|
NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 31288
|
| Hospital Charge Code |
31288
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$797.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.06
|
| Rate for Payer: Aetna of WY Medicare |
$223.43
|
| Rate for Payer: Beech Street Commercial |
$757.15
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: Cash Price |
$557.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.09
|
| Rate for Payer: Cigna of WY Commercial |
$781.06
|
| Rate for Payer: First Choice Health Commercial |
$717.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.43
|
| Rate for Payer: HealthUtah PPO |
$797.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.09
|
| Rate for Payer: Multiplan Medicare/VA |
$189.92
|
| Rate for Payer: One Health Plan of WY PPO |
$781.06
|
| Rate for Payer: PacificSource Commercial |
$717.30
|
| Rate for Payer: PHCS PPO |
$757.15
|
| Rate for Payer: Three Rivers PPO |
$597.75
|
| Rate for Payer: TriWest Veterans Administration |
$223.43
|
| Rate for Payer: United Healthcare Commercial |
$693.39
|
| Rate for Payer: United Healthcare Medicare |
$223.43
|
| Rate for Payer: WINHealth Partners Commercial |
$677.45
|
|
|
NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
99316
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$264.10
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: First Choice Health Commercial |
$250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$264.10
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$241.86
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$264.10
|
|
|
NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 99315
|
| Hospital Charge Code |
99315
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.71
|
| Rate for Payer: Beech Street Commercial |
$208.05
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: First Choice Health Commercial |
$197.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.71
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$66.90
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$208.05
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.71
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$78.71
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
|
|
NUTRITION TX GLU INTOL,LAC-FREE,SOY-FIBER 0.04 GRAM-1 KCAL/ML LIQUID [156178]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 7007464912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
NUTRITION TX GLU INTOL,LAC-FREE,SOY-FIBER 0.04 GRAM-1 KCAL/ML LIQUID [156178]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 7007464912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
NUTRITION TX GLU INTOL,LAC-FREE,SOY-FIBER 0.08 GRAM-1.5 KCAL/ML LIQUID [156179]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7007464919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.06
|
| Rate for Payer: Altius Commercial |
$0.06
|
| Rate for Payer: Beech Street Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.06
|
| Rate for Payer: Cigna of WY Commercial |
$0.06
|
| Rate for Payer: Entrust Commercial |
$0.06
|
| Rate for Payer: First Choice Health Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$0.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.06
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.06
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.06
|
| Rate for Payer: Wise Provider Network Commercial |
$0.06
|
|
|
NUTRITION TX GLU INTOL,LAC-FREE,SOY-FIBER 0.08 GRAM-1.5 KCAL/ML LIQUID [156179]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7007464919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.06
|
| Rate for Payer: Aetna of WY Medicare |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.06
|
| Rate for Payer: Altius Commercial |
$0.06
|
| Rate for Payer: Beech Street Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.06
|
| Rate for Payer: Cigna of WY Commercial |
$0.06
|
| Rate for Payer: Entrust Commercial |
$0.06
|
| Rate for Payer: First Choice Health Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.06
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.06
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.06
|
| Rate for Payer: Wise Provider Network Commercial |
$0.06
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [12756]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 0713067831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.76
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.76
|
| Rate for Payer: WINHealth Partners Commercial |
$2.54
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [12756]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 0713067831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Aetna of WY Medicare |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.55
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 0574200802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.44
|
| Rate for Payer: Altius Commercial |
$4.44
|
| Rate for Payer: Beech Street Commercial |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.48
|
| Rate for Payer: Cigna of WY Commercial |
$4.53
|
| Rate for Payer: Entrust Commercial |
$4.39
|
| Rate for Payer: First Choice Health Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.05
|
| Rate for Payer: HealthUtah PPO |
$4.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.48
|
| Rate for Payer: Multiplan Medicare/VA |
$2.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4.53
|
| Rate for Payer: PacificSource Commercial |
$4.16
|
| Rate for Payer: PHCS PPO |
$4.53
|
| Rate for Payer: Three Rivers PPO |
$3.46
|
| Rate for Payer: TriWest Veterans Administration |
$3.05
|
| Rate for Payer: United Healthcare Commercial |
$4.02
|
| Rate for Payer: United Healthcare Medicare |
$3.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4.39
|
| Rate for Payer: Wise Provider Network Commercial |
$4.39
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
NDC 6838237003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Aetna of WY Medicare |
$0.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 6931530660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.44
|
| Rate for Payer: Altius Commercial |
$4.44
|
| Rate for Payer: Beech Street Commercial |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.48
|
| Rate for Payer: Cigna of WY Commercial |
$4.53
|
| Rate for Payer: Entrust Commercial |
$4.39
|
| Rate for Payer: First Choice Health Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.05
|
| Rate for Payer: HealthUtah PPO |
$4.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.48
|
| Rate for Payer: Multiplan Medicare/VA |
$2.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4.53
|
| Rate for Payer: PacificSource Commercial |
$4.16
|
| Rate for Payer: PHCS PPO |
$4.53
|
| Rate for Payer: Three Rivers PPO |
$3.46
|
| Rate for Payer: TriWest Veterans Administration |
$3.05
|
| Rate for Payer: United Healthcare Commercial |
$4.02
|
| Rate for Payer: United Healthcare Medicare |
$3.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4.39
|
| Rate for Payer: Wise Provider Network Commercial |
$4.39
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 0574200802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.44
|
| Rate for Payer: Altius Commercial |
$4.44
|
| Rate for Payer: Beech Street Commercial |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.48
|
| Rate for Payer: Cigna of WY Commercial |
$4.53
|
| Rate for Payer: Entrust Commercial |
$4.39
|
| Rate for Payer: First Choice Health Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.68
|
| Rate for Payer: HealthUtah PPO |
$4.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.48
|
| Rate for Payer: Multiplan Medicare/VA |
$2.55
|
| Rate for Payer: One Health Plan of WY PPO |
$4.53
|
| Rate for Payer: PacificSource Commercial |
$4.16
|
| Rate for Payer: PHCS PPO |
$4.53
|
| Rate for Payer: Three Rivers PPO |
$3.46
|
| Rate for Payer: TriWest Veterans Administration |
$2.68
|
| Rate for Payer: United Healthcare Commercial |
$4.02
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WINHealth Partners Commercial |
$4.53
|
| Rate for Payer: Wise Provider Network Commercial |
$4.39
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 0574200830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.07
|
| Rate for Payer: Aetna of WY Medicare |
$3.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.96
|
| Rate for Payer: Altius Commercial |
$4.96
|
| Rate for Payer: Beech Street Commercial |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.01
|
| Rate for Payer: Cigna of WY Commercial |
$5.07
|
| Rate for Payer: Entrust Commercial |
$4.91
|
| Rate for Payer: First Choice Health Commercial |
$4.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.00
|
| Rate for Payer: HealthUtah PPO |
$5.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.01
|
| Rate for Payer: Multiplan Medicare/VA |
$2.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5.07
|
| Rate for Payer: PacificSource Commercial |
$4.65
|
| Rate for Payer: PHCS PPO |
$5.07
|
| Rate for Payer: Three Rivers PPO |
$3.88
|
| Rate for Payer: TriWest Veterans Administration |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$3.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5.07
|
| Rate for Payer: Wise Provider Network Commercial |
$4.91
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 6931530660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.44
|
| Rate for Payer: Altius Commercial |
$4.44
|
| Rate for Payer: Beech Street Commercial |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.48
|
| Rate for Payer: Cigna of WY Commercial |
$4.53
|
| Rate for Payer: Entrust Commercial |
$4.39
|
| Rate for Payer: First Choice Health Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.68
|
| Rate for Payer: HealthUtah PPO |
$4.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.48
|
| Rate for Payer: Multiplan Medicare/VA |
$2.55
|
| Rate for Payer: One Health Plan of WY PPO |
$4.53
|
| Rate for Payer: PacificSource Commercial |
$4.16
|
| Rate for Payer: PHCS PPO |
$4.53
|
| Rate for Payer: Three Rivers PPO |
$3.46
|
| Rate for Payer: TriWest Veterans Administration |
$2.68
|
| Rate for Payer: United Healthcare Commercial |
$4.02
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WINHealth Partners Commercial |
$4.53
|
| Rate for Payer: Wise Provider Network Commercial |
$4.39
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 0574200830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.96
|
| Rate for Payer: Altius Commercial |
$4.96
|
| Rate for Payer: Beech Street Commercial |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.01
|
| Rate for Payer: Cigna of WY Commercial |
$5.07
|
| Rate for Payer: Entrust Commercial |
$4.91
|
| Rate for Payer: First Choice Health Commercial |
$4.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.41
|
| Rate for Payer: HealthUtah PPO |
$5.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.01
|
| Rate for Payer: Multiplan Medicare/VA |
$3.24
|
| Rate for Payer: One Health Plan of WY PPO |
$5.07
|
| Rate for Payer: PacificSource Commercial |
$4.65
|
| Rate for Payer: PHCS PPO |
$5.07
|
| Rate for Payer: Three Rivers PPO |
$3.88
|
| Rate for Payer: TriWest Veterans Administration |
$3.41
|
| Rate for Payer: United Healthcare Commercial |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$3.41
|
| Rate for Payer: WINHealth Partners Commercial |
$4.91
|
| Rate for Payer: Wise Provider Network Commercial |
$4.91
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
NDC 6830815260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Aetna of WY Medicare |
$0.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 6830815260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.97
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [17005]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 6838237003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.97
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [1307]
|
Facility
|
IP
|
$1.51
|
|
|
Service Code
|
NDC 0121086805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.45
|
| Rate for Payer: Altius Commercial |
$1.45
|
| Rate for Payer: Beech Street Commercial |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.46
|
| Rate for Payer: Cigna of WY Commercial |
$1.48
|
| Rate for Payer: Entrust Commercial |
$1.43
|
| Rate for Payer: First Choice Health Commercial |
$1.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
| Rate for Payer: HealthUtah PPO |
$1.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.46
|
| Rate for Payer: Multiplan Medicare/VA |
$0.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1.48
|
| Rate for Payer: PacificSource Commercial |
$1.36
|
| Rate for Payer: PHCS PPO |
$1.48
|
| Rate for Payer: Three Rivers PPO |
$1.13
|
| Rate for Payer: TriWest Veterans Administration |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare |
$1.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1.43
|
| Rate for Payer: Wise Provider Network Commercial |
$1.43
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [1307]
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
NDC 0121086805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.48
|
| Rate for Payer: Aetna of WY Medicare |
$1.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.45
|
| Rate for Payer: Altius Commercial |
$1.45
|
| Rate for Payer: Beech Street Commercial |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.46
|
| Rate for Payer: Cigna of WY Commercial |
$1.48
|
| Rate for Payer: Entrust Commercial |
$1.43
|
| Rate for Payer: First Choice Health Commercial |
$1.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.88
|
| Rate for Payer: HealthUtah PPO |
$1.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.46
|
| Rate for Payer: Multiplan Medicare/VA |
$0.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1.48
|
| Rate for Payer: PacificSource Commercial |
$1.36
|
| Rate for Payer: PHCS PPO |
$1.48
|
| Rate for Payer: Three Rivers PPO |
$1.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare |
$0.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1.43
|
|
|
O2 FILTERLINE SET AIRWAY ADPT
|
Facility
|
OP
|
$27.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.17
|
| Rate for Payer: Aetna of WY Medicare |
$18.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.61
|
| Rate for Payer: Altius Commercial |
$26.61
|
| Rate for Payer: Beech Street Commercial |
$27.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.76
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.89
|
| Rate for Payer: Cigna of WY Commercial |
$27.17
|
| Rate for Payer: Entrust Commercial |
$26.33
|
| Rate for Payer: First Choice Health Commercial |
$26.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.08
|
| Rate for Payer: HealthUtah PPO |
$27.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.89
|
| Rate for Payer: Multiplan Medicare/VA |
$15.27
|
| Rate for Payer: One Health Plan of WY PPO |
$27.17
|
| Rate for Payer: PacificSource Commercial |
$24.95
|
| Rate for Payer: PHCS PPO |
$27.17
|
| Rate for Payer: Three Rivers PPO |
$20.79
|
| Rate for Payer: TriWest Veterans Administration |
$16.08
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicare |
$16.08
|
| Rate for Payer: WINHealth Partners Commercial |
$27.17
|
| Rate for Payer: Wise Provider Network Commercial |
$26.33
|
|
|
O2 FILTERLINE SET AIRWAY ADPT
|
Facility
|
IP
|
$27.72
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.61
|
| Rate for Payer: Altius Commercial |
$26.61
|
| Rate for Payer: Beech Street Commercial |
$27.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.76
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.89
|
| Rate for Payer: Cigna of WY Commercial |
$27.17
|
| Rate for Payer: Entrust Commercial |
$26.33
|
| Rate for Payer: First Choice Health Commercial |
$26.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.30
|
| Rate for Payer: HealthUtah PPO |
$27.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.89
|
| Rate for Payer: Multiplan Medicare/VA |
$17.38
|
| Rate for Payer: One Health Plan of WY PPO |
$27.17
|
| Rate for Payer: PacificSource Commercial |
$24.95
|
| Rate for Payer: PHCS PPO |
$27.17
|
| Rate for Payer: Three Rivers PPO |
$20.79
|
| Rate for Payer: TriWest Veterans Administration |
$18.30
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicare |
$18.30
|
| Rate for Payer: WINHealth Partners Commercial |
$26.33
|
| Rate for Payer: Wise Provider Network Commercial |
$26.33
|
|
|
O2 TUBING FOR NEOPUFF 900RD009
|
Facility
|
IP
|
$17.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$17.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.64
|
| Rate for Payer: Altius Commercial |
$16.64
|
| Rate for Payer: Beech Street Commercial |
$16.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.81
|
| Rate for Payer: Cigna of WY Commercial |
$16.98
|
| Rate for Payer: Entrust Commercial |
$16.46
|
| Rate for Payer: First Choice Health Commercial |
$16.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.44
|
| Rate for Payer: HealthUtah PPO |
$17.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.81
|
| Rate for Payer: Multiplan Medicare/VA |
$10.87
|
| Rate for Payer: One Health Plan of WY PPO |
$16.98
|
| Rate for Payer: PacificSource Commercial |
$15.60
|
| Rate for Payer: PHCS PPO |
$16.98
|
| Rate for Payer: Three Rivers PPO |
$13.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.44
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare |
$11.44
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$16.46
|
|
|
O2 TUBING FOR NEOPUFF 900RD009
|
Facility
|
OP
|
$17.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$17.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.98
|
| Rate for Payer: Aetna of WY Medicare |
$11.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.64
|
| Rate for Payer: Altius Commercial |
$16.64
|
| Rate for Payer: Beech Street Commercial |
$16.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.81
|
| Rate for Payer: Cigna of WY Commercial |
$16.98
|
| Rate for Payer: Entrust Commercial |
$16.46
|
| Rate for Payer: First Choice Health Commercial |
$16.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$17.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.81
|
| Rate for Payer: Multiplan Medicare/VA |
$9.55
|
| Rate for Payer: One Health Plan of WY PPO |
$16.98
|
| Rate for Payer: PacificSource Commercial |
$15.60
|
| Rate for Payer: PHCS PPO |
$16.98
|
| Rate for Payer: Three Rivers PPO |
$13.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$16.98
|
| Rate for Payer: Wise Provider Network Commercial |
$16.46
|
|
