|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
OP
|
$15.25
|
|
|
Service Code
|
NDC 8290306546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| 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 |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.79
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| 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 |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.49
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 6425311130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| 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 |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| 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 |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 8290306547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| 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 |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| 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 |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE [25633]
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
NDC 8290306553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| 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 |
$10.16
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$9.66
|
| 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 |
$10.16
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare |
$10.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.63
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION [18679]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 0487930133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.38
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.39
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
SODIUM CHLORIDE 0.9 % FOR NEBULIZATION [18679]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 0487930133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.38
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.25
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
OP
|
$15.38
|
|
|
Service Code
|
NDC 0409488802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$10.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.63
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.92
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.47
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$8.92
|
| Rate for Payer: WINHealth Partners Commercial |
$15.07
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
NDC 0409488806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.66
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.08
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$10.08
|
| Rate for Payer: WINHealth Partners Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
NDC 6332318601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
NDC 6332318601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
OP
|
$15.38
|
|
|
Service Code
|
NDC 0409488810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$10.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.63
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.92
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.47
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$8.92
|
| Rate for Payer: WINHealth Partners Commercial |
$15.07
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
NDC 0409488802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.63
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.15
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.15
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$10.15
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
NDC 0409488810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.63
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.15
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.15
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$10.15
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
NDC 0409488803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.66
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.08
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$10.08
|
| Rate for Payer: WINHealth Partners Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
NDC 0409488806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.66
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.86
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [10210]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
NDC 0409488803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.66
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.54
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.86
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 0264780020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$9.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.73
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.29
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$8.73
|
| Rate for Payer: United Healthcare Commercial |
$13.09
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
OP
|
$15.22
|
|
|
Service Code
|
NDC 0264180031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.61
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.83
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.39
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$8.83
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare |
$8.83
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 0264780020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.93
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$9.44
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$9.93
|
| Rate for Payer: United Healthcare Commercial |
$13.09
|
| Rate for Payer: United Healthcare Medicare |
$9.93
|
| Rate for Payer: WINHealth Partners Commercial |
$14.30
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
HCPCS J7040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
IP
|
$15.22
|
|
|
Service Code
|
NDC 0264180031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.61
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$14.46
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.81
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.97
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.51
|
| Rate for Payer: Altius Commercial |
$14.51
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.81
|
| Rate for Payer: Entrust Commercial |
$14.35
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: HealthUtah PPO |
$15.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.66
|
| Rate for Payer: Multiplan Medicare/VA |
$8.33
|
| Rate for Payer: Multiplan Medicare/VA |
$8.27
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: One Health Plan of WY PPO |
$14.81
|
| Rate for Payer: PacificSource Commercial |
$13.60
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: PHCS PPO |
$14.81
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.33
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Commercial |
$13.15
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.81
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.35
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
HCPCS J7040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [16788]
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.81
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.41
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Altius Commercial |
$14.51
|
| Rate for Payer: Beech Street Commercial |
$14.81
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.41
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.66
|
| Rate for Payer: Cigna of WY Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: Entrust Commercial |
$14.35
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.11
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.66
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: Multiplan Medicare/VA |
$9.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.81
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.60
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: PHCS PPO |
$14.81
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.33
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Commercial |
$13.15
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.26
|
| Rate for Payer: WINHealth Partners Commercial |
$14.35
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.35
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION [9394]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0264738860
|
|
Hospital Revenue Code
|
250
|
| 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 |
$0.02
|
| 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
|
|
