|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 6068765311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| 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 |
$2.24
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2.13
|
| 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 |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$2.24
|
| Rate for Payer: WINHealth Partners Commercial |
$3.23
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE [1357]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 5374654201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| 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 |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| 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 |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [29624]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 0245531701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.31
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [29624]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 0245531701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.90
|
| Rate for Payer: Altius Commercial |
$1.90
|
| Rate for Payer: Beech Street Commercial |
$1.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.92
|
| Rate for Payer: Cigna of WY Commercial |
$1.94
|
| Rate for Payer: Entrust Commercial |
$1.88
|
| Rate for Payer: First Choice Health Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.15
|
| Rate for Payer: HealthUtah PPO |
$1.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1.94
|
| Rate for Payer: PacificSource Commercial |
$1.78
|
| Rate for Payer: PHCS PPO |
$1.94
|
| Rate for Payer: Three Rivers PPO |
$1.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$1.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1.88
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [29624]
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
NDC 0245531789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.92
|
| Rate for Payer: Aetna of WY Medicare |
$1.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.88
|
| Rate for Payer: Altius Commercial |
$1.88
|
| Rate for Payer: Beech Street Commercial |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.90
|
| Rate for Payer: Cigna of WY Commercial |
$1.92
|
| Rate for Payer: Entrust Commercial |
$1.86
|
| Rate for Payer: First Choice Health Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.14
|
| Rate for Payer: HealthUtah PPO |
$1.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1.92
|
| Rate for Payer: PacificSource Commercial |
$1.76
|
| Rate for Payer: PHCS PPO |
$1.92
|
| Rate for Payer: Three Rivers PPO |
$1.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1.86
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [29624]
|
Facility
|
IP
|
$1.96
|
|
|
Service Code
|
NDC 0245531789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.88
|
| Rate for Payer: Altius Commercial |
$1.88
|
| Rate for Payer: Beech Street Commercial |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.90
|
| Rate for Payer: Cigna of WY Commercial |
$1.92
|
| Rate for Payer: Entrust Commercial |
$1.86
|
| Rate for Payer: First Choice Health Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.29
|
| Rate for Payer: HealthUtah PPO |
$1.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1.92
|
| Rate for Payer: PacificSource Commercial |
$1.76
|
| Rate for Payer: PHCS PPO |
$1.92
|
| Rate for Payer: Three Rivers PPO |
$1.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.86
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
NDC 0245531901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.09
|
| Rate for Payer: Altius Commercial |
$2.09
|
| Rate for Payer: Beech Street Commercial |
$2.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.11
|
| Rate for Payer: Cigna of WY Commercial |
$2.14
|
| Rate for Payer: Entrust Commercial |
$2.07
|
| Rate for Payer: First Choice Health Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.44
|
| Rate for Payer: HealthUtah PPO |
$2.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.14
|
| Rate for Payer: PacificSource Commercial |
$1.96
|
| Rate for Payer: PHCS PPO |
$2.14
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2.07
|
| Rate for Payer: Wise Provider Network Commercial |
$2.07
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 6800156700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.37
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
OP
|
$2.18
|
|
|
Service Code
|
NDC 0245531901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.14
|
| Rate for Payer: Aetna of WY Medicare |
$1.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.09
|
| Rate for Payer: Altius Commercial |
$2.09
|
| Rate for Payer: Beech Street Commercial |
$2.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.11
|
| Rate for Payer: Cigna of WY Commercial |
$2.14
|
| Rate for Payer: Entrust Commercial |
$2.07
|
| Rate for Payer: First Choice Health Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.26
|
| Rate for Payer: HealthUtah PPO |
$2.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2.14
|
| Rate for Payer: PacificSource Commercial |
$1.96
|
| Rate for Payer: PHCS PPO |
$2.14
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2.14
|
| Rate for Payer: Wise Provider Network Commercial |
$2.07
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 6800156700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 0245531989
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.12
|
| Rate for Payer: Aetna of WY Medicare |
$1.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.07
|
| Rate for Payer: Altius Commercial |
$2.07
|
| Rate for Payer: Beech Street Commercial |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.10
|
| Rate for Payer: Cigna of WY Commercial |
$2.12
|
| Rate for Payer: Entrust Commercial |
$2.05
|
| Rate for Payer: First Choice Health Commercial |
$2.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$2.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2.12
|
| Rate for Payer: PacificSource Commercial |
$1.94
|
| Rate for Payer: PHCS PPO |
$2.12
|
| Rate for Payer: Three Rivers PPO |
$1.62
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2.12
|
| Rate for Payer: Wise Provider Network Commercial |
$2.05
|
|
|
POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST) [10145]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 0245531989
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.07
|
| Rate for Payer: Altius Commercial |
$2.07
|
| Rate for Payer: Beech Street Commercial |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.10
|
| Rate for Payer: Cigna of WY Commercial |
$2.12
|
| Rate for Payer: Entrust Commercial |
$2.05
|
| Rate for Payer: First Choice Health Commercial |
$2.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.43
|
| Rate for Payer: HealthUtah PPO |
$2.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2.12
|
| Rate for Payer: PacificSource Commercial |
$1.94
|
| Rate for Payer: PHCS PPO |
$2.12
|
| Rate for Payer: Three Rivers PPO |
$1.62
|
| Rate for Payer: TriWest Veterans Administration |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Medicare |
$1.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2.05
|
| Rate for Payer: Wise Provider Network Commercial |
$2.05
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [1945]
|
Facility
|
IP
|
$32.98
|
|
|
Service Code
|
NDC 6521905209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.66
|
| Rate for Payer: Altius Commercial |
$31.66
|
| Rate for Payer: Beech Street Commercial |
$32.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.08
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.99
|
| Rate for Payer: Cigna of WY Commercial |
$32.32
|
| Rate for Payer: Entrust Commercial |
$31.33
|
| Rate for Payer: First Choice Health Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.77
|
| Rate for Payer: HealthUtah PPO |
$32.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.99
|
| Rate for Payer: Multiplan Medicare/VA |
$20.68
|
| Rate for Payer: One Health Plan of WY PPO |
$32.32
|
| Rate for Payer: PacificSource Commercial |
$29.68
|
| Rate for Payer: PHCS PPO |
$32.32
|
| Rate for Payer: Three Rivers PPO |
$24.74
|
| Rate for Payer: TriWest Veterans Administration |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$28.69
|
| Rate for Payer: United Healthcare Medicare |
$21.77
|
| Rate for Payer: WINHealth Partners Commercial |
$31.33
|
| Rate for Payer: Wise Provider Network Commercial |
$31.33
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [1945]
|
Facility
|
IP
|
$32.98
|
|
|
Service Code
|
NDC 0517205101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.66
|
| Rate for Payer: Altius Commercial |
$31.66
|
| Rate for Payer: Beech Street Commercial |
$32.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.08
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.99
|
| Rate for Payer: Cigna of WY Commercial |
$32.32
|
| Rate for Payer: Entrust Commercial |
$31.33
|
| Rate for Payer: First Choice Health Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.77
|
| Rate for Payer: HealthUtah PPO |
$32.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.99
|
| Rate for Payer: Multiplan Medicare/VA |
$20.68
|
| Rate for Payer: One Health Plan of WY PPO |
$32.32
|
| Rate for Payer: PacificSource Commercial |
$29.68
|
| Rate for Payer: PHCS PPO |
$32.32
|
| Rate for Payer: Three Rivers PPO |
$24.74
|
| Rate for Payer: TriWest Veterans Administration |
$21.77
|
| Rate for Payer: United Healthcare Commercial |
$28.69
|
| Rate for Payer: United Healthcare Medicare |
$21.77
|
| Rate for Payer: WINHealth Partners Commercial |
$31.33
|
| Rate for Payer: Wise Provider Network Commercial |
$31.33
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [1945]
|
Facility
|
OP
|
$32.98
|
|
|
Service Code
|
NDC 6521905209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.32
|
| Rate for Payer: Aetna of WY Medicare |
$21.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.66
|
| Rate for Payer: Altius Commercial |
$31.66
|
| Rate for Payer: Beech Street Commercial |
$32.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.08
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.99
|
| Rate for Payer: Cigna of WY Commercial |
$32.32
|
| Rate for Payer: Entrust Commercial |
$31.33
|
| Rate for Payer: First Choice Health Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.13
|
| Rate for Payer: HealthUtah PPO |
$32.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.99
|
| Rate for Payer: Multiplan Medicare/VA |
$18.17
|
| Rate for Payer: One Health Plan of WY PPO |
$32.32
|
| Rate for Payer: PacificSource Commercial |
$29.68
|
| Rate for Payer: PHCS PPO |
$32.32
|
| Rate for Payer: Three Rivers PPO |
$24.74
|
| Rate for Payer: TriWest Veterans Administration |
$19.13
|
| Rate for Payer: United Healthcare Commercial |
$28.69
|
| Rate for Payer: United Healthcare Medicare |
$19.13
|
| Rate for Payer: WINHealth Partners Commercial |
$32.32
|
| Rate for Payer: Wise Provider Network Commercial |
$31.33
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION [1945]
|
Facility
|
OP
|
$32.98
|
|
|
Service Code
|
NDC 0517205101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.32
|
| Rate for Payer: Aetna of WY Medicare |
$21.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.66
|
| Rate for Payer: Altius Commercial |
$31.66
|
| Rate for Payer: Beech Street Commercial |
$32.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.08
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.99
|
| Rate for Payer: Cigna of WY Commercial |
$32.32
|
| Rate for Payer: Entrust Commercial |
$31.33
|
| Rate for Payer: First Choice Health Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.13
|
| Rate for Payer: HealthUtah PPO |
$32.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.99
|
| Rate for Payer: Multiplan Medicare/VA |
$18.17
|
| Rate for Payer: One Health Plan of WY PPO |
$32.32
|
| Rate for Payer: PacificSource Commercial |
$29.68
|
| Rate for Payer: PHCS PPO |
$32.32
|
| Rate for Payer: Three Rivers PPO |
$24.74
|
| Rate for Payer: TriWest Veterans Administration |
$19.13
|
| Rate for Payer: United Healthcare Commercial |
$28.69
|
| Rate for Payer: United Healthcare Medicare |
$19.13
|
| Rate for Payer: WINHealth Partners Commercial |
$32.32
|
| Rate for Payer: Wise Provider Network Commercial |
$31.33
|
|
|
POTASSIUM SERUM PLASMA/WHOLE BLOOD
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
84132
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$4.76
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.76
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$4.05
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$4.76
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$4.76
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [45815]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 7135101099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.23
|
| Rate for Payer: Altius Commercial |
$1.23
|
| Rate for Payer: Beech Street Commercial |
$1.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.24
|
| Rate for Payer: Cigna of WY Commercial |
$1.25
|
| Rate for Payer: Entrust Commercial |
$1.22
|
| Rate for Payer: First Choice Health Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.84
|
| Rate for Payer: HealthUtah PPO |
$1.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.25
|
| Rate for Payer: PacificSource Commercial |
$1.15
|
| Rate for Payer: PHCS PPO |
$1.25
|
| Rate for Payer: Three Rivers PPO |
$0.96
|
| Rate for Payer: TriWest Veterans Administration |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
| Rate for Payer: United Healthcare Medicare |
$0.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1.22
|
|
|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [45815]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 7135101099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.23
|
| Rate for Payer: Altius Commercial |
$1.23
|
| Rate for Payer: Beech Street Commercial |
$1.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.24
|
| Rate for Payer: Cigna of WY Commercial |
$1.25
|
| Rate for Payer: Entrust Commercial |
$1.22
|
| Rate for Payer: First Choice Health Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.74
|
| Rate for Payer: HealthUtah PPO |
$1.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.25
|
| Rate for Payer: PacificSource Commercial |
$1.15
|
| Rate for Payer: PHCS PPO |
$1.25
|
| Rate for Payer: Three Rivers PPO |
$0.96
|
| Rate for Payer: TriWest Veterans Administration |
$0.74
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
| Rate for Payer: United Healthcare Medicare |
$0.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1.22
|
|
|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [45815]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 7135101001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.23
|
| Rate for Payer: Altius Commercial |
$1.23
|
| Rate for Payer: Beech Street Commercial |
$1.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.24
|
| Rate for Payer: Cigna of WY Commercial |
$1.25
|
| Rate for Payer: Entrust Commercial |
$1.22
|
| Rate for Payer: First Choice Health Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.74
|
| Rate for Payer: HealthUtah PPO |
$1.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.25
|
| Rate for Payer: PacificSource Commercial |
$1.15
|
| Rate for Payer: PHCS PPO |
$1.25
|
| Rate for Payer: Three Rivers PPO |
$0.96
|
| Rate for Payer: TriWest Veterans Administration |
$0.74
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
| Rate for Payer: United Healthcare Medicare |
$0.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1.22
|
|
|
POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET [45815]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 7135101001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.23
|
| Rate for Payer: Altius Commercial |
$1.23
|
| Rate for Payer: Beech Street Commercial |
$1.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.24
|
| Rate for Payer: Cigna of WY Commercial |
$1.25
|
| Rate for Payer: Entrust Commercial |
$1.22
|
| Rate for Payer: First Choice Health Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.84
|
| Rate for Payer: HealthUtah PPO |
$1.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.25
|
| Rate for Payer: PacificSource Commercial |
$1.15
|
| Rate for Payer: PHCS PPO |
$1.25
|
| Rate for Payer: Three Rivers PPO |
$0.96
|
| Rate for Payer: TriWest Veterans Administration |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
| Rate for Payer: United Healthcare Medicare |
$0.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1.22
|
|
|
POVIDONE-IODINE 10 % TOPICAL OINTMENT [10384]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 0536127180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
POVIDONE-IODINE 10 % TOPICAL OINTMENT [10384]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 0536127180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.14
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: WINHealth Partners Commercial |
$0.20
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
POWER PICC IR 5FR DUAL LUMEN
|
Facility
|
IP
|
$319.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.09 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$306.36
|
| Rate for Payer: Altius Commercial |
$306.36
|
| Rate for Payer: Beech Street Commercial |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.01
|
| Rate for Payer: Cash Price |
$223.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.56
|
| Rate for Payer: Cigna of WY Commercial |
$312.75
|
| Rate for Payer: Entrust Commercial |
$303.17
|
| Rate for Payer: First Choice Health Commercial |
$303.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$210.63
|
| Rate for Payer: HealthUtah PPO |
$319.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.56
|
| Rate for Payer: Multiplan Medicare/VA |
$200.09
|
| Rate for Payer: One Health Plan of WY PPO |
$312.75
|
| Rate for Payer: PacificSource Commercial |
$287.22
|
| Rate for Payer: PHCS PPO |
$312.75
|
| Rate for Payer: Three Rivers PPO |
$239.35
|
| Rate for Payer: TriWest Veterans Administration |
$210.63
|
| Rate for Payer: United Healthcare Commercial |
$277.64
|
| Rate for Payer: United Healthcare Medicare |
$210.63
|
| Rate for Payer: WINHealth Partners Commercial |
$303.17
|
| Rate for Payer: Wise Provider Network Commercial |
$303.17
|
|
|
POWER PICC IR 5FR DUAL LUMEN
|
Facility
|
OP
|
$319.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.75
|
| Rate for Payer: Aetna of WY Medicare |
$210.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$306.36
|
| Rate for Payer: Altius Commercial |
$306.36
|
| Rate for Payer: Beech Street Commercial |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.01
|
| Rate for Payer: Cash Price |
$223.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.56
|
| Rate for Payer: Cigna of WY Commercial |
$312.75
|
| Rate for Payer: Entrust Commercial |
$303.17
|
| Rate for Payer: First Choice Health Commercial |
$303.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.10
|
| Rate for Payer: HealthUtah PPO |
$319.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.56
|
| Rate for Payer: Multiplan Medicare/VA |
$175.84
|
| Rate for Payer: One Health Plan of WY PPO |
$312.75
|
| Rate for Payer: PacificSource Commercial |
$287.22
|
| Rate for Payer: PHCS PPO |
$312.75
|
| Rate for Payer: Three Rivers PPO |
$239.35
|
| Rate for Payer: TriWest Veterans Administration |
$185.10
|
| Rate for Payer: United Healthcare Commercial |
$277.64
|
| Rate for Payer: United Healthcare Medicare |
$185.10
|
| Rate for Payer: WINHealth Partners Commercial |
$312.75
|
| Rate for Payer: Wise Provider Network Commercial |
$303.17
|
|
