|
NIRMATRELVIR 150 MG-RITONAVIR 100 MG TABLETS IN A DOSE PACK [165107]
|
Facility
|
IP
|
$130.91
|
|
|
Service Code
|
NDC 0069531702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$130.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.67
|
| Rate for Payer: Altius Commercial |
$125.67
|
| Rate for Payer: Beech Street Commercial |
$128.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$91.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.98
|
| Rate for Payer: Cigna of WY Commercial |
$128.29
|
| Rate for Payer: Entrust Commercial |
$124.36
|
| Rate for Payer: First Choice Health Commercial |
$124.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.40
|
| Rate for Payer: HealthUtah PPO |
$130.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.98
|
| Rate for Payer: Multiplan Medicare/VA |
$82.08
|
| Rate for Payer: One Health Plan of WY PPO |
$128.29
|
| Rate for Payer: PacificSource Commercial |
$117.82
|
| Rate for Payer: PHCS PPO |
$128.29
|
| Rate for Payer: Three Rivers PPO |
$98.18
|
| Rate for Payer: TriWest Veterans Administration |
$86.40
|
| Rate for Payer: United Healthcare Commercial |
$113.89
|
| Rate for Payer: United Healthcare Medicare |
$86.40
|
| Rate for Payer: WINHealth Partners Commercial |
$124.36
|
| Rate for Payer: Wise Provider Network Commercial |
$124.36
|
|
|
NIRMATRELVIR 150 MG-RITONAVIR 100 MG TABLETS IN A DOSE PACK [165107]
|
Facility
|
IP
|
$130.91
|
|
|
Service Code
|
NDC 0069531720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$130.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.67
|
| Rate for Payer: Altius Commercial |
$125.67
|
| Rate for Payer: Beech Street Commercial |
$128.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$91.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.98
|
| Rate for Payer: Cigna of WY Commercial |
$128.29
|
| Rate for Payer: Entrust Commercial |
$124.36
|
| Rate for Payer: First Choice Health Commercial |
$124.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.40
|
| Rate for Payer: HealthUtah PPO |
$130.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.98
|
| Rate for Payer: Multiplan Medicare/VA |
$82.08
|
| Rate for Payer: One Health Plan of WY PPO |
$128.29
|
| Rate for Payer: PacificSource Commercial |
$117.82
|
| Rate for Payer: PHCS PPO |
$128.29
|
| Rate for Payer: Three Rivers PPO |
$98.18
|
| Rate for Payer: TriWest Veterans Administration |
$86.40
|
| Rate for Payer: United Healthcare Commercial |
$113.89
|
| Rate for Payer: United Healthcare Medicare |
$86.40
|
| Rate for Payer: WINHealth Partners Commercial |
$124.36
|
| Rate for Payer: Wise Provider Network Commercial |
$124.36
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [164052]
|
Facility
|
IP
|
$97.30
|
|
|
Service Code
|
NDC 0069532130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.41
|
| Rate for Payer: Altius Commercial |
$93.41
|
| Rate for Payer: Beech Street Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.88
|
| Rate for Payer: Cash Price |
$68.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.38
|
| Rate for Payer: Cigna of WY Commercial |
$95.35
|
| Rate for Payer: Entrust Commercial |
$92.44
|
| Rate for Payer: First Choice Health Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.22
|
| Rate for Payer: HealthUtah PPO |
$97.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.38
|
| Rate for Payer: Multiplan Medicare/VA |
$61.01
|
| Rate for Payer: One Health Plan of WY PPO |
$95.35
|
| Rate for Payer: PacificSource Commercial |
$87.57
|
| Rate for Payer: PHCS PPO |
$95.35
|
| Rate for Payer: Three Rivers PPO |
$72.98
|
| Rate for Payer: TriWest Veterans Administration |
$64.22
|
| Rate for Payer: United Healthcare Commercial |
$84.65
|
| Rate for Payer: United Healthcare Medicare |
$64.22
|
| Rate for Payer: WINHealth Partners Commercial |
$92.44
|
| Rate for Payer: Wise Provider Network Commercial |
$92.44
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [164052]
|
Facility
|
OP
|
$97.30
|
|
|
Service Code
|
NDC 0069532103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.35
|
| Rate for Payer: Aetna of WY Medicare |
$64.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.41
|
| Rate for Payer: Altius Commercial |
$93.41
|
| Rate for Payer: Beech Street Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.88
|
| Rate for Payer: Cash Price |
$68.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.38
|
| Rate for Payer: Cigna of WY Commercial |
$95.35
|
| Rate for Payer: Entrust Commercial |
$92.44
|
| Rate for Payer: First Choice Health Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.43
|
| Rate for Payer: HealthUtah PPO |
$97.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.38
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| Rate for Payer: One Health Plan of WY PPO |
$95.35
|
| Rate for Payer: PacificSource Commercial |
$87.57
|
| Rate for Payer: PHCS PPO |
$95.35
|
| Rate for Payer: Three Rivers PPO |
$72.98
|
| Rate for Payer: TriWest Veterans Administration |
$56.43
|
| Rate for Payer: United Healthcare Commercial |
$84.65
|
| Rate for Payer: United Healthcare Medicare |
$56.43
|
| Rate for Payer: WINHealth Partners Commercial |
$95.35
|
| Rate for Payer: Wise Provider Network Commercial |
$92.44
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [164052]
|
Facility
|
OP
|
$97.30
|
|
|
Service Code
|
NDC 0069532130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.35
|
| Rate for Payer: Aetna of WY Medicare |
$64.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.41
|
| Rate for Payer: Altius Commercial |
$93.41
|
| Rate for Payer: Beech Street Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.88
|
| Rate for Payer: Cash Price |
$68.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.38
|
| Rate for Payer: Cigna of WY Commercial |
$95.35
|
| Rate for Payer: Entrust Commercial |
$92.44
|
| Rate for Payer: First Choice Health Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.43
|
| Rate for Payer: HealthUtah PPO |
$97.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.38
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| Rate for Payer: One Health Plan of WY PPO |
$95.35
|
| Rate for Payer: PacificSource Commercial |
$87.57
|
| Rate for Payer: PHCS PPO |
$95.35
|
| Rate for Payer: Three Rivers PPO |
$72.98
|
| Rate for Payer: TriWest Veterans Administration |
$56.43
|
| Rate for Payer: United Healthcare Commercial |
$84.65
|
| Rate for Payer: United Healthcare Medicare |
$56.43
|
| Rate for Payer: WINHealth Partners Commercial |
$95.35
|
| Rate for Payer: Wise Provider Network Commercial |
$92.44
|
|
|
NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK [164052]
|
Facility
|
IP
|
$97.30
|
|
|
Service Code
|
NDC 0069532103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.41
|
| Rate for Payer: Altius Commercial |
$93.41
|
| Rate for Payer: Beech Street Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.88
|
| Rate for Payer: Cash Price |
$68.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.38
|
| Rate for Payer: Cigna of WY Commercial |
$95.35
|
| Rate for Payer: Entrust Commercial |
$92.44
|
| Rate for Payer: First Choice Health Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.22
|
| Rate for Payer: HealthUtah PPO |
$97.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.38
|
| Rate for Payer: Multiplan Medicare/VA |
$61.01
|
| Rate for Payer: One Health Plan of WY PPO |
$95.35
|
| Rate for Payer: PacificSource Commercial |
$87.57
|
| Rate for Payer: PHCS PPO |
$95.35
|
| Rate for Payer: Three Rivers PPO |
$72.98
|
| Rate for Payer: TriWest Veterans Administration |
$64.22
|
| Rate for Payer: United Healthcare Commercial |
$84.65
|
| Rate for Payer: United Healthcare Medicare |
$64.22
|
| Rate for Payer: WINHealth Partners Commercial |
$92.44
|
| Rate for Payer: Wise Provider Network Commercial |
$92.44
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [183316]
|
Facility
|
IP
|
$534.75
|
|
|
Service Code
|
HCPCS 90381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.29 |
| Max. Negotiated Rate |
$534.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$513.36
|
| Rate for Payer: Altius Commercial |
$513.36
|
| Rate for Payer: Beech Street Commercial |
$524.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$439.03
|
| Rate for Payer: Cash Price |
$374.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.71
|
| Rate for Payer: Cigna of WY Commercial |
$524.06
|
| Rate for Payer: Entrust Commercial |
$508.01
|
| Rate for Payer: First Choice Health Commercial |
$508.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.94
|
| Rate for Payer: HealthUtah PPO |
$534.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.71
|
| Rate for Payer: Multiplan Medicare/VA |
$335.29
|
| Rate for Payer: One Health Plan of WY PPO |
$524.06
|
| Rate for Payer: PacificSource Commercial |
$481.28
|
| Rate for Payer: PHCS PPO |
$524.06
|
| Rate for Payer: Three Rivers PPO |
$401.06
|
| Rate for Payer: TriWest Veterans Administration |
$352.94
|
| Rate for Payer: United Healthcare Commercial |
$465.23
|
| Rate for Payer: United Healthcare Medicare |
$352.94
|
| Rate for Payer: WINHealth Partners Commercial |
$508.01
|
| Rate for Payer: Wise Provider Network Commercial |
$508.01
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [183316]
|
Facility
|
OP
|
$534.75
|
|
|
Service Code
|
HCPCS 90381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.65 |
| Max. Negotiated Rate |
$534.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.06
|
| Rate for Payer: Aetna of WY Medicare |
$352.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$513.36
|
| Rate for Payer: Altius Commercial |
$513.36
|
| Rate for Payer: Beech Street Commercial |
$524.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$439.03
|
| Rate for Payer: Cash Price |
$374.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.71
|
| Rate for Payer: Cigna of WY Commercial |
$524.06
|
| Rate for Payer: Entrust Commercial |
$508.01
|
| Rate for Payer: First Choice Health Commercial |
$508.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.16
|
| Rate for Payer: HealthUtah PPO |
$534.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.71
|
| Rate for Payer: Multiplan Medicare/VA |
$294.65
|
| Rate for Payer: One Health Plan of WY PPO |
$524.06
|
| Rate for Payer: PacificSource Commercial |
$481.28
|
| Rate for Payer: PHCS PPO |
$524.06
|
| Rate for Payer: Three Rivers PPO |
$401.06
|
| Rate for Payer: TriWest Veterans Administration |
$310.16
|
| Rate for Payer: United Healthcare Commercial |
$465.23
|
| Rate for Payer: United Healthcare Medicare |
$310.16
|
| Rate for Payer: WINHealth Partners Commercial |
$524.06
|
| Rate for Payer: Wise Provider Network Commercial |
$508.01
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [183315]
|
Facility
|
OP
|
$1,054.50
|
|
|
Service Code
|
HCPCS 90380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$581.03 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,033.41
|
| Rate for Payer: Aetna of WY Medicare |
$695.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,012.32
|
| Rate for Payer: Altius Commercial |
$1,012.32
|
| Rate for Payer: Beech Street Commercial |
$1,033.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$865.74
|
| Rate for Payer: Cash Price |
$738.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,022.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,033.41
|
| Rate for Payer: Entrust Commercial |
$1,001.78
|
| Rate for Payer: First Choice Health Commercial |
$1,001.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,001.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$611.61
|
| Rate for Payer: HealthUtah PPO |
$1,054.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,022.86
|
| Rate for Payer: Multiplan Medicare/VA |
$581.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,033.41
|
| Rate for Payer: PacificSource Commercial |
$949.05
|
| Rate for Payer: PHCS PPO |
$1,033.41
|
| Rate for Payer: Three Rivers PPO |
$790.88
|
| Rate for Payer: TriWest Veterans Administration |
$611.61
|
| Rate for Payer: United Healthcare Commercial |
$917.42
|
| Rate for Payer: United Healthcare Medicare |
$611.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,033.41
|
| Rate for Payer: Wise Provider Network Commercial |
$1,001.78
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [183315]
|
Facility
|
IP
|
$1,054.50
|
|
|
Service Code
|
HCPCS 90380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$661.17 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,033.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,012.32
|
| Rate for Payer: Altius Commercial |
$1,012.32
|
| Rate for Payer: Beech Street Commercial |
$1,033.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$865.74
|
| Rate for Payer: Cash Price |
$738.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,022.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,033.41
|
| Rate for Payer: Entrust Commercial |
$1,001.78
|
| Rate for Payer: First Choice Health Commercial |
$1,001.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,001.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$695.97
|
| Rate for Payer: HealthUtah PPO |
$1,054.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,022.86
|
| Rate for Payer: Multiplan Medicare/VA |
$661.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,033.41
|
| Rate for Payer: PacificSource Commercial |
$949.05
|
| Rate for Payer: PHCS PPO |
$1,033.41
|
| Rate for Payer: Three Rivers PPO |
$790.88
|
| Rate for Payer: TriWest Veterans Administration |
$695.97
|
| Rate for Payer: United Healthcare Commercial |
$917.42
|
| Rate for Payer: United Healthcare Medicare |
$695.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,001.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,001.78
|
|
|
NITINOL STONE BASKET
|
Facility
|
IP
|
$965.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.29 |
| Max. Negotiated Rate |
$965.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$926.76
|
| Rate for Payer: Altius Commercial |
$926.76
|
| Rate for Payer: Beech Street Commercial |
$946.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$792.57
|
| Rate for Payer: Cash Price |
$675.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$936.41
|
| Rate for Payer: Cigna of WY Commercial |
$946.06
|
| Rate for Payer: Entrust Commercial |
$917.10
|
| Rate for Payer: First Choice Health Commercial |
$917.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$637.14
|
| Rate for Payer: HealthUtah PPO |
$965.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$936.41
|
| Rate for Payer: Multiplan Medicare/VA |
$605.29
|
| Rate for Payer: One Health Plan of WY PPO |
$946.06
|
| Rate for Payer: PacificSource Commercial |
$868.83
|
| Rate for Payer: PHCS PPO |
$946.06
|
| Rate for Payer: Three Rivers PPO |
$724.03
|
| Rate for Payer: TriWest Veterans Administration |
$637.14
|
| Rate for Payer: United Healthcare Commercial |
$839.87
|
| Rate for Payer: United Healthcare Medicare |
$637.14
|
| Rate for Payer: WINHealth Partners Commercial |
$917.10
|
| Rate for Payer: Wise Provider Network Commercial |
$917.10
|
|
|
NITINOL STONE BASKET
|
Facility
|
OP
|
$965.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.92 |
| Max. Negotiated Rate |
$965.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$946.06
|
| Rate for Payer: Aetna of WY Medicare |
$637.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$926.76
|
| Rate for Payer: Altius Commercial |
$926.76
|
| Rate for Payer: Beech Street Commercial |
$946.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$792.57
|
| Rate for Payer: Cash Price |
$675.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$936.41
|
| Rate for Payer: Cigna of WY Commercial |
$946.06
|
| Rate for Payer: Entrust Commercial |
$917.10
|
| Rate for Payer: First Choice Health Commercial |
$917.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$917.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$559.91
|
| Rate for Payer: HealthUtah PPO |
$965.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$936.41
|
| Rate for Payer: Multiplan Medicare/VA |
$531.92
|
| Rate for Payer: One Health Plan of WY PPO |
$946.06
|
| Rate for Payer: PacificSource Commercial |
$868.83
|
| Rate for Payer: PHCS PPO |
$946.06
|
| Rate for Payer: Three Rivers PPO |
$724.03
|
| Rate for Payer: TriWest Veterans Administration |
$559.91
|
| Rate for Payer: United Healthcare Commercial |
$839.87
|
| Rate for Payer: United Healthcare Medicare |
$559.91
|
| Rate for Payer: WINHealth Partners Commercial |
$946.06
|
| Rate for Payer: Wise Provider Network Commercial |
$917.10
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [1625]
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
NDC 6800160400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.94
|
| Rate for Payer: Aetna of WY Medicare |
$2.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.86
|
| Rate for Payer: Altius Commercial |
$3.86
|
| Rate for Payer: Beech Street Commercial |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.90
|
| Rate for Payer: Cigna of WY Commercial |
$3.94
|
| Rate for Payer: Entrust Commercial |
$3.82
|
| Rate for Payer: First Choice Health Commercial |
$3.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.33
|
| Rate for Payer: HealthUtah PPO |
$4.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.90
|
| Rate for Payer: Multiplan Medicare/VA |
$2.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3.94
|
| Rate for Payer: PacificSource Commercial |
$3.62
|
| Rate for Payer: PHCS PPO |
$3.94
|
| Rate for Payer: Three Rivers PPO |
$3.02
|
| Rate for Payer: TriWest Veterans Administration |
$2.33
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$2.33
|
| Rate for Payer: WINHealth Partners Commercial |
$3.94
|
| Rate for Payer: Wise Provider Network Commercial |
$3.82
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [1625]
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
NDC 6800160400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.86
|
| Rate for Payer: Altius Commercial |
$3.86
|
| Rate for Payer: Beech Street Commercial |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.90
|
| Rate for Payer: Cigna of WY Commercial |
$3.94
|
| Rate for Payer: Entrust Commercial |
$3.82
|
| Rate for Payer: First Choice Health Commercial |
$3.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.65
|
| Rate for Payer: HealthUtah PPO |
$4.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.90
|
| Rate for Payer: Multiplan Medicare/VA |
$2.52
|
| Rate for Payer: One Health Plan of WY PPO |
$3.94
|
| Rate for Payer: PacificSource Commercial |
$3.62
|
| Rate for Payer: PHCS PPO |
$3.94
|
| Rate for Payer: Three Rivers PPO |
$3.02
|
| Rate for Payer: TriWest Veterans Administration |
$2.65
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$2.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3.82
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [1625]
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 6233239031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.83
|
| Rate for Payer: Aetna of WY Medicare |
$0.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.82
|
| Rate for Payer: Altius Commercial |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.82
|
| Rate for Payer: Cigna of WY Commercial |
$0.83
|
| Rate for Payer: Entrust Commercial |
$0.81
|
| Rate for Payer: First Choice Health Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.82
|
| Rate for Payer: Multiplan Medicare/VA |
$0.47
|
| Rate for Payer: One Health Plan of WY PPO |
$0.83
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PHCS PPO |
$0.83
|
| Rate for Payer: Three Rivers PPO |
$0.64
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.74
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.83
|
| Rate for Payer: Wise Provider Network Commercial |
$0.81
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [1625]
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 6233239031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.82
|
| Rate for Payer: Altius Commercial |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.82
|
| Rate for Payer: Cigna of WY Commercial |
$0.83
|
| Rate for Payer: Entrust Commercial |
$0.81
|
| Rate for Payer: First Choice Health Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.56
|
| Rate for Payer: HealthUtah PPO |
$0.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.82
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.83
|
| Rate for Payer: PacificSource Commercial |
$0.77
|
| Rate for Payer: PHCS PPO |
$0.83
|
| Rate for Payer: Three Rivers PPO |
$0.64
|
| Rate for Payer: TriWest Veterans Administration |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.74
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WINHealth Partners Commercial |
$0.81
|
| Rate for Payer: Wise Provider Network Commercial |
$0.81
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [36290]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 7075640411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.37
|
| Rate for Payer: Altius Commercial |
$1.37
|
| Rate for Payer: Beech Street Commercial |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.39
|
| Rate for Payer: Cigna of WY Commercial |
$1.40
|
| Rate for Payer: Entrust Commercial |
$1.36
|
| Rate for Payer: First Choice Health Commercial |
$1.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1.40
|
| Rate for Payer: PacificSource Commercial |
$1.29
|
| Rate for Payer: PHCS PPO |
$1.40
|
| Rate for Payer: Three Rivers PPO |
$1.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.36
|
| Rate for Payer: Wise Provider Network Commercial |
$1.36
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [36290]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 7075640411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.40
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.37
|
| Rate for Payer: Altius Commercial |
$1.37
|
| Rate for Payer: Beech Street Commercial |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.39
|
| Rate for Payer: Cigna of WY Commercial |
$1.40
|
| Rate for Payer: Entrust Commercial |
$1.36
|
| Rate for Payer: First Choice Health Commercial |
$1.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.83
|
| Rate for Payer: HealthUtah PPO |
$1.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.79
|
| Rate for Payer: One Health Plan of WY PPO |
$1.40
|
| Rate for Payer: PacificSource Commercial |
$1.29
|
| Rate for Payer: PHCS PPO |
$1.40
|
| Rate for Payer: Three Rivers PPO |
$1.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1.36
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [36290]
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
NDC 6800142300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.13
|
| Rate for Payer: Aetna of WY Medicare |
$4.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.01
|
| Rate for Payer: Altius Commercial |
$6.01
|
| Rate for Payer: Beech Street Commercial |
$6.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.14
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.07
|
| Rate for Payer: Cigna of WY Commercial |
$6.13
|
| Rate for Payer: Entrust Commercial |
$5.95
|
| Rate for Payer: First Choice Health Commercial |
$5.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.63
|
| Rate for Payer: HealthUtah PPO |
$6.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.07
|
| Rate for Payer: Multiplan Medicare/VA |
$3.45
|
| Rate for Payer: One Health Plan of WY PPO |
$6.13
|
| Rate for Payer: PacificSource Commercial |
$5.63
|
| Rate for Payer: PHCS PPO |
$6.13
|
| Rate for Payer: Three Rivers PPO |
$4.70
|
| Rate for Payer: TriWest Veterans Administration |
$3.63
|
| Rate for Payer: United Healthcare Commercial |
$5.45
|
| Rate for Payer: United Healthcare Medicare |
$3.63
|
| Rate for Payer: WINHealth Partners Commercial |
$6.13
|
| Rate for Payer: Wise Provider Network Commercial |
$5.95
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [36290]
|
Facility
|
IP
|
$6.26
|
|
|
Service Code
|
NDC 6800142300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.01
|
| Rate for Payer: Altius Commercial |
$6.01
|
| Rate for Payer: Beech Street Commercial |
$6.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.14
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.07
|
| Rate for Payer: Cigna of WY Commercial |
$6.13
|
| Rate for Payer: Entrust Commercial |
$5.95
|
| Rate for Payer: First Choice Health Commercial |
$5.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.13
|
| Rate for Payer: HealthUtah PPO |
$6.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.07
|
| Rate for Payer: Multiplan Medicare/VA |
$3.93
|
| Rate for Payer: One Health Plan of WY PPO |
$6.13
|
| Rate for Payer: PacificSource Commercial |
$5.63
|
| Rate for Payer: PHCS PPO |
$6.13
|
| Rate for Payer: Three Rivers PPO |
$4.70
|
| Rate for Payer: TriWest Veterans Administration |
$4.13
|
| Rate for Payer: United Healthcare Commercial |
$5.45
|
| Rate for Payer: United Healthcare Medicare |
$4.13
|
| Rate for Payer: WINHealth Partners Commercial |
$5.95
|
| Rate for Payer: Wise Provider Network Commercial |
$5.95
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [14687]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 6846263945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.40
|
| Rate for Payer: Altius Commercial |
$0.40
|
| Rate for Payer: Beech Street Commercial |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.41
|
| Rate for Payer: Cigna of WY Commercial |
$0.41
|
| Rate for Payer: Entrust Commercial |
$0.40
|
| Rate for Payer: First Choice Health Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.41
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.41
|
| Rate for Payer: PacificSource Commercial |
$0.38
|
| Rate for Payer: PHCS PPO |
$0.41
|
| Rate for Payer: Three Rivers PPO |
$0.32
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.37
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.40
|
| Rate for Payer: Wise Provider Network Commercial |
$0.40
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [14687]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 7075601405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.13
|
| Rate for Payer: Aetna of WY Medicare |
$0.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.10
|
| Rate for Payer: Altius Commercial |
$1.10
|
| Rate for Payer: Beech Street Commercial |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.12
|
| Rate for Payer: Cigna of WY Commercial |
$1.13
|
| Rate for Payer: Entrust Commercial |
$1.09
|
| Rate for Payer: First Choice Health Commercial |
$1.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1.13
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.13
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.13
|
| Rate for Payer: Wise Provider Network Commercial |
$1.09
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [14687]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 7075601405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.10
|
| Rate for Payer: Altius Commercial |
$1.10
|
| Rate for Payer: Beech Street Commercial |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.12
|
| Rate for Payer: Cigna of WY Commercial |
$1.13
|
| Rate for Payer: Entrust Commercial |
$1.09
|
| Rate for Payer: First Choice Health Commercial |
$1.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.76
|
| Rate for Payer: HealthUtah PPO |
$1.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1.13
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.13
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$0.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1.09
|
| Rate for Payer: Wise Provider Network Commercial |
$1.09
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [14687]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 6846263945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.41
|
| Rate for Payer: Aetna of WY Medicare |
$0.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.40
|
| Rate for Payer: Altius Commercial |
$0.40
|
| Rate for Payer: Beech Street Commercial |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.41
|
| Rate for Payer: Cigna of WY Commercial |
$0.41
|
| Rate for Payer: Entrust Commercial |
$0.40
|
| Rate for Payer: First Choice Health Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.41
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.41
|
| Rate for Payer: PacificSource Commercial |
$0.38
|
| Rate for Payer: PHCS PPO |
$0.41
|
| Rate for Payer: Three Rivers PPO |
$0.32
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.37
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.41
|
| Rate for Payer: Wise Provider Network Commercial |
$0.40
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [14687]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 6846263925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.41
|
| Rate for Payer: Aetna of WY Medicare |
$0.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.40
|
| Rate for Payer: Altius Commercial |
$0.40
|
| Rate for Payer: Beech Street Commercial |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.41
|
| Rate for Payer: Cigna of WY Commercial |
$0.41
|
| Rate for Payer: Entrust Commercial |
$0.40
|
| Rate for Payer: First Choice Health Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.41
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.41
|
| Rate for Payer: PacificSource Commercial |
$0.38
|
| Rate for Payer: PHCS PPO |
$0.41
|
| Rate for Payer: Three Rivers PPO |
$0.32
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.37
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.41
|
| Rate for Payer: Wise Provider Network Commercial |
$0.40
|
|
