|
SOD CHLORIDE-SOD BICARB-HYALURONATE SOD-ALOE 0.9 % NASAL GEL [94598]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 0592800099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.76
|
| Rate for Payer: Aetna of WY Medicare |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.75
|
| Rate for Payer: Altius Commercial |
$0.75
|
| Rate for Payer: Beech Street Commercial |
$0.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.76
|
| Rate for Payer: Cigna of WY Commercial |
$0.76
|
| Rate for Payer: Entrust Commercial |
$0.74
|
| Rate for Payer: First Choice Health Commercial |
$0.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.76
|
| Rate for Payer: Multiplan Medicare/VA |
$0.43
|
| Rate for Payer: One Health Plan of WY PPO |
$0.76
|
| Rate for Payer: PacificSource Commercial |
$0.70
|
| Rate for Payer: PHCS PPO |
$0.76
|
| Rate for Payer: Three Rivers PPO |
$0.59
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.68
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.74
|
|
|
SODIUM BICARBONATE 650 MG TABLET [11536]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0536104710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
|
SODIUM BICARBONATE 650 MG TABLET [11536]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0536104710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
IP
|
$15.70
|
|
|
Service Code
|
NDC 5175450011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.07
|
| Rate for Payer: Altius Commercial |
$15.07
|
| Rate for Payer: Beech Street Commercial |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$10.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.23
|
| Rate for Payer: Cigna of WY Commercial |
$15.39
|
| Rate for Payer: Entrust Commercial |
$14.92
|
| Rate for Payer: First Choice Health Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.36
|
| Rate for Payer: HealthUtah PPO |
$15.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.23
|
| Rate for Payer: Multiplan Medicare/VA |
$9.84
|
| Rate for Payer: One Health Plan of WY PPO |
$15.39
|
| Rate for Payer: PacificSource Commercial |
$14.13
|
| Rate for Payer: PHCS PPO |
$15.39
|
| Rate for Payer: Three Rivers PPO |
$11.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.36
|
| Rate for Payer: United Healthcare Commercial |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.92
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 0409663724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.02
|
| Rate for Payer: Altius Commercial |
$16.02
|
| Rate for Payer: Beech Street Commercial |
$16.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.19
|
| Rate for Payer: Cigna of WY Commercial |
$16.36
|
| Rate for Payer: Entrust Commercial |
$15.86
|
| Rate for Payer: First Choice Health Commercial |
$15.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$16.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.19
|
| Rate for Payer: Multiplan Medicare/VA |
$10.46
|
| Rate for Payer: One Health Plan of WY PPO |
$16.36
|
| Rate for Payer: PacificSource Commercial |
$15.02
|
| Rate for Payer: PHCS PPO |
$16.36
|
| Rate for Payer: Three Rivers PPO |
$12.52
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$15.86
|
| Rate for Payer: Wise Provider Network Commercial |
$15.86
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 7009505003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.48
|
| Rate for Payer: Aetna of WY Medicare |
$10.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.17
|
| Rate for Payer: Altius Commercial |
$15.17
|
| Rate for Payer: Beech Street Commercial |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.97
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.33
|
| Rate for Payer: Cigna of WY Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.01
|
| Rate for Payer: First Choice Health Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.33
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.48
|
| Rate for Payer: PacificSource Commercial |
$14.22
|
| Rate for Payer: PHCS PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$11.85
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$13.75
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$15.48
|
| Rate for Payer: Wise Provider Network Commercial |
$15.01
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
OP
|
$16.74
|
|
|
Service Code
|
NDC 7009505001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.41
|
| Rate for Payer: Aetna of WY Medicare |
$11.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.07
|
| Rate for Payer: Altius Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.24
|
| Rate for Payer: Cigna of WY Commercial |
$16.41
|
| Rate for Payer: Entrust Commercial |
$15.90
|
| Rate for Payer: First Choice Health Commercial |
$15.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.71
|
| Rate for Payer: HealthUtah PPO |
$16.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.24
|
| Rate for Payer: Multiplan Medicare/VA |
$9.22
|
| Rate for Payer: One Health Plan of WY PPO |
$16.41
|
| Rate for Payer: PacificSource Commercial |
$15.07
|
| Rate for Payer: PHCS PPO |
$16.41
|
| Rate for Payer: Three Rivers PPO |
$12.56
|
| Rate for Payer: TriWest Veterans Administration |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$14.56
|
| Rate for Payer: United Healthcare Medicare |
$9.71
|
| Rate for Payer: WINHealth Partners Commercial |
$16.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.90
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
IP
|
$16.74
|
|
|
Service Code
|
NDC 7009505001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.07
|
| Rate for Payer: Altius Commercial |
$16.07
|
| Rate for Payer: Beech Street Commercial |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.24
|
| Rate for Payer: Cigna of WY Commercial |
$16.41
|
| Rate for Payer: Entrust Commercial |
$15.90
|
| Rate for Payer: First Choice Health Commercial |
$15.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.05
|
| Rate for Payer: HealthUtah PPO |
$16.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.24
|
| Rate for Payer: Multiplan Medicare/VA |
$10.50
|
| Rate for Payer: One Health Plan of WY PPO |
$16.41
|
| Rate for Payer: PacificSource Commercial |
$15.07
|
| Rate for Payer: PHCS PPO |
$16.41
|
| Rate for Payer: Three Rivers PPO |
$12.56
|
| Rate for Payer: TriWest Veterans Administration |
$11.05
|
| Rate for Payer: United Healthcare Commercial |
$14.56
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.90
|
| Rate for Payer: Wise Provider Network Commercial |
$15.90
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 7009505003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.17
|
| Rate for Payer: Altius Commercial |
$15.17
|
| Rate for Payer: Beech Street Commercial |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.97
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.33
|
| Rate for Payer: Cigna of WY Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.01
|
| Rate for Payer: First Choice Health Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.43
|
| Rate for Payer: HealthUtah PPO |
$15.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.33
|
| Rate for Payer: Multiplan Medicare/VA |
$9.91
|
| Rate for Payer: One Health Plan of WY PPO |
$15.48
|
| Rate for Payer: PacificSource Commercial |
$14.22
|
| Rate for Payer: PHCS PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$11.85
|
| Rate for Payer: TriWest Veterans Administration |
$10.43
|
| Rate for Payer: United Healthcare Commercial |
$13.75
|
| Rate for Payer: United Healthcare Medicare |
$10.43
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.01
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
NDC 0409663724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.36
|
| Rate for Payer: Aetna of WY Medicare |
$11.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.02
|
| Rate for Payer: Altius Commercial |
$16.02
|
| Rate for Payer: Beech Street Commercial |
$16.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.19
|
| Rate for Payer: Cigna of WY Commercial |
$16.36
|
| Rate for Payer: Entrust Commercial |
$15.86
|
| Rate for Payer: First Choice Health Commercial |
$15.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.68
|
| Rate for Payer: HealthUtah PPO |
$16.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.19
|
| Rate for Payer: Multiplan Medicare/VA |
$9.20
|
| Rate for Payer: One Health Plan of WY PPO |
$16.36
|
| Rate for Payer: PacificSource Commercial |
$15.02
|
| Rate for Payer: PHCS PPO |
$16.36
|
| Rate for Payer: Three Rivers PPO |
$12.52
|
| Rate for Payer: TriWest Veterans Administration |
$9.68
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$9.68
|
| Rate for Payer: WINHealth Partners Commercial |
$16.36
|
| Rate for Payer: Wise Provider Network Commercial |
$15.86
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
IP
|
$15.70
|
|
|
Service Code
|
NDC 5175450014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.07
|
| Rate for Payer: Altius Commercial |
$15.07
|
| Rate for Payer: Beech Street Commercial |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$10.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.23
|
| Rate for Payer: Cigna of WY Commercial |
$15.39
|
| Rate for Payer: Entrust Commercial |
$14.92
|
| Rate for Payer: First Choice Health Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.36
|
| Rate for Payer: HealthUtah PPO |
$15.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.23
|
| Rate for Payer: Multiplan Medicare/VA |
$9.84
|
| Rate for Payer: One Health Plan of WY PPO |
$15.39
|
| Rate for Payer: PacificSource Commercial |
$14.13
|
| Rate for Payer: PHCS PPO |
$15.39
|
| Rate for Payer: Three Rivers PPO |
$11.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.36
|
| Rate for Payer: United Healthcare Commercial |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.92
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
OP
|
$15.70
|
|
|
Service Code
|
NDC 5175450014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.39
|
| Rate for Payer: Aetna of WY Medicare |
$10.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.07
|
| Rate for Payer: Altius Commercial |
$15.07
|
| Rate for Payer: Beech Street Commercial |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$10.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.23
|
| Rate for Payer: Cigna of WY Commercial |
$15.39
|
| Rate for Payer: Entrust Commercial |
$14.92
|
| Rate for Payer: First Choice Health Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.11
|
| Rate for Payer: HealthUtah PPO |
$15.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.23
|
| Rate for Payer: Multiplan Medicare/VA |
$8.65
|
| Rate for Payer: One Health Plan of WY PPO |
$15.39
|
| Rate for Payer: PacificSource Commercial |
$14.13
|
| Rate for Payer: PHCS PPO |
$15.39
|
| Rate for Payer: Three Rivers PPO |
$11.78
|
| Rate for Payer: TriWest Veterans Administration |
$9.11
|
| Rate for Payer: United Healthcare Commercial |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
| Rate for Payer: WINHealth Partners Commercial |
$15.39
|
| Rate for Payer: Wise Provider Network Commercial |
$14.92
|
|
|
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE (WRAPPED) [40000714]
|
Facility
|
OP
|
$15.70
|
|
|
Service Code
|
NDC 5175450011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.39
|
| Rate for Payer: Aetna of WY Medicare |
$10.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.07
|
| Rate for Payer: Altius Commercial |
$15.07
|
| Rate for Payer: Beech Street Commercial |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$10.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.23
|
| Rate for Payer: Cigna of WY Commercial |
$15.39
|
| Rate for Payer: Entrust Commercial |
$14.92
|
| Rate for Payer: First Choice Health Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.11
|
| Rate for Payer: HealthUtah PPO |
$15.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.23
|
| Rate for Payer: Multiplan Medicare/VA |
$8.65
|
| Rate for Payer: One Health Plan of WY PPO |
$15.39
|
| Rate for Payer: PacificSource Commercial |
$14.13
|
| Rate for Payer: PHCS PPO |
$15.39
|
| Rate for Payer: Three Rivers PPO |
$11.78
|
| Rate for Payer: TriWest Veterans Administration |
$9.11
|
| Rate for Payer: United Healthcare Commercial |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
| Rate for Payer: WINHealth Partners Commercial |
$15.39
|
| Rate for Payer: Wise Provider Network Commercial |
$14.92
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [5501]
|
Facility
|
IP
|
$15.02
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [5501]
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [28649]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0904386575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Aetna of WY Medicare |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [28649]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0904386575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
IP
|
$15.25
|
|
|
Service Code
|
NDC 8290306546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.64
|
| Rate for Payer: Altius Commercial |
$14.64
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.52
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.79
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.49
|
| Rate for Payer: First Choice Health Commercial |
$14.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: HealthUtah PPO |
$15.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.79
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: WINHealth Partners Commercial |
$14.49
|
| Rate for Payer: Wise Provider Network Commercial |
$14.49
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
NDC 8290306553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Aetna of WY Medicare |
$10.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.78
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.93
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$8.49
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$8.93
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare |
$8.93
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 6425311130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
OP
|
$15.32
|
|
|
Service Code
|
NDC 8290306545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.89
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.44
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
NDC 8290306545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.11
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.61
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$10.11
|
| Rate for Payer: WINHealth Partners Commercial |
$14.55
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 8290306547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
