OXYMETAZOLINE 0.05 % NASAL SPRAY [28558]
|
Facility
|
OP
|
$1.70
|
|
Service Code
|
NDC 4110081127
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.94 |
Max. Negotiated Rate |
$1.70 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.67
|
Rate for Payer: Aetna of WY Medicare |
$1.12
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.63
|
Rate for Payer: Altius Commercial |
$1.63
|
Rate for Payer: Beech Street Commercial |
$1.67
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.40
|
Rate for Payer: Cash Price |
$1.19
|
Rate for Payer: ChoiceCare Network Commercial |
$1.65
|
Rate for Payer: Cigna of WY Commercial |
$1.67
|
Rate for Payer: Entrust Commercial |
$1.62
|
Rate for Payer: First Choice Health Commercial |
$1.62
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.62
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.99
|
Rate for Payer: HealthUtah PPO |
$1.70
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.65
|
Rate for Payer: Multiplan Medicare/VA |
$0.94
|
Rate for Payer: One Health Plan of WY PPO |
$1.67
|
Rate for Payer: PacificSource Commercial |
$1.53
|
Rate for Payer: PHCS PPO |
$1.67
|
Rate for Payer: Three Rivers PPO |
$1.28
|
Rate for Payer: TriWest Veterans Administration |
$0.99
|
Rate for Payer: United Healthcare Commercial |
$1.48
|
Rate for Payer: United Healthcare Medicare |
$0.99
|
Rate for Payer: WINHealth Partners Commercial |
$1.67
|
Rate for Payer: Wise Provider Network Commercial |
$1.62
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [28558]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 0904743535
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.29 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
Rate for Payer: Aetna of WY Medicare |
$0.35
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
Rate for Payer: Altius Commercial |
$0.51
|
Rate for Payer: Beech Street Commercial |
$0.52
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
Rate for Payer: Cigna of WY Commercial |
$0.52
|
Rate for Payer: Entrust Commercial |
$0.50
|
Rate for Payer: First Choice Health Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.31
|
Rate for Payer: HealthUtah PPO |
$0.53
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
Rate for Payer: Multiplan Medicare/VA |
$0.29
|
Rate for Payer: One Health Plan of WY PPO |
$0.52
|
Rate for Payer: PacificSource Commercial |
$0.48
|
Rate for Payer: PHCS PPO |
$0.52
|
Rate for Payer: Three Rivers PPO |
$0.40
|
Rate for Payer: TriWest Veterans Administration |
$0.31
|
Rate for Payer: United Healthcare Commercial |
$0.46
|
Rate for Payer: United Healthcare Medicare |
$0.31
|
Rate for Payer: WINHealth Partners Commercial |
$0.52
|
Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [28558]
|
Facility
|
IP
|
$0.53
|
|
Service Code
|
NDC 0904743535
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.33 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
Rate for Payer: Altius Commercial |
$0.51
|
Rate for Payer: Beech Street Commercial |
$0.52
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
Rate for Payer: Cigna of WY Commercial |
$0.52
|
Rate for Payer: Entrust Commercial |
$0.50
|
Rate for Payer: First Choice Health Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
Rate for Payer: HealthUtah PPO |
$0.53
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
Rate for Payer: Multiplan Medicare/VA |
$0.33
|
Rate for Payer: One Health Plan of WY PPO |
$0.52
|
Rate for Payer: PacificSource Commercial |
$0.48
|
Rate for Payer: PHCS PPO |
$0.52
|
Rate for Payer: Three Rivers PPO |
$0.40
|
Rate for Payer: TriWest Veterans Administration |
$0.35
|
Rate for Payer: United Healthcare Commercial |
$0.46
|
Rate for Payer: United Healthcare Medicare |
$0.35
|
Rate for Payer: WINHealth Partners Commercial |
$0.50
|
Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [28558]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 0904700635
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.29 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
Rate for Payer: Aetna of WY Medicare |
$0.35
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
Rate for Payer: Altius Commercial |
$0.51
|
Rate for Payer: Beech Street Commercial |
$0.52
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
Rate for Payer: Cash Price |
$0.37
|
Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
Rate for Payer: Cigna of WY Commercial |
$0.52
|
Rate for Payer: Entrust Commercial |
$0.50
|
Rate for Payer: First Choice Health Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.31
|
Rate for Payer: HealthUtah PPO |
$0.53
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
Rate for Payer: Multiplan Medicare/VA |
$0.29
|
Rate for Payer: One Health Plan of WY PPO |
$0.52
|
Rate for Payer: PacificSource Commercial |
$0.48
|
Rate for Payer: PHCS PPO |
$0.52
|
Rate for Payer: Three Rivers PPO |
$0.40
|
Rate for Payer: TriWest Veterans Administration |
$0.31
|
Rate for Payer: United Healthcare Commercial |
$0.46
|
Rate for Payer: United Healthcare Medicare |
$0.31
|
Rate for Payer: WINHealth Partners Commercial |
$0.52
|
Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
OP
|
$27.94
|
|
Service Code
|
NDC 6332301211
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$15.39 |
Max. Negotiated Rate |
$27.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
Rate for Payer: Aetna of WY Medicare |
$18.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
Rate for Payer: Altius Commercial |
$26.82
|
Rate for Payer: Beech Street Commercial |
$27.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
Rate for Payer: Cash Price |
$19.56
|
Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
Rate for Payer: Cigna of WY Commercial |
$27.38
|
Rate for Payer: Entrust Commercial |
$26.54
|
Rate for Payer: First Choice Health Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.21
|
Rate for Payer: HealthUtah PPO |
$27.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
Rate for Payer: Multiplan Medicare/VA |
$15.39
|
Rate for Payer: One Health Plan of WY PPO |
$27.38
|
Rate for Payer: PacificSource Commercial |
$25.15
|
Rate for Payer: PHCS PPO |
$27.38
|
Rate for Payer: Three Rivers PPO |
$20.96
|
Rate for Payer: TriWest Veterans Administration |
$16.21
|
Rate for Payer: United Healthcare Commercial |
$24.31
|
Rate for Payer: United Healthcare Medicare |
$16.21
|
Rate for Payer: WINHealth Partners Commercial |
$27.38
|
Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
IP
|
$27.94
|
|
Service Code
|
NDC 6332301211
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$17.52 |
Max. Negotiated Rate |
$27.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
Rate for Payer: Altius Commercial |
$26.82
|
Rate for Payer: Beech Street Commercial |
$27.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
Rate for Payer: Cash Price |
$19.56
|
Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
Rate for Payer: Cigna of WY Commercial |
$27.38
|
Rate for Payer: Entrust Commercial |
$26.54
|
Rate for Payer: First Choice Health Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.44
|
Rate for Payer: HealthUtah PPO |
$27.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
Rate for Payer: Multiplan Medicare/VA |
$17.52
|
Rate for Payer: One Health Plan of WY PPO |
$27.38
|
Rate for Payer: PacificSource Commercial |
$25.15
|
Rate for Payer: PHCS PPO |
$27.38
|
Rate for Payer: Three Rivers PPO |
$20.96
|
Rate for Payer: TriWest Veterans Administration |
$18.44
|
Rate for Payer: United Healthcare Commercial |
$24.31
|
Rate for Payer: United Healthcare Medicare |
$18.44
|
Rate for Payer: WINHealth Partners Commercial |
$26.54
|
Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
IP
|
$28.50
|
|
Service Code
|
NDC 4202311625
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$17.87 |
Max. Negotiated Rate |
$28.50 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.93
|
Rate for Payer: Altius Auto/Workers Compensation |
$27.36
|
Rate for Payer: Altius Commercial |
$27.36
|
Rate for Payer: Beech Street Commercial |
$27.93
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.40
|
Rate for Payer: Cash Price |
$19.95
|
Rate for Payer: ChoiceCare Network Commercial |
$27.64
|
Rate for Payer: Cigna of WY Commercial |
$27.93
|
Rate for Payer: Entrust Commercial |
$27.08
|
Rate for Payer: First Choice Health Commercial |
$27.08
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.08
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.81
|
Rate for Payer: HealthUtah PPO |
$28.50
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.64
|
Rate for Payer: Multiplan Medicare/VA |
$17.87
|
Rate for Payer: One Health Plan of WY PPO |
$27.93
|
Rate for Payer: PacificSource Commercial |
$25.65
|
Rate for Payer: PHCS PPO |
$27.93
|
Rate for Payer: Three Rivers PPO |
$21.38
|
Rate for Payer: TriWest Veterans Administration |
$18.81
|
Rate for Payer: United Healthcare Commercial |
$24.80
|
Rate for Payer: United Healthcare Medicare |
$18.81
|
Rate for Payer: WINHealth Partners Commercial |
$27.08
|
Rate for Payer: Wise Provider Network Commercial |
$27.08
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
IP
|
$27.94
|
|
Service Code
|
NDC 6332301203
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$17.52 |
Max. Negotiated Rate |
$27.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
Rate for Payer: Altius Commercial |
$26.82
|
Rate for Payer: Beech Street Commercial |
$27.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
Rate for Payer: Cash Price |
$19.56
|
Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
Rate for Payer: Cigna of WY Commercial |
$27.38
|
Rate for Payer: Entrust Commercial |
$26.54
|
Rate for Payer: First Choice Health Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.44
|
Rate for Payer: HealthUtah PPO |
$27.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
Rate for Payer: Multiplan Medicare/VA |
$17.52
|
Rate for Payer: One Health Plan of WY PPO |
$27.38
|
Rate for Payer: PacificSource Commercial |
$25.15
|
Rate for Payer: PHCS PPO |
$27.38
|
Rate for Payer: Three Rivers PPO |
$20.96
|
Rate for Payer: TriWest Veterans Administration |
$18.44
|
Rate for Payer: United Healthcare Commercial |
$24.31
|
Rate for Payer: United Healthcare Medicare |
$18.44
|
Rate for Payer: WINHealth Partners Commercial |
$26.54
|
Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
OP
|
$28.50
|
|
Service Code
|
NDC 4202311625
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$15.70 |
Max. Negotiated Rate |
$28.50 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.93
|
Rate for Payer: Aetna of WY Medicare |
$18.81
|
Rate for Payer: Altius Auto/Workers Compensation |
$27.36
|
Rate for Payer: Altius Commercial |
$27.36
|
Rate for Payer: Beech Street Commercial |
$27.93
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.40
|
Rate for Payer: Cash Price |
$19.95
|
Rate for Payer: ChoiceCare Network Commercial |
$27.64
|
Rate for Payer: Cigna of WY Commercial |
$27.93
|
Rate for Payer: Entrust Commercial |
$27.08
|
Rate for Payer: First Choice Health Commercial |
$27.08
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.08
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.53
|
Rate for Payer: HealthUtah PPO |
$28.50
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.64
|
Rate for Payer: Multiplan Medicare/VA |
$15.70
|
Rate for Payer: One Health Plan of WY PPO |
$27.93
|
Rate for Payer: PacificSource Commercial |
$25.65
|
Rate for Payer: PHCS PPO |
$27.93
|
Rate for Payer: Three Rivers PPO |
$21.38
|
Rate for Payer: TriWest Veterans Administration |
$16.53
|
Rate for Payer: United Healthcare Commercial |
$24.80
|
Rate for Payer: United Healthcare Medicare |
$16.53
|
Rate for Payer: WINHealth Partners Commercial |
$27.93
|
Rate for Payer: Wise Provider Network Commercial |
$27.08
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [12205]
|
Facility
|
OP
|
$27.94
|
|
Service Code
|
NDC 6332301203
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$15.39 |
Max. Negotiated Rate |
$27.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
Rate for Payer: Aetna of WY Medicare |
$18.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
Rate for Payer: Altius Commercial |
$26.82
|
Rate for Payer: Beech Street Commercial |
$27.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
Rate for Payer: Cash Price |
$19.56
|
Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
Rate for Payer: Cigna of WY Commercial |
$27.38
|
Rate for Payer: Entrust Commercial |
$26.54
|
Rate for Payer: First Choice Health Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.21
|
Rate for Payer: HealthUtah PPO |
$27.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
Rate for Payer: Multiplan Medicare/VA |
$15.39
|
Rate for Payer: One Health Plan of WY PPO |
$27.38
|
Rate for Payer: PacificSource Commercial |
$25.15
|
Rate for Payer: PHCS PPO |
$27.38
|
Rate for Payer: Three Rivers PPO |
$20.96
|
Rate for Payer: TriWest Veterans Administration |
$16.21
|
Rate for Payer: United Healthcare Commercial |
$24.31
|
Rate for Payer: United Healthcare Medicare |
$16.21
|
Rate for Payer: WINHealth Partners Commercial |
$27.38
|
Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
PACEMAKER AICD TRAY
|
Facility
|
IP
|
$159.84
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$100.22 |
Max. Negotiated Rate |
$159.84 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.64
|
Rate for Payer: Altius Auto/Workers Compensation |
$153.45
|
Rate for Payer: Altius Commercial |
$153.45
|
Rate for Payer: Beech Street Commercial |
$156.64
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.23
|
Rate for Payer: Cash Price |
$111.89
|
Rate for Payer: ChoiceCare Network Commercial |
$155.04
|
Rate for Payer: Cigna of WY Commercial |
$156.64
|
Rate for Payer: Entrust Commercial |
$151.85
|
Rate for Payer: First Choice Health Commercial |
$151.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.49
|
Rate for Payer: HealthUtah PPO |
$159.84
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.04
|
Rate for Payer: Multiplan Medicare/VA |
$100.22
|
Rate for Payer: One Health Plan of WY PPO |
$156.64
|
Rate for Payer: PacificSource Commercial |
$143.86
|
Rate for Payer: PHCS PPO |
$156.64
|
Rate for Payer: Three Rivers PPO |
$119.88
|
Rate for Payer: TriWest Veterans Administration |
$105.49
|
Rate for Payer: United Healthcare Commercial |
$139.06
|
Rate for Payer: United Healthcare Medicare |
$105.49
|
Rate for Payer: WINHealth Partners Commercial |
$151.85
|
Rate for Payer: Wise Provider Network Commercial |
$151.85
|
|
PACEMAKER AICD TRAY
|
Facility
|
OP
|
$159.84
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$88.07 |
Max. Negotiated Rate |
$159.84 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.64
|
Rate for Payer: Aetna of WY Medicare |
$105.49
|
Rate for Payer: Altius Auto/Workers Compensation |
$153.45
|
Rate for Payer: Altius Commercial |
$153.45
|
Rate for Payer: Beech Street Commercial |
$156.64
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.23
|
Rate for Payer: Cash Price |
$111.89
|
Rate for Payer: ChoiceCare Network Commercial |
$155.04
|
Rate for Payer: Cigna of WY Commercial |
$156.64
|
Rate for Payer: Entrust Commercial |
$151.85
|
Rate for Payer: First Choice Health Commercial |
$151.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.71
|
Rate for Payer: HealthUtah PPO |
$159.84
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.04
|
Rate for Payer: Multiplan Medicare/VA |
$88.07
|
Rate for Payer: One Health Plan of WY PPO |
$156.64
|
Rate for Payer: PacificSource Commercial |
$143.86
|
Rate for Payer: PHCS PPO |
$156.64
|
Rate for Payer: Three Rivers PPO |
$119.88
|
Rate for Payer: TriWest Veterans Administration |
$92.71
|
Rate for Payer: United Healthcare Commercial |
$139.06
|
Rate for Payer: United Healthcare Medicare |
$92.71
|
Rate for Payer: WINHealth Partners Commercial |
$156.64
|
Rate for Payer: Wise Provider Network Commercial |
$151.85
|
|
PACEMAKER EXTERNAL LEAD KIT
|
Facility
|
OP
|
$1,501.50
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$827.33 |
Max. Negotiated Rate |
$1,501.50 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.47
|
Rate for Payer: Aetna of WY Medicare |
$990.99
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,441.44
|
Rate for Payer: Altius Commercial |
$1,441.44
|
Rate for Payer: Beech Street Commercial |
$1,471.47
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,232.73
|
Rate for Payer: Cash Price |
$1,051.05
|
Rate for Payer: ChoiceCare Network Commercial |
$1,456.46
|
Rate for Payer: Cigna of WY Commercial |
$1,471.47
|
Rate for Payer: Entrust Commercial |
$1,426.42
|
Rate for Payer: First Choice Health Commercial |
$1,426.42
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.42
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.87
|
Rate for Payer: HealthUtah PPO |
$1,501.50
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.46
|
Rate for Payer: Multiplan Medicare/VA |
$827.33
|
Rate for Payer: One Health Plan of WY PPO |
$1,471.47
|
Rate for Payer: PacificSource Commercial |
$1,351.35
|
Rate for Payer: PHCS PPO |
$1,471.47
|
Rate for Payer: Three Rivers PPO |
$1,126.12
|
Rate for Payer: TriWest Veterans Administration |
$870.87
|
Rate for Payer: United Healthcare Commercial |
$1,306.30
|
Rate for Payer: United Healthcare Medicare |
$870.87
|
Rate for Payer: WINHealth Partners Commercial |
$1,471.47
|
Rate for Payer: Wise Provider Network Commercial |
$1,426.42
|
|
PACEMAKER EXTERNAL LEAD KIT
|
Facility
|
IP
|
$1,501.50
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$941.44 |
Max. Negotiated Rate |
$1,501.50 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.47
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,441.44
|
Rate for Payer: Altius Commercial |
$1,441.44
|
Rate for Payer: Beech Street Commercial |
$1,471.47
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,232.73
|
Rate for Payer: Cash Price |
$1,051.05
|
Rate for Payer: ChoiceCare Network Commercial |
$1,456.46
|
Rate for Payer: Cigna of WY Commercial |
$1,471.47
|
Rate for Payer: Entrust Commercial |
$1,426.42
|
Rate for Payer: First Choice Health Commercial |
$1,426.42
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.42
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.99
|
Rate for Payer: HealthUtah PPO |
$1,501.50
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.46
|
Rate for Payer: Multiplan Medicare/VA |
$941.44
|
Rate for Payer: One Health Plan of WY PPO |
$1,471.47
|
Rate for Payer: PacificSource Commercial |
$1,351.35
|
Rate for Payer: PHCS PPO |
$1,471.47
|
Rate for Payer: Three Rivers PPO |
$1,126.12
|
Rate for Payer: TriWest Veterans Administration |
$990.99
|
Rate for Payer: United Healthcare Commercial |
$1,306.30
|
Rate for Payer: United Healthcare Medicare |
$990.99
|
Rate for Payer: WINHealth Partners Commercial |
$1,426.42
|
Rate for Payer: Wise Provider Network Commercial |
$1,426.42
|
|
PACKING GAUZE IODOFORM 1"
|
Facility
|
OP
|
$6.88
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3.79 |
Max. Negotiated Rate |
$6.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.74
|
Rate for Payer: Aetna of WY Medicare |
$4.54
|
Rate for Payer: Altius Auto/Workers Compensation |
$6.60
|
Rate for Payer: Altius Commercial |
$6.60
|
Rate for Payer: Beech Street Commercial |
$6.74
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.65
|
Rate for Payer: Cash Price |
$4.82
|
Rate for Payer: ChoiceCare Network Commercial |
$6.67
|
Rate for Payer: Cigna of WY Commercial |
$6.74
|
Rate for Payer: Entrust Commercial |
$6.54
|
Rate for Payer: First Choice Health Commercial |
$6.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.99
|
Rate for Payer: HealthUtah PPO |
$6.88
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.67
|
Rate for Payer: Multiplan Medicare/VA |
$3.79
|
Rate for Payer: One Health Plan of WY PPO |
$6.74
|
Rate for Payer: PacificSource Commercial |
$6.19
|
Rate for Payer: PHCS PPO |
$6.74
|
Rate for Payer: Three Rivers PPO |
$5.16
|
Rate for Payer: TriWest Veterans Administration |
$3.99
|
Rate for Payer: United Healthcare Commercial |
$5.99
|
Rate for Payer: United Healthcare Medicare |
$3.99
|
Rate for Payer: WINHealth Partners Commercial |
$6.74
|
Rate for Payer: Wise Provider Network Commercial |
$6.54
|
|
PACKING GAUZE IODOFORM 1"
|
Facility
|
IP
|
$6.88
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$4.31 |
Max. Negotiated Rate |
$6.88 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.74
|
Rate for Payer: Altius Auto/Workers Compensation |
$6.60
|
Rate for Payer: Altius Commercial |
$6.60
|
Rate for Payer: Beech Street Commercial |
$6.74
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.65
|
Rate for Payer: Cash Price |
$4.82
|
Rate for Payer: ChoiceCare Network Commercial |
$6.67
|
Rate for Payer: Cigna of WY Commercial |
$6.74
|
Rate for Payer: Entrust Commercial |
$6.54
|
Rate for Payer: First Choice Health Commercial |
$6.54
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.54
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.54
|
Rate for Payer: HealthUtah PPO |
$6.88
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.67
|
Rate for Payer: Multiplan Medicare/VA |
$4.31
|
Rate for Payer: One Health Plan of WY PPO |
$6.74
|
Rate for Payer: PacificSource Commercial |
$6.19
|
Rate for Payer: PHCS PPO |
$6.74
|
Rate for Payer: Three Rivers PPO |
$5.16
|
Rate for Payer: TriWest Veterans Administration |
$4.54
|
Rate for Payer: United Healthcare Commercial |
$5.99
|
Rate for Payer: United Healthcare Medicare |
$4.54
|
Rate for Payer: WINHealth Partners Commercial |
$6.54
|
Rate for Payer: Wise Provider Network Commercial |
$6.54
|
|
PACKING GAUZE IODOFORM 1/2"
|
Facility
|
OP
|
$6.00
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3.31 |
Max. Negotiated Rate |
$6.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.88
|
Rate for Payer: Aetna of WY Medicare |
$3.96
|
Rate for Payer: Altius Auto/Workers Compensation |
$5.76
|
Rate for Payer: Altius Commercial |
$5.76
|
Rate for Payer: Beech Street Commercial |
$5.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.93
|
Rate for Payer: Cash Price |
$4.20
|
Rate for Payer: ChoiceCare Network Commercial |
$5.82
|
Rate for Payer: Cigna of WY Commercial |
$5.88
|
Rate for Payer: Entrust Commercial |
$5.70
|
Rate for Payer: First Choice Health Commercial |
$5.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.48
|
Rate for Payer: HealthUtah PPO |
$6.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.82
|
Rate for Payer: Multiplan Medicare/VA |
$3.31
|
Rate for Payer: One Health Plan of WY PPO |
$5.88
|
Rate for Payer: PacificSource Commercial |
$5.40
|
Rate for Payer: PHCS PPO |
$5.88
|
Rate for Payer: Three Rivers PPO |
$4.50
|
Rate for Payer: TriWest Veterans Administration |
$3.48
|
Rate for Payer: United Healthcare Commercial |
$5.22
|
Rate for Payer: United Healthcare Medicare |
$3.48
|
Rate for Payer: WINHealth Partners Commercial |
$5.88
|
Rate for Payer: Wise Provider Network Commercial |
$5.70
|
|
PACKING GAUZE IODOFORM 1/2"
|
Facility
|
IP
|
$6.00
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3.76 |
Max. Negotiated Rate |
$6.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$5.76
|
Rate for Payer: Altius Commercial |
$5.76
|
Rate for Payer: Beech Street Commercial |
$5.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.93
|
Rate for Payer: Cash Price |
$4.20
|
Rate for Payer: ChoiceCare Network Commercial |
$5.82
|
Rate for Payer: Cigna of WY Commercial |
$5.88
|
Rate for Payer: Entrust Commercial |
$5.70
|
Rate for Payer: First Choice Health Commercial |
$5.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.96
|
Rate for Payer: HealthUtah PPO |
$6.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.82
|
Rate for Payer: Multiplan Medicare/VA |
$3.76
|
Rate for Payer: One Health Plan of WY PPO |
$5.88
|
Rate for Payer: PacificSource Commercial |
$5.40
|
Rate for Payer: PHCS PPO |
$5.88
|
Rate for Payer: Three Rivers PPO |
$4.50
|
Rate for Payer: TriWest Veterans Administration |
$3.96
|
Rate for Payer: United Healthcare Commercial |
$5.22
|
Rate for Payer: United Healthcare Medicare |
$3.96
|
Rate for Payer: WINHealth Partners Commercial |
$5.70
|
Rate for Payer: Wise Provider Network Commercial |
$5.70
|
|
PACKING GAUZE IODOFORM 1/4"
|
Facility
|
IP
|
$5.74
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3.60 |
Max. Negotiated Rate |
$5.74 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.63
|
Rate for Payer: Altius Auto/Workers Compensation |
$5.51
|
Rate for Payer: Altius Commercial |
$5.51
|
Rate for Payer: Beech Street Commercial |
$5.63
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.71
|
Rate for Payer: Cash Price |
$4.02
|
Rate for Payer: ChoiceCare Network Commercial |
$5.57
|
Rate for Payer: Cigna of WY Commercial |
$5.63
|
Rate for Payer: Entrust Commercial |
$5.45
|
Rate for Payer: First Choice Health Commercial |
$5.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.79
|
Rate for Payer: HealthUtah PPO |
$5.74
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.57
|
Rate for Payer: Multiplan Medicare/VA |
$3.60
|
Rate for Payer: One Health Plan of WY PPO |
$5.63
|
Rate for Payer: PacificSource Commercial |
$5.17
|
Rate for Payer: PHCS PPO |
$5.63
|
Rate for Payer: Three Rivers PPO |
$4.30
|
Rate for Payer: TriWest Veterans Administration |
$3.79
|
Rate for Payer: United Healthcare Commercial |
$4.99
|
Rate for Payer: United Healthcare Medicare |
$3.79
|
Rate for Payer: WINHealth Partners Commercial |
$5.45
|
Rate for Payer: Wise Provider Network Commercial |
$5.45
|
|
PACKING GAUZE IODOFORM 1/4"
|
Facility
|
OP
|
$5.74
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$3.16 |
Max. Negotiated Rate |
$5.74 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.63
|
Rate for Payer: Aetna of WY Medicare |
$3.79
|
Rate for Payer: Altius Auto/Workers Compensation |
$5.51
|
Rate for Payer: Altius Commercial |
$5.51
|
Rate for Payer: Beech Street Commercial |
$5.63
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.71
|
Rate for Payer: Cash Price |
$4.02
|
Rate for Payer: ChoiceCare Network Commercial |
$5.57
|
Rate for Payer: Cigna of WY Commercial |
$5.63
|
Rate for Payer: Entrust Commercial |
$5.45
|
Rate for Payer: First Choice Health Commercial |
$5.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.33
|
Rate for Payer: HealthUtah PPO |
$5.74
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.57
|
Rate for Payer: Multiplan Medicare/VA |
$3.16
|
Rate for Payer: One Health Plan of WY PPO |
$5.63
|
Rate for Payer: PacificSource Commercial |
$5.17
|
Rate for Payer: PHCS PPO |
$5.63
|
Rate for Payer: Three Rivers PPO |
$4.30
|
Rate for Payer: TriWest Veterans Administration |
$3.33
|
Rate for Payer: United Healthcare Commercial |
$4.99
|
Rate for Payer: United Healthcare Medicare |
$3.33
|
Rate for Payer: WINHealth Partners Commercial |
$5.63
|
Rate for Payer: Wise Provider Network Commercial |
$5.45
|
|
PACK KNEE ARTHROSCOPY
|
Facility
|
IP
|
$224.24
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$140.60 |
Max. Negotiated Rate |
$224.24 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.76
|
Rate for Payer: Altius Auto/Workers Compensation |
$215.27
|
Rate for Payer: Altius Commercial |
$215.27
|
Rate for Payer: Beech Street Commercial |
$219.76
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.10
|
Rate for Payer: Cash Price |
$156.97
|
Rate for Payer: ChoiceCare Network Commercial |
$217.51
|
Rate for Payer: Cigna of WY Commercial |
$219.76
|
Rate for Payer: Entrust Commercial |
$213.03
|
Rate for Payer: First Choice Health Commercial |
$213.03
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.03
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.00
|
Rate for Payer: HealthUtah PPO |
$224.24
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.51
|
Rate for Payer: Multiplan Medicare/VA |
$140.60
|
Rate for Payer: One Health Plan of WY PPO |
$219.76
|
Rate for Payer: PacificSource Commercial |
$201.82
|
Rate for Payer: PHCS PPO |
$219.76
|
Rate for Payer: Three Rivers PPO |
$168.18
|
Rate for Payer: TriWest Veterans Administration |
$148.00
|
Rate for Payer: United Healthcare Commercial |
$195.09
|
Rate for Payer: United Healthcare Medicare |
$148.00
|
Rate for Payer: WINHealth Partners Commercial |
$213.03
|
Rate for Payer: Wise Provider Network Commercial |
$213.03
|
|
PACK KNEE ARTHROSCOPY
|
Facility
|
OP
|
$224.24
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$123.56 |
Max. Negotiated Rate |
$224.24 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.76
|
Rate for Payer: Aetna of WY Medicare |
$148.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$215.27
|
Rate for Payer: Altius Commercial |
$215.27
|
Rate for Payer: Beech Street Commercial |
$219.76
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.10
|
Rate for Payer: Cash Price |
$156.97
|
Rate for Payer: ChoiceCare Network Commercial |
$217.51
|
Rate for Payer: Cigna of WY Commercial |
$219.76
|
Rate for Payer: Entrust Commercial |
$213.03
|
Rate for Payer: First Choice Health Commercial |
$213.03
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.03
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.06
|
Rate for Payer: HealthUtah PPO |
$224.24
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.51
|
Rate for Payer: Multiplan Medicare/VA |
$123.56
|
Rate for Payer: One Health Plan of WY PPO |
$219.76
|
Rate for Payer: PacificSource Commercial |
$201.82
|
Rate for Payer: PHCS PPO |
$219.76
|
Rate for Payer: Three Rivers PPO |
$168.18
|
Rate for Payer: TriWest Veterans Administration |
$130.06
|
Rate for Payer: United Healthcare Commercial |
$195.09
|
Rate for Payer: United Healthcare Medicare |
$130.06
|
Rate for Payer: WINHealth Partners Commercial |
$219.76
|
Rate for Payer: Wise Provider Network Commercial |
$213.03
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [17594]
|
Facility
|
IP
|
$20.70
|
|
Service Code
|
HCPCS J9267
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.98 |
Max. Negotiated Rate |
$20.70 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.29
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.21
|
Rate for Payer: Altius Auto/Workers Compensation |
$19.87
|
Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
Rate for Payer: Altius Auto/Workers Compensation |
$23.71
|
Rate for Payer: Altius Commercial |
$22.08
|
Rate for Payer: Altius Commercial |
$19.87
|
Rate for Payer: Altius Commercial |
$23.71
|
Rate for Payer: Beech Street Commercial |
$24.21
|
Rate for Payer: Beech Street Commercial |
$22.54
|
Rate for Payer: Beech Street Commercial |
$20.29
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.99
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.28
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
Rate for Payer: Cash Price |
$16.10
|
Rate for Payer: Cash Price |
$14.49
|
Rate for Payer: Cash Price |
$17.29
|
Rate for Payer: ChoiceCare Network Commercial |
$20.08
|
Rate for Payer: ChoiceCare Network Commercial |
$23.96
|
Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
Rate for Payer: Cigna of WY Commercial |
$22.54
|
Rate for Payer: Cigna of WY Commercial |
$24.21
|
Rate for Payer: Cigna of WY Commercial |
$20.29
|
Rate for Payer: Entrust Commercial |
$23.46
|
Rate for Payer: Entrust Commercial |
$19.66
|
Rate for Payer: Entrust Commercial |
$21.85
|
Rate for Payer: First Choice Health Commercial |
$21.85
|
Rate for Payer: First Choice Health Commercial |
$23.46
|
Rate for Payer: First Choice Health Commercial |
$19.66
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.66
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.46
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.66
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.30
|
Rate for Payer: HealthUtah PPO |
$20.70
|
Rate for Payer: HealthUtah PPO |
$23.00
|
Rate for Payer: HealthUtah PPO |
$24.70
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.96
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.08
|
Rate for Payer: Multiplan Medicare/VA |
$15.49
|
Rate for Payer: Multiplan Medicare/VA |
$12.98
|
Rate for Payer: Multiplan Medicare/VA |
$14.42
|
Rate for Payer: One Health Plan of WY PPO |
$20.29
|
Rate for Payer: One Health Plan of WY PPO |
$22.54
|
Rate for Payer: One Health Plan of WY PPO |
$24.21
|
Rate for Payer: PacificSource Commercial |
$22.23
|
Rate for Payer: PacificSource Commercial |
$18.63
|
Rate for Payer: PacificSource Commercial |
$20.70
|
Rate for Payer: PHCS PPO |
$22.54
|
Rate for Payer: PHCS PPO |
$20.29
|
Rate for Payer: PHCS PPO |
$24.21
|
Rate for Payer: Three Rivers PPO |
$17.25
|
Rate for Payer: Three Rivers PPO |
$15.52
|
Rate for Payer: Three Rivers PPO |
$18.52
|
Rate for Payer: TriWest Veterans Administration |
$15.18
|
Rate for Payer: TriWest Veterans Administration |
$13.66
|
Rate for Payer: TriWest Veterans Administration |
$16.30
|
Rate for Payer: United Healthcare Commercial |
$18.01
|
Rate for Payer: United Healthcare Commercial |
$21.49
|
Rate for Payer: United Healthcare Commercial |
$20.01
|
Rate for Payer: United Healthcare Medicare |
$13.66
|
Rate for Payer: United Healthcare Medicare |
$16.30
|
Rate for Payer: United Healthcare Medicare |
$15.18
|
Rate for Payer: WINHealth Partners Commercial |
$21.85
|
Rate for Payer: WINHealth Partners Commercial |
$19.66
|
Rate for Payer: WINHealth Partners Commercial |
$23.46
|
Rate for Payer: Wise Provider Network Commercial |
$23.46
|
Rate for Payer: Wise Provider Network Commercial |
$19.66
|
Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [17594]
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS J9267
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.67 |
Max. Negotiated Rate |
$23.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.29
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.21
|
Rate for Payer: Aetna of WY Medicare |
$15.18
|
Rate for Payer: Aetna of WY Medicare |
$16.30
|
Rate for Payer: Aetna of WY Medicare |
$13.66
|
Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
Rate for Payer: Altius Auto/Workers Compensation |
$19.87
|
Rate for Payer: Altius Auto/Workers Compensation |
$23.71
|
Rate for Payer: Altius Commercial |
$22.08
|
Rate for Payer: Altius Commercial |
$23.71
|
Rate for Payer: Altius Commercial |
$19.87
|
Rate for Payer: Beech Street Commercial |
$22.54
|
Rate for Payer: Beech Street Commercial |
$24.21
|
Rate for Payer: Beech Street Commercial |
$20.29
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.99
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.28
|
Rate for Payer: Cash Price |
$16.10
|
Rate for Payer: Cash Price |
$14.49
|
Rate for Payer: Cash Price |
$17.29
|
Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
Rate for Payer: ChoiceCare Network Commercial |
$23.96
|
Rate for Payer: ChoiceCare Network Commercial |
$20.08
|
Rate for Payer: Cigna of WY Commercial |
$24.21
|
Rate for Payer: Cigna of WY Commercial |
$20.29
|
Rate for Payer: Cigna of WY Commercial |
$22.54
|
Rate for Payer: Entrust Commercial |
$23.46
|
Rate for Payer: Entrust Commercial |
$21.85
|
Rate for Payer: Entrust Commercial |
$19.66
|
Rate for Payer: First Choice Health Commercial |
$21.85
|
Rate for Payer: First Choice Health Commercial |
$19.66
|
Rate for Payer: First Choice Health Commercial |
$23.46
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.66
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.46
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.01
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.33
|
Rate for Payer: HealthUtah PPO |
$20.70
|
Rate for Payer: HealthUtah PPO |
$24.70
|
Rate for Payer: HealthUtah PPO |
$23.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.96
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.08
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
Rate for Payer: Multiplan Medicare/VA |
$11.41
|
Rate for Payer: Multiplan Medicare/VA |
$12.67
|
Rate for Payer: Multiplan Medicare/VA |
$13.61
|
Rate for Payer: One Health Plan of WY PPO |
$20.29
|
Rate for Payer: One Health Plan of WY PPO |
$24.21
|
Rate for Payer: One Health Plan of WY PPO |
$22.54
|
Rate for Payer: PacificSource Commercial |
$22.23
|
Rate for Payer: PacificSource Commercial |
$20.70
|
Rate for Payer: PacificSource Commercial |
$18.63
|
Rate for Payer: PHCS PPO |
$22.54
|
Rate for Payer: PHCS PPO |
$20.29
|
Rate for Payer: PHCS PPO |
$24.21
|
Rate for Payer: Three Rivers PPO |
$17.25
|
Rate for Payer: Three Rivers PPO |
$15.52
|
Rate for Payer: Three Rivers PPO |
$18.52
|
Rate for Payer: TriWest Veterans Administration |
$14.33
|
Rate for Payer: TriWest Veterans Administration |
$13.34
|
Rate for Payer: TriWest Veterans Administration |
$12.01
|
Rate for Payer: United Healthcare Commercial |
$18.01
|
Rate for Payer: United Healthcare Commercial |
$20.01
|
Rate for Payer: United Healthcare Commercial |
$21.49
|
Rate for Payer: United Healthcare Medicare |
$14.33
|
Rate for Payer: United Healthcare Medicare |
$12.01
|
Rate for Payer: United Healthcare Medicare |
$13.34
|
Rate for Payer: WINHealth Partners Commercial |
$24.21
|
Rate for Payer: WINHealth Partners Commercial |
$20.29
|
Rate for Payer: WINHealth Partners Commercial |
$22.54
|
Rate for Payer: Wise Provider Network Commercial |
$19.66
|
Rate for Payer: Wise Provider Network Commercial |
$23.46
|
Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [37725]
|
Facility
|
OP
|
$1,595.06
|
|
Service Code
|
HCPCS J9264
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$878.88 |
Max. Negotiated Rate |
$1,595.06 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,563.16
|
Rate for Payer: Aetna of WY Medicare |
$1,052.74
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,531.26
|
Rate for Payer: Altius Commercial |
$1,531.26
|
Rate for Payer: Beech Street Commercial |
$1,563.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,309.54
|
Rate for Payer: Cash Price |
$1,116.54
|
Rate for Payer: ChoiceCare Network Commercial |
$1,547.21
|
Rate for Payer: Cigna of WY Commercial |
$1,563.16
|
Rate for Payer: Entrust Commercial |
$1,515.31
|
Rate for Payer: First Choice Health Commercial |
$1,515.31
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,515.31
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$925.13
|
Rate for Payer: HealthUtah PPO |
$1,595.06
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,547.21
|
Rate for Payer: Multiplan Medicare/VA |
$878.88
|
Rate for Payer: One Health Plan of WY PPO |
$1,563.16
|
Rate for Payer: PacificSource Commercial |
$1,435.55
|
Rate for Payer: PHCS PPO |
$1,563.16
|
Rate for Payer: Three Rivers PPO |
$1,196.30
|
Rate for Payer: TriWest Veterans Administration |
$925.13
|
Rate for Payer: United Healthcare Commercial |
$1,387.70
|
Rate for Payer: United Healthcare Medicare |
$925.13
|
Rate for Payer: WINHealth Partners Commercial |
$1,563.16
|
Rate for Payer: Wise Provider Network Commercial |
$1,515.31
|
|