|
TICAGRELOR 90 MG TABLET [93051]
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
NDC 0186077739
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.67
|
| Rate for Payer: Aetna of WY Medicare |
$16.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.16
|
| Rate for Payer: Altius Commercial |
$24.16
|
| Rate for Payer: Beech Street Commercial |
$24.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.66
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.41
|
| Rate for Payer: Cigna of WY Commercial |
$24.67
|
| Rate for Payer: Entrust Commercial |
$23.91
|
| Rate for Payer: First Choice Health Commercial |
$23.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.60
|
| Rate for Payer: HealthUtah PPO |
$25.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.41
|
| Rate for Payer: Multiplan Medicare/VA |
$13.87
|
| Rate for Payer: One Health Plan of WY PPO |
$24.67
|
| Rate for Payer: PacificSource Commercial |
$22.65
|
| Rate for Payer: PHCS PPO |
$24.67
|
| Rate for Payer: Three Rivers PPO |
$18.88
|
| Rate for Payer: TriWest Veterans Administration |
$14.60
|
| Rate for Payer: United Healthcare Commercial |
$21.90
|
| Rate for Payer: United Healthcare Medicare |
$14.60
|
| Rate for Payer: WINHealth Partners Commercial |
$24.67
|
| Rate for Payer: Wise Provider Network Commercial |
$23.91
|
|
|
TIGERSTICK #2 TIGERWIRE 7209T
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.16 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.22
|
| Rate for Payer: Altius Commercial |
$196.22
|
| Rate for Payer: Beech Street Commercial |
$200.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$143.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.27
|
| Rate for Payer: Cigna of WY Commercial |
$200.31
|
| Rate for Payer: Entrust Commercial |
$194.18
|
| Rate for Payer: First Choice Health Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.90
|
| Rate for Payer: HealthUtah PPO |
$204.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.27
|
| Rate for Payer: Multiplan Medicare/VA |
$128.16
|
| Rate for Payer: One Health Plan of WY PPO |
$200.31
|
| Rate for Payer: PacificSource Commercial |
$183.96
|
| Rate for Payer: PHCS PPO |
$200.31
|
| Rate for Payer: Three Rivers PPO |
$153.30
|
| Rate for Payer: TriWest Veterans Administration |
$134.90
|
| Rate for Payer: United Healthcare Commercial |
$177.83
|
| Rate for Payer: United Healthcare Medicare |
$134.90
|
| Rate for Payer: WINHealth Partners Commercial |
$194.18
|
| Rate for Payer: Wise Provider Network Commercial |
$194.18
|
|
|
TIGERSTICK #2 TIGERWIRE 7209T
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.62 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.31
|
| Rate for Payer: Aetna of WY Medicare |
$134.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.22
|
| Rate for Payer: Altius Commercial |
$196.22
|
| Rate for Payer: Beech Street Commercial |
$200.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$143.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.27
|
| Rate for Payer: Cigna of WY Commercial |
$200.31
|
| Rate for Payer: Entrust Commercial |
$194.18
|
| Rate for Payer: First Choice Health Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.55
|
| Rate for Payer: HealthUtah PPO |
$204.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.27
|
| Rate for Payer: Multiplan Medicare/VA |
$112.62
|
| Rate for Payer: One Health Plan of WY PPO |
$200.31
|
| Rate for Payer: PacificSource Commercial |
$183.96
|
| Rate for Payer: PHCS PPO |
$200.31
|
| Rate for Payer: Three Rivers PPO |
$153.30
|
| Rate for Payer: TriWest Veterans Administration |
$118.55
|
| Rate for Payer: United Healthcare Commercial |
$177.83
|
| Rate for Payer: United Healthcare Medicare |
$118.55
|
| Rate for Payer: WINHealth Partners Commercial |
$200.31
|
| Rate for Payer: Wise Provider Network Commercial |
$194.18
|
|
|
TIGHTROPE ABS BUTTON OBLONG
|
Facility
|
IP
|
$703.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.09 |
| Max. Negotiated Rate |
$703.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$689.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$675.36
|
| Rate for Payer: Altius Commercial |
$675.36
|
| Rate for Payer: Beech Street Commercial |
$689.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.57
|
| Rate for Payer: Cash Price |
$492.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$682.40
|
| Rate for Payer: Cigna of WY Commercial |
$689.43
|
| Rate for Payer: Entrust Commercial |
$668.32
|
| Rate for Payer: First Choice Health Commercial |
$668.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$668.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$464.31
|
| Rate for Payer: HealthUtah PPO |
$703.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$682.40
|
| Rate for Payer: Multiplan Medicare/VA |
$441.09
|
| Rate for Payer: One Health Plan of WY PPO |
$689.43
|
| Rate for Payer: PacificSource Commercial |
$633.15
|
| Rate for Payer: PHCS PPO |
$689.43
|
| Rate for Payer: Three Rivers PPO |
$527.62
|
| Rate for Payer: TriWest Veterans Administration |
$464.31
|
| Rate for Payer: United Healthcare Commercial |
$612.04
|
| Rate for Payer: United Healthcare Medicare |
$464.31
|
| Rate for Payer: WINHealth Partners Commercial |
$668.32
|
| Rate for Payer: Wise Provider Network Commercial |
$668.32
|
|
|
TIGHTROPE ABS BUTTON OBLONG
|
Facility
|
OP
|
$703.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.63 |
| Max. Negotiated Rate |
$703.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$689.43
|
| Rate for Payer: Aetna of WY Medicare |
$464.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$675.36
|
| Rate for Payer: Altius Commercial |
$675.36
|
| Rate for Payer: Beech Street Commercial |
$689.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.57
|
| Rate for Payer: Cash Price |
$492.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$682.40
|
| Rate for Payer: Cigna of WY Commercial |
$689.43
|
| Rate for Payer: Entrust Commercial |
$668.32
|
| Rate for Payer: First Choice Health Commercial |
$668.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$668.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.03
|
| Rate for Payer: HealthUtah PPO |
$703.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$682.40
|
| Rate for Payer: Multiplan Medicare/VA |
$387.63
|
| Rate for Payer: One Health Plan of WY PPO |
$689.43
|
| Rate for Payer: PacificSource Commercial |
$633.15
|
| Rate for Payer: PHCS PPO |
$689.43
|
| Rate for Payer: Three Rivers PPO |
$527.62
|
| Rate for Payer: TriWest Veterans Administration |
$408.03
|
| Rate for Payer: United Healthcare Commercial |
$612.04
|
| Rate for Payer: United Healthcare Medicare |
$408.03
|
| Rate for Payer: WINHealth Partners Commercial |
$689.43
|
| Rate for Payer: Wise Provider Network Commercial |
$668.32
|
|
|
TIGHTROPE ABS BUTTON ROUND
|
Facility
|
IP
|
$874.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.51 |
| Max. Negotiated Rate |
$874.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$839.83
|
| Rate for Payer: Altius Commercial |
$839.83
|
| Rate for Payer: Beech Street Commercial |
$857.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.23
|
| Rate for Payer: Cash Price |
$612.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.58
|
| Rate for Payer: Cigna of WY Commercial |
$857.32
|
| Rate for Payer: Entrust Commercial |
$831.08
|
| Rate for Payer: First Choice Health Commercial |
$831.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.38
|
| Rate for Payer: HealthUtah PPO |
$874.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.58
|
| Rate for Payer: Multiplan Medicare/VA |
$548.51
|
| Rate for Payer: One Health Plan of WY PPO |
$857.32
|
| Rate for Payer: PacificSource Commercial |
$787.34
|
| Rate for Payer: PHCS PPO |
$857.32
|
| Rate for Payer: Three Rivers PPO |
$656.12
|
| Rate for Payer: TriWest Veterans Administration |
$577.38
|
| Rate for Payer: United Healthcare Commercial |
$761.09
|
| Rate for Payer: United Healthcare Medicare |
$577.38
|
| Rate for Payer: WINHealth Partners Commercial |
$831.08
|
| Rate for Payer: Wise Provider Network Commercial |
$831.08
|
|
|
TIGHTROPE ABS BUTTON ROUND
|
Facility
|
OP
|
$874.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.03 |
| Max. Negotiated Rate |
$874.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.32
|
| Rate for Payer: Aetna of WY Medicare |
$577.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$839.83
|
| Rate for Payer: Altius Commercial |
$839.83
|
| Rate for Payer: Beech Street Commercial |
$857.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.23
|
| Rate for Payer: Cash Price |
$612.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.58
|
| Rate for Payer: Cigna of WY Commercial |
$857.32
|
| Rate for Payer: Entrust Commercial |
$831.08
|
| Rate for Payer: First Choice Health Commercial |
$831.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.40
|
| Rate for Payer: HealthUtah PPO |
$874.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.58
|
| Rate for Payer: Multiplan Medicare/VA |
$482.03
|
| Rate for Payer: One Health Plan of WY PPO |
$857.32
|
| Rate for Payer: PacificSource Commercial |
$787.34
|
| Rate for Payer: PHCS PPO |
$857.32
|
| Rate for Payer: Three Rivers PPO |
$656.12
|
| Rate for Payer: TriWest Veterans Administration |
$507.40
|
| Rate for Payer: United Healthcare Commercial |
$761.09
|
| Rate for Payer: United Healthcare Medicare |
$507.40
|
| Rate for Payer: WINHealth Partners Commercial |
$857.32
|
| Rate for Payer: Wise Provider Network Commercial |
$831.08
|
|
|
TIGHTROPE ABS IMPLANT UHMWPE
|
Facility
|
IP
|
$644.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.79 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$618.24
|
| Rate for Payer: Altius Commercial |
$618.24
|
| Rate for Payer: Beech Street Commercial |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$528.72
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: Entrust Commercial |
$611.80
|
| Rate for Payer: First Choice Health Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.04
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$403.79
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$631.12
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$425.04
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$425.04
|
| Rate for Payer: WINHealth Partners Commercial |
$611.80
|
| Rate for Payer: Wise Provider Network Commercial |
$611.80
|
|
|
TIGHTROPE ABS IMPLANT UHMWPE
|
Facility
|
OP
|
$644.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.84 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$631.12
|
| Rate for Payer: Aetna of WY Medicare |
$425.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$618.24
|
| Rate for Payer: Altius Commercial |
$618.24
|
| Rate for Payer: Beech Street Commercial |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$528.72
|
| Rate for Payer: Cash Price |
$450.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$624.68
|
| Rate for Payer: Cigna of WY Commercial |
$631.12
|
| Rate for Payer: Entrust Commercial |
$611.80
|
| Rate for Payer: First Choice Health Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$611.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$373.52
|
| Rate for Payer: HealthUtah PPO |
$644.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$624.68
|
| Rate for Payer: Multiplan Medicare/VA |
$354.84
|
| Rate for Payer: One Health Plan of WY PPO |
$631.12
|
| Rate for Payer: PacificSource Commercial |
$579.60
|
| Rate for Payer: PHCS PPO |
$631.12
|
| Rate for Payer: Three Rivers PPO |
$483.00
|
| Rate for Payer: TriWest Veterans Administration |
$373.52
|
| Rate for Payer: United Healthcare Commercial |
$560.28
|
| Rate for Payer: United Healthcare Medicare |
$373.52
|
| Rate for Payer: WINHealth Partners Commercial |
$631.12
|
| Rate for Payer: Wise Provider Network Commercial |
$611.80
|
|
|
TIGHTROPE ABS OPEN AR-1588TN-1
|
Facility
|
IP
|
$679.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.73 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$665.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$651.84
|
| Rate for Payer: Altius Commercial |
$651.84
|
| Rate for Payer: Beech Street Commercial |
$665.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$557.46
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$658.63
|
| Rate for Payer: Cigna of WY Commercial |
$665.42
|
| Rate for Payer: Entrust Commercial |
$645.05
|
| Rate for Payer: First Choice Health Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.14
|
| Rate for Payer: HealthUtah PPO |
$679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$658.63
|
| Rate for Payer: Multiplan Medicare/VA |
$425.73
|
| Rate for Payer: One Health Plan of WY PPO |
$665.42
|
| Rate for Payer: PacificSource Commercial |
$611.10
|
| Rate for Payer: PHCS PPO |
$665.42
|
| Rate for Payer: Three Rivers PPO |
$509.25
|
| Rate for Payer: TriWest Veterans Administration |
$448.14
|
| Rate for Payer: United Healthcare Commercial |
$590.73
|
| Rate for Payer: United Healthcare Medicare |
$448.14
|
| Rate for Payer: WINHealth Partners Commercial |
$645.05
|
| Rate for Payer: Wise Provider Network Commercial |
$645.05
|
|
|
TIGHTROPE ABS OPEN AR-1588TN-1
|
Facility
|
OP
|
$679.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.13 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$665.42
|
| Rate for Payer: Aetna of WY Medicare |
$448.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$651.84
|
| Rate for Payer: Altius Commercial |
$651.84
|
| Rate for Payer: Beech Street Commercial |
$665.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$557.46
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$658.63
|
| Rate for Payer: Cigna of WY Commercial |
$665.42
|
| Rate for Payer: Entrust Commercial |
$645.05
|
| Rate for Payer: First Choice Health Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$393.82
|
| Rate for Payer: HealthUtah PPO |
$679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$658.63
|
| Rate for Payer: Multiplan Medicare/VA |
$374.13
|
| Rate for Payer: One Health Plan of WY PPO |
$665.42
|
| Rate for Payer: PacificSource Commercial |
$611.10
|
| Rate for Payer: PHCS PPO |
$665.42
|
| Rate for Payer: Three Rivers PPO |
$509.25
|
| Rate for Payer: TriWest Veterans Administration |
$393.82
|
| Rate for Payer: United Healthcare Commercial |
$590.73
|
| Rate for Payer: United Healthcare Medicare |
$393.82
|
| Rate for Payer: WINHealth Partners Commercial |
$665.42
|
| Rate for Payer: Wise Provider Network Commercial |
$645.05
|
|
|
TIGHTROPE BUTTON EXTEND 1589RT
|
Facility
|
OP
|
$919.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.81 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Aetna of WY Medicare |
$607.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.48
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$506.81
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$533.48
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$533.48
|
| Rate for Payer: WINHealth Partners Commercial |
$901.40
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
TIGHTROPE BUTTON EXTEND 1589RT
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.07
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$576.71
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$607.07
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$607.07
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
|
TIGHTROPE CMC MINI KIT 1.1MM
|
Facility
|
IP
|
$1,396.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.61 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,368.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,340.64
|
| Rate for Payer: Altius Commercial |
$1,340.64
|
| Rate for Payer: Beech Street Commercial |
$1,368.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,146.53
|
| Rate for Payer: Cash Price |
$977.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,354.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,368.57
|
| Rate for Payer: Entrust Commercial |
$1,326.68
|
| Rate for Payer: First Choice Health Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$921.69
|
| Rate for Payer: HealthUtah PPO |
$1,396.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,354.60
|
| Rate for Payer: Multiplan Medicare/VA |
$875.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,368.57
|
| Rate for Payer: PacificSource Commercial |
$1,256.85
|
| Rate for Payer: PHCS PPO |
$1,368.57
|
| Rate for Payer: Three Rivers PPO |
$1,047.38
|
| Rate for Payer: TriWest Veterans Administration |
$921.69
|
| Rate for Payer: United Healthcare Commercial |
$1,214.96
|
| Rate for Payer: United Healthcare Medicare |
$921.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1,326.68
|
|
|
TIGHTROPE CMC MINI KIT 1.1MM
|
Facility
|
OP
|
$1,396.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.47 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,368.57
|
| Rate for Payer: Aetna of WY Medicare |
$921.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,340.64
|
| Rate for Payer: Altius Commercial |
$1,340.64
|
| Rate for Payer: Beech Street Commercial |
$1,368.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,146.53
|
| Rate for Payer: Cash Price |
$977.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,354.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,368.57
|
| Rate for Payer: Entrust Commercial |
$1,326.68
|
| Rate for Payer: First Choice Health Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,326.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$809.97
|
| Rate for Payer: HealthUtah PPO |
$1,396.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,354.60
|
| Rate for Payer: Multiplan Medicare/VA |
$769.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,368.57
|
| Rate for Payer: PacificSource Commercial |
$1,256.85
|
| Rate for Payer: PHCS PPO |
$1,368.57
|
| Rate for Payer: Three Rivers PPO |
$1,047.38
|
| Rate for Payer: TriWest Veterans Administration |
$809.97
|
| Rate for Payer: United Healthcare Commercial |
$1,214.96
|
| Rate for Payer: United Healthcare Medicare |
$809.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,368.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1,326.68
|
|
|
TIGHTROPE SYNDESMOSIS XP 8925T
|
Facility
|
OP
|
$6,111.56
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.47 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Aetna of WY Medicare |
$4,033.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,867.10
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,017.59
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,544.70
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,367.47
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: TriWest Veterans Administration |
$3,544.70
|
| Rate for Payer: United Healthcare Commercial |
$5,317.06
|
| Rate for Payer: United Healthcare Medicare |
$3,544.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,989.33
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
TIGHTROPE SYNDESMOSIS XP 8925T
|
Facility
|
IP
|
$6,111.56
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,831.95 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,867.10
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,017.59
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,033.63
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,831.95
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: TriWest Veterans Administration |
$4,033.63
|
| Rate for Payer: United Healthcare Commercial |
$5,317.06
|
| Rate for Payer: United Healthcare Medicare |
$4,033.63
|
| Rate for Payer: WINHealth Partners Commercial |
$5,805.98
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 6131422705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.57
|
| Rate for Payer: Aetna of WY Medicare |
$5.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.41
|
| Rate for Payer: Altius Commercial |
$7.41
|
| Rate for Payer: Beech Street Commercial |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.34
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.49
|
| Rate for Payer: Cigna of WY Commercial |
$7.57
|
| Rate for Payer: Entrust Commercial |
$7.33
|
| Rate for Payer: First Choice Health Commercial |
$7.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.48
|
| Rate for Payer: HealthUtah PPO |
$7.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.49
|
| Rate for Payer: Multiplan Medicare/VA |
$4.25
|
| Rate for Payer: One Health Plan of WY PPO |
$7.57
|
| Rate for Payer: PacificSource Commercial |
$6.95
|
| Rate for Payer: PHCS PPO |
$7.57
|
| Rate for Payer: Three Rivers PPO |
$5.79
|
| Rate for Payer: TriWest Veterans Administration |
$4.48
|
| Rate for Payer: United Healthcare Commercial |
$6.72
|
| Rate for Payer: United Healthcare Medicare |
$4.48
|
| Rate for Payer: WINHealth Partners Commercial |
$7.57
|
| Rate for Payer: Wise Provider Network Commercial |
$7.33
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 6075880105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.20
|
| Rate for Payer: Altius Commercial |
$4.20
|
| Rate for Payer: Beech Street Commercial |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.25
|
| Rate for Payer: Cigna of WY Commercial |
$4.29
|
| Rate for Payer: Entrust Commercial |
$4.16
|
| Rate for Payer: First Choice Health Commercial |
$4.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.89
|
| Rate for Payer: HealthUtah PPO |
$4.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2.75
|
| Rate for Payer: One Health Plan of WY PPO |
$4.29
|
| Rate for Payer: PacificSource Commercial |
$3.94
|
| Rate for Payer: PHCS PPO |
$4.29
|
| Rate for Payer: Three Rivers PPO |
$3.28
|
| Rate for Payer: TriWest Veterans Administration |
$2.89
|
| Rate for Payer: United Healthcare Commercial |
$3.81
|
| Rate for Payer: United Healthcare Medicare |
$2.89
|
| Rate for Payer: WINHealth Partners Commercial |
$4.16
|
| Rate for Payer: Wise Provider Network Commercial |
$4.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 6075880105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.29
|
| Rate for Payer: Aetna of WY Medicare |
$2.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.20
|
| Rate for Payer: Altius Commercial |
$4.20
|
| Rate for Payer: Beech Street Commercial |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.25
|
| Rate for Payer: Cigna of WY Commercial |
$4.29
|
| Rate for Payer: Entrust Commercial |
$4.16
|
| Rate for Payer: First Choice Health Commercial |
$4.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.54
|
| Rate for Payer: HealthUtah PPO |
$4.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2.41
|
| Rate for Payer: One Health Plan of WY PPO |
$4.29
|
| Rate for Payer: PacificSource Commercial |
$3.94
|
| Rate for Payer: PHCS PPO |
$4.29
|
| Rate for Payer: Three Rivers PPO |
$3.28
|
| Rate for Payer: TriWest Veterans Administration |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$3.81
|
| Rate for Payer: United Healthcare Medicare |
$2.54
|
| Rate for Payer: WINHealth Partners Commercial |
$4.29
|
| Rate for Payer: Wise Provider Network Commercial |
$4.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
NDC 6131422705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.41
|
| Rate for Payer: Altius Commercial |
$7.41
|
| Rate for Payer: Beech Street Commercial |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.34
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.49
|
| Rate for Payer: Cigna of WY Commercial |
$7.57
|
| Rate for Payer: Entrust Commercial |
$7.33
|
| Rate for Payer: First Choice Health Commercial |
$7.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.10
|
| Rate for Payer: HealthUtah PPO |
$7.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.49
|
| Rate for Payer: Multiplan Medicare/VA |
$4.84
|
| Rate for Payer: One Health Plan of WY PPO |
$7.57
|
| Rate for Payer: PacificSource Commercial |
$6.95
|
| Rate for Payer: PHCS PPO |
$7.57
|
| Rate for Payer: Three Rivers PPO |
$5.79
|
| Rate for Payer: TriWest Veterans Administration |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$6.72
|
| Rate for Payer: United Healthcare Medicare |
$5.10
|
| Rate for Payer: WINHealth Partners Commercial |
$7.33
|
| Rate for Payer: Wise Provider Network Commercial |
$7.33
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
NDC 6498051405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.45
|
| Rate for Payer: Altius Commercial |
$7.45
|
| Rate for Payer: Beech Street Commercial |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.53
|
| Rate for Payer: Cigna of WY Commercial |
$7.60
|
| Rate for Payer: Entrust Commercial |
$7.37
|
| Rate for Payer: First Choice Health Commercial |
$7.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.12
|
| Rate for Payer: HealthUtah PPO |
$7.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.53
|
| Rate for Payer: Multiplan Medicare/VA |
$4.87
|
| Rate for Payer: One Health Plan of WY PPO |
$7.60
|
| Rate for Payer: PacificSource Commercial |
$6.98
|
| Rate for Payer: PHCS PPO |
$7.60
|
| Rate for Payer: Three Rivers PPO |
$5.82
|
| Rate for Payer: TriWest Veterans Administration |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$6.75
|
| Rate for Payer: United Healthcare Medicare |
$5.12
|
| Rate for Payer: WINHealth Partners Commercial |
$7.37
|
| Rate for Payer: Wise Provider Network Commercial |
$7.37
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS [17947]
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
NDC 6498051405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.60
|
| Rate for Payer: Aetna of WY Medicare |
$5.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.45
|
| Rate for Payer: Altius Commercial |
$7.45
|
| Rate for Payer: Beech Street Commercial |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.53
|
| Rate for Payer: Cigna of WY Commercial |
$7.60
|
| Rate for Payer: Entrust Commercial |
$7.37
|
| Rate for Payer: First Choice Health Commercial |
$7.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.50
|
| Rate for Payer: HealthUtah PPO |
$7.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.53
|
| Rate for Payer: Multiplan Medicare/VA |
$4.28
|
| Rate for Payer: One Health Plan of WY PPO |
$7.60
|
| Rate for Payer: PacificSource Commercial |
$6.98
|
| Rate for Payer: PHCS PPO |
$7.60
|
| Rate for Payer: Three Rivers PPO |
$5.82
|
| Rate for Payer: TriWest Veterans Administration |
$4.50
|
| Rate for Payer: United Healthcare Commercial |
$6.75
|
| Rate for Payer: United Healthcare Medicare |
$4.50
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.37
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
IP
|
$33.28
|
|
|
Service Code
|
NDC 0597007541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.95
|
| Rate for Payer: Altius Commercial |
$31.95
|
| Rate for Payer: Beech Street Commercial |
$32.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.28
|
| Rate for Payer: Cigna of WY Commercial |
$32.61
|
| Rate for Payer: Entrust Commercial |
$31.62
|
| Rate for Payer: First Choice Health Commercial |
$31.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.96
|
| Rate for Payer: HealthUtah PPO |
$33.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.28
|
| Rate for Payer: Multiplan Medicare/VA |
$20.87
|
| Rate for Payer: One Health Plan of WY PPO |
$32.61
|
| Rate for Payer: PacificSource Commercial |
$29.95
|
| Rate for Payer: PHCS PPO |
$32.61
|
| Rate for Payer: Three Rivers PPO |
$24.96
|
| Rate for Payer: TriWest Veterans Administration |
$21.96
|
| Rate for Payer: United Healthcare Commercial |
$28.95
|
| Rate for Payer: United Healthcare Medicare |
$21.96
|
| Rate for Payer: WINHealth Partners Commercial |
$31.62
|
| Rate for Payer: Wise Provider Network Commercial |
$31.62
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
OP
|
$33.28
|
|
|
Service Code
|
NDC 0597007541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.61
|
| Rate for Payer: Aetna of WY Medicare |
$21.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.95
|
| Rate for Payer: Altius Commercial |
$31.95
|
| Rate for Payer: Beech Street Commercial |
$32.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.28
|
| Rate for Payer: Cigna of WY Commercial |
$32.61
|
| Rate for Payer: Entrust Commercial |
$31.62
|
| Rate for Payer: First Choice Health Commercial |
$31.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.30
|
| Rate for Payer: HealthUtah PPO |
$33.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.28
|
| Rate for Payer: Multiplan Medicare/VA |
$18.34
|
| Rate for Payer: One Health Plan of WY PPO |
$32.61
|
| Rate for Payer: PacificSource Commercial |
$29.95
|
| Rate for Payer: PHCS PPO |
$32.61
|
| Rate for Payer: Three Rivers PPO |
$24.96
|
| Rate for Payer: TriWest Veterans Administration |
$19.30
|
| Rate for Payer: United Healthcare Commercial |
$28.95
|
| Rate for Payer: United Healthcare Medicare |
$19.30
|
| Rate for Payer: WINHealth Partners Commercial |
$32.61
|
| Rate for Payer: Wise Provider Network Commercial |
$31.62
|
|
