|
SODIUM HYALURONATE 10 MG/ML INTRA-ARTICULAR SYRINGE [25737]
|
Facility
|
OP
|
$181.05
|
|
|
Service Code
|
HCPCS J7320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.43
|
| Rate for Payer: Aetna of WY Medicare |
$119.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$173.81
|
| Rate for Payer: Altius Commercial |
$173.81
|
| Rate for Payer: Beech Street Commercial |
$177.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.64
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.62
|
| Rate for Payer: Cigna of WY Commercial |
$177.43
|
| Rate for Payer: Entrust Commercial |
$172.00
|
| Rate for Payer: First Choice Health Commercial |
$172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.01
|
| Rate for Payer: HealthUtah PPO |
$181.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.62
|
| Rate for Payer: Multiplan Medicare/VA |
$99.76
|
| Rate for Payer: One Health Plan of WY PPO |
$177.43
|
| Rate for Payer: PacificSource Commercial |
$162.94
|
| Rate for Payer: PHCS PPO |
$177.43
|
| Rate for Payer: Three Rivers PPO |
$135.79
|
| Rate for Payer: TriWest Veterans Administration |
$105.01
|
| Rate for Payer: United Healthcare Commercial |
$157.51
|
| Rate for Payer: United Healthcare Medicare |
$105.01
|
| Rate for Payer: WINHealth Partners Commercial |
$177.43
|
| Rate for Payer: Wise Provider Network Commercial |
$172.00
|
|
|
SODIUM HYALURONATE 10 MG/ML INTRA-ARTICULAR SYRINGE [25737]
|
Facility
|
IP
|
$181.05
|
|
|
Service Code
|
HCPCS J7320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.52 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$173.81
|
| Rate for Payer: Altius Commercial |
$173.81
|
| Rate for Payer: Beech Street Commercial |
$177.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.64
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.62
|
| Rate for Payer: Cigna of WY Commercial |
$177.43
|
| Rate for Payer: Entrust Commercial |
$172.00
|
| Rate for Payer: First Choice Health Commercial |
$172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.49
|
| Rate for Payer: HealthUtah PPO |
$181.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.62
|
| Rate for Payer: Multiplan Medicare/VA |
$113.52
|
| Rate for Payer: One Health Plan of WY PPO |
$177.43
|
| Rate for Payer: PacificSource Commercial |
$162.94
|
| Rate for Payer: PHCS PPO |
$177.43
|
| Rate for Payer: Three Rivers PPO |
$135.79
|
| Rate for Payer: TriWest Veterans Administration |
$119.49
|
| Rate for Payer: United Healthcare Commercial |
$157.51
|
| Rate for Payer: United Healthcare Medicare |
$119.49
|
| Rate for Payer: WINHealth Partners Commercial |
$172.00
|
| Rate for Payer: Wise Provider Network Commercial |
$172.00
|
|
|
SODIUM HYALURONATE 10 MG/ML(MW 2.4-3.6 MILLION)INTRA-ARTICULAR SYRINGE [147032]
|
Facility
|
IP
|
$277.59
|
|
|
Service Code
|
HCPCS J7323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.05 |
| Max. Negotiated Rate |
$277.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$266.49
|
| Rate for Payer: Altius Commercial |
$266.49
|
| Rate for Payer: Beech Street Commercial |
$272.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.90
|
| Rate for Payer: Cash Price |
$194.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.26
|
| Rate for Payer: Cigna of WY Commercial |
$272.04
|
| Rate for Payer: Entrust Commercial |
$263.71
|
| Rate for Payer: First Choice Health Commercial |
$263.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$183.21
|
| Rate for Payer: HealthUtah PPO |
$277.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.26
|
| Rate for Payer: Multiplan Medicare/VA |
$174.05
|
| Rate for Payer: One Health Plan of WY PPO |
$272.04
|
| Rate for Payer: PacificSource Commercial |
$249.83
|
| Rate for Payer: PHCS PPO |
$272.04
|
| Rate for Payer: Three Rivers PPO |
$208.19
|
| Rate for Payer: TriWest Veterans Administration |
$183.21
|
| Rate for Payer: United Healthcare Commercial |
$241.50
|
| Rate for Payer: United Healthcare Medicare |
$183.21
|
| Rate for Payer: WINHealth Partners Commercial |
$263.71
|
| Rate for Payer: Wise Provider Network Commercial |
$263.71
|
|
|
SODIUM HYALURONATE 10 MG/ML(MW 2.4-3.6 MILLION)INTRA-ARTICULAR SYRINGE [147032]
|
Facility
|
OP
|
$277.59
|
|
|
Service Code
|
HCPCS J7323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.95 |
| Max. Negotiated Rate |
$277.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.04
|
| Rate for Payer: Aetna of WY Medicare |
$183.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$266.49
|
| Rate for Payer: Altius Commercial |
$266.49
|
| Rate for Payer: Beech Street Commercial |
$272.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.90
|
| Rate for Payer: Cash Price |
$194.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.26
|
| Rate for Payer: Cigna of WY Commercial |
$272.04
|
| Rate for Payer: Entrust Commercial |
$263.71
|
| Rate for Payer: First Choice Health Commercial |
$263.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.00
|
| Rate for Payer: HealthUtah PPO |
$277.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.26
|
| Rate for Payer: Multiplan Medicare/VA |
$152.95
|
| Rate for Payer: One Health Plan of WY PPO |
$272.04
|
| Rate for Payer: PacificSource Commercial |
$249.83
|
| Rate for Payer: PHCS PPO |
$272.04
|
| Rate for Payer: Three Rivers PPO |
$208.19
|
| Rate for Payer: TriWest Veterans Administration |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$241.50
|
| Rate for Payer: United Healthcare Medicare |
$161.00
|
| Rate for Payer: WINHealth Partners Commercial |
$272.04
|
| Rate for Payer: Wise Provider Network Commercial |
$263.71
|
|
|
SODIUM HYALURONATE 30 MG/2 ML INTRA-ARTICULAR SYRINGE [31802]
|
Facility
|
IP
|
$313.75
|
|
|
Service Code
|
HCPCS J7324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.72 |
| Max. Negotiated Rate |
$313.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.20
|
| Rate for Payer: Altius Commercial |
$301.20
|
| Rate for Payer: Beech Street Commercial |
$307.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.59
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.34
|
| Rate for Payer: Cigna of WY Commercial |
$307.48
|
| Rate for Payer: Entrust Commercial |
$298.06
|
| Rate for Payer: First Choice Health Commercial |
$298.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.08
|
| Rate for Payer: HealthUtah PPO |
$313.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.34
|
| Rate for Payer: Multiplan Medicare/VA |
$196.72
|
| Rate for Payer: One Health Plan of WY PPO |
$307.48
|
| Rate for Payer: PacificSource Commercial |
$282.38
|
| Rate for Payer: PHCS PPO |
$307.48
|
| Rate for Payer: Three Rivers PPO |
$235.31
|
| Rate for Payer: TriWest Veterans Administration |
$207.08
|
| Rate for Payer: United Healthcare Commercial |
$272.96
|
| Rate for Payer: United Healthcare Medicare |
$207.08
|
| Rate for Payer: WINHealth Partners Commercial |
$298.06
|
| Rate for Payer: Wise Provider Network Commercial |
$298.06
|
|
|
SODIUM HYALURONATE 30 MG/2 ML INTRA-ARTICULAR SYRINGE [31802]
|
Facility
|
OP
|
$313.75
|
|
|
Service Code
|
HCPCS J7324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.88 |
| Max. Negotiated Rate |
$313.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.48
|
| Rate for Payer: Aetna of WY Medicare |
$207.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.20
|
| Rate for Payer: Altius Commercial |
$301.20
|
| Rate for Payer: Beech Street Commercial |
$307.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.59
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.34
|
| Rate for Payer: Cigna of WY Commercial |
$307.48
|
| Rate for Payer: Entrust Commercial |
$298.06
|
| Rate for Payer: First Choice Health Commercial |
$298.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.98
|
| Rate for Payer: HealthUtah PPO |
$313.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.34
|
| Rate for Payer: Multiplan Medicare/VA |
$172.88
|
| Rate for Payer: One Health Plan of WY PPO |
$307.48
|
| Rate for Payer: PacificSource Commercial |
$282.38
|
| Rate for Payer: PHCS PPO |
$307.48
|
| Rate for Payer: Three Rivers PPO |
$235.31
|
| Rate for Payer: TriWest Veterans Administration |
$181.98
|
| Rate for Payer: United Healthcare Commercial |
$272.96
|
| Rate for Payer: United Healthcare Medicare |
$181.98
|
| Rate for Payer: WINHealth Partners Commercial |
$307.48
|
| Rate for Payer: Wise Provider Network Commercial |
$298.06
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION [21329]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0436093616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| 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 |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION [21329]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0436093616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| 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 |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION [21329]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 3932806325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.12
|
| Rate for Payer: Altius Commercial |
$0.12
|
| Rate for Payer: Beech Street Commercial |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.12
|
| Rate for Payer: Cigna of WY Commercial |
$0.12
|
| Rate for Payer: Entrust Commercial |
$0.11
|
| Rate for Payer: First Choice Health Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.08
|
| Rate for Payer: HealthUtah PPO |
$0.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.12
|
| Rate for Payer: PacificSource Commercial |
$0.11
|
| Rate for Payer: PHCS PPO |
$0.12
|
| Rate for Payer: Three Rivers PPO |
$0.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.08
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.11
|
|
|
SODIUM HYPOCHLORITE 0.25 % SOLUTION [21329]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 3932806325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.12
|
| Rate for Payer: Aetna of WY Medicare |
$0.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.12
|
| Rate for Payer: Altius Commercial |
$0.12
|
| Rate for Payer: Beech Street Commercial |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.12
|
| Rate for Payer: Cigna of WY Commercial |
$0.12
|
| Rate for Payer: Entrust Commercial |
$0.11
|
| Rate for Payer: First Choice Health Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.12
|
| Rate for Payer: PacificSource Commercial |
$0.11
|
| Rate for Payer: PHCS PPO |
$0.12
|
| Rate for Payer: Three Rivers PPO |
$0.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.12
|
| Rate for Payer: Wise Provider Network Commercial |
$0.11
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
NDC 4359858723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
NDC 4359858723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$26.17
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
NDC 7043602880
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
NDC 7043602880
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$26.17
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
NDC 7128820202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [16510]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
NDC 7128820202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [14465]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0536741551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [14465]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0132020140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [14465]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0536741551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [14465]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0132020140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [90567]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 4338670083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.95
|
| Rate for Payer: Altius Commercial |
$0.95
|
| Rate for Payer: Beech Street Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.96
|
| Rate for Payer: Cigna of WY Commercial |
$0.97
|
| Rate for Payer: Entrust Commercial |
$0.94
|
| Rate for Payer: First Choice Health Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.65
|
| Rate for Payer: HealthUtah PPO |
$0.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.96
|
| Rate for Payer: Multiplan Medicare/VA |
$0.62
|
| Rate for Payer: One Health Plan of WY PPO |
$0.97
|
| Rate for Payer: PacificSource Commercial |
$0.89
|
| Rate for Payer: PHCS PPO |
$0.97
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$0.65
|
| Rate for Payer: WINHealth Partners Commercial |
$0.94
|
| Rate for Payer: Wise Provider Network Commercial |
$0.94
|
|
|
SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN [90567]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 4338670083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.97
|
| Rate for Payer: Aetna of WY Medicare |
$0.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.95
|
| Rate for Payer: Altius Commercial |
$0.95
|
| Rate for Payer: Beech Street Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.96
|
| Rate for Payer: Cigna of WY Commercial |
$0.97
|
| Rate for Payer: Entrust Commercial |
$0.94
|
| Rate for Payer: First Choice Health Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: HealthUtah PPO |
$0.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.96
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.97
|
| Rate for Payer: PacificSource Commercial |
$0.89
|
| Rate for Payer: PHCS PPO |
$0.97
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: WINHealth Partners Commercial |
$0.97
|
| Rate for Payer: Wise Provider Network Commercial |
$0.94
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [152624]
|
Facility
|
OP
|
$57.44
|
|
|
Service Code
|
NDC 0310111001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$57.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.29
|
| Rate for Payer: Aetna of WY Medicare |
$37.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.14
|
| Rate for Payer: Altius Commercial |
$55.14
|
| Rate for Payer: Beech Street Commercial |
$56.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.16
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.72
|
| Rate for Payer: Cigna of WY Commercial |
$56.29
|
| Rate for Payer: Entrust Commercial |
$54.57
|
| Rate for Payer: First Choice Health Commercial |
$54.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.32
|
| Rate for Payer: HealthUtah PPO |
$57.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.72
|
| Rate for Payer: Multiplan Medicare/VA |
$31.65
|
| Rate for Payer: One Health Plan of WY PPO |
$56.29
|
| Rate for Payer: PacificSource Commercial |
$51.70
|
| Rate for Payer: PHCS PPO |
$56.29
|
| Rate for Payer: Three Rivers PPO |
$43.08
|
| Rate for Payer: TriWest Veterans Administration |
$33.32
|
| Rate for Payer: United Healthcare Commercial |
$49.97
|
| Rate for Payer: United Healthcare Medicare |
$33.32
|
| Rate for Payer: WINHealth Partners Commercial |
$56.29
|
| Rate for Payer: Wise Provider Network Commercial |
$54.57
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [152624]
|
Facility
|
OP
|
$57.43
|
|
|
Service Code
|
NDC 0310111039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$57.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.28
|
| Rate for Payer: Aetna of WY Medicare |
$37.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.13
|
| Rate for Payer: Altius Commercial |
$55.13
|
| Rate for Payer: Beech Street Commercial |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.15
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.71
|
| Rate for Payer: Cigna of WY Commercial |
$56.28
|
| Rate for Payer: Entrust Commercial |
$54.56
|
| Rate for Payer: First Choice Health Commercial |
$54.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.31
|
| Rate for Payer: HealthUtah PPO |
$57.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.71
|
| Rate for Payer: Multiplan Medicare/VA |
$31.64
|
| Rate for Payer: One Health Plan of WY PPO |
$56.28
|
| Rate for Payer: PacificSource Commercial |
$51.69
|
| Rate for Payer: PHCS PPO |
$56.28
|
| Rate for Payer: Three Rivers PPO |
$43.07
|
| Rate for Payer: TriWest Veterans Administration |
$33.31
|
| Rate for Payer: United Healthcare Commercial |
$49.96
|
| Rate for Payer: United Healthcare Medicare |
$33.31
|
| Rate for Payer: WINHealth Partners Commercial |
$56.28
|
| Rate for Payer: Wise Provider Network Commercial |
$54.56
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [152624]
|
Facility
|
IP
|
$57.44
|
|
|
Service Code
|
NDC 0310111001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$57.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.14
|
| Rate for Payer: Altius Commercial |
$55.14
|
| Rate for Payer: Beech Street Commercial |
$56.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.16
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.72
|
| Rate for Payer: Cigna of WY Commercial |
$56.29
|
| Rate for Payer: Entrust Commercial |
$54.57
|
| Rate for Payer: First Choice Health Commercial |
$54.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.91
|
| Rate for Payer: HealthUtah PPO |
$57.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.72
|
| Rate for Payer: Multiplan Medicare/VA |
$36.01
|
| Rate for Payer: One Health Plan of WY PPO |
$56.29
|
| Rate for Payer: PacificSource Commercial |
$51.70
|
| Rate for Payer: PHCS PPO |
$56.29
|
| Rate for Payer: Three Rivers PPO |
$43.08
|
| Rate for Payer: TriWest Veterans Administration |
$37.91
|
| Rate for Payer: United Healthcare Commercial |
$49.97
|
| Rate for Payer: United Healthcare Medicare |
$37.91
|
| Rate for Payer: WINHealth Partners Commercial |
$54.57
|
| Rate for Payer: Wise Provider Network Commercial |
$54.57
|
|
