|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [152624]
|
Facility
|
IP
|
$57.43
|
|
|
Service Code
|
NDC 0310111039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$57.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.28
|
| 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 |
$37.90
|
| Rate for Payer: HealthUtah PPO |
$57.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.71
|
| Rate for Payer: Multiplan Medicare/VA |
$36.01
|
| 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 |
$37.90
|
| Rate for Payer: United Healthcare Commercial |
$49.96
|
| Rate for Payer: United Healthcare Medicare |
$37.90
|
| Rate for Payer: WINHealth Partners Commercial |
$54.56
|
| Rate for Payer: Wise Provider Network Commercial |
$54.56
|
|
|
SOFTSHELLS SORE NIPPLES 80210S
|
Facility
|
IP
|
$30.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$30.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.64
|
| Rate for Payer: Altius Commercial |
$29.64
|
| Rate for Payer: Beech Street Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.95
|
| Rate for Payer: Cigna of WY Commercial |
$30.26
|
| Rate for Payer: Entrust Commercial |
$29.34
|
| Rate for Payer: First Choice Health Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.38
|
| Rate for Payer: HealthUtah PPO |
$30.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.26
|
| Rate for Payer: PacificSource Commercial |
$27.79
|
| Rate for Payer: PHCS PPO |
$30.26
|
| Rate for Payer: Three Rivers PPO |
$23.16
|
| Rate for Payer: TriWest Veterans Administration |
$20.38
|
| Rate for Payer: United Healthcare Commercial |
$26.87
|
| Rate for Payer: United Healthcare Medicare |
$20.38
|
| Rate for Payer: WINHealth Partners Commercial |
$29.34
|
| Rate for Payer: Wise Provider Network Commercial |
$29.34
|
|
|
SOFTSHELLS SORE NIPPLES 80210S
|
Facility
|
OP
|
$30.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$30.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.26
|
| Rate for Payer: Aetna of WY Medicare |
$20.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.64
|
| Rate for Payer: Altius Commercial |
$29.64
|
| Rate for Payer: Beech Street Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.95
|
| Rate for Payer: Cigna of WY Commercial |
$30.26
|
| Rate for Payer: Entrust Commercial |
$29.34
|
| Rate for Payer: First Choice Health Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.91
|
| Rate for Payer: HealthUtah PPO |
$30.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.95
|
| Rate for Payer: Multiplan Medicare/VA |
$17.01
|
| Rate for Payer: One Health Plan of WY PPO |
$30.26
|
| Rate for Payer: PacificSource Commercial |
$27.79
|
| Rate for Payer: PHCS PPO |
$30.26
|
| Rate for Payer: Three Rivers PPO |
$23.16
|
| Rate for Payer: TriWest Veterans Administration |
$17.91
|
| Rate for Payer: United Healthcare Commercial |
$26.87
|
| Rate for Payer: United Healthcare Medicare |
$17.91
|
| Rate for Payer: WINHealth Partners Commercial |
$30.26
|
| Rate for Payer: Wise Provider Network Commercial |
$29.34
|
|
|
SOLIFENACIN 5 MG TABLET [37402]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 6787752730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.57
|
| Rate for Payer: Aetna of WY Medicare |
$1.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.54
|
| Rate for Payer: Altius Commercial |
$1.54
|
| Rate for Payer: Beech Street Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.55
|
| Rate for Payer: Cigna of WY Commercial |
$1.57
|
| Rate for Payer: Entrust Commercial |
$1.52
|
| Rate for Payer: First Choice Health Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.93
|
| Rate for Payer: HealthUtah PPO |
$1.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.57
|
| Rate for Payer: PacificSource Commercial |
$1.44
|
| Rate for Payer: PHCS PPO |
$1.57
|
| Rate for Payer: Three Rivers PPO |
$1.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1.52
|
|
|
SOLIFENACIN 5 MG TABLET [37402]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 6787752730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.54
|
| Rate for Payer: Altius Commercial |
$1.54
|
| Rate for Payer: Beech Street Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.55
|
| Rate for Payer: Cigna of WY Commercial |
$1.57
|
| Rate for Payer: Entrust Commercial |
$1.52
|
| Rate for Payer: First Choice Health Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.57
|
| Rate for Payer: PacificSource Commercial |
$1.44
|
| Rate for Payer: PHCS PPO |
$1.57
|
| Rate for Payer: Three Rivers PPO |
$1.20
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.52
|
| Rate for Payer: Wise Provider Network Commercial |
$1.52
|
|
|
SOOTHIES COOLING GEL PADS
|
Facility
|
OP
|
$24.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.46
|
| Rate for Payer: Aetna of WY Medicare |
$16.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.96
|
| Rate for Payer: Altius Commercial |
$23.96
|
| Rate for Payer: Beech Street Commercial |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.49
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.21
|
| Rate for Payer: Cigna of WY Commercial |
$24.46
|
| Rate for Payer: Entrust Commercial |
$23.71
|
| Rate for Payer: First Choice Health Commercial |
$23.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.48
|
| Rate for Payer: HealthUtah PPO |
$24.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.21
|
| Rate for Payer: Multiplan Medicare/VA |
$13.75
|
| Rate for Payer: One Health Plan of WY PPO |
$24.46
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.46
|
| Rate for Payer: Three Rivers PPO |
$18.72
|
| Rate for Payer: TriWest Veterans Administration |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare |
$14.48
|
| Rate for Payer: WINHealth Partners Commercial |
$24.46
|
| Rate for Payer: Wise Provider Network Commercial |
$23.71
|
|
|
SOOTHIES COOLING GEL PADS
|
Facility
|
IP
|
$24.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.96
|
| Rate for Payer: Altius Commercial |
$23.96
|
| Rate for Payer: Beech Street Commercial |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.49
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.21
|
| Rate for Payer: Cigna of WY Commercial |
$24.46
|
| Rate for Payer: Entrust Commercial |
$23.71
|
| Rate for Payer: First Choice Health Commercial |
$23.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.47
|
| Rate for Payer: HealthUtah PPO |
$24.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.21
|
| Rate for Payer: Multiplan Medicare/VA |
$15.65
|
| Rate for Payer: One Health Plan of WY PPO |
$24.46
|
| Rate for Payer: PacificSource Commercial |
$22.46
|
| Rate for Payer: PHCS PPO |
$24.46
|
| Rate for Payer: Three Rivers PPO |
$18.72
|
| Rate for Payer: TriWest Veterans Administration |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare |
$16.47
|
| Rate for Payer: WINHealth Partners Commercial |
$23.71
|
| Rate for Payer: Wise Provider Network Commercial |
$23.71
|
|
|
SOTALOL 80 MG TABLET [3933]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6050500800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
SOTALOL 80 MG TABLET [3933]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 6050500800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Aetna of WY Medicare |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.35
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
SPECIMEN RETRIEVAL BAG 10MM
|
Facility
|
OP
|
$100.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$100.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.74
|
| Rate for Payer: Aetna of WY Medicare |
$66.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.73
|
| Rate for Payer: Altius Commercial |
$96.73
|
| Rate for Payer: Beech Street Commercial |
$98.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.72
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.74
|
| Rate for Payer: Cigna of WY Commercial |
$98.74
|
| Rate for Payer: Entrust Commercial |
$95.72
|
| Rate for Payer: First Choice Health Commercial |
$95.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.44
|
| Rate for Payer: HealthUtah PPO |
$100.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.74
|
| Rate for Payer: Multiplan Medicare/VA |
$55.52
|
| Rate for Payer: One Health Plan of WY PPO |
$98.74
|
| Rate for Payer: PacificSource Commercial |
$90.68
|
| Rate for Payer: PHCS PPO |
$98.74
|
| Rate for Payer: Three Rivers PPO |
$75.57
|
| Rate for Payer: TriWest Veterans Administration |
$58.44
|
| Rate for Payer: United Healthcare Commercial |
$87.66
|
| Rate for Payer: United Healthcare Medicare |
$58.44
|
| Rate for Payer: WINHealth Partners Commercial |
$98.74
|
| Rate for Payer: Wise Provider Network Commercial |
$95.72
|
|
|
SPECIMEN RETRIEVAL BAG 10MM
|
Facility
|
IP
|
$100.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$100.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.73
|
| Rate for Payer: Altius Commercial |
$96.73
|
| Rate for Payer: Beech Street Commercial |
$98.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.72
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.74
|
| Rate for Payer: Cigna of WY Commercial |
$98.74
|
| Rate for Payer: Entrust Commercial |
$95.72
|
| Rate for Payer: First Choice Health Commercial |
$95.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.50
|
| Rate for Payer: HealthUtah PPO |
$100.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.74
|
| Rate for Payer: Multiplan Medicare/VA |
$63.18
|
| Rate for Payer: One Health Plan of WY PPO |
$98.74
|
| Rate for Payer: PacificSource Commercial |
$90.68
|
| Rate for Payer: PHCS PPO |
$98.74
|
| Rate for Payer: Three Rivers PPO |
$75.57
|
| Rate for Payer: TriWest Veterans Administration |
$66.50
|
| Rate for Payer: United Healthcare Commercial |
$87.66
|
| Rate for Payer: United Healthcare Medicare |
$66.50
|
| Rate for Payer: WINHealth Partners Commercial |
$95.72
|
| Rate for Payer: Wise Provider Network Commercial |
$95.72
|
|
|
SPECIMEN RETRIEVAL BAG 7MM
|
Facility
|
OP
|
$118.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.59
|
| Rate for Payer: Aetna of WY Medicare |
$78.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.21
|
| Rate for Payer: Altius Commercial |
$114.21
|
| Rate for Payer: Beech Street Commercial |
$116.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.67
|
| Rate for Payer: Cash Price |
$83.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.40
|
| Rate for Payer: Cigna of WY Commercial |
$116.59
|
| Rate for Payer: Entrust Commercial |
$113.02
|
| Rate for Payer: First Choice Health Commercial |
$113.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.00
|
| Rate for Payer: HealthUtah PPO |
$118.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.40
|
| Rate for Payer: Multiplan Medicare/VA |
$65.55
|
| Rate for Payer: One Health Plan of WY PPO |
$116.59
|
| Rate for Payer: PacificSource Commercial |
$107.07
|
| Rate for Payer: PHCS PPO |
$116.59
|
| Rate for Payer: Three Rivers PPO |
$89.23
|
| Rate for Payer: TriWest Veterans Administration |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Medicare |
$69.00
|
| Rate for Payer: WINHealth Partners Commercial |
$116.59
|
| Rate for Payer: Wise Provider Network Commercial |
$113.02
|
|
|
SPECIMEN RETRIEVAL BAG 7MM
|
Facility
|
IP
|
$118.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.21
|
| Rate for Payer: Altius Commercial |
$114.21
|
| Rate for Payer: Beech Street Commercial |
$116.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.67
|
| Rate for Payer: Cash Price |
$83.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.40
|
| Rate for Payer: Cigna of WY Commercial |
$116.59
|
| Rate for Payer: Entrust Commercial |
$113.02
|
| Rate for Payer: First Choice Health Commercial |
$113.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.52
|
| Rate for Payer: HealthUtah PPO |
$118.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.40
|
| Rate for Payer: Multiplan Medicare/VA |
$74.59
|
| Rate for Payer: One Health Plan of WY PPO |
$116.59
|
| Rate for Payer: PacificSource Commercial |
$107.07
|
| Rate for Payer: PHCS PPO |
$116.59
|
| Rate for Payer: Three Rivers PPO |
$89.23
|
| Rate for Payer: TriWest Veterans Administration |
$78.52
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Medicare |
$78.52
|
| Rate for Payer: WINHealth Partners Commercial |
$113.02
|
| Rate for Payer: Wise Provider Network Commercial |
$113.02
|
|
|
SPEEDBRIDGE 4.75 SYS 2600SBS-6
|
Facility
|
IP
|
$5,596.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,509.01 |
| Max. Negotiated Rate |
$5,596.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,484.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,372.64
|
| Rate for Payer: Altius Commercial |
$5,372.64
|
| Rate for Payer: Beech Street Commercial |
$5,484.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,594.73
|
| Rate for Payer: Cash Price |
$3,917.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,428.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,484.57
|
| Rate for Payer: Entrust Commercial |
$5,316.68
|
| Rate for Payer: First Choice Health Commercial |
$5,316.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,316.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,693.69
|
| Rate for Payer: HealthUtah PPO |
$5,596.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,428.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,509.01
|
| Rate for Payer: One Health Plan of WY PPO |
$5,484.57
|
| Rate for Payer: PacificSource Commercial |
$5,036.85
|
| Rate for Payer: PHCS PPO |
$5,484.57
|
| Rate for Payer: Three Rivers PPO |
$4,197.38
|
| Rate for Payer: TriWest Veterans Administration |
$3,693.69
|
| Rate for Payer: United Healthcare Commercial |
$4,868.96
|
| Rate for Payer: United Healthcare Medicare |
$3,693.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,316.68
|
| Rate for Payer: Wise Provider Network Commercial |
$5,316.68
|
|
|
SPEEDBRIDGE 4.75 SYS 2600SBS-6
|
Facility
|
OP
|
$5,596.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.67 |
| Max. Negotiated Rate |
$5,596.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,484.57
|
| Rate for Payer: Aetna of WY Medicare |
$3,693.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,372.64
|
| Rate for Payer: Altius Commercial |
$5,372.64
|
| Rate for Payer: Beech Street Commercial |
$5,484.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,594.73
|
| Rate for Payer: Cash Price |
$3,917.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,428.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,484.57
|
| Rate for Payer: Entrust Commercial |
$5,316.68
|
| Rate for Payer: First Choice Health Commercial |
$5,316.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,316.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,245.97
|
| Rate for Payer: HealthUtah PPO |
$5,596.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,428.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3,083.67
|
| Rate for Payer: One Health Plan of WY PPO |
$5,484.57
|
| Rate for Payer: PacificSource Commercial |
$5,036.85
|
| Rate for Payer: PHCS PPO |
$5,484.57
|
| Rate for Payer: Three Rivers PPO |
$4,197.38
|
| Rate for Payer: TriWest Veterans Administration |
$3,245.97
|
| Rate for Payer: United Healthcare Commercial |
$4,868.96
|
| Rate for Payer: United Healthcare Medicare |
$3,245.97
|
| Rate for Payer: WINHealth Partners Commercial |
$5,484.57
|
| Rate for Payer: Wise Provider Network Commercial |
$5,316.68
|
|
|
SPERM WASHING ARTIFICIAL INSEMINATION
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 58323
|
| Hospital Charge Code |
58323
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$208.74
|
| Rate for Payer: Aetna of WY Medicare |
$11.45
|
| Rate for Payer: Beech Street Commercial |
$202.35
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$206.61
|
| Rate for Payer: Cigna of WY Commercial |
$208.74
|
| Rate for Payer: First Choice Health Commercial |
$191.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$202.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.45
|
| Rate for Payer: HealthUtah PPO |
$213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$206.61
|
| Rate for Payer: Multiplan Medicare/VA |
$9.73
|
| Rate for Payer: One Health Plan of WY PPO |
$208.74
|
| Rate for Payer: PacificSource Commercial |
$191.70
|
| Rate for Payer: PHCS PPO |
$202.35
|
| Rate for Payer: Three Rivers PPO |
$159.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$185.31
|
| Rate for Payer: United Healthcare Medicare |
$11.45
|
| Rate for Payer: WINHealth Partners Commercial |
$181.05
|
|
|
SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$7,047.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
46080
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$7,047.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,906.06
|
| Rate for Payer: Aetna of WY Medicare |
$151.35
|
| Rate for Payer: Beech Street Commercial |
$6,694.65
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,835.59
|
| Rate for Payer: Cigna of WY Commercial |
$6,906.06
|
| Rate for Payer: First Choice Health Commercial |
$6,342.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,694.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.35
|
| Rate for Payer: HealthUtah PPO |
$7,047.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,835.59
|
| Rate for Payer: Multiplan Medicare/VA |
$128.65
|
| Rate for Payer: One Health Plan of WY PPO |
$6,906.06
|
| Rate for Payer: PacificSource Commercial |
$6,342.30
|
| Rate for Payer: PHCS PPO |
$6,694.65
|
| Rate for Payer: Three Rivers PPO |
$5,285.25
|
| Rate for Payer: TriWest Veterans Administration |
$151.35
|
| Rate for Payer: United Healthcare Commercial |
$6,130.89
|
| Rate for Payer: United Healthcare Medicare |
$151.35
|
| Rate for Payer: WINHealth Partners Commercial |
$5,989.95
|
|
|
SPIKE BAG IRRIG 82" V4608-20
|
Facility
|
IP
|
$14.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.30
|
| Rate for Payer: Altius Commercial |
$14.30
|
| Rate for Payer: Beech Street Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.45
|
| Rate for Payer: Cigna of WY Commercial |
$14.60
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.83
|
| Rate for Payer: HealthUtah PPO |
$14.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.45
|
| Rate for Payer: Multiplan Medicare/VA |
$9.34
|
| Rate for Payer: One Health Plan of WY PPO |
$14.60
|
| Rate for Payer: PacificSource Commercial |
$13.41
|
| Rate for Payer: PHCS PPO |
$14.60
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
| Rate for Payer: United Healthcare Medicare |
$9.83
|
| Rate for Payer: WINHealth Partners Commercial |
$14.16
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SPIKE BAG IRRIG 82" V4608-20
|
Facility
|
OP
|
$14.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.60
|
| Rate for Payer: Aetna of WY Medicare |
$9.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.30
|
| Rate for Payer: Altius Commercial |
$14.30
|
| Rate for Payer: Beech Street Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.45
|
| Rate for Payer: Cigna of WY Commercial |
$14.60
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$14.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.45
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$14.60
|
| Rate for Payer: PacificSource Commercial |
$13.41
|
| Rate for Payer: PHCS PPO |
$14.60
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.60
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SPIKE BOTTLE IRRIG SET 313005
|
Facility
|
IP
|
$14.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.30
|
| Rate for Payer: Altius Commercial |
$14.30
|
| Rate for Payer: Beech Street Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.45
|
| Rate for Payer: Cigna of WY Commercial |
$14.60
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.83
|
| Rate for Payer: HealthUtah PPO |
$14.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.45
|
| Rate for Payer: Multiplan Medicare/VA |
$9.34
|
| Rate for Payer: One Health Plan of WY PPO |
$14.60
|
| Rate for Payer: PacificSource Commercial |
$13.41
|
| Rate for Payer: PHCS PPO |
$14.60
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
| Rate for Payer: United Healthcare Medicare |
$9.83
|
| Rate for Payer: WINHealth Partners Commercial |
$14.16
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SPIKE BOTTLE IRRIG SET 313005
|
Facility
|
OP
|
$14.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.60
|
| Rate for Payer: Aetna of WY Medicare |
$9.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.30
|
| Rate for Payer: Altius Commercial |
$14.30
|
| Rate for Payer: Beech Street Commercial |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$10.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.45
|
| Rate for Payer: Cigna of WY Commercial |
$14.60
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$14.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.45
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$14.60
|
| Rate for Payer: PacificSource Commercial |
$13.41
|
| Rate for Payer: PHCS PPO |
$14.60
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.60
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SPINAL PENCAN DRUG TRAY
|
Facility
|
IP
|
$45.75
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.92
|
| Rate for Payer: Altius Commercial |
$43.92
|
| Rate for Payer: Beech Street Commercial |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.56
|
| Rate for Payer: Cash Price |
$32.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.38
|
| Rate for Payer: Cigna of WY Commercial |
$44.84
|
| Rate for Payer: Entrust Commercial |
$43.46
|
| Rate for Payer: First Choice Health Commercial |
$43.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.20
|
| Rate for Payer: HealthUtah PPO |
$45.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.38
|
| Rate for Payer: Multiplan Medicare/VA |
$28.69
|
| Rate for Payer: One Health Plan of WY PPO |
$44.84
|
| Rate for Payer: PacificSource Commercial |
$41.18
|
| Rate for Payer: PHCS PPO |
$44.84
|
| Rate for Payer: Three Rivers PPO |
$34.31
|
| Rate for Payer: TriWest Veterans Administration |
$30.20
|
| Rate for Payer: United Healthcare Commercial |
$39.80
|
| Rate for Payer: United Healthcare Medicare |
$30.20
|
| Rate for Payer: WINHealth Partners Commercial |
$43.46
|
| Rate for Payer: Wise Provider Network Commercial |
$43.46
|
|
|
SPINAL PENCAN DRUG TRAY
|
Facility
|
OP
|
$45.75
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.84
|
| Rate for Payer: Aetna of WY Medicare |
$30.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.92
|
| Rate for Payer: Altius Commercial |
$43.92
|
| Rate for Payer: Beech Street Commercial |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.56
|
| Rate for Payer: Cash Price |
$32.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.38
|
| Rate for Payer: Cigna of WY Commercial |
$44.84
|
| Rate for Payer: Entrust Commercial |
$43.46
|
| Rate for Payer: First Choice Health Commercial |
$43.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.54
|
| Rate for Payer: HealthUtah PPO |
$45.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.38
|
| Rate for Payer: Multiplan Medicare/VA |
$25.21
|
| Rate for Payer: One Health Plan of WY PPO |
$44.84
|
| Rate for Payer: PacificSource Commercial |
$41.18
|
| Rate for Payer: PHCS PPO |
$44.84
|
| Rate for Payer: Three Rivers PPO |
$34.31
|
| Rate for Payer: TriWest Veterans Administration |
$26.54
|
| Rate for Payer: United Healthcare Commercial |
$39.80
|
| Rate for Payer: United Healthcare Medicare |
$26.54
|
| Rate for Payer: WINHealth Partners Commercial |
$44.84
|
| Rate for Payer: Wise Provider Network Commercial |
$43.46
|
|
|
SPIRONOLACTONE 25 MG TABLET [8082]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 6068746511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.74
|
| Rate for Payer: Aetna of WY Medicare |
$0.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.73
|
| Rate for Payer: Altius Commercial |
$0.73
|
| Rate for Payer: Beech Street Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.74
|
| Rate for Payer: Cigna of WY Commercial |
$0.74
|
| Rate for Payer: Entrust Commercial |
$0.72
|
| Rate for Payer: First Choice Health Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.44
|
| Rate for Payer: HealthUtah PPO |
$0.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.74
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.74
|
| Rate for Payer: PacificSource Commercial |
$0.68
|
| Rate for Payer: PHCS PPO |
$0.74
|
| Rate for Payer: Three Rivers PPO |
$0.57
|
| Rate for Payer: TriWest Veterans Administration |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
| Rate for Payer: WINHealth Partners Commercial |
$0.74
|
| Rate for Payer: Wise Provider Network Commercial |
$0.72
|
|
|
SPIRONOLACTONE 25 MG TABLET [8082]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 6068746501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.73
|
| Rate for Payer: Altius Commercial |
$0.73
|
| Rate for Payer: Beech Street Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.74
|
| Rate for Payer: Cigna of WY Commercial |
$0.74
|
| Rate for Payer: Entrust Commercial |
$0.72
|
| Rate for Payer: First Choice Health Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.50
|
| Rate for Payer: HealthUtah PPO |
$0.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.74
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.74
|
| Rate for Payer: PacificSource Commercial |
$0.68
|
| Rate for Payer: PHCS PPO |
$0.74
|
| Rate for Payer: Three Rivers PPO |
$0.57
|
| Rate for Payer: TriWest Veterans Administration |
$0.50
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.50
|
| Rate for Payer: WINHealth Partners Commercial |
$0.72
|
| Rate for Payer: Wise Provider Network Commercial |
$0.72
|
|
