|
RIFAMPIN 150 MG CAPSULE [10952]
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
NDC 6068757511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.46
|
| Rate for Payer: Altius Commercial |
$11.46
|
| Rate for Payer: Beech Street Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.58
|
| Rate for Payer: Cigna of WY Commercial |
$11.70
|
| Rate for Payer: Entrust Commercial |
$11.34
|
| Rate for Payer: First Choice Health Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.88
|
| Rate for Payer: HealthUtah PPO |
$11.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.58
|
| Rate for Payer: Multiplan Medicare/VA |
$7.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.70
|
| Rate for Payer: PacificSource Commercial |
$10.75
|
| Rate for Payer: PHCS PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$8.96
|
| Rate for Payer: TriWest Veterans Administration |
$7.88
|
| Rate for Payer: United Healthcare Commercial |
$10.39
|
| Rate for Payer: United Healthcare Medicare |
$7.88
|
| Rate for Payer: WINHealth Partners Commercial |
$11.34
|
| Rate for Payer: Wise Provider Network Commercial |
$11.34
|
|
|
RING CUSHION INVALID DYND70146
|
Facility
|
OP
|
$2.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.48
|
| Rate for Payer: Aetna of WY Medicare |
$1.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.43
|
| Rate for Payer: Altius Commercial |
$2.43
|
| Rate for Payer: Beech Street Commercial |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.45
|
| Rate for Payer: Cigna of WY Commercial |
$2.48
|
| Rate for Payer: Entrust Commercial |
$2.40
|
| Rate for Payer: First Choice Health Commercial |
$2.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.47
|
| Rate for Payer: HealthUtah PPO |
$2.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2.48
|
| Rate for Payer: PacificSource Commercial |
$2.28
|
| Rate for Payer: PHCS PPO |
$2.48
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$2.20
|
| Rate for Payer: United Healthcare Medicare |
$1.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2.48
|
| Rate for Payer: Wise Provider Network Commercial |
$2.40
|
|
|
RING CUSHION INVALID DYND70146
|
Facility
|
IP
|
$2.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.43
|
| Rate for Payer: Altius Commercial |
$2.43
|
| Rate for Payer: Beech Street Commercial |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.45
|
| Rate for Payer: Cigna of WY Commercial |
$2.48
|
| Rate for Payer: Entrust Commercial |
$2.40
|
| Rate for Payer: First Choice Health Commercial |
$2.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.67
|
| Rate for Payer: HealthUtah PPO |
$2.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2.48
|
| Rate for Payer: PacificSource Commercial |
$2.28
|
| Rate for Payer: PHCS PPO |
$2.48
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.67
|
| Rate for Payer: United Healthcare Commercial |
$2.20
|
| Rate for Payer: United Healthcare Medicare |
$1.67
|
| Rate for Payer: WINHealth Partners Commercial |
$2.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2.40
|
|
|
RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
J7120
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$2.43
|
| Rate for Payer: Beech Street Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: First Choice Health Commercial |
$12.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.43
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.30
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.43
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$2.43
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
|
|
RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 24342 80
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$638.94 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$751.70
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$751.70
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$638.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$751.70
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$751.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$638.94 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$751.70
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$751.70
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$638.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$751.70
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$751.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 24342 AS
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$638.94 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$751.70
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$751.70
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$638.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$751.70
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$751.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
RISPERIDONE 0.25 MG TABLET [6770]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 6808427001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Aetna of WY Medicare |
$0.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.89
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
RISPERIDONE 0.25 MG TABLET [6770]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 6808427011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Aetna of WY Medicare |
$0.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.89
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
RISPERIDONE 0.25 MG TABLET [6770]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 6808427011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$0.86
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
RISPERIDONE 0.25 MG TABLET [6770]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 6808427001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.87
|
| Rate for Payer: Altius Commercial |
$0.87
|
| Rate for Payer: Beech Street Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.88
|
| Rate for Payer: Cigna of WY Commercial |
$0.89
|
| Rate for Payer: Entrust Commercial |
$0.86
|
| Rate for Payer: First Choice Health Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$0.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$0.89
|
| Rate for Payer: PacificSource Commercial |
$0.82
|
| Rate for Payer: PHCS PPO |
$0.89
|
| Rate for Payer: Three Rivers PPO |
$0.68
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$0.86
|
| Rate for Payer: Wise Provider Network Commercial |
$0.86
|
|
|
RISPERIDONE 0.5 MG TABLET [19766]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 6808427111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.05
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
RISPERIDONE 0.5 MG TABLET [19766]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 6808427111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.05
|
| Rate for Payer: Altius Commercial |
$1.05
|
| Rate for Payer: Beech Street Commercial |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.06
|
| Rate for Payer: Cigna of WY Commercial |
$1.07
|
| Rate for Payer: Entrust Commercial |
$1.04
|
| Rate for Payer: First Choice Health Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.72
|
| Rate for Payer: HealthUtah PPO |
$1.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.07
|
| Rate for Payer: PacificSource Commercial |
$0.98
|
| Rate for Payer: PHCS PPO |
$1.07
|
| Rate for Payer: Three Rivers PPO |
$0.82
|
| Rate for Payer: TriWest Veterans Administration |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1.04
|
|
|
RISPERIDONE 0.5 MG TABLET [19766]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 0904635861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.76
|
| Rate for Payer: Altius Commercial |
$0.76
|
| Rate for Payer: Beech Street Commercial |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.77
|
| Rate for Payer: Cigna of WY Commercial |
$0.77
|
| Rate for Payer: Entrust Commercial |
$0.75
|
| Rate for Payer: First Choice Health Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.52
|
| Rate for Payer: HealthUtah PPO |
$0.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.77
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.71
|
| Rate for Payer: PHCS PPO |
$0.77
|
| Rate for Payer: Three Rivers PPO |
$0.59
|
| Rate for Payer: TriWest Veterans Administration |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$0.69
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.75
|
|
|
RISPERIDONE 0.5 MG TABLET [19766]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 0904635861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.77
|
| Rate for Payer: Aetna of WY Medicare |
$0.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.76
|
| Rate for Payer: Altius Commercial |
$0.76
|
| Rate for Payer: Beech Street Commercial |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.77
|
| Rate for Payer: Cigna of WY Commercial |
$0.77
|
| Rate for Payer: Entrust Commercial |
$0.75
|
| Rate for Payer: First Choice Health Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.77
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.71
|
| Rate for Payer: PHCS PPO |
$0.77
|
| Rate for Payer: Three Rivers PPO |
$0.59
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.69
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.77
|
| Rate for Payer: Wise Provider Network Commercial |
$0.75
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [19063]
|
Facility
|
OP
|
$179.42
|
|
|
Service Code
|
HCPCS J9312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$179.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.83
|
| Rate for Payer: Aetna of WY Medicare |
$118.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.24
|
| Rate for Payer: Altius Commercial |
$172.24
|
| Rate for Payer: Beech Street Commercial |
$175.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.30
|
| Rate for Payer: Cash Price |
$125.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.04
|
| Rate for Payer: Cigna of WY Commercial |
$175.83
|
| Rate for Payer: Entrust Commercial |
$170.45
|
| Rate for Payer: First Choice Health Commercial |
$170.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.06
|
| Rate for Payer: HealthUtah PPO |
$179.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.04
|
| Rate for Payer: Multiplan Medicare/VA |
$98.86
|
| Rate for Payer: One Health Plan of WY PPO |
$175.83
|
| Rate for Payer: PacificSource Commercial |
$161.48
|
| Rate for Payer: PHCS PPO |
$175.83
|
| Rate for Payer: Three Rivers PPO |
$134.56
|
| Rate for Payer: TriWest Veterans Administration |
$104.06
|
| Rate for Payer: United Healthcare Commercial |
$156.10
|
| Rate for Payer: United Healthcare Medicare |
$104.06
|
| Rate for Payer: WINHealth Partners Commercial |
$175.83
|
| Rate for Payer: Wise Provider Network Commercial |
$170.45
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [19063]
|
Facility
|
IP
|
$179.42
|
|
|
Service Code
|
HCPCS J9312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$179.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.24
|
| Rate for Payer: Altius Commercial |
$172.24
|
| Rate for Payer: Beech Street Commercial |
$175.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.30
|
| Rate for Payer: Cash Price |
$125.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.04
|
| Rate for Payer: Cigna of WY Commercial |
$175.83
|
| Rate for Payer: Entrust Commercial |
$170.45
|
| Rate for Payer: First Choice Health Commercial |
$170.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.42
|
| Rate for Payer: HealthUtah PPO |
$179.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.04
|
| Rate for Payer: Multiplan Medicare/VA |
$112.50
|
| Rate for Payer: One Health Plan of WY PPO |
$175.83
|
| Rate for Payer: PacificSource Commercial |
$161.48
|
| Rate for Payer: PHCS PPO |
$175.83
|
| Rate for Payer: Three Rivers PPO |
$134.56
|
| Rate for Payer: TriWest Veterans Administration |
$118.42
|
| Rate for Payer: United Healthcare Commercial |
$156.10
|
| Rate for Payer: United Healthcare Medicare |
$118.42
|
| Rate for Payer: WINHealth Partners Commercial |
$170.45
|
| Rate for Payer: Wise Provider Network Commercial |
$170.45
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [154924]
|
Facility
|
IP
|
$162.97
|
|
|
Service Code
|
HCPCS Q5115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$162.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.45
|
| Rate for Payer: Altius Commercial |
$156.45
|
| Rate for Payer: Beech Street Commercial |
$159.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.80
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.08
|
| Rate for Payer: Cigna of WY Commercial |
$159.71
|
| Rate for Payer: Entrust Commercial |
$154.82
|
| Rate for Payer: First Choice Health Commercial |
$154.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.56
|
| Rate for Payer: HealthUtah PPO |
$162.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.08
|
| Rate for Payer: Multiplan Medicare/VA |
$102.18
|
| Rate for Payer: One Health Plan of WY PPO |
$159.71
|
| Rate for Payer: PacificSource Commercial |
$146.67
|
| Rate for Payer: PHCS PPO |
$159.71
|
| Rate for Payer: Three Rivers PPO |
$122.23
|
| Rate for Payer: TriWest Veterans Administration |
$107.56
|
| Rate for Payer: United Healthcare Commercial |
$141.78
|
| Rate for Payer: United Healthcare Medicare |
$107.56
|
| Rate for Payer: WINHealth Partners Commercial |
$154.82
|
| Rate for Payer: Wise Provider Network Commercial |
$154.82
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [154924]
|
Facility
|
OP
|
$162.97
|
|
|
Service Code
|
HCPCS Q5115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$162.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.71
|
| Rate for Payer: Aetna of WY Medicare |
$107.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.45
|
| Rate for Payer: Altius Commercial |
$156.45
|
| Rate for Payer: Beech Street Commercial |
$159.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.80
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.08
|
| Rate for Payer: Cigna of WY Commercial |
$159.71
|
| Rate for Payer: Entrust Commercial |
$154.82
|
| Rate for Payer: First Choice Health Commercial |
$154.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.52
|
| Rate for Payer: HealthUtah PPO |
$162.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.08
|
| Rate for Payer: Multiplan Medicare/VA |
$89.80
|
| Rate for Payer: One Health Plan of WY PPO |
$159.71
|
| Rate for Payer: PacificSource Commercial |
$146.67
|
| Rate for Payer: PHCS PPO |
$159.71
|
| Rate for Payer: Three Rivers PPO |
$122.23
|
| Rate for Payer: TriWest Veterans Administration |
$94.52
|
| Rate for Payer: United Healthcare Commercial |
$141.78
|
| Rate for Payer: United Healthcare Medicare |
$94.52
|
| Rate for Payer: WINHealth Partners Commercial |
$159.71
|
| Rate for Payer: Wise Provider Network Commercial |
$154.82
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [156550]
|
Facility
|
IP
|
$140.44
|
|
|
Service Code
|
HCPCS Q5119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$140.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.82
|
| Rate for Payer: Altius Commercial |
$134.82
|
| Rate for Payer: Beech Street Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.30
|
| Rate for Payer: Cash Price |
$98.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.23
|
| Rate for Payer: Cigna of WY Commercial |
$137.63
|
| Rate for Payer: Entrust Commercial |
$133.42
|
| Rate for Payer: First Choice Health Commercial |
$133.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.69
|
| Rate for Payer: HealthUtah PPO |
$140.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.23
|
| Rate for Payer: Multiplan Medicare/VA |
$88.06
|
| Rate for Payer: One Health Plan of WY PPO |
$137.63
|
| Rate for Payer: PacificSource Commercial |
$126.40
|
| Rate for Payer: PHCS PPO |
$137.63
|
| Rate for Payer: Three Rivers PPO |
$105.33
|
| Rate for Payer: TriWest Veterans Administration |
$92.69
|
| Rate for Payer: United Healthcare Commercial |
$122.18
|
| Rate for Payer: United Healthcare Medicare |
$92.69
|
| Rate for Payer: WINHealth Partners Commercial |
$133.42
|
| Rate for Payer: Wise Provider Network Commercial |
$133.42
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [156550]
|
Facility
|
OP
|
$140.44
|
|
|
Service Code
|
HCPCS Q5119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$140.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.63
|
| Rate for Payer: Aetna of WY Medicare |
$92.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.82
|
| Rate for Payer: Altius Commercial |
$134.82
|
| Rate for Payer: Beech Street Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.30
|
| Rate for Payer: Cash Price |
$98.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.23
|
| Rate for Payer: Cigna of WY Commercial |
$137.63
|
| Rate for Payer: Entrust Commercial |
$133.42
|
| Rate for Payer: First Choice Health Commercial |
$133.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.46
|
| Rate for Payer: HealthUtah PPO |
$140.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.23
|
| Rate for Payer: Multiplan Medicare/VA |
$77.38
|
| Rate for Payer: One Health Plan of WY PPO |
$137.63
|
| Rate for Payer: PacificSource Commercial |
$126.40
|
| Rate for Payer: PHCS PPO |
$137.63
|
| Rate for Payer: Three Rivers PPO |
$105.33
|
| Rate for Payer: TriWest Veterans Administration |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$122.18
|
| Rate for Payer: United Healthcare Medicare |
$81.46
|
| Rate for Payer: WINHealth Partners Commercial |
$137.63
|
| Rate for Payer: Wise Provider Network Commercial |
$133.42
|
|
|
RIVAROXABAN 10 MG TABLET [92804]
|
Facility
|
OP
|
$44.85
|
|
|
Service Code
|
NDC 5045858001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.95
|
| Rate for Payer: Aetna of WY Medicare |
$29.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.06
|
| Rate for Payer: Altius Commercial |
$43.06
|
| Rate for Payer: Beech Street Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$31.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.50
|
| Rate for Payer: Cigna of WY Commercial |
$43.95
|
| Rate for Payer: Entrust Commercial |
$42.61
|
| Rate for Payer: First Choice Health Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.01
|
| Rate for Payer: HealthUtah PPO |
$44.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.50
|
| Rate for Payer: Multiplan Medicare/VA |
$24.71
|
| Rate for Payer: One Health Plan of WY PPO |
$43.95
|
| Rate for Payer: PacificSource Commercial |
$40.36
|
| Rate for Payer: PHCS PPO |
$43.95
|
| Rate for Payer: Three Rivers PPO |
$33.64
|
| Rate for Payer: TriWest Veterans Administration |
$26.01
|
| Rate for Payer: United Healthcare Commercial |
$39.02
|
| Rate for Payer: United Healthcare Medicare |
$26.01
|
| Rate for Payer: WINHealth Partners Commercial |
$43.95
|
| Rate for Payer: Wise Provider Network Commercial |
$42.61
|
|
|
RIVAROXABAN 10 MG TABLET [92804]
|
Facility
|
IP
|
$44.85
|
|
|
Service Code
|
NDC 5045858010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.06
|
| Rate for Payer: Altius Commercial |
$43.06
|
| Rate for Payer: Beech Street Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$31.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.50
|
| Rate for Payer: Cigna of WY Commercial |
$43.95
|
| Rate for Payer: Entrust Commercial |
$42.61
|
| Rate for Payer: First Choice Health Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.60
|
| Rate for Payer: HealthUtah PPO |
$44.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.50
|
| Rate for Payer: Multiplan Medicare/VA |
$28.12
|
| Rate for Payer: One Health Plan of WY PPO |
$43.95
|
| Rate for Payer: PacificSource Commercial |
$40.36
|
| Rate for Payer: PHCS PPO |
$43.95
|
| Rate for Payer: Three Rivers PPO |
$33.64
|
| Rate for Payer: TriWest Veterans Administration |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$39.02
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: WINHealth Partners Commercial |
$42.61
|
| Rate for Payer: Wise Provider Network Commercial |
$42.61
|
|
|
RIVAROXABAN 10 MG TABLET [92804]
|
Facility
|
IP
|
$44.85
|
|
|
Service Code
|
NDC 5045858001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.06
|
| Rate for Payer: Altius Commercial |
$43.06
|
| Rate for Payer: Beech Street Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$31.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.50
|
| Rate for Payer: Cigna of WY Commercial |
$43.95
|
| Rate for Payer: Entrust Commercial |
$42.61
|
| Rate for Payer: First Choice Health Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.60
|
| Rate for Payer: HealthUtah PPO |
$44.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.50
|
| Rate for Payer: Multiplan Medicare/VA |
$28.12
|
| Rate for Payer: One Health Plan of WY PPO |
$43.95
|
| Rate for Payer: PacificSource Commercial |
$40.36
|
| Rate for Payer: PHCS PPO |
$43.95
|
| Rate for Payer: Three Rivers PPO |
$33.64
|
| Rate for Payer: TriWest Veterans Administration |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$39.02
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: WINHealth Partners Commercial |
$42.61
|
| Rate for Payer: Wise Provider Network Commercial |
$42.61
|
|
|
RIVAROXABAN 10 MG TABLET [92804]
|
Facility
|
OP
|
$44.85
|
|
|
Service Code
|
NDC 5045858010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.95
|
| Rate for Payer: Aetna of WY Medicare |
$29.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.06
|
| Rate for Payer: Altius Commercial |
$43.06
|
| Rate for Payer: Beech Street Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$31.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.50
|
| Rate for Payer: Cigna of WY Commercial |
$43.95
|
| Rate for Payer: Entrust Commercial |
$42.61
|
| Rate for Payer: First Choice Health Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.01
|
| Rate for Payer: HealthUtah PPO |
$44.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.50
|
| Rate for Payer: Multiplan Medicare/VA |
$24.71
|
| Rate for Payer: One Health Plan of WY PPO |
$43.95
|
| Rate for Payer: PacificSource Commercial |
$40.36
|
| Rate for Payer: PHCS PPO |
$43.95
|
| Rate for Payer: Three Rivers PPO |
$33.64
|
| Rate for Payer: TriWest Veterans Administration |
$26.01
|
| Rate for Payer: United Healthcare Commercial |
$39.02
|
| Rate for Payer: United Healthcare Medicare |
$26.01
|
| Rate for Payer: WINHealth Partners Commercial |
$43.95
|
| Rate for Payer: Wise Provider Network Commercial |
$42.61
|
|
