Commercial |
$4,422.25
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,515.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,561.90
|
| Rate for Payer: First Choice Health Commercial |
$4,189.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,422.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.73
|
| Rate for Payer: HealthUtah PPO |
$4,655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,515.35
|
| Rate for Payer: Multiplan Medicare/VA |
$753.72
|
| Rate for Payer: One Health Plan of WY PPO |
$4,561.90
|
| Rate for Payer: PacificSource Commercial |
$4,189.50
|
| Rate for Payer: PHCS PPO |
$4,422.25
|
| Rate for Payer: Three Rivers PPO |
$3,491.25
|
| Rate for Payer: TriWest Veterans Administration |
$886.73
|
| Rate for Payer: United Healthcare Commercial |
$4,049.85
|
| Rate for Payer: United Healthcare Medicare |
$886.73
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
|
|
MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
58140
|
| Min. Negotiated Rate |
$753.72 |
| Max. Negotiated Rate |
$4,655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,561.90
|
| Rate for Payer: Aetna of WY Medicare |
$886.73
|
| Rate for Payer: Beech Street Commercial |
$4,422.25
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: Cash Price |
$3,258.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,515.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,561.90
|
| Rate for Payer: First Choice Health Commercial |
$4,189.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,422.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.73
|
| Rate for Payer: HealthUtah PPO |
$4,655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,515.35
|
| Rate for Payer: Multiplan Medicare/VA |
$753.72
|
| Rate for Payer: One Health Plan of WY PPO |
$4,561.90
|
| Rate for Payer: PacificSource Commercial |
$4,189.50
|
| Rate for Payer: PHCS PPO |
$4,422.25
|
| Rate for Payer: Three Rivers PPO |
$3,491.25
|
| Rate for Payer: TriWest Veterans Administration |
$886.73
|
| Rate for Payer: United Healthcare Commercial |
$4,049.85
|
| Rate for Payer: United Healthcare Medicare |
$886.73
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
|
|
MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 58146
|
| Hospital Charge Code |
58146
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,108.38
|
| Rate for Payer: Beech Street Commercial |
$1,871.50
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: First Choice Health Commercial |
$1,773.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,108.38
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$942.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,871.50
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,108.38
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,108.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,674.50
|
|
|
MYRINGOPLASTY
|
Professional
|
Both
|
$5,178.00
|
|
|
Service Code
|
HCPCS 69620 50
|
| Hospital Charge Code |
69620
|
| Min. Negotiated Rate |
$410.18 |
| Max. Negotiated Rate |
$5,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,074.44
|
| Rate for Payer: Aetna of WY Medicare |
$482.57
|
| Rate for Payer: Beech Street Commercial |
$4,919.10
|
| Rate for Payer: Cash Price |
$3,624.60
|
| Rate for Payer: Cash Price |
$3,624.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,022.66
|
| Rate for Payer: Cigna of WY Commercial |
$5,074.44
|
| Rate for Payer: First Choice Health Commercial |
$4,660.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,919.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$482.57
|
| Rate for Payer: HealthUtah PPO |
$5,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,022.66
|
| Rate for Payer: Multiplan Medicare/VA |
$410.18
|
| Rate for Payer: One Health Plan of WY PPO |
$5,074.44
|
| Rate for Payer: PacificSource Commercial |
$4,660.20
|
| Rate for Payer: PHCS PPO |
$4,919.10
|
| Rate for Payer: Three Rivers PPO |
$3,883.50
|
| Rate for Payer: TriWest Veterans Administration |
$482.57
|
| Rate for Payer: United Healthcare Commercial |
$4,504.86
|
| Rate for Payer: United Healthcare Medicare |
$482.57
|
| Rate for Payer: WINHealth Partners Commercial |
$4,401.30
|
|
|
MYRINGOPLASTY
|
Professional
|
Both
|
$2,589.00
|
|
|
Service Code
|
HCPCS 69620
|
| Hospital Charge Code |
69620
|
| Min. Negotiated Rate |
$410.18 |
| Max. Negotiated Rate |
$2,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,537.22
|
| Rate for Payer: Aetna of WY Medicare |
$482.57
|
| Rate for Payer: Beech Street Commercial |
$2,459.55
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,511.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,537.22
|
| Rate for Payer: First Choice Health Commercial |
$2,330.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,459.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$482.57
|
| Rate for Payer: HealthUtah PPO |
$2,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,511.33
|
| Rate for Payer: Multiplan Medicare/VA |
$410.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,537.22
|
| Rate for Payer: PacificSource Commercial |
$2,330.10
|
| Rate for Payer: PHCS PPO |
$2,459.55
|
| Rate for Payer: Three Rivers PPO |
$1,941.75
|
| Rate for Payer: TriWest Veterans Administration |
$482.57
|
| Rate for Payer: United Healthcare Commercial |
$2,252.43
|
| Rate for Payer: United Healthcare Medicare |
$482.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,200.65
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
69420
|
| Min. Negotiated Rate |
$100.41 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Aetna of WY Medicare |
$118.13
|
| Rate for Payer: Beech Street Commercial |
$862.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: First Choice Health Commercial |
$817.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.13
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$100.41
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$862.60
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.13
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$118.13
|
| Rate for Payer: WINHealth Partners Commercial |
$771.80
|
|
|
MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
69421
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$1,956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,916.88
|
| Rate for Payer: Aetna of WY Medicare |
$148.16
|
| Rate for Payer: Beech Street Commercial |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,897.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,916.88
|
| Rate for Payer: First Choice Health Commercial |
$1,760.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.16
|
| Rate for Payer: HealthUtah PPO |
$1,956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,897.32
|
| Rate for Payer: Multiplan Medicare/VA |
$125.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,916.88
|
| Rate for Payer: PacificSource Commercial |
$1,760.40
|
| Rate for Payer: PHCS PPO |
$1,858.20
|
| Rate for Payer: Three Rivers PPO |
$1,467.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.16
|
| Rate for Payer: United Healthcare Commercial |
$1,701.72
|
| Rate for Payer: United Healthcare Medicare |
$148.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.60
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [6766]
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
NDC 7248540601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.17
|
| Rate for Payer: Aetna of WY Medicare |
$29.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.27
|
| Rate for Payer: Altius Commercial |
$43.27
|
| Rate for Payer: Beech Street Commercial |
$44.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.72
|
| Rate for Payer: Cigna of WY Commercial |
$44.17
|
| Rate for Payer: Entrust Commercial |
$42.82
|
| Rate for Payer: First Choice Health Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.14
|
| Rate for Payer: HealthUtah PPO |
$45.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.72
|
| Rate for Payer: Multiplan Medicare/VA |
$24.83
|
| Rate for Payer: One Health Plan of WY PPO |
$44.17
|
| Rate for Payer: PacificSource Commercial |
$40.56
|
| Rate for Payer: PHCS PPO |
$44.17
|
| Rate for Payer: Three Rivers PPO |
$33.80
|
| Rate for Payer: TriWest Veterans Administration |
$26.14
|
| Rate for Payer: United Healthcare Commercial |
$39.21
|
| Rate for Payer: United Healthcare Medicare |
$26.14
|
| Rate for Payer: WINHealth Partners Commercial |
$44.17
|
| Rate for Payer: Wise Provider Network Commercial |
$42.82
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [6766]
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
NDC 7248540610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.27
|
| Rate for Payer: Altius Commercial |
$43.27
|
| Rate for Payer: Beech Street Commercial |
$44.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.72
|
| Rate for Payer: Cigna of WY Commercial |
$44.17
|
| Rate for Payer: Entrust Commercial |
$42.82
|
| Rate for Payer: First Choice Health Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.75
|
| Rate for Payer: HealthUtah PPO |
$45.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.72
|
| Rate for Payer: Multiplan Medicare/VA |
$28.26
|
| Rate for Payer: One Health Plan of WY PPO |
$44.17
|
| Rate for Payer: PacificSource Commercial |
$40.56
|
| Rate for Payer: PHCS PPO |
$44.17
|
| Rate for Payer: Three Rivers PPO |
$33.80
|
| Rate for Payer: TriWest Veterans Administration |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$39.21
|
| Rate for Payer: United Healthcare Medicare |
$29.75
|
| Rate for Payer: WINHealth Partners Commercial |
$42.82
|
| Rate for Payer: Wise Provider Network Commercial |
$42.82
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [6766]
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
NDC 7248540610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.17
|
| Rate for Payer: Aetna of WY Medicare |
$29.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.27
|
| Rate for Payer: Altius Commercial |
$43.27
|
| Rate for Payer: Beech Street Commercial |
$44.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.72
|
| Rate for Payer: Cigna of WY Commercial |
$44.17
|
| Rate for Payer: Entrust Commercial |
$42.82
|
| Rate for Payer: First Choice Health Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.14
|
| Rate for Payer: HealthUtah PPO |
$45.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.72
|
| Rate for Payer: Multiplan Medicare/VA |
$24.83
|
| Rate for Payer: One Health Plan of WY PPO |
$44.17
|
| Rate for Payer: PacificSource Commercial |
$40.56
|
| Rate for Payer: PHCS PPO |
$44.17
|
| Rate for Payer: Three Rivers PPO |
$33.80
|
| Rate for Payer: TriWest Veterans Administration |
$26.14
|
| Rate for Payer: United Healthcare Commercial |
$39.21
|
| Rate for Payer: United Healthcare Medicare |
$26.14
|
| Rate for Payer: WINHealth Partners Commercial |
$44.17
|
| Rate for Payer: Wise Provider Network Commercial |
$42.82
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [6766]
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
NDC 7248540601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.27
|
| Rate for Payer: Altius Commercial |
$43.27
|
| Rate for Payer: Beech Street Commercial |
$44.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.72
|
| Rate for Payer: Cigna of WY Commercial |
$44.17
|
| Rate for Payer: Entrust Commercial |
$42.82
|
| Rate for Payer: First Choice Health Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.75
|
| Rate for Payer: HealthUtah PPO |
$45.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.72
|
| Rate for Payer: Multiplan Medicare/VA |
$28.26
|
| Rate for Payer: One Health Plan of WY PPO |
$44.17
|
| Rate for Payer: PacificSource Commercial |
$40.56
|
| Rate for Payer: PHCS PPO |
$44.17
|
| Rate for Payer: Three Rivers PPO |
$33.80
|
| Rate for Payer: TriWest Veterans Administration |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$39.21
|
| Rate for Payer: United Healthcare Medicare |
$29.75
|
| Rate for Payer: WINHealth Partners Commercial |
$42.82
|
| Rate for Payer: Wise Provider Network Commercial |
$42.82
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [4135]
|
Facility
|
IP
|
$54.58
|
|
|
Service Code
|
HCPCS J2310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.49
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Altius Commercial |
$52.40
|
| Rate for Payer: Beech Street Commercial |
$53.49
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.81
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.94
|
| Rate for Payer: Cigna of WY Commercial |
$53.49
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: Entrust Commercial |
$51.85
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$51.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.28
|
| Rate for Payer: HealthUtah PPO |
$54.58
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.94
|
| Rate for Payer: Multiplan Medicare/VA |
$34.22
|
| Rate for Payer: Multiplan Medicare/VA |
$21.16
|
| Rate for Payer: One Health Plan of WY PPO |
$53.49
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$49.12
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$53.49
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$40.94
|
| Rate for Payer: TriWest Veterans Administration |
$36.02
|
| Rate for Payer: TriWest Veterans Administration |
$22.28
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Commercial |
$47.48
|
| Rate for Payer: United Healthcare Medicare |
$36.02
|
| Rate for Payer: United Healthcare Medicare |
$22.28
|
| Rate for Payer: WINHealth Partners Commercial |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$51.85
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
| Rate for Payer: Wise Provider Network Commercial |
$51.85
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [4135]
|
Facility
|
OP
|
$54.58
|
|
|
Service Code
|
HCPCS J2310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.49
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Medicare |
$36.02
|
| Rate for Payer: Aetna of WY Medicare |
$22.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.40
|
| Rate for Payer: Altius Commercial |
$52.40
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Beech Street Commercial |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Cigna of WY Commercial |
$53.49
|
| Rate for Payer: Entrust Commercial |
$51.85
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$51.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: HealthUtah PPO |
$54.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.94
|
| Rate for Payer: Multiplan Medicare/VA |
$30.07
|
| Rate for Payer: Multiplan Medicare/VA |
$18.60
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: One Health Plan of WY PPO |
$53.49
|
| Rate for Payer: PacificSource Commercial |
$49.12
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$53.49
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$40.94
|
| Rate for Payer: TriWest Veterans Administration |
$31.66
|
| Rate for Payer: TriWest Veterans Administration |
$19.58
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Commercial |
$47.48
|
| Rate for Payer: United Healthcare Medicare |
$31.66
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
| Rate for Payer: WINHealth Partners Commercial |
$33.08
|
| Rate for Payer: WINHealth Partners Commercial |
$53.49
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
| Rate for Payer: Wise Provider Network Commercial |
$51.85
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE [25752]
|
Facility
|
OP
|
$54.38
|
|
|
Service Code
|
HCPCS J2310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$54.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.29
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$35.89
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$35.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$52.20
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$52.02
|
| Rate for Payer: Beech Street Commercial |
$53.29
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$53.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cash Price |
$37.93
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$53.11
|
| Rate for Payer: Cigna of WY Commercial |
$53.29
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$51.66
|
| Rate for Payer: Entrust Commercial |
$51.48
|
| Rate for Payer: First Choice Health Commercial |
$51.66
|
| Rate for Payer: First Choice Health Commercial |
$51.48
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: HealthUtah PPO |
$54.19
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$54.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.75
|
| Rate for Payer: Multiplan Medicare/VA |
$29.86
|
| Rate for Payer: Multiplan Medicare/VA |
$29.96
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: One Health Plan of WY PPO |
$53.11
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$53.29
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$48.94
|
| Rate for Payer: PacificSource Commercial |
$48.77
|
| Rate for Payer: PHCS PPO |
$53.29
|
| Rate for Payer: PHCS PPO |
$53.11
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$40.78
|
| Rate for Payer: Three Rivers PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: TriWest Veterans Administration |
$31.54
|
| Rate for Payer: TriWest Veterans Administration |
$31.43
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Commercial |
$47.31
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$31.43
|
| Rate for Payer: United Healthcare Medicare |
$31.54
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: WINHealth Partners Commercial |
$53.11
|
| Rate for Payer: WINHealth Partners Commercial |
$53.29
|
| Rate for Payer: Wise Provider Network Commercial |
$51.48
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$51.66
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE [25752]
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
HCPCS J2310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.29
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$52.20
|
| Rate for Payer: Altius Commercial |
$52.02
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$53.29
|
| Rate for Payer: Beech Street Commercial |
$53.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.65
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cash Price |
$37.93
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.75
|
| Rate for Payer: Cigna of WY Commercial |
$53.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$53.11
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$51.48
|
| Rate for Payer: Entrust Commercial |
$51.66
|
| Rate for Payer: First Choice Health Commercial |
$51.66
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$51.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$54.19
|
| Rate for Payer: HealthUtah PPO |
$54.38
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.56
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: Multiplan Medicare/VA |
$33.98
|
| Rate for Payer: Multiplan Medicare/VA |
$34.10
|
| Rate for Payer: One Health Plan of WY PPO |
$53.11
|
| Rate for Payer: One Health Plan of WY PPO |
$53.29
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$48.77
|
| Rate for Payer: PacificSource Commercial |
$48.94
|
| Rate for Payer: PHCS PPO |
$53.29
|
| Rate for Payer: PHCS PPO |
$53.11
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$40.78
|
| Rate for Payer: Three Rivers PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: TriWest Veterans Administration |
$35.77
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Commercial |
$47.31
|
| Rate for Payer: United Healthcare Medicare |
$35.77
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$51.66
|
| Rate for Payer: WINHealth Partners Commercial |
$51.48
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$51.48
|
| Rate for Payer: Wise Provider Network Commercial |
$51.66
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE [41251]
|
Facility
|
IP
|
$1,705.34
|
|
|
Service Code
|
HCPCS J2315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,069.25 |
| Max. Negotiated Rate |
$1,705.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,671.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,637.13
|
| Rate for Payer: Altius Commercial |
$1,637.13
|
| Rate for Payer: Beech Street Commercial |
$1,671.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,400.08
|
| Rate for Payer: Cash Price |
$1,193.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,654.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,671.23
|
| Rate for Payer: Entrust Commercial |
$1,620.07
|
| Rate for Payer: First Choice Health Commercial |
$1,620.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,620.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,125.52
|
| Rate for Payer: HealthUtah PPO |
$1,705.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,654.18
|
| Rate for Payer: Multiplan Medicare/VA |
$1,069.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,671.23
|
| Rate for Payer: PacificSource Commercial |
$1,534.81
|
| Rate for Payer: PHCS PPO |
$1,671.23
|
| Rate for Payer: Three Rivers PPO |
$1,279.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,125.52
|
| Rate for Payer: United Healthcare Commercial |
$1,483.65
|
| Rate for Payer: United Healthcare Medicare |
$1,125.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,620.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,620.07
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE [41251]
|
Facility
|
OP
|
$1,705.34
|
|
|
Service Code
|
HCPCS J2315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$939.64 |
| Max. Negotiated Rate |
$1,705.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,671.23
|
| Rate for Payer: Aetna of WY Medicare |
$1,125.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,637.13
|
| Rate for Payer: Altius Commercial |
$1,637.13
|
| Rate for Payer: Beech Street Commercial |
$1,671.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,400.08
|
| Rate for Payer: Cash Price |
$1,193.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,654.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,671.23
|
| Rate for Payer: Entrust Commercial |
$1,620.07
|
| Rate for Payer: First Choice Health Commercial |
$1,620.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,620.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$989.10
|
| Rate for Payer: HealthUtah PPO |
$1,705.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,654.18
|
| Rate for Payer: Multiplan Medicare/VA |
$939.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,671.23
|
| Rate for Payer: PacificSource Commercial |
$1,534.81
|
| Rate for Payer: PHCS PPO |
$1,671.23
|
| Rate for Payer: Three Rivers PPO |
$1,279.00
|
| Rate for Payer: TriWest Veterans Administration |
$989.10
|
| Rate for Payer: United Healthcare Commercial |
$1,483.65
|
| Rate for Payer: United Healthcare Medicare |
$989.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,671.23
|
| Rate for Payer: Wise Provider Network Commercial |
$1,620.07
|
|
|
NAPROXEN 500 MG TABLET [19875]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 6846219001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
NAPROXEN 500 MG TABLET [19875]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 6846219001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
NAPROXEN SODIUM 220 MG TABLET [13253]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 4612256271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.26
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.26
|
| Rate for Payer: Altius Commercial |
$0.26
|
| Rate for Payer: Beech Street Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.26
|
| Rate for Payer: Cigna of WY Commercial |
$0.26
|
| Rate for Payer: Entrust Commercial |
$0.26
|
| Rate for Payer: First Choice Health Commercial |
$0.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.26
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.26
|
| Rate for Payer: PacificSource Commercial |
$0.24
|
| Rate for Payer: PHCS PPO |
$0.26
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.26
|
| Rate for Payer: Wise Provider Network Commercial |
$0.26
|
|
|
NAPROXEN SODIUM 220 MG TABLET [13253]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 4612256271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.26
|
| Rate for Payer: Altius Commercial |
$0.26
|
| Rate for Payer: Beech Street Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.26
|
| Rate for Payer: Cigna of WY Commercial |
$0.26
|
| Rate for Payer: Entrust Commercial |
$0.26
|
| Rate for Payer: First Choice Health Commercial |
$0.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.18
|
| Rate for Payer: HealthUtah PPO |
$0.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.26
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$0.26
|
| Rate for Payer: PacificSource Commercial |
$0.24
|
| Rate for Payer: PHCS PPO |
$0.26
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WINHealth Partners Commercial |
$0.26
|
| Rate for Payer: Wise Provider Network Commercial |
$0.26
|
|
|
NASAL CO2 SAMPLE LINE ADU
|
Facility
|
IP
|
$22.56
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$22.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.66
|
| Rate for Payer: Altius Commercial |
$21.66
|
| Rate for Payer: Beech Street Commercial |
$22.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.52
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.88
|
| Rate for Payer: Cigna of WY Commercial |
$22.11
|
| Rate for Payer: Entrust Commercial |
$21.43
|
| Rate for Payer: First Choice Health Commercial |
$21.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.89
|
| Rate for Payer: HealthUtah PPO |
$22.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.88
|
| Rate for Payer: Multiplan Medicare/VA |
$14.15
|
| Rate for Payer: One Health Plan of WY PPO |
$22.11
|
| Rate for Payer: PacificSource Commercial |
$20.30
|
| Rate for Payer: PHCS PPO |
$22.11
|
| Rate for Payer: Three Rivers PPO |
$16.92
|
| Rate for Payer: TriWest Veterans Administration |
$14.89
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare |
$14.89
|
| Rate for Payer: WINHealth Partners Commercial |
$21.43
|
| Rate for Payer: Wise Provider Network Commercial |
$21.43
|
|
|
NASAL CO2 SAMPLE LINE ADU
|
Facility
|
OP
|
$22.56
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$22.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.11
|
| Rate for Payer: Aetna of WY Medicare |
$14.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.66
|
| Rate for Payer: Altius Commercial |
$21.66
|
| Rate for Payer: Beech Street Commercial |
$22.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.52
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.88
|
| Rate for Payer: Cigna of WY Commercial |
$22.11
|
| Rate for Payer: Entrust Commercial |
$21.43
|
| Rate for Payer: First Choice Health Commercial |
$21.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.08
|
| Rate for Payer: HealthUtah PPO |
$22.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.88
|
| Rate for Payer: Multiplan Medicare/VA |
$12.43
|
| Rate for Payer: One Health Plan of WY PPO |
$22.11
|
| Rate for Payer: PacificSource Commercial |
$20.30
|
| Rate for Payer: PHCS PPO |
$22.11
|
| Rate for Payer: Three Rivers PPO |
$16.92
|
| Rate for Payer: TriWest Veterans Administration |
$13.08
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare |
$13.08
|
| Rate for Payer: WINHealth Partners Commercial |
$22.11
|
| Rate for Payer: Wise Provider Network Commercial |
$21.43
|
|
