|
OLYMPUS ENDOJAW FB-225U 2.8
|
Facility
|
OP
|
$21.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.27
|
| Rate for Payer: Aetna of WY Medicare |
$14.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.83
|
| Rate for Payer: Altius Commercial |
$20.83
|
| Rate for Payer: Beech Street Commercial |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.05
|
| Rate for Payer: Cigna of WY Commercial |
$21.27
|
| Rate for Payer: Entrust Commercial |
$20.62
|
| Rate for Payer: First Choice Health Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.59
|
| Rate for Payer: HealthUtah PPO |
$21.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.05
|
| Rate for Payer: Multiplan Medicare/VA |
$11.96
|
| Rate for Payer: One Health Plan of WY PPO |
$21.27
|
| Rate for Payer: PacificSource Commercial |
$19.53
|
| Rate for Payer: PHCS PPO |
$21.27
|
| Rate for Payer: Three Rivers PPO |
$16.28
|
| Rate for Payer: TriWest Veterans Administration |
$12.59
|
| Rate for Payer: United Healthcare Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
| Rate for Payer: WINHealth Partners Commercial |
$21.27
|
| Rate for Payer: Wise Provider Network Commercial |
$20.62
|
|
|
OLYMPUS ENDOJAW FB-225U 2.8
|
Facility
|
IP
|
$21.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.83
|
| Rate for Payer: Altius Commercial |
$20.83
|
| Rate for Payer: Beech Street Commercial |
$21.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.05
|
| Rate for Payer: Cigna of WY Commercial |
$21.27
|
| Rate for Payer: Entrust Commercial |
$20.62
|
| Rate for Payer: First Choice Health Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.32
|
| Rate for Payer: HealthUtah PPO |
$21.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.05
|
| Rate for Payer: Multiplan Medicare/VA |
$13.61
|
| Rate for Payer: One Health Plan of WY PPO |
$21.27
|
| Rate for Payer: PacificSource Commercial |
$19.53
|
| Rate for Payer: PHCS PPO |
$21.27
|
| Rate for Payer: Three Rivers PPO |
$16.28
|
| Rate for Payer: TriWest Veterans Administration |
$14.32
|
| Rate for Payer: United Healthcare Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicare |
$14.32
|
| Rate for Payer: WINHealth Partners Commercial |
$20.62
|
| Rate for Payer: Wise Provider Network Commercial |
$20.62
|
|
|
OLYMPUS SINGLE USE CONN TYPE O
|
Facility
|
IP
|
$12.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.67
|
| Rate for Payer: Altius Commercial |
$11.67
|
| Rate for Payer: Beech Street Commercial |
$11.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.80
|
| Rate for Payer: Cigna of WY Commercial |
$11.92
|
| Rate for Payer: Entrust Commercial |
$11.55
|
| Rate for Payer: First Choice Health Commercial |
$11.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.03
|
| Rate for Payer: HealthUtah PPO |
$12.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.80
|
| Rate for Payer: Multiplan Medicare/VA |
$7.62
|
| Rate for Payer: One Health Plan of WY PPO |
$11.92
|
| Rate for Payer: PacificSource Commercial |
$10.94
|
| Rate for Payer: PHCS PPO |
$11.92
|
| Rate for Payer: Three Rivers PPO |
$9.12
|
| Rate for Payer: TriWest Veterans Administration |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$10.58
|
| Rate for Payer: United Healthcare Medicare |
$8.03
|
| Rate for Payer: WINHealth Partners Commercial |
$11.55
|
| Rate for Payer: Wise Provider Network Commercial |
$11.55
|
|
|
OLYMPUS SINGLE USE CONN TYPE O
|
Facility
|
OP
|
$12.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.92
|
| Rate for Payer: Aetna of WY Medicare |
$8.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.67
|
| Rate for Payer: Altius Commercial |
$11.67
|
| Rate for Payer: Beech Street Commercial |
$11.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.80
|
| Rate for Payer: Cigna of WY Commercial |
$11.92
|
| Rate for Payer: Entrust Commercial |
$11.55
|
| Rate for Payer: First Choice Health Commercial |
$11.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.05
|
| Rate for Payer: HealthUtah PPO |
$12.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.80
|
| Rate for Payer: Multiplan Medicare/VA |
$6.70
|
| Rate for Payer: One Health Plan of WY PPO |
$11.92
|
| Rate for Payer: PacificSource Commercial |
$10.94
|
| Rate for Payer: PHCS PPO |
$11.92
|
| Rate for Payer: Three Rivers PPO |
$9.12
|
| Rate for Payer: TriWest Veterans Administration |
$7.05
|
| Rate for Payer: United Healthcare Commercial |
$10.58
|
| Rate for Payer: United Healthcare Medicare |
$7.05
|
| Rate for Payer: WINHealth Partners Commercial |
$11.92
|
| Rate for Payer: Wise Provider Network Commercial |
$11.55
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [154547]
|
Facility
|
IP
|
$1,431.12
|
|
|
Service Code
|
HCPCS J2357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$897.31 |
| Max. Negotiated Rate |
$1,431.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,402.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,373.88
|
| Rate for Payer: Altius Commercial |
$1,373.88
|
| Rate for Payer: Beech Street Commercial |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,001.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,388.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,402.50
|
| Rate for Payer: Entrust Commercial |
$1,359.56
|
| Rate for Payer: First Choice Health Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$944.54
|
| Rate for Payer: HealthUtah PPO |
$1,431.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,388.19
|
| Rate for Payer: Multiplan Medicare/VA |
$897.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,402.50
|
| Rate for Payer: PacificSource Commercial |
$1,288.01
|
| Rate for Payer: PHCS PPO |
$1,402.50
|
| Rate for Payer: Three Rivers PPO |
$1,073.34
|
| Rate for Payer: TriWest Veterans Administration |
$944.54
|
| Rate for Payer: United Healthcare Commercial |
$1,245.07
|
| Rate for Payer: United Healthcare Medicare |
$944.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,359.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,359.56
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE [154547]
|
Facility
|
OP
|
$1,431.12
|
|
|
Service Code
|
HCPCS J2357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$788.55 |
| Max. Negotiated Rate |
$1,431.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,402.50
|
| Rate for Payer: Aetna of WY Medicare |
$944.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,373.88
|
| Rate for Payer: Altius Commercial |
$1,373.88
|
| Rate for Payer: Beech Street Commercial |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,001.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,388.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,402.50
|
| Rate for Payer: Entrust Commercial |
$1,359.56
|
| Rate for Payer: First Choice Health Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$830.05
|
| Rate for Payer: HealthUtah PPO |
$1,431.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,388.19
|
| Rate for Payer: Multiplan Medicare/VA |
$788.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,402.50
|
| Rate for Payer: PacificSource Commercial |
$1,288.01
|
| Rate for Payer: PHCS PPO |
$1,402.50
|
| Rate for Payer: Three Rivers PPO |
$1,073.34
|
| Rate for Payer: TriWest Veterans Administration |
$830.05
|
| Rate for Payer: United Healthcare Commercial |
$1,245.07
|
| Rate for Payer: United Healthcare Medicare |
$830.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,359.56
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [154545]
|
Facility
|
IP
|
$1,431.12
|
|
|
Service Code
|
HCPCS J2357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$897.31 |
| Max. Negotiated Rate |
$1,431.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,402.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,373.88
|
| Rate for Payer: Altius Commercial |
$1,373.88
|
| Rate for Payer: Beech Street Commercial |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,001.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,388.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,402.50
|
| Rate for Payer: Entrust Commercial |
$1,359.56
|
| Rate for Payer: First Choice Health Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$944.54
|
| Rate for Payer: HealthUtah PPO |
$1,431.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,388.19
|
| Rate for Payer: Multiplan Medicare/VA |
$897.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,402.50
|
| Rate for Payer: PacificSource Commercial |
$1,288.01
|
| Rate for Payer: PHCS PPO |
$1,402.50
|
| Rate for Payer: Three Rivers PPO |
$1,073.34
|
| Rate for Payer: TriWest Veterans Administration |
$944.54
|
| Rate for Payer: United Healthcare Commercial |
$1,245.07
|
| Rate for Payer: United Healthcare Medicare |
$944.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,359.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,359.56
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE [154545]
|
Facility
|
OP
|
$1,431.12
|
|
|
Service Code
|
HCPCS J2357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$788.55 |
| Max. Negotiated Rate |
$1,431.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,402.50
|
| Rate for Payer: Aetna of WY Medicare |
$944.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,373.88
|
| Rate for Payer: Altius Commercial |
$1,373.88
|
| Rate for Payer: Beech Street Commercial |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,001.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,388.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,402.50
|
| Rate for Payer: Entrust Commercial |
$1,359.56
|
| Rate for Payer: First Choice Health Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,359.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$830.05
|
| Rate for Payer: HealthUtah PPO |
$1,431.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,388.19
|
| Rate for Payer: Multiplan Medicare/VA |
$788.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,402.50
|
| Rate for Payer: PacificSource Commercial |
$1,288.01
|
| Rate for Payer: PHCS PPO |
$1,402.50
|
| Rate for Payer: Three Rivers PPO |
$1,073.34
|
| Rate for Payer: TriWest Veterans Administration |
$830.05
|
| Rate for Payer: United Healthcare Commercial |
$1,245.07
|
| Rate for Payer: United Healthcare Medicare |
$830.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,359.56
|
|
|
OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE [88544]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 8770140819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.14
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: WINHealth Partners Commercial |
$0.20
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE [88544]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 8770140819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [15136]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6808412811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Aetna of WY Medicare |
$1.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.89
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$0.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [15136]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 6808412811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.01
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$1.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [15136]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 6808412801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.01
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$1.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE [15136]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6808412801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Aetna of WY Medicare |
$1.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.89
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$0.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
OMEPRAZOLE 40 MG CAPSULE,DELAYED RELEASE [7634]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
NDC 6068760811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.42
|
| Rate for Payer: Aetna of WY Medicare |
$0.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.39
|
| Rate for Payer: Altius Commercial |
$1.39
|
| Rate for Payer: Beech Street Commercial |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.41
|
| Rate for Payer: Cigna of WY Commercial |
$1.42
|
| Rate for Payer: Entrust Commercial |
$1.38
|
| Rate for Payer: First Choice Health Commercial |
$1.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.84
|
| Rate for Payer: HealthUtah PPO |
$1.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.41
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.42
|
| Rate for Payer: PacificSource Commercial |
$1.30
|
| Rate for Payer: PHCS PPO |
$1.42
|
| Rate for Payer: Three Rivers PPO |
$1.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Medicare |
$0.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1.42
|
| Rate for Payer: Wise Provider Network Commercial |
$1.38
|
|
|
OMEPRAZOLE 40 MG CAPSULE,DELAYED RELEASE [7634]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
NDC 6068760811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.39
|
| Rate for Payer: Altius Commercial |
$1.39
|
| Rate for Payer: Beech Street Commercial |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.41
|
| Rate for Payer: Cigna of WY Commercial |
$1.42
|
| Rate for Payer: Entrust Commercial |
$1.38
|
| Rate for Payer: First Choice Health Commercial |
$1.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.96
|
| Rate for Payer: HealthUtah PPO |
$1.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.41
|
| Rate for Payer: Multiplan Medicare/VA |
$0.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1.42
|
| Rate for Payer: PacificSource Commercial |
$1.30
|
| Rate for Payer: PHCS PPO |
$1.42
|
| Rate for Payer: Three Rivers PPO |
$1.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.26
|
| Rate for Payer: United Healthcare Medicare |
$0.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1.38
|
|
|
OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$4,075.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
49255
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$4,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,993.50
|
| Rate for Payer: Aetna of WY Medicare |
$758.60
|
| Rate for Payer: Beech Street Commercial |
$3,871.25
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,952.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,993.50
|
| Rate for Payer: First Choice Health Commercial |
$3,667.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,871.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$758.60
|
| Rate for Payer: HealthUtah PPO |
$4,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,952.75
|
| Rate for Payer: Multiplan Medicare/VA |
$644.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,993.50
|
| Rate for Payer: PacificSource Commercial |
$3,667.50
|
| Rate for Payer: PHCS PPO |
$3,871.25
|
| Rate for Payer: Three Rivers PPO |
$3,056.25
|
| Rate for Payer: TriWest Veterans Administration |
$758.60
|
| Rate for Payer: United Healthcare Commercial |
$3,545.25
|
| Rate for Payer: United Healthcare Medicare |
$758.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,463.75
|
|
|
OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$4,075.00
|
|
|
Service Code
|
HCPCS 49255 80
|
| Hospital Charge Code |
49255
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$4,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,993.50
|
| Rate for Payer: Aetna of WY Medicare |
$758.60
|
| Rate for Payer: Beech Street Commercial |
$3,871.25
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,952.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,993.50
|
| Rate for Payer: First Choice Health Commercial |
$3,667.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,871.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$758.60
|
| Rate for Payer: HealthUtah PPO |
$4,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,952.75
|
| Rate for Payer: Multiplan Medicare/VA |
$644.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,993.50
|
| Rate for Payer: PacificSource Commercial |
$3,667.50
|
| Rate for Payer: PHCS PPO |
$3,871.25
|
| Rate for Payer: Three Rivers PPO |
$3,056.25
|
| Rate for Payer: TriWest Veterans Administration |
$758.60
|
| Rate for Payer: United Healthcare Commercial |
$3,545.25
|
| Rate for Payer: United Healthcare Medicare |
$758.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,463.75
|
|
|
OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$4,075.00
|
|
|
Service Code
|
HCPCS 49255 AS
|
| Hospital Charge Code |
49255
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$4,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,993.50
|
| Rate for Payer: Aetna of WY Medicare |
$758.60
|
| Rate for Payer: Beech Street Commercial |
$3,871.25
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: Cash Price |
$2,852.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,952.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,993.50
|
| Rate for Payer: First Choice Health Commercial |
$3,667.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,871.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$758.60
|
| Rate for Payer: HealthUtah PPO |
$4,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,952.75
|
| Rate for Payer: Multiplan Medicare/VA |
$644.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3,993.50
|
| Rate for Payer: PacificSource Commercial |
$3,667.50
|
| Rate for Payer: PHCS PPO |
$3,871.25
|
| Rate for Payer: Three Rivers PPO |
$3,056.25
|
| Rate for Payer: TriWest Veterans Administration |
$758.60
|
| Rate for Payer: United Healthcare Commercial |
$3,545.25
|
| Rate for Payer: United Healthcare Medicare |
$758.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,463.75
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [3768]
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
HCPCS J0585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$364.21 |
| Max. Negotiated Rate |
$661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$647.78
|
| Rate for Payer: Aetna of WY Medicare |
$436.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$634.56
|
| Rate for Payer: Altius Commercial |
$634.56
|
| Rate for Payer: Beech Street Commercial |
$647.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$542.68
|
| Rate for Payer: Cash Price |
$462.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$641.17
|
| Rate for Payer: Cigna of WY Commercial |
$647.78
|
| Rate for Payer: Entrust Commercial |
$627.95
|
| Rate for Payer: First Choice Health Commercial |
$627.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.38
|
| Rate for Payer: HealthUtah PPO |
$661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$641.17
|
| Rate for Payer: Multiplan Medicare/VA |
$364.21
|
| Rate for Payer: One Health Plan of WY PPO |
$647.78
|
| Rate for Payer: PacificSource Commercial |
$594.90
|
| Rate for Payer: PHCS PPO |
$647.78
|
| Rate for Payer: Three Rivers PPO |
$495.75
|
| Rate for Payer: TriWest Veterans Administration |
$383.38
|
| Rate for Payer: United Healthcare Commercial |
$575.07
|
| Rate for Payer: United Healthcare Medicare |
$383.38
|
| Rate for Payer: WINHealth Partners Commercial |
$647.78
|
| Rate for Payer: Wise Provider Network Commercial |
$627.95
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [3768]
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
HCPCS J0585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.45 |
| Max. Negotiated Rate |
$661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$647.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$634.56
|
| Rate for Payer: Altius Commercial |
$634.56
|
| Rate for Payer: Beech Street Commercial |
$647.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$542.68
|
| Rate for Payer: Cash Price |
$462.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$641.17
|
| Rate for Payer: Cigna of WY Commercial |
$647.78
|
| Rate for Payer: Entrust Commercial |
$627.95
|
| Rate for Payer: First Choice Health Commercial |
$627.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$436.26
|
| Rate for Payer: HealthUtah PPO |
$661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$641.17
|
| Rate for Payer: Multiplan Medicare/VA |
$414.45
|
| Rate for Payer: One Health Plan of WY PPO |
$647.78
|
| Rate for Payer: PacificSource Commercial |
$594.90
|
| Rate for Payer: PHCS PPO |
$647.78
|
| Rate for Payer: Three Rivers PPO |
$495.75
|
| Rate for Payer: TriWest Veterans Administration |
$436.26
|
| Rate for Payer: United Healthcare Commercial |
$575.07
|
| Rate for Payer: United Healthcare Medicare |
$436.26
|
| Rate for Payer: WINHealth Partners Commercial |
$627.95
|
| Rate for Payer: Wise Provider Network Commercial |
$627.95
|
|
|
ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 83951
|
| Hospital Charge Code |
83951
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$64.41
|
| Rate for Payer: Beech Street Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: First Choice Health Commercial |
$140.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.41
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$54.75
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$148.20
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$64.41
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [18638]
|
Facility
|
OP
|
$2.76
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.70
|
| Rate for Payer: Aetna of WY Medicare |
$1.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.65
|
| Rate for Payer: Altius Commercial |
$2.65
|
| Rate for Payer: Beech Street Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.68
|
| Rate for Payer: Cigna of WY Commercial |
$2.70
|
| Rate for Payer: Entrust Commercial |
$2.62
|
| Rate for Payer: First Choice Health Commercial |
$2.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.60
|
| Rate for Payer: HealthUtah PPO |
$2.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2.70
|
| Rate for Payer: PacificSource Commercial |
$2.48
|
| Rate for Payer: PHCS PPO |
$2.70
|
| Rate for Payer: Three Rivers PPO |
$2.07
|
| Rate for Payer: TriWest Veterans Administration |
$1.60
|
| Rate for Payer: United Healthcare Commercial |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$1.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [18638]
|
Facility
|
IP
|
$2.76
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.65
|
| Rate for Payer: Altius Commercial |
$2.65
|
| Rate for Payer: Beech Street Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.68
|
| Rate for Payer: Cigna of WY Commercial |
$2.70
|
| Rate for Payer: Entrust Commercial |
$2.62
|
| Rate for Payer: First Choice Health Commercial |
$2.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.82
|
| Rate for Payer: HealthUtah PPO |
$2.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2.70
|
| Rate for Payer: PacificSource Commercial |
$2.48
|
| Rate for Payer: PHCS PPO |
$2.70
|
| Rate for Payer: Three Rivers PPO |
$2.07
|
| Rate for Payer: TriWest Veterans Administration |
$1.82
|
| Rate for Payer: United Healthcare Commercial |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$1.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2.62
|
|
|
ONDANSETRON 8 MG DISINTEGRATING TABLET [8304]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.41
|
| Rate for Payer: Aetna of WY Medicare |
$2.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.32
|
| Rate for Payer: Altius Commercial |
$4.32
|
| Rate for Payer: Beech Street Commercial |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.69
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.36
|
| Rate for Payer: Cigna of WY Commercial |
$4.41
|
| Rate for Payer: Entrust Commercial |
$4.28
|
| Rate for Payer: First Choice Health Commercial |
$4.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.61
|
| Rate for Payer: HealthUtah PPO |
$4.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.36
|
| Rate for Payer: Multiplan Medicare/VA |
$2.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4.41
|
| Rate for Payer: PacificSource Commercial |
$4.05
|
| Rate for Payer: PHCS PPO |
$4.41
|
| Rate for Payer: Three Rivers PPO |
$3.38
|
| Rate for Payer: TriWest Veterans Administration |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
| Rate for Payer: United Healthcare Medicare |
$2.61
|
| Rate for Payer: WINHealth Partners Commercial |
$4.41
|
| Rate for Payer: Wise Provider Network Commercial |
$4.28
|
|
