|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [37725]
|
Facility
|
IP
|
$1,595.06
|
|
|
Service Code
|
HCPCS J9264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,000.10 |
| Max. Negotiated Rate |
$1,595.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,563.16
|
| 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 |
$1,052.74
|
| Rate for Payer: HealthUtah PPO |
$1,595.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,547.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1,000.10
|
| 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 |
$1,052.74
|
| Rate for Payer: United Healthcare Commercial |
$1,387.70
|
| Rate for Payer: United Healthcare Medicare |
$1,052.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,515.31
|
| Rate for Payer: Wise Provider Network Commercial |
$1,515.31
|
|
|
PAD EGG CRATE BLUE 72 X 32 X 2
|
Facility
|
OP
|
$24.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.83
|
| Rate for Payer: Aetna of WY Medicare |
$16.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.35
|
| Rate for Payer: Altius Commercial |
$23.35
|
| Rate for Payer: Beech Street Commercial |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.97
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.59
|
| Rate for Payer: Cigna of WY Commercial |
$23.83
|
| Rate for Payer: Entrust Commercial |
$23.10
|
| Rate for Payer: First Choice Health Commercial |
$23.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.11
|
| Rate for Payer: HealthUtah PPO |
$24.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.59
|
| Rate for Payer: Multiplan Medicare/VA |
$13.40
|
| Rate for Payer: One Health Plan of WY PPO |
$23.83
|
| Rate for Payer: PacificSource Commercial |
$21.89
|
| Rate for Payer: PHCS PPO |
$23.83
|
| Rate for Payer: Three Rivers PPO |
$18.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.11
|
| Rate for Payer: United Healthcare Commercial |
$21.16
|
| Rate for Payer: United Healthcare Medicare |
$14.11
|
| Rate for Payer: WINHealth Partners Commercial |
$23.83
|
| Rate for Payer: Wise Provider Network Commercial |
$23.10
|
|
|
PAD EGG CRATE BLUE 72 X 32 X 2
|
Facility
|
IP
|
$24.32
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.35
|
| Rate for Payer: Altius Commercial |
$23.35
|
| Rate for Payer: Beech Street Commercial |
$23.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.97
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.59
|
| Rate for Payer: Cigna of WY Commercial |
$23.83
|
| Rate for Payer: Entrust Commercial |
$23.10
|
| Rate for Payer: First Choice Health Commercial |
$23.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.05
|
| Rate for Payer: HealthUtah PPO |
$24.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.59
|
| Rate for Payer: Multiplan Medicare/VA |
$15.25
|
| Rate for Payer: One Health Plan of WY PPO |
$23.83
|
| Rate for Payer: PacificSource Commercial |
$21.89
|
| Rate for Payer: PHCS PPO |
$23.83
|
| Rate for Payer: Three Rivers PPO |
$18.24
|
| Rate for Payer: TriWest Veterans Administration |
$16.05
|
| Rate for Payer: United Healthcare Commercial |
$21.16
|
| Rate for Payer: United Healthcare Medicare |
$16.05
|
| Rate for Payer: WINHealth Partners Commercial |
$23.10
|
| Rate for Payer: Wise Provider Network Commercial |
$23.10
|
|
|
PAIN MANAGEMENT PACK DR. MCCLU
|
Facility
|
IP
|
$79.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$79.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.27
|
| Rate for Payer: Altius Commercial |
$76.27
|
| Rate for Payer: Beech Street Commercial |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$55.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.07
|
| Rate for Payer: Cigna of WY Commercial |
$77.86
|
| Rate for Payer: Entrust Commercial |
$75.48
|
| Rate for Payer: First Choice Health Commercial |
$75.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.44
|
| Rate for Payer: HealthUtah PPO |
$79.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.07
|
| Rate for Payer: Multiplan Medicare/VA |
$49.82
|
| Rate for Payer: One Health Plan of WY PPO |
$77.86
|
| Rate for Payer: PacificSource Commercial |
$71.50
|
| Rate for Payer: PHCS PPO |
$77.86
|
| Rate for Payer: Three Rivers PPO |
$59.59
|
| Rate for Payer: TriWest Veterans Administration |
$52.44
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
| Rate for Payer: WINHealth Partners Commercial |
$75.48
|
| Rate for Payer: Wise Provider Network Commercial |
$75.48
|
|
|
PAIN MANAGEMENT PACK DR. MCCLU
|
Facility
|
OP
|
$79.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$79.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.86
|
| Rate for Payer: Aetna of WY Medicare |
$52.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.27
|
| Rate for Payer: Altius Commercial |
$76.27
|
| Rate for Payer: Beech Street Commercial |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$55.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.07
|
| Rate for Payer: Cigna of WY Commercial |
$77.86
|
| Rate for Payer: Entrust Commercial |
$75.48
|
| Rate for Payer: First Choice Health Commercial |
$75.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.08
|
| Rate for Payer: HealthUtah PPO |
$79.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.07
|
| Rate for Payer: Multiplan Medicare/VA |
$43.78
|
| Rate for Payer: One Health Plan of WY PPO |
$77.86
|
| Rate for Payer: PacificSource Commercial |
$71.50
|
| Rate for Payer: PHCS PPO |
$77.86
|
| Rate for Payer: Three Rivers PPO |
$59.59
|
| Rate for Payer: TriWest Veterans Administration |
$46.08
|
| Rate for Payer: United Healthcare Commercial |
$69.12
|
| Rate for Payer: United Healthcare Medicare |
$46.08
|
| Rate for Payer: WINHealth Partners Commercial |
$77.86
|
| Rate for Payer: Wise Provider Network Commercial |
$75.48
|
|
|
PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$3,552.00
|
|
|
Service Code
|
HCPCS 42145
|
| Hospital Charge Code |
42145
|
| Min. Negotiated Rate |
$568.18 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,480.96
|
| Rate for Payer: Aetna of WY Medicare |
$668.45
|
| Rate for Payer: Beech Street Commercial |
$3,374.40
|
| Rate for Payer: Cash Price |
$2,486.40
|
| Rate for Payer: Cash Price |
$2,486.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,445.44
|
| Rate for Payer: Cigna of WY Commercial |
$3,480.96
|
| Rate for Payer: First Choice Health Commercial |
$3,196.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,374.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$668.45
|
| Rate for Payer: HealthUtah PPO |
$3,552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,445.44
|
| Rate for Payer: Multiplan Medicare/VA |
$568.18
|
| Rate for Payer: One Health Plan of WY PPO |
$3,480.96
|
| Rate for Payer: PacificSource Commercial |
$3,196.80
|
| Rate for Payer: PHCS PPO |
$3,374.40
|
| Rate for Payer: Three Rivers PPO |
$2,664.00
|
| Rate for Payer: TriWest Veterans Administration |
$668.45
|
| Rate for Payer: United Healthcare Commercial |
$3,090.24
|
| Rate for Payer: United Healthcare Medicare |
$668.45
|
| Rate for Payer: WINHealth Partners Commercial |
$3,019.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [29448]
|
Facility
|
IP
|
$28.50
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.93
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.71
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.01
|
| Rate for Payer: Altius Commercial |
$27.36
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Altius Commercial |
$19.01
|
| Rate for Payer: Altius Commercial |
$37.92
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Beech Street Commercial |
$38.71
|
| Rate for Payer: Beech Street Commercial |
$27.93
|
| Rate for Payer: Beech Street Commercial |
$19.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Cigna of WY Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$38.71
|
| Rate for Payer: Cigna of WY Commercial |
$27.93
|
| Rate for Payer: Entrust Commercial |
$37.52
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: Entrust Commercial |
$18.81
|
| Rate for Payer: Entrust Commercial |
$27.08
|
| Rate for Payer: First Choice Health Commercial |
$27.08
|
| Rate for Payer: First Choice Health Commercial |
$18.81
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$28.50
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: HealthUtah PPO |
$39.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.32
|
| Rate for Payer: Multiplan Medicare/VA |
$12.41
|
| Rate for Payer: Multiplan Medicare/VA |
$24.77
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: Multiplan Medicare/VA |
$17.87
|
| Rate for Payer: One Health Plan of WY PPO |
$38.71
|
| Rate for Payer: One Health Plan of WY PPO |
$27.93
|
| Rate for Payer: One Health Plan of WY PPO |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$35.55
|
| Rate for Payer: PacificSource Commercial |
$17.82
|
| Rate for Payer: PacificSource Commercial |
$25.65
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: PHCS PPO |
$38.71
|
| Rate for Payer: PHCS PPO |
$19.40
|
| Rate for Payer: PHCS PPO |
$27.93
|
| Rate for Payer: Three Rivers PPO |
$21.38
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: Three Rivers PPO |
$29.62
|
| Rate for Payer: Three Rivers PPO |
$14.85
|
| Rate for Payer: TriWest Veterans Administration |
$26.07
|
| Rate for Payer: TriWest Veterans Administration |
$13.07
|
| Rate for Payer: TriWest Veterans Administration |
$18.81
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
| Rate for Payer: United Healthcare Commercial |
$24.80
|
| Rate for Payer: United Healthcare Commercial |
$17.23
|
| Rate for Payer: United Healthcare Medicare |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: United Healthcare Medicare |
$26.07
|
| Rate for Payer: United Healthcare Medicare |
$18.81
|
| Rate for Payer: WINHealth Partners Commercial |
$27.08
|
| Rate for Payer: WINHealth Partners Commercial |
$18.81
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: WINHealth Partners Commercial |
$37.52
|
| Rate for Payer: Wise Provider Network Commercial |
$37.52
|
| Rate for Payer: Wise Provider Network Commercial |
$27.08
|
| Rate for Payer: Wise Provider Network Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [29448]
|
Facility
|
OP
|
$39.50
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.71
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.93
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$18.81
|
| Rate for Payer: Aetna of WY Medicare |
$26.07
|
| Rate for Payer: Aetna of WY Medicare |
$13.07
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.01
|
| Rate for Payer: Altius Commercial |
$37.92
|
| Rate for Payer: Altius Commercial |
$27.36
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Altius Commercial |
$19.01
|
| Rate for Payer: Beech Street Commercial |
$27.93
|
| Rate for Payer: Beech Street Commercial |
$38.71
|
| Rate for Payer: Beech Street Commercial |
$19.40
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$38.71
|
| Rate for Payer: Cigna of WY Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$27.93
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$27.08
|
| Rate for Payer: Entrust Commercial |
$18.81
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: Entrust Commercial |
$37.52
|
| Rate for Payer: First Choice Health Commercial |
$37.52
|
| Rate for Payer: First Choice Health Commercial |
$18.81
|
| Rate for Payer: First Choice Health Commercial |
$27.08
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.91
|
| Rate for Payer: HealthUtah PPO |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: HealthUtah PPO |
$39.50
|
| Rate for Payer: HealthUtah PPO |
$28.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.21
|
| Rate for Payer: Multiplan Medicare/VA |
$21.76
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: Multiplan Medicare/VA |
$26.17
|
| Rate for Payer: Multiplan Medicare/VA |
$15.70
|
| Rate for Payer: One Health Plan of WY PPO |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: One Health Plan of WY PPO |
$38.71
|
| Rate for Payer: One Health Plan of WY PPO |
$27.93
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PacificSource Commercial |
$17.82
|
| Rate for Payer: PacificSource Commercial |
$25.65
|
| Rate for Payer: PacificSource Commercial |
$35.55
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: PHCS PPO |
$38.71
|
| Rate for Payer: PHCS PPO |
$27.93
|
| Rate for Payer: PHCS PPO |
$19.40
|
| Rate for Payer: Three Rivers PPO |
$21.38
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: Three Rivers PPO |
$29.62
|
| Rate for Payer: Three Rivers PPO |
$14.85
|
| Rate for Payer: TriWest Veterans Administration |
$16.53
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$22.91
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
| Rate for Payer: United Healthcare Commercial |
$24.80
|
| Rate for Payer: United Healthcare Commercial |
$17.23
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$22.91
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: WINHealth Partners Commercial |
$27.93
|
| Rate for Payer: WINHealth Partners Commercial |
$19.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.71
|
| Rate for Payer: Wise Provider Network Commercial |
$27.08
|
| Rate for Payer: Wise Provider Network Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$37.52
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [21373]
|
Facility
|
IP
|
$45.41
|
|
|
Service Code
|
HCPCS J2430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.47 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.90
|
| Rate for Payer: Altius Commercial |
$27.90
|
| Rate for Payer: Altius Commercial |
$43.59
|
| Rate for Payer: Beech Street Commercial |
$44.50
|
| Rate for Payer: Beech Street Commercial |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.28
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.05
|
| Rate for Payer: Cigna of WY Commercial |
$44.50
|
| Rate for Payer: Cigna of WY Commercial |
$28.48
|
| Rate for Payer: Entrust Commercial |
$27.61
|
| Rate for Payer: Entrust Commercial |
$43.14
|
| Rate for Payer: First Choice Health Commercial |
$27.61
|
| Rate for Payer: First Choice Health Commercial |
$43.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.18
|
| Rate for Payer: HealthUtah PPO |
$45.41
|
| Rate for Payer: HealthUtah PPO |
$29.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.05
|
| Rate for Payer: Multiplan Medicare/VA |
$28.47
|
| Rate for Payer: Multiplan Medicare/VA |
$18.22
|
| Rate for Payer: One Health Plan of WY PPO |
$44.50
|
| Rate for Payer: One Health Plan of WY PPO |
$28.48
|
| Rate for Payer: PacificSource Commercial |
$40.87
|
| Rate for Payer: PacificSource Commercial |
$26.15
|
| Rate for Payer: PHCS PPO |
$28.48
|
| Rate for Payer: PHCS PPO |
$44.50
|
| Rate for Payer: Three Rivers PPO |
$21.80
|
| Rate for Payer: Three Rivers PPO |
$34.06
|
| Rate for Payer: TriWest Veterans Administration |
$29.97
|
| Rate for Payer: TriWest Veterans Administration |
$19.18
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Commercial |
$39.51
|
| Rate for Payer: United Healthcare Medicare |
$29.97
|
| Rate for Payer: United Healthcare Medicare |
$19.18
|
| Rate for Payer: WINHealth Partners Commercial |
$27.61
|
| Rate for Payer: WINHealth Partners Commercial |
$43.14
|
| Rate for Payer: Wise Provider Network Commercial |
$27.61
|
| Rate for Payer: Wise Provider Network Commercial |
$43.14
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [21373]
|
Facility
|
OP
|
$45.41
|
|
|
Service Code
|
HCPCS J2430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.48
|
| Rate for Payer: Aetna of WY Medicare |
$29.97
|
| Rate for Payer: Aetna of WY Medicare |
$19.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.59
|
| Rate for Payer: Altius Commercial |
$43.59
|
| Rate for Payer: Altius Commercial |
$27.90
|
| Rate for Payer: Beech Street Commercial |
$28.48
|
| Rate for Payer: Beech Street Commercial |
$44.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$20.34
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.19
|
| Rate for Payer: Cigna of WY Commercial |
$28.48
|
| Rate for Payer: Cigna of WY Commercial |
$44.50
|
| Rate for Payer: Entrust Commercial |
$43.14
|
| Rate for Payer: Entrust Commercial |
$27.61
|
| Rate for Payer: First Choice Health Commercial |
$27.61
|
| Rate for Payer: First Choice Health Commercial |
$43.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.85
|
| Rate for Payer: HealthUtah PPO |
$29.06
|
| Rate for Payer: HealthUtah PPO |
$45.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.05
|
| Rate for Payer: Multiplan Medicare/VA |
$25.02
|
| Rate for Payer: Multiplan Medicare/VA |
$16.01
|
| Rate for Payer: One Health Plan of WY PPO |
$28.48
|
| Rate for Payer: One Health Plan of WY PPO |
$44.50
|
| Rate for Payer: PacificSource Commercial |
$40.87
|
| Rate for Payer: PacificSource Commercial |
$26.15
|
| Rate for Payer: PHCS PPO |
$28.48
|
| Rate for Payer: PHCS PPO |
$44.50
|
| Rate for Payer: Three Rivers PPO |
$21.80
|
| Rate for Payer: Three Rivers PPO |
$34.06
|
| Rate for Payer: TriWest Veterans Administration |
$26.34
|
| Rate for Payer: TriWest Veterans Administration |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Commercial |
$39.51
|
| Rate for Payer: United Healthcare Medicare |
$26.34
|
| Rate for Payer: United Healthcare Medicare |
$16.85
|
| Rate for Payer: WINHealth Partners Commercial |
$28.48
|
| Rate for Payer: WINHealth Partners Commercial |
$44.50
|
| Rate for Payer: Wise Provider Network Commercial |
$27.61
|
| Rate for Payer: Wise Provider Network Commercial |
$43.14
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [5960]
|
Facility
|
IP
|
$28.12
|
|
|
Service Code
|
HCPCS J2470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.09
|
| Rate for Payer: Altius Commercial |
$27.00
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Altius Commercial |
$25.09
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Beech Street Commercial |
$27.56
|
| Rate for Payer: Beech Street Commercial |
$25.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Cigna of WY Commercial |
$25.62
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Cigna of WY Commercial |
$27.56
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: Entrust Commercial |
$24.83
|
| Rate for Payer: Entrust Commercial |
$26.71
|
| Rate for Payer: First Choice Health Commercial |
$26.71
|
| Rate for Payer: First Choice Health Commercial |
$24.83
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.28
|
| Rate for Payer: HealthUtah PPO |
$26.14
|
| Rate for Payer: HealthUtah PPO |
$28.12
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Multiplan Medicare/VA |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$20.54
|
| Rate for Payer: Multiplan Medicare/VA |
$21.16
|
| Rate for Payer: Multiplan Medicare/VA |
$17.63
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: One Health Plan of WY PPO |
$27.56
|
| Rate for Payer: One Health Plan of WY PPO |
$25.62
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PacificSource Commercial |
$23.53
|
| Rate for Payer: PacificSource Commercial |
$25.31
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: PHCS PPO |
$25.62
|
| Rate for Payer: PHCS PPO |
$27.56
|
| Rate for Payer: Three Rivers PPO |
$21.09
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: Three Rivers PPO |
$19.60
|
| Rate for Payer: TriWest Veterans Administration |
$21.62
|
| Rate for Payer: TriWest Veterans Administration |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$18.56
|
| Rate for Payer: TriWest Veterans Administration |
$22.28
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
| Rate for Payer: United Healthcare Commercial |
$22.74
|
| Rate for Payer: United Healthcare Medicare |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$22.28
|
| Rate for Payer: United Healthcare Medicare |
$21.62
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
| Rate for Payer: WINHealth Partners Commercial |
$26.71
|
| Rate for Payer: WINHealth Partners Commercial |
$24.83
|
| Rate for Payer: WINHealth Partners Commercial |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$26.71
|
| Rate for Payer: Wise Provider Network Commercial |
$24.83
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [5960]
|
Facility
|
OP
|
$32.76
|
|
|
Service Code
|
HCPCS J2470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Medicare |
$18.56
|
| Rate for Payer: Aetna of WY Medicare |
$21.62
|
| Rate for Payer: Aetna of WY Medicare |
$17.25
|
| Rate for Payer: Aetna of WY Medicare |
$22.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.09
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Altius Commercial |
$27.00
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Altius Commercial |
$25.09
|
| Rate for Payer: Beech Street Commercial |
$27.56
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Beech Street Commercial |
$25.62
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Cigna of WY Commercial |
$25.62
|
| Rate for Payer: Cigna of WY Commercial |
$27.56
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$26.71
|
| Rate for Payer: Entrust Commercial |
$24.83
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$24.83
|
| Rate for Payer: First Choice Health Commercial |
$26.71
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$26.14
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: HealthUtah PPO |
$28.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.36
|
| Rate for Payer: Multiplan Medicare/VA |
$18.05
|
| Rate for Payer: Multiplan Medicare/VA |
$14.40
|
| Rate for Payer: Multiplan Medicare/VA |
$18.60
|
| Rate for Payer: Multiplan Medicare/VA |
$15.49
|
| Rate for Payer: One Health Plan of WY PPO |
$25.62
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: One Health Plan of WY PPO |
$27.56
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PacificSource Commercial |
$23.53
|
| Rate for Payer: PacificSource Commercial |
$25.31
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: PHCS PPO |
$27.56
|
| Rate for Payer: PHCS PPO |
$25.62
|
| Rate for Payer: Three Rivers PPO |
$21.09
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: Three Rivers PPO |
$19.60
|
| Rate for Payer: TriWest Veterans Administration |
$16.31
|
| Rate for Payer: TriWest Veterans Administration |
$19.58
|
| Rate for Payer: TriWest Veterans Administration |
$15.16
|
| Rate for Payer: TriWest Veterans Administration |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
| Rate for Payer: United Healthcare Commercial |
$22.74
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$19.00
|
| Rate for Payer: United Healthcare Medicare |
$15.16
|
| Rate for Payer: United Healthcare Medicare |
$16.31
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
| Rate for Payer: WINHealth Partners Commercial |
$33.08
|
| Rate for Payer: WINHealth Partners Commercial |
$27.56
|
| Rate for Payer: WINHealth Partners Commercial |
$25.62
|
| Rate for Payer: WINHealth Partners Commercial |
$32.10
|
| Rate for Payer: Wise Provider Network Commercial |
$26.71
|
| Rate for Payer: Wise Provider Network Commercial |
$24.83
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 1366842990
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Aetna of WY Medicare |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.43
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808481309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.68
|
| Rate for Payer: Altius Commercial |
$0.68
|
| Rate for Payer: Beech Street Commercial |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.69
|
| Rate for Payer: Cigna of WY Commercial |
$0.70
|
| Rate for Payer: Entrust Commercial |
$0.67
|
| Rate for Payer: First Choice Health Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.47
|
| Rate for Payer: HealthUtah PPO |
$0.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.69
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.70
|
| Rate for Payer: PacificSource Commercial |
$0.64
|
| Rate for Payer: PHCS PPO |
$0.70
|
| Rate for Payer: Three Rivers PPO |
$0.53
|
| Rate for Payer: TriWest Veterans Administration |
$0.47
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.47
|
| Rate for Payer: WINHealth Partners Commercial |
$0.67
|
| Rate for Payer: Wise Provider Network Commercial |
$0.67
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 6068773611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.86
|
| Rate for Payer: Aetna of WY Medicare |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.85
|
| Rate for Payer: Cigna of WY Commercial |
$0.86
|
| Rate for Payer: Entrust Commercial |
$0.84
|
| Rate for Payer: First Choice Health Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.85
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.86
|
| Rate for Payer: PacificSource Commercial |
$0.79
|
| Rate for Payer: PHCS PPO |
$0.86
|
| Rate for Payer: Three Rivers PPO |
$0.66
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.86
|
| Rate for Payer: Wise Provider Network Commercial |
$0.84
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6808481311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.68
|
| Rate for Payer: Altius Commercial |
$0.68
|
| Rate for Payer: Beech Street Commercial |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.69
|
| Rate for Payer: Cigna of WY Commercial |
$0.70
|
| Rate for Payer: Entrust Commercial |
$0.67
|
| Rate for Payer: First Choice Health Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.47
|
| Rate for Payer: HealthUtah PPO |
$0.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.69
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.70
|
| Rate for Payer: PacificSource Commercial |
$0.64
|
| Rate for Payer: PHCS PPO |
$0.70
|
| Rate for Payer: Three Rivers PPO |
$0.53
|
| Rate for Payer: TriWest Veterans Administration |
$0.47
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.47
|
| Rate for Payer: WINHealth Partners Commercial |
$0.67
|
| Rate for Payer: Wise Provider Network Commercial |
$0.67
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6808481309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.70
|
| Rate for Payer: Aetna of WY Medicare |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.68
|
| Rate for Payer: Altius Commercial |
$0.68
|
| Rate for Payer: Beech Street Commercial |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.69
|
| Rate for Payer: Cigna of WY Commercial |
$0.70
|
| Rate for Payer: Entrust Commercial |
$0.67
|
| Rate for Payer: First Choice Health Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.41
|
| Rate for Payer: HealthUtah PPO |
$0.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.69
|
| Rate for Payer: Multiplan Medicare/VA |
$0.39
|
| Rate for Payer: One Health Plan of WY PPO |
$0.70
|
| Rate for Payer: PacificSource Commercial |
$0.64
|
| Rate for Payer: PHCS PPO |
$0.70
|
| Rate for Payer: Three Rivers PPO |
$0.53
|
| Rate for Payer: TriWest Veterans Administration |
$0.41
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.41
|
| Rate for Payer: WINHealth Partners Commercial |
$0.70
|
| Rate for Payer: Wise Provider Network Commercial |
$0.67
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 6068773611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.84
|
| Rate for Payer: Altius Commercial |
$0.84
|
| Rate for Payer: Beech Street Commercial |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.85
|
| Rate for Payer: Cigna of WY Commercial |
$0.86
|
| Rate for Payer: Entrust Commercial |
$0.84
|
| Rate for Payer: First Choice Health Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$0.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.85
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.86
|
| Rate for Payer: PacificSource Commercial |
$0.79
|
| Rate for Payer: PHCS PPO |
$0.86
|
| Rate for Payer: Three Rivers PPO |
$0.66
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.77
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.84
|
| Rate for Payer: Wise Provider Network Commercial |
$0.84
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6808481311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.70
|
| Rate for Payer: Aetna of WY Medicare |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.68
|
| Rate for Payer: Altius Commercial |
$0.68
|
| Rate for Payer: Beech Street Commercial |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.69
|
| Rate for Payer: Cigna of WY Commercial |
$0.70
|
| Rate for Payer: Entrust Commercial |
$0.67
|
| Rate for Payer: First Choice Health Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.41
|
| Rate for Payer: HealthUtah PPO |
$0.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.69
|
| Rate for Payer: Multiplan Medicare/VA |
$0.39
|
| Rate for Payer: One Health Plan of WY PPO |
$0.70
|
| Rate for Payer: PacificSource Commercial |
$0.64
|
| Rate for Payer: PHCS PPO |
$0.70
|
| Rate for Payer: Three Rivers PPO |
$0.53
|
| Rate for Payer: TriWest Veterans Administration |
$0.41
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.41
|
| Rate for Payer: WINHealth Partners Commercial |
$0.70
|
| Rate for Payer: Wise Provider Network Commercial |
$0.67
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 1366842990
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.42
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 5026863911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.71
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [12176]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 5026863911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.68
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
PARAGUARD IUD
|
Facility
|
IP
|
$1,045.97
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.82 |
| Max. Negotiated Rate |
$1,045.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,025.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,004.13
|
| Rate for Payer: Altius Commercial |
$1,004.13
|
| Rate for Payer: Beech Street Commercial |
$1,025.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$858.74
|
| Rate for Payer: Cash Price |
$732.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,014.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,025.05
|
| Rate for Payer: Entrust Commercial |
$993.67
|
| Rate for Payer: First Choice Health Commercial |
$993.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$993.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$690.34
|
| Rate for Payer: HealthUtah PPO |
$1,045.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,014.59
|
| Rate for Payer: Multiplan Medicare/VA |
$655.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,025.05
|
| Rate for Payer: PacificSource Commercial |
$941.37
|
| Rate for Payer: PHCS PPO |
$1,025.05
|
| Rate for Payer: Three Rivers PPO |
$784.48
|
| Rate for Payer: TriWest Veterans Administration |
$690.34
|
| Rate for Payer: United Healthcare Commercial |
$909.99
|
| Rate for Payer: United Healthcare Medicare |
$690.34
|
| Rate for Payer: WINHealth Partners Commercial |
$993.67
|
| Rate for Payer: Wise Provider Network Commercial |
$993.67
|
|
|
PARAGUARD IUD
|
Facility
|
OP
|
$1,045.97
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.33 |
| Max. Negotiated Rate |
$1,045.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,025.05
|
| Rate for Payer: Aetna of WY Medicare |
$690.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,004.13
|
| Rate for Payer: Altius Commercial |
$1,004.13
|
| Rate for Payer: Beech Street Commercial |
$1,025.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$858.74
|
| Rate for Payer: Cash Price |
$732.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,014.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,025.05
|
| Rate for Payer: Entrust Commercial |
$993.67
|
| Rate for Payer: First Choice Health Commercial |
$993.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$993.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$606.66
|
| Rate for Payer: HealthUtah PPO |
$1,045.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,014.59
|
| Rate for Payer: Multiplan Medicare/VA |
$576.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,025.05
|
| Rate for Payer: PacificSource Commercial |
$941.37
|
| Rate for Payer: PHCS PPO |
$1,025.05
|
| Rate for Payer: Three Rivers PPO |
$784.48
|
| Rate for Payer: TriWest Veterans Administration |
$606.66
|
| Rate for Payer: United Healthcare Commercial |
$909.99
|
| Rate for Payer: United Healthcare Medicare |
$606.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,025.05
|
| Rate for Payer: Wise Provider Network Commercial |
$993.67
|
|
|
PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS
|
Professional
|
Both
|
$4,985.00
|
|
|
Service Code
|
HCPCS 60500
|
| Hospital Charge Code |
60500
|
| Min. Negotiated Rate |
$787.94 |
| Max. Negotiated Rate |
$4,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,885.30
|
| Rate for Payer: Aetna of WY Medicare |
$926.99
|
| Rate for Payer: Beech Street Commercial |
$4,735.75
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,835.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,885.30
|
| Rate for Payer: First Choice Health Commercial |
$4,486.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,735.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$926.99
|
| Rate for Payer: HealthUtah PPO |
$4,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,835.45
|
| Rate for Payer: Multiplan Medicare/VA |
$787.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,885.30
|
| Rate for Payer: PacificSource Commercial |
$4,486.50
|
| Rate for Payer: PHCS PPO |
$4,735.75
|
| Rate for Payer: Three Rivers PPO |
$3,738.75
|
| Rate for Payer: TriWest Veterans Administration |
$926.99
|
| Rate for Payer: United Healthcare Commercial |
$4,336.95
|
| Rate for Payer: United Healthcare Medicare |
$926.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.25
|
|
