|
RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$3,481.00
|
|
|
Service Code
|
HCPCS 26392 AS
|
| Hospital Charge Code |
26392
|
| Min. Negotiated Rate |
$829.23 |
| Max. Negotiated Rate |
$3,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,411.38
|
| Rate for Payer: Aetna of WY Medicare |
$975.57
|
| Rate for Payer: Beech Street Commercial |
$3,306.95
|
| Rate for Payer: Cash Price |
$2,436.70
|
| Rate for Payer: Cash Price |
$2,436.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,376.57
|
| Rate for Payer: Cigna of WY Commercial |
$3,411.38
|
| Rate for Payer: First Choice Health Commercial |
$3,132.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,306.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$975.57
|
| Rate for Payer: HealthUtah PPO |
$3,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,376.57
|
| Rate for Payer: Multiplan Medicare/VA |
$829.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,411.38
|
| Rate for Payer: PacificSource Commercial |
$3,132.90
|
| Rate for Payer: PHCS PPO |
$3,306.95
|
| Rate for Payer: Three Rivers PPO |
$2,610.75
|
| Rate for Payer: TriWest Veterans Administration |
$975.57
|
| Rate for Payer: United Healthcare Commercial |
$3,028.47
|
| Rate for Payer: United Healthcare Medicare |
$975.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,958.85
|
|
|
RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
36590
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$179.41
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: First Choice Health Commercial |
$885.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.41
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$152.50
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$179.41
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$179.41
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Medicare |
$129.05
|
| Rate for Payer: Beech Street Commercial |
$674.50
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: First Choice Health Commercial |
$639.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.05
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$109.69
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$674.50
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$129.05
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$129.05
|
| Rate for Payer: WINHealth Partners Commercial |
$603.50
|
|
|
RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
11983
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$97.95
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.95
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$83.26
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$97.95
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$97.95
|
| Rate for Payer: WINHealth Partners Commercial |
$443.70
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
NDC 7128871810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.47
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.01
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$11.41
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$15.83
|
| Rate for Payer: United Healthcare Medicare |
$12.01
|
| Rate for Payer: WINHealth Partners Commercial |
$17.29
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$17.60
|
|
|
Service Code
|
NDC 7183914201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.90
|
| Rate for Payer: Altius Commercial |
$16.90
|
| Rate for Payer: Beech Street Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.07
|
| Rate for Payer: Cigna of WY Commercial |
$17.25
|
| Rate for Payer: Entrust Commercial |
$16.72
|
| Rate for Payer: First Choice Health Commercial |
$16.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.62
|
| Rate for Payer: HealthUtah PPO |
$17.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.07
|
| Rate for Payer: Multiplan Medicare/VA |
$11.04
|
| Rate for Payer: One Health Plan of WY PPO |
$17.25
|
| Rate for Payer: PacificSource Commercial |
$15.84
|
| Rate for Payer: PHCS PPO |
$17.25
|
| Rate for Payer: Three Rivers PPO |
$13.20
|
| Rate for Payer: TriWest Veterans Administration |
$11.62
|
| Rate for Payer: United Healthcare Commercial |
$15.31
|
| Rate for Payer: United Healthcare Medicare |
$11.62
|
| Rate for Payer: WINHealth Partners Commercial |
$16.72
|
| Rate for Payer: Wise Provider Network Commercial |
$16.72
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$19.60
|
|
|
Service Code
|
NDC 5515022610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.21
|
| Rate for Payer: Aetna of WY Medicare |
$12.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.82
|
| Rate for Payer: Altius Commercial |
$18.82
|
| Rate for Payer: Beech Street Commercial |
$19.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.09
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$19.21
|
| Rate for Payer: Entrust Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.37
|
| Rate for Payer: HealthUtah PPO |
$19.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.01
|
| Rate for Payer: Multiplan Medicare/VA |
$10.80
|
| Rate for Payer: One Health Plan of WY PPO |
$19.21
|
| Rate for Payer: PacificSource Commercial |
$17.64
|
| Rate for Payer: PHCS PPO |
$19.21
|
| Rate for Payer: Three Rivers PPO |
$14.70
|
| Rate for Payer: TriWest Veterans Administration |
$11.37
|
| Rate for Payer: United Healthcare Commercial |
$17.05
|
| Rate for Payer: United Healthcare Medicare |
$11.37
|
| Rate for Payer: WINHealth Partners Commercial |
$19.21
|
| Rate for Payer: Wise Provider Network Commercial |
$18.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$17.60
|
|
|
Service Code
|
NDC 7183914201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.25
|
| Rate for Payer: Aetna of WY Medicare |
$11.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.90
|
| Rate for Payer: Altius Commercial |
$16.90
|
| Rate for Payer: Beech Street Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.07
|
| Rate for Payer: Cigna of WY Commercial |
$17.25
|
| Rate for Payer: Entrust Commercial |
$16.72
|
| Rate for Payer: First Choice Health Commercial |
$16.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.21
|
| Rate for Payer: HealthUtah PPO |
$17.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.07
|
| Rate for Payer: Multiplan Medicare/VA |
$9.70
|
| Rate for Payer: One Health Plan of WY PPO |
$17.25
|
| Rate for Payer: PacificSource Commercial |
$15.84
|
| Rate for Payer: PHCS PPO |
$17.25
|
| Rate for Payer: Three Rivers PPO |
$13.20
|
| Rate for Payer: TriWest Veterans Administration |
$10.21
|
| Rate for Payer: United Healthcare Commercial |
$15.31
|
| Rate for Payer: United Healthcare Medicare |
$10.21
|
| Rate for Payer: WINHealth Partners Commercial |
$17.25
|
| Rate for Payer: Wise Provider Network Commercial |
$16.72
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$18.60
|
|
|
Service Code
|
NDC 2502168710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.86
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.28
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.66
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$12.28
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
| Rate for Payer: WINHealth Partners Commercial |
$17.67
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
NDC 0409703701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.15
|
| Rate for Payer: Altius Commercial |
$17.15
|
| Rate for Payer: Beech Street Commercial |
$17.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.32
|
| Rate for Payer: Cigna of WY Commercial |
$17.50
|
| Rate for Payer: Entrust Commercial |
$16.97
|
| Rate for Payer: First Choice Health Commercial |
$16.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.79
|
| Rate for Payer: HealthUtah PPO |
$17.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.32
|
| Rate for Payer: Multiplan Medicare/VA |
$11.20
|
| Rate for Payer: One Health Plan of WY PPO |
$17.50
|
| Rate for Payer: PacificSource Commercial |
$16.07
|
| Rate for Payer: PHCS PPO |
$17.50
|
| Rate for Payer: Three Rivers PPO |
$13.40
|
| Rate for Payer: TriWest Veterans Administration |
$11.79
|
| Rate for Payer: United Healthcare Commercial |
$15.54
|
| Rate for Payer: United Healthcare Medicare |
$11.79
|
| Rate for Payer: WINHealth Partners Commercial |
$16.97
|
| Rate for Payer: Wise Provider Network Commercial |
$16.97
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 7128871810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Aetna of WY Medicare |
$12.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.47
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$15.83
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$17.84
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$17.96
|
|
|
Service Code
|
NDC 6679422902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.60
|
| Rate for Payer: Aetna of WY Medicare |
$11.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.24
|
| Rate for Payer: Altius Commercial |
$17.24
|
| Rate for Payer: Beech Street Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.75
|
| Rate for Payer: Cash Price |
$12.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.42
|
| Rate for Payer: Cigna of WY Commercial |
$17.60
|
| Rate for Payer: Entrust Commercial |
$17.06
|
| Rate for Payer: First Choice Health Commercial |
$17.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.42
|
| Rate for Payer: HealthUtah PPO |
$17.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.42
|
| Rate for Payer: Multiplan Medicare/VA |
$9.90
|
| Rate for Payer: One Health Plan of WY PPO |
$17.60
|
| Rate for Payer: PacificSource Commercial |
$16.16
|
| Rate for Payer: PHCS PPO |
$17.60
|
| Rate for Payer: Three Rivers PPO |
$13.47
|
| Rate for Payer: TriWest Veterans Administration |
$10.42
|
| Rate for Payer: United Healthcare Commercial |
$15.63
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
| Rate for Payer: WINHealth Partners Commercial |
$17.60
|
| Rate for Payer: Wise Provider Network Commercial |
$17.06
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 6679422902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.24
|
| Rate for Payer: Altius Commercial |
$17.24
|
| Rate for Payer: Beech Street Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.75
|
| Rate for Payer: Cash Price |
$12.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.42
|
| Rate for Payer: Cigna of WY Commercial |
$17.60
|
| Rate for Payer: Entrust Commercial |
$17.06
|
| Rate for Payer: First Choice Health Commercial |
$17.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.85
|
| Rate for Payer: HealthUtah PPO |
$17.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.42
|
| Rate for Payer: Multiplan Medicare/VA |
$11.26
|
| Rate for Payer: One Health Plan of WY PPO |
$17.60
|
| Rate for Payer: PacificSource Commercial |
$16.16
|
| Rate for Payer: PHCS PPO |
$17.60
|
| Rate for Payer: Three Rivers PPO |
$13.47
|
| Rate for Payer: TriWest Veterans Administration |
$11.85
|
| Rate for Payer: United Healthcare Commercial |
$15.63
|
| Rate for Payer: United Healthcare Medicare |
$11.85
|
| Rate for Payer: WINHealth Partners Commercial |
$17.06
|
| Rate for Payer: Wise Provider Network Commercial |
$17.06
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$18.60
|
|
|
Service Code
|
NDC 2502168710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Aetna of WY Medicare |
$12.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.86
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.79
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
| Rate for Payer: WINHealth Partners Commercial |
$18.23
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$20.20
|
|
|
Service Code
|
NDC 6332342601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.80
|
| Rate for Payer: Aetna of WY Medicare |
$13.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.39
|
| Rate for Payer: Altius Commercial |
$19.39
|
| Rate for Payer: Beech Street Commercial |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.59
|
| Rate for Payer: Cigna of WY Commercial |
$19.80
|
| Rate for Payer: Entrust Commercial |
$19.19
|
| Rate for Payer: First Choice Health Commercial |
$19.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.72
|
| Rate for Payer: HealthUtah PPO |
$20.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.59
|
| Rate for Payer: Multiplan Medicare/VA |
$11.13
|
| Rate for Payer: One Health Plan of WY PPO |
$19.80
|
| Rate for Payer: PacificSource Commercial |
$18.18
|
| Rate for Payer: PHCS PPO |
$19.80
|
| Rate for Payer: Three Rivers PPO |
$15.15
|
| Rate for Payer: TriWest Veterans Administration |
$11.72
|
| Rate for Payer: United Healthcare Commercial |
$17.57
|
| Rate for Payer: United Healthcare Medicare |
$11.72
|
| Rate for Payer: WINHealth Partners Commercial |
$19.80
|
| Rate for Payer: Wise Provider Network Commercial |
$19.19
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$19.60
|
|
|
Service Code
|
NDC 5515022610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.82
|
| Rate for Payer: Altius Commercial |
$18.82
|
| Rate for Payer: Beech Street Commercial |
$19.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.09
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$19.21
|
| Rate for Payer: Entrust Commercial |
$18.62
|
| Rate for Payer: First Choice Health Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.94
|
| Rate for Payer: HealthUtah PPO |
$19.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.01
|
| Rate for Payer: Multiplan Medicare/VA |
$12.29
|
| Rate for Payer: One Health Plan of WY PPO |
$19.21
|
| Rate for Payer: PacificSource Commercial |
$17.64
|
| Rate for Payer: PHCS PPO |
$19.21
|
| Rate for Payer: Three Rivers PPO |
$14.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$17.05
|
| Rate for Payer: United Healthcare Medicare |
$12.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
NDC 0409703701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.50
|
| Rate for Payer: Aetna of WY Medicare |
$11.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.15
|
| Rate for Payer: Altius Commercial |
$17.15
|
| Rate for Payer: Beech Street Commercial |
$17.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.32
|
| Rate for Payer: Cigna of WY Commercial |
$17.50
|
| Rate for Payer: Entrust Commercial |
$16.97
|
| Rate for Payer: First Choice Health Commercial |
$16.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.36
|
| Rate for Payer: HealthUtah PPO |
$17.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.84
|
| Rate for Payer: One Health Plan of WY PPO |
$17.50
|
| Rate for Payer: PacificSource Commercial |
$16.07
|
| Rate for Payer: PHCS PPO |
$17.50
|
| Rate for Payer: Three Rivers PPO |
$13.40
|
| Rate for Payer: TriWest Veterans Administration |
$10.36
|
| Rate for Payer: United Healthcare Commercial |
$15.54
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WINHealth Partners Commercial |
$17.50
|
| Rate for Payer: Wise Provider Network Commercial |
$16.97
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [6663]
|
Facility
|
IP
|
$20.20
|
|
|
Service Code
|
NDC 6332342601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.39
|
| Rate for Payer: Altius Commercial |
$19.39
|
| Rate for Payer: Beech Street Commercial |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.59
|
| Rate for Payer: Cigna of WY Commercial |
$19.80
|
| Rate for Payer: Entrust Commercial |
$19.19
|
| Rate for Payer: First Choice Health Commercial |
$19.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.33
|
| Rate for Payer: HealthUtah PPO |
$20.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.59
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$19.80
|
| Rate for Payer: PacificSource Commercial |
$18.18
|
| Rate for Payer: PHCS PPO |
$19.80
|
| Rate for Payer: Three Rivers PPO |
$15.15
|
| Rate for Payer: TriWest Veterans Administration |
$13.33
|
| Rate for Payer: United Healthcare Commercial |
$17.57
|
| Rate for Payer: United Healthcare Medicare |
$13.33
|
| Rate for Payer: WINHealth Partners Commercial |
$19.19
|
| Rate for Payer: Wise Provider Network Commercial |
$19.19
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [157570]
|
Facility
|
IP
|
$1,207.50
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$757.10 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,159.20
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$991.36
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$796.95
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$757.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$796.95
|
| Rate for Payer: United Healthcare Commercial |
$1,050.52
|
| Rate for Payer: United Healthcare Medicare |
$796.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,147.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION [157570]
|
Facility
|
OP
|
$1,207.50
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$665.33 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$796.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,159.20
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$991.36
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$700.35
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$665.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$700.35
|
| Rate for Payer: United Healthcare Commercial |
$1,050.52
|
| Rate for Payer: United Healthcare Medicare |
$700.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 95851
|
| Hospital Charge Code |
95851
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.45
|
| 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 |
$7.45
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$6.33
|
| 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 |
$7.45
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$7.45
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [155699]
|
Facility
|
OP
|
$969.06
|
|
|
Service Code
|
HCPCS J3111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$533.95 |
| Max. Negotiated Rate |
$969.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$949.68
|
| Rate for Payer: Aetna of WY Medicare |
$639.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$930.30
|
| Rate for Payer: Altius Commercial |
$930.30
|
| Rate for Payer: Beech Street Commercial |
$949.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$678.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$939.99
|
| Rate for Payer: Cigna of WY Commercial |
$949.68
|
| Rate for Payer: Entrust Commercial |
$920.61
|
| Rate for Payer: First Choice Health Commercial |
$920.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$920.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.05
|
| Rate for Payer: HealthUtah PPO |
$969.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$939.99
|
| Rate for Payer: Multiplan Medicare/VA |
$533.95
|
| Rate for Payer: One Health Plan of WY PPO |
$949.68
|
| Rate for Payer: PacificSource Commercial |
$872.15
|
| Rate for Payer: PHCS PPO |
$949.68
|
| Rate for Payer: Three Rivers PPO |
$726.80
|
| Rate for Payer: TriWest Veterans Administration |
$562.05
|
| Rate for Payer: United Healthcare Commercial |
$843.08
|
| Rate for Payer: United Healthcare Medicare |
$562.05
|
| Rate for Payer: WINHealth Partners Commercial |
$949.68
|
| Rate for Payer: Wise Provider Network Commercial |
$920.61
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [155699]
|
Facility
|
IP
|
$969.06
|
|
|
Service Code
|
HCPCS J3111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$969.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$949.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$930.30
|
| Rate for Payer: Altius Commercial |
$930.30
|
| Rate for Payer: Beech Street Commercial |
$949.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$678.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$939.99
|
| Rate for Payer: Cigna of WY Commercial |
$949.68
|
| Rate for Payer: Entrust Commercial |
$920.61
|
| Rate for Payer: First Choice Health Commercial |
$920.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$920.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$639.58
|
| Rate for Payer: HealthUtah PPO |
$969.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$939.99
|
| Rate for Payer: Multiplan Medicare/VA |
$607.60
|
| Rate for Payer: One Health Plan of WY PPO |
$949.68
|
| Rate for Payer: PacificSource Commercial |
$872.15
|
| Rate for Payer: PHCS PPO |
$949.68
|
| Rate for Payer: Three Rivers PPO |
$726.80
|
| Rate for Payer: TriWest Veterans Administration |
$639.58
|
| Rate for Payer: United Healthcare Commercial |
$843.08
|
| Rate for Payer: United Healthcare Medicare |
$639.58
|
| Rate for Payer: WINHealth Partners Commercial |
$920.61
|
| Rate for Payer: Wise Provider Network Commercial |
$920.61
|
|
|
ROPINIROLE 0.5 MG TABLET [12726]
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
NDC 5026874211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.17
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
ROPINIROLE 0.5 MG TABLET [12726]
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
NDC 5026874211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Aetna of WY Medicare |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
