|
NEEDLE ULTRAPLEX 20G 4"
|
Facility
|
IP
|
$40.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.07
|
| Rate for Payer: Altius Commercial |
$39.07
|
| Rate for Payer: Beech Street Commercial |
$39.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.41
|
| Rate for Payer: Cash Price |
$28.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.48
|
| Rate for Payer: Cigna of WY Commercial |
$39.89
|
| Rate for Payer: Entrust Commercial |
$38.66
|
| Rate for Payer: First Choice Health Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.86
|
| Rate for Payer: HealthUtah PPO |
$40.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.48
|
| Rate for Payer: Multiplan Medicare/VA |
$25.52
|
| Rate for Payer: One Health Plan of WY PPO |
$39.89
|
| Rate for Payer: PacificSource Commercial |
$36.63
|
| Rate for Payer: PHCS PPO |
$39.89
|
| Rate for Payer: Three Rivers PPO |
$30.52
|
| Rate for Payer: TriWest Veterans Administration |
$26.86
|
| Rate for Payer: United Healthcare Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare |
$26.86
|
| Rate for Payer: WINHealth Partners Commercial |
$38.66
|
| Rate for Payer: Wise Provider Network Commercial |
$38.66
|
|
|
NEEDLE ULTRAPLEX 20G 4"
|
Facility
|
OP
|
$40.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.89
|
| Rate for Payer: Aetna of WY Medicare |
$26.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.07
|
| Rate for Payer: Altius Commercial |
$39.07
|
| Rate for Payer: Beech Street Commercial |
$39.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.41
|
| Rate for Payer: Cash Price |
$28.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.48
|
| Rate for Payer: Cigna of WY Commercial |
$39.89
|
| Rate for Payer: Entrust Commercial |
$38.66
|
| Rate for Payer: First Choice Health Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.61
|
| Rate for Payer: HealthUtah PPO |
$40.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.48
|
| Rate for Payer: Multiplan Medicare/VA |
$22.43
|
| Rate for Payer: One Health Plan of WY PPO |
$39.89
|
| Rate for Payer: PacificSource Commercial |
$36.63
|
| Rate for Payer: PHCS PPO |
$39.89
|
| Rate for Payer: Three Rivers PPO |
$30.52
|
| Rate for Payer: TriWest Veterans Administration |
$23.61
|
| Rate for Payer: United Healthcare Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare |
$23.61
|
| Rate for Payer: WINHealth Partners Commercial |
$39.89
|
| Rate for Payer: Wise Provider Network Commercial |
$38.66
|
|
|
NEGATIVE PRESSURE WOUND THERAPY DME <= 50 SQ CM
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 97605 80
|
| Hospital Charge Code |
97605
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$423.36
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$419.04
|
| Rate for Payer: Cigna of WY Commercial |
$423.36
|
| Rate for Payer: First Choice Health Commercial |
$388.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$419.04
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$423.36
|
| Rate for Payer: PacificSource Commercial |
$388.80
|
| Rate for Payer: PHCS PPO |
$410.40
|
| Rate for Payer: Three Rivers PPO |
$324.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$375.84
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$410.40
|
|
|
NEGATIVE PRESSURE WOUND THERAPY DME <= 50 SQ CM
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
97605
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$423.36
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$419.04
|
| Rate for Payer: Cigna of WY Commercial |
$423.36
|
| Rate for Payer: First Choice Health Commercial |
$388.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$419.04
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$423.36
|
| Rate for Payer: PacificSource Commercial |
$388.80
|
| Rate for Payer: PHCS PPO |
$410.40
|
| Rate for Payer: Three Rivers PPO |
$324.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$375.84
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$410.40
|
|
|
NEGATIVE PRESSURE WOUND THERAPY DME <= 50 SQ CM
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 97605 AS
|
| Hospital Charge Code |
97605
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$423.36
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$419.04
|
| Rate for Payer: Cigna of WY Commercial |
$423.36
|
| Rate for Payer: First Choice Health Commercial |
$388.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$419.04
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$423.36
|
| Rate for Payer: PacificSource Commercial |
$388.80
|
| Rate for Payer: PHCS PPO |
$410.40
|
| Rate for Payer: Three Rivers PPO |
$324.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$375.84
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$410.40
|
|
|
NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
97606
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,369.06
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$1,327.15
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,355.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,369.06
|
| Rate for Payer: First Choice Health Commercial |
$1,257.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,327.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$1,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,355.09
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,369.06
|
| Rate for Payer: PacificSource Commercial |
$1,257.30
|
| Rate for Payer: PHCS PPO |
$1,327.15
|
| Rate for Payer: Three Rivers PPO |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$1,215.39
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,327.15
|
|
|
NEG PRESSURE WOUND THERAPY NON DME <= 50 SQ CM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
97607
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$516.46
|
| Rate for Payer: Aetna of WY Medicare |
$20.12
|
| Rate for Payer: Beech Street Commercial |
$500.65
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$511.19
|
| Rate for Payer: Cigna of WY Commercial |
$516.46
|
| Rate for Payer: First Choice Health Commercial |
$474.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.12
|
| Rate for Payer: HealthUtah PPO |
$527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$511.19
|
| Rate for Payer: Multiplan Medicare/VA |
$17.10
|
| Rate for Payer: One Health Plan of WY PPO |
$516.46
|
| Rate for Payer: PacificSource Commercial |
$474.30
|
| Rate for Payer: PHCS PPO |
$500.65
|
| Rate for Payer: Three Rivers PPO |
$395.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.12
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
| Rate for Payer: United Healthcare Medicare |
$20.12
|
| Rate for Payer: WINHealth Partners Commercial |
$500.65
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
OP
|
$33.90
|
|
|
Service Code
|
NDC 3982212015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$33.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.22
|
| Rate for Payer: Aetna of WY Medicare |
$22.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.54
|
| Rate for Payer: Altius Commercial |
$32.54
|
| Rate for Payer: Beech Street Commercial |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.83
|
| Rate for Payer: Cash Price |
$23.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.88
|
| Rate for Payer: Cigna of WY Commercial |
$33.22
|
| Rate for Payer: Entrust Commercial |
$32.20
|
| Rate for Payer: First Choice Health Commercial |
$32.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.66
|
| Rate for Payer: HealthUtah PPO |
$33.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.88
|
| Rate for Payer: Multiplan Medicare/VA |
$18.68
|
| Rate for Payer: One Health Plan of WY PPO |
$33.22
|
| Rate for Payer: PacificSource Commercial |
$30.51
|
| Rate for Payer: PHCS PPO |
$33.22
|
| Rate for Payer: Three Rivers PPO |
$25.42
|
| Rate for Payer: TriWest Veterans Administration |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$29.49
|
| Rate for Payer: United Healthcare Medicare |
$19.66
|
| Rate for Payer: WINHealth Partners Commercial |
$33.22
|
| Rate for Payer: Wise Provider Network Commercial |
$32.20
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
IP
|
$33.90
|
|
|
Service Code
|
NDC 3982212015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$33.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.54
|
| Rate for Payer: Altius Commercial |
$32.54
|
| Rate for Payer: Beech Street Commercial |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.83
|
| Rate for Payer: Cash Price |
$23.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.88
|
| Rate for Payer: Cigna of WY Commercial |
$33.22
|
| Rate for Payer: Entrust Commercial |
$32.20
|
| Rate for Payer: First Choice Health Commercial |
$32.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.37
|
| Rate for Payer: HealthUtah PPO |
$33.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.88
|
| Rate for Payer: Multiplan Medicare/VA |
$21.26
|
| Rate for Payer: One Health Plan of WY PPO |
$33.22
|
| Rate for Payer: PacificSource Commercial |
$30.51
|
| Rate for Payer: PHCS PPO |
$33.22
|
| Rate for Payer: Three Rivers PPO |
$25.42
|
| Rate for Payer: TriWest Veterans Administration |
$22.37
|
| Rate for Payer: United Healthcare Commercial |
$29.49
|
| Rate for Payer: United Healthcare Medicare |
$22.37
|
| Rate for Payer: WINHealth Partners Commercial |
$32.20
|
| Rate for Payer: Wise Provider Network Commercial |
$32.20
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
IP
|
$32.77
|
|
|
Service Code
|
NDC 3982212011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.46
|
| Rate for Payer: Altius Commercial |
$31.46
|
| Rate for Payer: Beech Street Commercial |
$32.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.79
|
| Rate for Payer: Cigna of WY Commercial |
$32.11
|
| Rate for Payer: Entrust Commercial |
$31.13
|
| Rate for Payer: First Choice Health Commercial |
$31.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.63
|
| Rate for Payer: HealthUtah PPO |
$32.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.79
|
| Rate for Payer: Multiplan Medicare/VA |
$20.55
|
| Rate for Payer: One Health Plan of WY PPO |
$32.11
|
| Rate for Payer: PacificSource Commercial |
$29.49
|
| Rate for Payer: PHCS PPO |
$32.11
|
| Rate for Payer: Three Rivers PPO |
$24.58
|
| Rate for Payer: TriWest Veterans Administration |
$21.63
|
| Rate for Payer: United Healthcare Commercial |
$28.51
|
| Rate for Payer: United Healthcare Medicare |
$21.63
|
| Rate for Payer: WINHealth Partners Commercial |
$31.13
|
| Rate for Payer: Wise Provider Network Commercial |
$31.13
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
OP
|
$23.80
|
|
|
Service Code
|
NDC 3982212201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Aetna of WY Medicare |
$15.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.85
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.54
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.80
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$13.11
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$20.71
|
| Rate for Payer: United Healthcare Medicare |
$13.80
|
| Rate for Payer: WINHealth Partners Commercial |
$23.32
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
OP
|
$32.77
|
|
|
Service Code
|
NDC 3982212011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.11
|
| Rate for Payer: Aetna of WY Medicare |
$21.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.46
|
| Rate for Payer: Altius Commercial |
$31.46
|
| Rate for Payer: Beech Street Commercial |
$32.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.79
|
| Rate for Payer: Cigna of WY Commercial |
$32.11
|
| Rate for Payer: Entrust Commercial |
$31.13
|
| Rate for Payer: First Choice Health Commercial |
$31.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.01
|
| Rate for Payer: HealthUtah PPO |
$32.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.79
|
| Rate for Payer: Multiplan Medicare/VA |
$18.06
|
| Rate for Payer: One Health Plan of WY PPO |
$32.11
|
| Rate for Payer: PacificSource Commercial |
$29.49
|
| Rate for Payer: PHCS PPO |
$32.11
|
| Rate for Payer: Three Rivers PPO |
$24.58
|
| Rate for Payer: TriWest Veterans Administration |
$19.01
|
| Rate for Payer: United Healthcare Commercial |
$28.51
|
| Rate for Payer: United Healthcare Medicare |
$19.01
|
| Rate for Payer: WINHealth Partners Commercial |
$32.11
|
| Rate for Payer: Wise Provider Network Commercial |
$31.13
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [19626]
|
Facility
|
IP
|
$23.80
|
|
|
Service Code
|
NDC 3982212201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.85
|
| Rate for Payer: Altius Commercial |
$22.85
|
| Rate for Payer: Beech Street Commercial |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.54
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.09
|
| Rate for Payer: Cigna of WY Commercial |
$23.32
|
| Rate for Payer: Entrust Commercial |
$22.61
|
| Rate for Payer: First Choice Health Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.71
|
| Rate for Payer: HealthUtah PPO |
$23.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.09
|
| Rate for Payer: Multiplan Medicare/VA |
$14.92
|
| Rate for Payer: One Health Plan of WY PPO |
$23.32
|
| Rate for Payer: PacificSource Commercial |
$21.42
|
| Rate for Payer: PHCS PPO |
$23.32
|
| Rate for Payer: Three Rivers PPO |
$17.85
|
| Rate for Payer: TriWest Veterans Administration |
$15.71
|
| Rate for Payer: United Healthcare Commercial |
$20.71
|
| Rate for Payer: United Healthcare Medicare |
$15.71
|
| Rate for Payer: WINHealth Partners Commercial |
$22.61
|
| Rate for Payer: Wise Provider Network Commercial |
$22.61
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 4612241405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.62
|
| Rate for Payer: Altius Commercial |
$0.62
|
| Rate for Payer: Beech Street Commercial |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.63
|
| Rate for Payer: Cigna of WY Commercial |
$0.64
|
| Rate for Payer: Entrust Commercial |
$0.62
|
| Rate for Payer: First Choice Health Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.43
|
| Rate for Payer: HealthUtah PPO |
$0.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.63
|
| Rate for Payer: Multiplan Medicare/VA |
$0.41
|
| Rate for Payer: One Health Plan of WY PPO |
$0.64
|
| Rate for Payer: PacificSource Commercial |
$0.59
|
| Rate for Payer: PHCS PPO |
$0.64
|
| Rate for Payer: Three Rivers PPO |
$0.49
|
| Rate for Payer: TriWest Veterans Administration |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.43
|
| Rate for Payer: WINHealth Partners Commercial |
$0.62
|
| Rate for Payer: Wise Provider Network Commercial |
$0.62
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 4580214301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.54
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 4612241405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.64
|
| Rate for Payer: Aetna of WY Medicare |
$0.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.62
|
| Rate for Payer: Altius Commercial |
$0.62
|
| Rate for Payer: Beech Street Commercial |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.63
|
| Rate for Payer: Cigna of WY Commercial |
$0.64
|
| Rate for Payer: Entrust Commercial |
$0.62
|
| Rate for Payer: First Choice Health Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.63
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.64
|
| Rate for Payer: PacificSource Commercial |
$0.59
|
| Rate for Payer: PHCS PPO |
$0.64
|
| Rate for Payer: Three Rivers PPO |
$0.49
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.64
|
| Rate for Payer: Wise Provider Network Commercial |
$0.62
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 4580214301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 6800148346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Aetna of WY Medicare |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.56
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WINHealth Partners Commercial |
$0.94
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [1737]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 6800148346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$0.91
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [12664]
|
Facility
|
OP
|
$11.92
|
|
|
Service Code
|
NDC 2420883060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.68
|
| Rate for Payer: Aetna of WY Medicare |
$7.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.44
|
| Rate for Payer: Altius Commercial |
$11.44
|
| Rate for Payer: Beech Street Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.56
|
| Rate for Payer: Cigna of WY Commercial |
$11.68
|
| Rate for Payer: Entrust Commercial |
$11.32
|
| Rate for Payer: First Choice Health Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.91
|
| Rate for Payer: HealthUtah PPO |
$11.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.56
|
| Rate for Payer: Multiplan Medicare/VA |
$6.57
|
| Rate for Payer: One Health Plan of WY PPO |
$11.68
|
| Rate for Payer: PacificSource Commercial |
$10.73
|
| Rate for Payer: PHCS PPO |
$11.68
|
| Rate for Payer: Three Rivers PPO |
$8.94
|
| Rate for Payer: TriWest Veterans Administration |
$6.91
|
| Rate for Payer: United Healthcare Commercial |
$10.37
|
| Rate for Payer: United Healthcare Medicare |
$6.91
|
| Rate for Payer: WINHealth Partners Commercial |
$11.68
|
| Rate for Payer: Wise Provider Network Commercial |
$11.32
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [12664]
|
Facility
|
IP
|
$11.92
|
|
|
Service Code
|
NDC 2420883060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.44
|
| Rate for Payer: Altius Commercial |
$11.44
|
| Rate for Payer: Beech Street Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.56
|
| Rate for Payer: Cigna of WY Commercial |
$11.68
|
| Rate for Payer: Entrust Commercial |
$11.32
|
| Rate for Payer: First Choice Health Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.87
|
| Rate for Payer: HealthUtah PPO |
$11.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.56
|
| Rate for Payer: Multiplan Medicare/VA |
$7.47
|
| Rate for Payer: One Health Plan of WY PPO |
$11.68
|
| Rate for Payer: PacificSource Commercial |
$10.73
|
| Rate for Payer: PHCS PPO |
$11.68
|
| Rate for Payer: Three Rivers PPO |
$8.94
|
| Rate for Payer: TriWest Veterans Administration |
$7.87
|
| Rate for Payer: United Healthcare Commercial |
$10.37
|
| Rate for Payer: United Healthcare Medicare |
$7.87
|
| Rate for Payer: WINHealth Partners Commercial |
$11.32
|
| Rate for Payer: Wise Provider Network Commercial |
$11.32
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [20721]
|
Facility
|
IP
|
$27.27
|
|
|
Service Code
|
NDC 2420863562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$27.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.18
|
| Rate for Payer: Altius Commercial |
$26.18
|
| Rate for Payer: Beech Street Commercial |
$26.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.45
|
| Rate for Payer: Cigna of WY Commercial |
$26.72
|
| Rate for Payer: Entrust Commercial |
$25.91
|
| Rate for Payer: First Choice Health Commercial |
$25.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.00
|
| Rate for Payer: HealthUtah PPO |
$27.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.45
|
| Rate for Payer: Multiplan Medicare/VA |
$17.10
|
| Rate for Payer: One Health Plan of WY PPO |
$26.72
|
| Rate for Payer: PacificSource Commercial |
$24.54
|
| Rate for Payer: PHCS PPO |
$26.72
|
| Rate for Payer: Three Rivers PPO |
$20.45
|
| Rate for Payer: TriWest Veterans Administration |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$23.72
|
| Rate for Payer: United Healthcare Medicare |
$18.00
|
| Rate for Payer: WINHealth Partners Commercial |
$25.91
|
| Rate for Payer: Wise Provider Network Commercial |
$25.91
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [20721]
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
NDC 6498044801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.74
|
| Rate for Payer: Altius Commercial |
$30.74
|
| Rate for Payer: Beech Street Commercial |
$31.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.06
|
| Rate for Payer: Cigna of WY Commercial |
$31.38
|
| Rate for Payer: Entrust Commercial |
$30.42
|
| Rate for Payer: First Choice Health Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.13
|
| Rate for Payer: HealthUtah PPO |
$32.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.06
|
| Rate for Payer: Multiplan Medicare/VA |
$20.08
|
| Rate for Payer: One Health Plan of WY PPO |
$31.38
|
| Rate for Payer: PacificSource Commercial |
$28.82
|
| Rate for Payer: PHCS PPO |
$31.38
|
| Rate for Payer: Three Rivers PPO |
$24.02
|
| Rate for Payer: TriWest Veterans Administration |
$21.13
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
| Rate for Payer: United Healthcare Medicare |
$21.13
|
| Rate for Payer: WINHealth Partners Commercial |
$30.42
|
| Rate for Payer: Wise Provider Network Commercial |
$30.42
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [20721]
|
Facility
|
OP
|
$27.27
|
|
|
Service Code
|
NDC 2420863562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$27.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.72
|
| Rate for Payer: Aetna of WY Medicare |
$18.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.18
|
| Rate for Payer: Altius Commercial |
$26.18
|
| Rate for Payer: Beech Street Commercial |
$26.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.45
|
| Rate for Payer: Cigna of WY Commercial |
$26.72
|
| Rate for Payer: Entrust Commercial |
$25.91
|
| Rate for Payer: First Choice Health Commercial |
$25.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.82
|
| Rate for Payer: HealthUtah PPO |
$27.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.45
|
| Rate for Payer: Multiplan Medicare/VA |
$15.03
|
| Rate for Payer: One Health Plan of WY PPO |
$26.72
|
| Rate for Payer: PacificSource Commercial |
$24.54
|
| Rate for Payer: PHCS PPO |
$26.72
|
| Rate for Payer: Three Rivers PPO |
$20.45
|
| Rate for Payer: TriWest Veterans Administration |
$15.82
|
| Rate for Payer: United Healthcare Commercial |
$23.72
|
| Rate for Payer: United Healthcare Medicare |
$15.82
|
| Rate for Payer: WINHealth Partners Commercial |
$26.72
|
| Rate for Payer: Wise Provider Network Commercial |
$25.91
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [20721]
|
Facility
|
OP
|
$32.02
|
|
|
Service Code
|
NDC 6498044801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.38
|
| Rate for Payer: Aetna of WY Medicare |
$21.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.74
|
| Rate for Payer: Altius Commercial |
$30.74
|
| Rate for Payer: Beech Street Commercial |
$31.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.06
|
| Rate for Payer: Cigna of WY Commercial |
$31.38
|
| Rate for Payer: Entrust Commercial |
$30.42
|
| Rate for Payer: First Choice Health Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.57
|
| Rate for Payer: HealthUtah PPO |
$32.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.06
|
| Rate for Payer: Multiplan Medicare/VA |
$17.64
|
| Rate for Payer: One Health Plan of WY PPO |
$31.38
|
| Rate for Payer: PacificSource Commercial |
$28.82
|
| Rate for Payer: PHCS PPO |
$31.38
|
| Rate for Payer: Three Rivers PPO |
$24.02
|
| Rate for Payer: TriWest Veterans Administration |
$18.57
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
| Rate for Payer: United Healthcare Medicare |
$18.57
|
| Rate for Payer: WINHealth Partners Commercial |
$31.38
|
| Rate for Payer: Wise Provider Network Commercial |
$30.42
|
|
