|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [14206]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [5019]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
NDC 0990710709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS [5019]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
NDC 0990710709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [8999]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0990790209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [8999]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0990790209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 6021916171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.01
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.81
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.01
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$4.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5.78
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 6923816171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.01
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.81
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.01
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$4.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5.78
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 6923816173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Aetna of WY Medicare |
$4.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.35
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$5.96
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 6923816173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.01
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.81
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.01
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$4.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5.78
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 6923816171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Aetna of WY Medicare |
$4.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.35
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$5.96
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 20 MEQ ORAL PACKET [9917]
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 6021916171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.96
|
| Rate for Payer: Aetna of WY Medicare |
$4.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.84
|
| Rate for Payer: Altius Commercial |
$5.84
|
| Rate for Payer: Beech Street Commercial |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.90
|
| Rate for Payer: Cigna of WY Commercial |
$5.96
|
| Rate for Payer: Entrust Commercial |
$5.78
|
| Rate for Payer: First Choice Health Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3.35
|
| Rate for Payer: One Health Plan of WY PPO |
$5.96
|
| Rate for Payer: PacificSource Commercial |
$5.47
|
| Rate for Payer: PHCS PPO |
$5.96
|
| Rate for Payer: Three Rivers PPO |
$4.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.29
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$5.96
|
| Rate for Payer: Wise Provider Network Commercial |
$5.78
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [29205]
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.21
|
| Rate for Payer: Aetna of WY Medicare |
$10.51
|
| Rate for Payer: Aetna of WY Medicare |
$10.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.28
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Altius Commercial |
$14.90
|
| Rate for Payer: Beech Street Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.74
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.05
|
| Rate for Payer: Cigna of WY Commercial |
$15.21
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: Entrust Commercial |
$14.74
|
| Rate for Payer: First Choice Health Commercial |
$14.74
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.00
|
| Rate for Payer: HealthUtah PPO |
$15.52
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: Multiplan Medicare/VA |
$8.55
|
| Rate for Payer: One Health Plan of WY PPO |
$15.21
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PacificSource Commercial |
$13.97
|
| Rate for Payer: PHCS PPO |
$15.21
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.64
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: TriWest Veterans Administration |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
| Rate for Payer: WINHealth Partners Commercial |
$15.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.60
|
| Rate for Payer: Wise Provider Network Commercial |
$14.74
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION [29205]
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.90
|
| Rate for Payer: Altius Commercial |
$14.90
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Beech Street Commercial |
$15.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Cigna of WY Commercial |
$15.21
|
| Rate for Payer: Entrust Commercial |
$14.74
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: First Choice Health Commercial |
$14.74
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.24
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: HealthUtah PPO |
$15.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$9.98
|
| Rate for Payer: Multiplan Medicare/VA |
$9.73
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: One Health Plan of WY PPO |
$15.21
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PacificSource Commercial |
$13.97
|
| Rate for Payer: PHCS PPO |
$15.21
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.64
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$10.51
|
| Rate for Payer: TriWest Veterans Administration |
$10.24
|
| Rate for Payer: United Healthcare Commercial |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
| Rate for Payer: United Healthcare Medicare |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$10.24
|
| Rate for Payer: WINHealth Partners Commercial |
$14.74
|
| Rate for Payer: WINHealth Partners Commercial |
$15.12
|
| Rate for Payer: Wise Provider Network Commercial |
$14.74
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [5887]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [5887]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0264763800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0990790409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0990790409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0338067504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0338067504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [2609]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0264763800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 6068765321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Aetna of WY Medicare |
$2.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.28
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.28
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.28
|
| Rate for Payer: WINHealth Partners Commercial |
$3.85
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 5374654201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 6068765321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.59
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WINHealth Partners Commercial |
$3.73
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 6068765311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| Rate for Payer: Aetna of WY Medicare |
$2.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.26
|
| Rate for Payer: Altius Commercial |
$3.26
|
| Rate for Payer: Beech Street Commercial |
$3.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.30
|
| Rate for Payer: Cigna of WY Commercial |
$3.33
|
| Rate for Payer: Entrust Commercial |
$3.23
|
| Rate for Payer: First Choice Health Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.97
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3.33
|
| Rate for Payer: PacificSource Commercial |
$3.06
|
| Rate for Payer: PHCS PPO |
$3.33
|
| Rate for Payer: Three Rivers PPO |
$2.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
| Rate for Payer: WINHealth Partners Commercial |
$3.33
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
