|
TOURNIQUET FINGER/TOE XL
|
Facility
|
OP
|
$11.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.60
|
| Rate for Payer: Aetna of WY Medicare |
$7.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.37
|
| Rate for Payer: Altius Commercial |
$11.37
|
| Rate for Payer: Beech Street Commercial |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.72
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.48
|
| Rate for Payer: Cigna of WY Commercial |
$11.60
|
| Rate for Payer: Entrust Commercial |
$11.25
|
| Rate for Payer: First Choice Health Commercial |
$11.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.87
|
| Rate for Payer: HealthUtah PPO |
$11.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.48
|
| Rate for Payer: Multiplan Medicare/VA |
$6.52
|
| Rate for Payer: One Health Plan of WY PPO |
$11.60
|
| Rate for Payer: PacificSource Commercial |
$10.66
|
| Rate for Payer: PHCS PPO |
$11.60
|
| Rate for Payer: Three Rivers PPO |
$8.88
|
| Rate for Payer: TriWest Veterans Administration |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$10.30
|
| Rate for Payer: United Healthcare Medicare |
$6.87
|
| Rate for Payer: WINHealth Partners Commercial |
$11.60
|
| Rate for Payer: Wise Provider Network Commercial |
$11.25
|
|
|
TOURNIQUET UNI-COT UNIVERSAL
|
Facility
|
OP
|
$20.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.64
|
| Rate for Payer: Aetna of WY Medicare |
$13.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.24
|
| Rate for Payer: Altius Commercial |
$19.24
|
| Rate for Payer: Beech Street Commercial |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.44
|
| Rate for Payer: Cigna of WY Commercial |
$19.64
|
| Rate for Payer: Entrust Commercial |
$19.04
|
| Rate for Payer: First Choice Health Commercial |
$19.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.62
|
| Rate for Payer: HealthUtah PPO |
$20.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.44
|
| Rate for Payer: Multiplan Medicare/VA |
$11.04
|
| Rate for Payer: One Health Plan of WY PPO |
$19.64
|
| Rate for Payer: PacificSource Commercial |
$18.04
|
| Rate for Payer: PHCS PPO |
$19.64
|
| Rate for Payer: Three Rivers PPO |
$15.03
|
| Rate for Payer: TriWest Veterans Administration |
$11.62
|
| Rate for Payer: United Healthcare Commercial |
$17.43
|
| Rate for Payer: United Healthcare Medicare |
$11.62
|
| Rate for Payer: WINHealth Partners Commercial |
$19.64
|
| Rate for Payer: Wise Provider Network Commercial |
$19.04
|
|
|
TOURNIQUET UNI-COT UNIVERSAL
|
Facility
|
IP
|
$20.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.24
|
| Rate for Payer: Altius Commercial |
$19.24
|
| Rate for Payer: Beech Street Commercial |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.44
|
| Rate for Payer: Cigna of WY Commercial |
$19.64
|
| Rate for Payer: Entrust Commercial |
$19.04
|
| Rate for Payer: First Choice Health Commercial |
$19.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.23
|
| Rate for Payer: HealthUtah PPO |
$20.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.44
|
| Rate for Payer: Multiplan Medicare/VA |
$12.57
|
| Rate for Payer: One Health Plan of WY PPO |
$19.64
|
| Rate for Payer: PacificSource Commercial |
$18.04
|
| Rate for Payer: PHCS PPO |
$19.64
|
| Rate for Payer: Three Rivers PPO |
$15.03
|
| Rate for Payer: TriWest Veterans Administration |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$17.43
|
| Rate for Payer: United Healthcare Medicare |
$13.23
|
| Rate for Payer: WINHealth Partners Commercial |
$19.04
|
| Rate for Payer: Wise Provider Network Commercial |
$19.04
|
|
|
T-PUMP MUL-T-PADS 13X18
|
Facility
|
OP
|
$38.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$38.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.18
|
| Rate for Payer: Aetna of WY Medicare |
$25.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.40
|
| Rate for Payer: Altius Commercial |
$37.40
|
| Rate for Payer: Beech Street Commercial |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.99
|
| Rate for Payer: Cash Price |
$27.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.79
|
| Rate for Payer: Cigna of WY Commercial |
$38.18
|
| Rate for Payer: Entrust Commercial |
$37.01
|
| Rate for Payer: First Choice Health Commercial |
$37.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$38.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.79
|
| Rate for Payer: Multiplan Medicare/VA |
$21.47
|
| Rate for Payer: One Health Plan of WY PPO |
$38.18
|
| Rate for Payer: PacificSource Commercial |
$35.06
|
| Rate for Payer: PHCS PPO |
$38.18
|
| Rate for Payer: Three Rivers PPO |
$29.22
|
| Rate for Payer: TriWest Veterans Administration |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$33.90
|
| Rate for Payer: United Healthcare Medicare |
$22.60
|
| Rate for Payer: WINHealth Partners Commercial |
$38.18
|
| Rate for Payer: Wise Provider Network Commercial |
$37.01
|
|
|
T-PUMP MUL-T-PADS 13X18
|
Facility
|
IP
|
$38.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$38.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.40
|
| Rate for Payer: Altius Commercial |
$37.40
|
| Rate for Payer: Beech Street Commercial |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.99
|
| Rate for Payer: Cash Price |
$27.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.79
|
| Rate for Payer: Cigna of WY Commercial |
$38.18
|
| Rate for Payer: Entrust Commercial |
$37.01
|
| Rate for Payer: First Choice Health Commercial |
$37.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.71
|
| Rate for Payer: HealthUtah PPO |
$38.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.79
|
| Rate for Payer: Multiplan Medicare/VA |
$24.43
|
| Rate for Payer: One Health Plan of WY PPO |
$38.18
|
| Rate for Payer: PacificSource Commercial |
$35.06
|
| Rate for Payer: PHCS PPO |
$38.18
|
| Rate for Payer: Three Rivers PPO |
$29.22
|
| Rate for Payer: TriWest Veterans Administration |
$25.71
|
| Rate for Payer: United Healthcare Commercial |
$33.90
|
| Rate for Payer: United Healthcare Medicare |
$25.71
|
| Rate for Payer: WINHealth Partners Commercial |
$37.01
|
| Rate for Payer: Wise Provider Network Commercial |
$37.01
|
|
|
T-PUMP MUL-T-PADS 18X26
|
Facility
|
IP
|
$37.19
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$37.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.70
|
| Rate for Payer: Altius Commercial |
$35.70
|
| Rate for Payer: Beech Street Commercial |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.53
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.07
|
| Rate for Payer: Cigna of WY Commercial |
$36.45
|
| Rate for Payer: Entrust Commercial |
$35.33
|
| Rate for Payer: First Choice Health Commercial |
$35.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.55
|
| Rate for Payer: HealthUtah PPO |
$37.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.07
|
| Rate for Payer: Multiplan Medicare/VA |
$23.32
|
| Rate for Payer: One Health Plan of WY PPO |
$36.45
|
| Rate for Payer: PacificSource Commercial |
$33.47
|
| Rate for Payer: PHCS PPO |
$36.45
|
| Rate for Payer: Three Rivers PPO |
$27.89
|
| Rate for Payer: TriWest Veterans Administration |
$24.55
|
| Rate for Payer: United Healthcare Commercial |
$32.36
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
| Rate for Payer: WINHealth Partners Commercial |
$35.33
|
| Rate for Payer: Wise Provider Network Commercial |
$35.33
|
|
|
T-PUMP MUL-T-PADS 18X26
|
Facility
|
OP
|
$37.19
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$37.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.45
|
| Rate for Payer: Aetna of WY Medicare |
$24.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.70
|
| Rate for Payer: Altius Commercial |
$35.70
|
| Rate for Payer: Beech Street Commercial |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.53
|
| Rate for Payer: Cash Price |
$26.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.07
|
| Rate for Payer: Cigna of WY Commercial |
$36.45
|
| Rate for Payer: Entrust Commercial |
$35.33
|
| Rate for Payer: First Choice Health Commercial |
$35.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.57
|
| Rate for Payer: HealthUtah PPO |
$37.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.07
|
| Rate for Payer: Multiplan Medicare/VA |
$20.49
|
| Rate for Payer: One Health Plan of WY PPO |
$36.45
|
| Rate for Payer: PacificSource Commercial |
$33.47
|
| Rate for Payer: PHCS PPO |
$36.45
|
| Rate for Payer: Three Rivers PPO |
$27.89
|
| Rate for Payer: TriWest Veterans Administration |
$21.57
|
| Rate for Payer: United Healthcare Commercial |
$32.36
|
| Rate for Payer: United Healthcare Medicare |
$21.57
|
| Rate for Payer: WINHealth Partners Commercial |
$36.45
|
| Rate for Payer: Wise Provider Network Commercial |
$35.33
|
|
|
TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 57720
|
| Hospital Charge Code |
57720
|
| Min. Negotiated Rate |
$276.63 |
| Max. Negotiated Rate |
$1,591.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,559.18
|
| Rate for Payer: Aetna of WY Medicare |
$325.45
|
| Rate for Payer: Beech Street Commercial |
$1,511.45
|
| Rate for Payer: Cash Price |
$1,113.70
|
| Rate for Payer: Cash Price |
$1,113.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,543.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,559.18
|
| Rate for Payer: First Choice Health Commercial |
$1,431.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,511.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$325.45
|
| Rate for Payer: HealthUtah PPO |
$1,591.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,543.27
|
| Rate for Payer: Multiplan Medicare/VA |
$276.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,559.18
|
| Rate for Payer: PacificSource Commercial |
$1,431.90
|
| Rate for Payer: PHCS PPO |
$1,511.45
|
| Rate for Payer: Three Rivers PPO |
$1,193.25
|
| Rate for Payer: TriWest Veterans Administration |
$325.45
|
| Rate for Payer: United Healthcare Commercial |
$1,384.17
|
| Rate for Payer: United Healthcare Medicare |
$325.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,352.35
|
|
|
TRACHEOSTOMY PLANNED SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 31600
|
| Hospital Charge Code |
31600
|
| Min. Negotiated Rate |
$244.60 |
| Max. Negotiated Rate |
$1,426.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,397.48
|
| Rate for Payer: Aetna of WY Medicare |
$287.76
|
| Rate for Payer: Beech Street Commercial |
$1,354.70
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,383.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,397.48
|
| Rate for Payer: First Choice Health Commercial |
$1,283.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,354.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.76
|
| Rate for Payer: HealthUtah PPO |
$1,426.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,383.22
|
| Rate for Payer: Multiplan Medicare/VA |
$244.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,397.48
|
| Rate for Payer: PacificSource Commercial |
$1,283.40
|
| Rate for Payer: PHCS PPO |
$1,354.70
|
| Rate for Payer: Three Rivers PPO |
$1,069.50
|
| Rate for Payer: TriWest Veterans Administration |
$287.76
|
| Rate for Payer: United Healthcare Commercial |
$1,240.62
|
| Rate for Payer: United Healthcare Medicare |
$287.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,212.10
|
|
|
TRAMADOL 50 MG TABLET [7794]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 6068779511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
TRAMADOL 50 MG TABLET [7794]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 6068779511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
TRAMADOL 50 MG TABLET [7794]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 6808480811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TRAMADOL 50 MG TABLET [7794]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 6808480811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.51
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
NDC 2315516631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.97
|
| Rate for Payer: Altius Commercial |
$15.97
|
| Rate for Payer: Beech Street Commercial |
$16.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.66
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.14
|
| Rate for Payer: Cigna of WY Commercial |
$16.31
|
| Rate for Payer: Entrust Commercial |
$15.81
|
| Rate for Payer: First Choice Health Commercial |
$15.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.98
|
| Rate for Payer: HealthUtah PPO |
$16.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.14
|
| Rate for Payer: Multiplan Medicare/VA |
$10.43
|
| Rate for Payer: One Health Plan of WY PPO |
$16.31
|
| Rate for Payer: PacificSource Commercial |
$14.98
|
| Rate for Payer: PHCS PPO |
$16.31
|
| Rate for Payer: Three Rivers PPO |
$12.48
|
| Rate for Payer: TriWest Veterans Administration |
$10.98
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$10.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.81
|
| Rate for Payer: Wise Provider Network Commercial |
$15.81
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
NDC 2315516631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.31
|
| Rate for Payer: Aetna of WY Medicare |
$10.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.97
|
| Rate for Payer: Altius Commercial |
$15.97
|
| Rate for Payer: Beech Street Commercial |
$16.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.66
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.14
|
| Rate for Payer: Cigna of WY Commercial |
$16.31
|
| Rate for Payer: Entrust Commercial |
$15.81
|
| Rate for Payer: First Choice Health Commercial |
$15.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.65
|
| Rate for Payer: HealthUtah PPO |
$16.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.17
|
| Rate for Payer: One Health Plan of WY PPO |
$16.31
|
| Rate for Payer: PacificSource Commercial |
$14.98
|
| Rate for Payer: PHCS PPO |
$16.31
|
| Rate for Payer: Three Rivers PPO |
$12.48
|
| Rate for Payer: TriWest Veterans Administration |
$9.65
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$9.65
|
| Rate for Payer: WINHealth Partners Commercial |
$16.31
|
| Rate for Payer: Wise Provider Network Commercial |
$15.81
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 4306600801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.06
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$11.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 4306600801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 4306600810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.06
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$11.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 4306600810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$17.40
|
|
|
Service Code
|
NDC 5515018810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: WINHealth Partners Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$17.40
|
|
|
Service Code
|
NDC 5515018810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.09
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$10.09
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$10.09
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
NDC 6199006110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.47
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.01
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$11.41
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$15.83
|
| Rate for Payer: United Healthcare Medicare |
$12.01
|
| Rate for Payer: WINHealth Partners Commercial |
$17.29
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 6199006110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Aetna of WY Medicare |
$12.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.47
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$15.83
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$17.84
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
NDC 8128461100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.51
|
| Rate for Payer: Altius Commercial |
$16.51
|
| Rate for Payer: Beech Street Commercial |
$16.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.68
|
| Rate for Payer: Cigna of WY Commercial |
$16.86
|
| Rate for Payer: Entrust Commercial |
$16.34
|
| Rate for Payer: First Choice Health Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.35
|
| Rate for Payer: HealthUtah PPO |
$17.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.68
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16.86
|
| Rate for Payer: PacificSource Commercial |
$15.48
|
| Rate for Payer: PHCS PPO |
$16.86
|
| Rate for Payer: Three Rivers PPO |
$12.90
|
| Rate for Payer: TriWest Veterans Administration |
$11.35
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
| Rate for Payer: WINHealth Partners Commercial |
$16.34
|
| Rate for Payer: Wise Provider Network Commercial |
$16.34
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [94721]
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
NDC 8128461100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.86
|
| Rate for Payer: Aetna of WY Medicare |
$11.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.51
|
| Rate for Payer: Altius Commercial |
$16.51
|
| Rate for Payer: Beech Street Commercial |
$16.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.68
|
| Rate for Payer: Cigna of WY Commercial |
$16.86
|
| Rate for Payer: Entrust Commercial |
$16.34
|
| Rate for Payer: First Choice Health Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.98
|
| Rate for Payer: HealthUtah PPO |
$17.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.48
|
| Rate for Payer: One Health Plan of WY PPO |
$16.86
|
| Rate for Payer: PacificSource Commercial |
$15.48
|
| Rate for Payer: PHCS PPO |
$16.86
|
| Rate for Payer: Three Rivers PPO |
$12.90
|
| Rate for Payer: TriWest Veterans Administration |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$9.98
|
| Rate for Payer: WINHealth Partners Commercial |
$16.86
|
| Rate for Payer: Wise Provider Network Commercial |
$16.34
|
|
