|
VALSARTAN 160 MG TABLET [20623]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 5511173390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.98
|
| Rate for Payer: Altius Commercial |
$0.98
|
| Rate for Payer: Beech Street Commercial |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.99
|
| Rate for Payer: Cigna of WY Commercial |
$1.00
|
| Rate for Payer: Entrust Commercial |
$0.97
|
| Rate for Payer: First Choice Health Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.99
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.00
|
| Rate for Payer: PacificSource Commercial |
$0.92
|
| Rate for Payer: PHCS PPO |
$1.00
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$0.97
|
| Rate for Payer: Wise Provider Network Commercial |
$0.97
|
|
|
VALSARTAN 160 MG TABLET [20623]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 5511173390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.00
|
| Rate for Payer: Aetna of WY Medicare |
$0.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.98
|
| Rate for Payer: Altius Commercial |
$0.98
|
| Rate for Payer: Beech Street Commercial |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.99
|
| Rate for Payer: Cigna of WY Commercial |
$1.00
|
| Rate for Payer: Entrust Commercial |
$0.97
|
| Rate for Payer: First Choice Health Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.59
|
| Rate for Payer: HealthUtah PPO |
$1.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.99
|
| Rate for Payer: Multiplan Medicare/VA |
$0.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1.00
|
| Rate for Payer: PacificSource Commercial |
$0.92
|
| Rate for Payer: PHCS PPO |
$1.00
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1.00
|
| Rate for Payer: Wise Provider Network Commercial |
$0.97
|
|
|
VALSARTAN 160 MG TABLET [20623]
|
Facility
|
IP
|
$4.82
|
|
|
Service Code
|
NDC 6068763411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.63
|
| Rate for Payer: Altius Commercial |
$4.63
|
| Rate for Payer: Beech Street Commercial |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.68
|
| Rate for Payer: Cigna of WY Commercial |
$4.72
|
| Rate for Payer: Entrust Commercial |
$4.58
|
| Rate for Payer: First Choice Health Commercial |
$4.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.18
|
| Rate for Payer: HealthUtah PPO |
$4.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.68
|
| Rate for Payer: Multiplan Medicare/VA |
$3.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4.72
|
| Rate for Payer: PacificSource Commercial |
$4.34
|
| Rate for Payer: PHCS PPO |
$4.72
|
| Rate for Payer: Three Rivers PPO |
$3.62
|
| Rate for Payer: TriWest Veterans Administration |
$3.18
|
| Rate for Payer: United Healthcare Commercial |
$4.19
|
| Rate for Payer: United Healthcare Medicare |
$3.18
|
| Rate for Payer: WINHealth Partners Commercial |
$4.58
|
| Rate for Payer: Wise Provider Network Commercial |
$4.58
|
|
|
VALSARTAN 160 MG TABLET [20623]
|
Facility
|
OP
|
$4.82
|
|
|
Service Code
|
NDC 6068763411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.72
|
| Rate for Payer: Aetna of WY Medicare |
$3.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.63
|
| Rate for Payer: Altius Commercial |
$4.63
|
| Rate for Payer: Beech Street Commercial |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.68
|
| Rate for Payer: Cigna of WY Commercial |
$4.72
|
| Rate for Payer: Entrust Commercial |
$4.58
|
| Rate for Payer: First Choice Health Commercial |
$4.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.80
|
| Rate for Payer: HealthUtah PPO |
$4.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.68
|
| Rate for Payer: Multiplan Medicare/VA |
$2.66
|
| Rate for Payer: One Health Plan of WY PPO |
$4.72
|
| Rate for Payer: PacificSource Commercial |
$4.34
|
| Rate for Payer: PHCS PPO |
$4.72
|
| Rate for Payer: Three Rivers PPO |
$3.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$4.19
|
| Rate for Payer: United Healthcare Medicare |
$2.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4.72
|
| Rate for Payer: Wise Provider Network Commercial |
$4.58
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [7798]
|
Facility
|
IP
|
$55.10
|
|
|
Service Code
|
HCPCS J3370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.87
|
| Rate for Payer: Altius Commercial |
$31.87
|
| Rate for Payer: Altius Commercial |
$52.90
|
| Rate for Payer: Beech Street Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$32.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.24
|
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.45
|
| Rate for Payer: Cigna of WY Commercial |
$54.00
|
| Rate for Payer: Cigna of WY Commercial |
$32.54
|
| Rate for Payer: Entrust Commercial |
$31.54
|
| Rate for Payer: Entrust Commercial |
$52.34
|
| Rate for Payer: First Choice Health Commercial |
$31.54
|
| Rate for Payer: First Choice Health Commercial |
$52.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.91
|
| Rate for Payer: HealthUtah PPO |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$33.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.45
|
| Rate for Payer: Multiplan Medicare/VA |
$34.55
|
| Rate for Payer: Multiplan Medicare/VA |
$20.82
|
| Rate for Payer: One Health Plan of WY PPO |
$54.00
|
| Rate for Payer: One Health Plan of WY PPO |
$32.54
|
| Rate for Payer: PacificSource Commercial |
$49.59
|
| Rate for Payer: PacificSource Commercial |
$29.88
|
| Rate for Payer: PHCS PPO |
$32.54
|
| Rate for Payer: PHCS PPO |
$54.00
|
| Rate for Payer: Three Rivers PPO |
$24.90
|
| Rate for Payer: Three Rivers PPO |
$41.32
|
| Rate for Payer: TriWest Veterans Administration |
$36.37
|
| Rate for Payer: TriWest Veterans Administration |
$21.91
|
| Rate for Payer: United Healthcare Commercial |
$28.88
|
| Rate for Payer: United Healthcare Commercial |
$47.94
|
| Rate for Payer: United Healthcare Medicare |
$36.37
|
| Rate for Payer: United Healthcare Medicare |
$21.91
|
| Rate for Payer: WINHealth Partners Commercial |
$31.54
|
| Rate for Payer: WINHealth Partners Commercial |
$52.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.54
|
| Rate for Payer: Wise Provider Network Commercial |
$52.34
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [7798]
|
Facility
|
OP
|
$55.10
|
|
|
Service Code
|
HCPCS J3370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.54
|
| Rate for Payer: Aetna of WY Medicare |
$36.37
|
| Rate for Payer: Aetna of WY Medicare |
$21.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.90
|
| Rate for Payer: Altius Commercial |
$52.90
|
| Rate for Payer: Altius Commercial |
$31.87
|
| Rate for Payer: Beech Street Commercial |
$32.54
|
| Rate for Payer: Beech Street Commercial |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.26
|
| Rate for Payer: Cash Price |
$23.24
|
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.20
|
| Rate for Payer: Cigna of WY Commercial |
$32.54
|
| Rate for Payer: Cigna of WY Commercial |
$54.00
|
| Rate for Payer: Entrust Commercial |
$52.34
|
| Rate for Payer: Entrust Commercial |
$31.54
|
| Rate for Payer: First Choice Health Commercial |
$31.54
|
| Rate for Payer: First Choice Health Commercial |
$52.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.26
|
| Rate for Payer: HealthUtah PPO |
$33.20
|
| Rate for Payer: HealthUtah PPO |
$55.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.45
|
| Rate for Payer: Multiplan Medicare/VA |
$30.36
|
| Rate for Payer: Multiplan Medicare/VA |
$18.29
|
| Rate for Payer: One Health Plan of WY PPO |
$32.54
|
| Rate for Payer: One Health Plan of WY PPO |
$54.00
|
| Rate for Payer: PacificSource Commercial |
$49.59
|
| Rate for Payer: PacificSource Commercial |
$29.88
|
| Rate for Payer: PHCS PPO |
$32.54
|
| Rate for Payer: PHCS PPO |
$54.00
|
| Rate for Payer: Three Rivers PPO |
$24.90
|
| Rate for Payer: Three Rivers PPO |
$41.32
|
| Rate for Payer: TriWest Veterans Administration |
$31.96
|
| Rate for Payer: TriWest Veterans Administration |
$19.26
|
| Rate for Payer: United Healthcare Commercial |
$28.88
|
| Rate for Payer: United Healthcare Commercial |
$47.94
|
| Rate for Payer: United Healthcare Medicare |
$31.96
|
| Rate for Payer: United Healthcare Medicare |
$19.26
|
| Rate for Payer: WINHealth Partners Commercial |
$32.54
|
| Rate for Payer: WINHealth Partners Commercial |
$54.00
|
| Rate for Payer: Wise Provider Network Commercial |
$31.54
|
| Rate for Payer: Wise Provider Network Commercial |
$52.34
|
|
|
VANCOMYCIN 125 MG CAPSULE [8184]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 0121086720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
VANCOMYCIN 125 MG CAPSULE [8184]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 0121086720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
VANCOMYCIN 125 MG CAPSULE [8184]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 4249445020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
VANCOMYCIN 125 MG CAPSULE [8184]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 4249445020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK [155368]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.30
|
| Rate for Payer: Altius Commercial |
$0.30
|
| Rate for Payer: Beech Street Commercial |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.30
|
| Rate for Payer: Cigna of WY Commercial |
$0.30
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.30
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.30
|
| Rate for Payer: PacificSource Commercial |
$0.28
|
| Rate for Payer: PHCS PPO |
$0.30
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK [155368]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.30
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.30
|
| Rate for Payer: Altius Commercial |
$0.30
|
| Rate for Payer: Beech Street Commercial |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.30
|
| Rate for Payer: Cigna of WY Commercial |
$0.30
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.18
|
| Rate for Payer: HealthUtah PPO |
$0.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.30
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$0.30
|
| Rate for Payer: PacificSource Commercial |
$0.28
|
| Rate for Payer: PHCS PPO |
$0.30
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WINHealth Partners Commercial |
$0.30
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK [155367]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.31
|
| Rate for Payer: Altius Commercial |
$0.31
|
| Rate for Payer: Beech Street Commercial |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.31
|
| Rate for Payer: Cigna of WY Commercial |
$0.31
|
| Rate for Payer: Entrust Commercial |
$0.30
|
| Rate for Payer: First Choice Health Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.31
|
| Rate for Payer: PacificSource Commercial |
$0.29
|
| Rate for Payer: PHCS PPO |
$0.31
|
| Rate for Payer: Three Rivers PPO |
$0.24
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.28
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.30
|
| Rate for Payer: Wise Provider Network Commercial |
$0.30
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DILUENT COMBINATION IV PIGGYBACK [155367]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.31
|
| Rate for Payer: Aetna of WY Medicare |
$0.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.31
|
| Rate for Payer: Altius Commercial |
$0.31
|
| Rate for Payer: Beech Street Commercial |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.31
|
| Rate for Payer: Cigna of WY Commercial |
$0.31
|
| Rate for Payer: Entrust Commercial |
$0.30
|
| Rate for Payer: First Choice Health Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.31
|
| Rate for Payer: PacificSource Commercial |
$0.29
|
| Rate for Payer: PHCS PPO |
$0.31
|
| Rate for Payer: Three Rivers PPO |
$0.24
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.28
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.31
|
| Rate for Payer: Wise Provider Network Commercial |
$0.30
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK [155374]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.18
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK [155374]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
HCPCS J3372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
VAPOR-CLEAN MHAUS FILTER
|
Facility
|
IP
|
$442.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.24 |
| Max. Negotiated Rate |
$442.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$424.48
|
| Rate for Payer: Altius Commercial |
$424.48
|
| Rate for Payer: Beech Street Commercial |
$433.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$363.02
|
| Rate for Payer: Cash Price |
$309.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.90
|
| Rate for Payer: Cigna of WY Commercial |
$433.33
|
| Rate for Payer: Entrust Commercial |
$420.06
|
| Rate for Payer: First Choice Health Commercial |
$420.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$420.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.83
|
| Rate for Payer: HealthUtah PPO |
$442.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.90
|
| Rate for Payer: Multiplan Medicare/VA |
$277.24
|
| Rate for Payer: One Health Plan of WY PPO |
$433.33
|
| Rate for Payer: PacificSource Commercial |
$397.95
|
| Rate for Payer: PHCS PPO |
$433.33
|
| Rate for Payer: Three Rivers PPO |
$331.63
|
| Rate for Payer: TriWest Veterans Administration |
$291.83
|
| Rate for Payer: United Healthcare Commercial |
$384.69
|
| Rate for Payer: United Healthcare Medicare |
$291.83
|
| Rate for Payer: WINHealth Partners Commercial |
$420.06
|
| Rate for Payer: Wise Provider Network Commercial |
$420.06
|
|
|
VAPOR-CLEAN MHAUS FILTER
|
Facility
|
OP
|
$442.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.64 |
| Max. Negotiated Rate |
$442.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.33
|
| Rate for Payer: Aetna of WY Medicare |
$291.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$424.48
|
| Rate for Payer: Altius Commercial |
$424.48
|
| Rate for Payer: Beech Street Commercial |
$433.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$363.02
|
| Rate for Payer: Cash Price |
$309.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.90
|
| Rate for Payer: Cigna of WY Commercial |
$433.33
|
| Rate for Payer: Entrust Commercial |
$420.06
|
| Rate for Payer: First Choice Health Commercial |
$420.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$420.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.46
|
| Rate for Payer: HealthUtah PPO |
$442.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.90
|
| Rate for Payer: Multiplan Medicare/VA |
$243.64
|
| Rate for Payer: One Health Plan of WY PPO |
$433.33
|
| Rate for Payer: PacificSource Commercial |
$397.95
|
| Rate for Payer: PHCS PPO |
$433.33
|
| Rate for Payer: Three Rivers PPO |
$331.63
|
| Rate for Payer: TriWest Veterans Administration |
$256.46
|
| Rate for Payer: United Healthcare Commercial |
$384.69
|
| Rate for Payer: United Healthcare Medicare |
$256.46
|
| Rate for Payer: WINHealth Partners Commercial |
$433.33
|
| Rate for Payer: Wise Provider Network Commercial |
$420.06
|
|
|
VAPR HOOK ELECTRODE 227305
|
Facility
|
OP
|
$920.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$920.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$902.09
|
| Rate for Payer: Aetna of WY Medicare |
$607.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.68
|
| Rate for Payer: Altius Commercial |
$883.68
|
| Rate for Payer: Beech Street Commercial |
$902.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.73
|
| Rate for Payer: Cash Price |
$644.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.88
|
| Rate for Payer: Cigna of WY Commercial |
$902.09
|
| Rate for Payer: Entrust Commercial |
$874.48
|
| Rate for Payer: First Choice Health Commercial |
$874.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.89
|
| Rate for Payer: HealthUtah PPO |
$920.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.88
|
| Rate for Payer: Multiplan Medicare/VA |
$507.20
|
| Rate for Payer: One Health Plan of WY PPO |
$902.09
|
| Rate for Payer: PacificSource Commercial |
$828.45
|
| Rate for Payer: PHCS PPO |
$902.09
|
| Rate for Payer: Three Rivers PPO |
$690.38
|
| Rate for Payer: TriWest Veterans Administration |
$533.89
|
| Rate for Payer: United Healthcare Commercial |
$800.84
|
| Rate for Payer: United Healthcare Medicare |
$533.89
|
| Rate for Payer: WINHealth Partners Commercial |
$902.09
|
| Rate for Payer: Wise Provider Network Commercial |
$874.48
|
|
|
VAPR HOOK ELECTRODE 227305
|
Facility
|
IP
|
$920.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.15 |
| Max. Negotiated Rate |
$920.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$902.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.68
|
| Rate for Payer: Altius Commercial |
$883.68
|
| Rate for Payer: Beech Street Commercial |
$902.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.73
|
| Rate for Payer: Cash Price |
$644.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.88
|
| Rate for Payer: Cigna of WY Commercial |
$902.09
|
| Rate for Payer: Entrust Commercial |
$874.48
|
| Rate for Payer: First Choice Health Commercial |
$874.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.53
|
| Rate for Payer: HealthUtah PPO |
$920.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.88
|
| Rate for Payer: Multiplan Medicare/VA |
$577.15
|
| Rate for Payer: One Health Plan of WY PPO |
$902.09
|
| Rate for Payer: PacificSource Commercial |
$828.45
|
| Rate for Payer: PHCS PPO |
$902.09
|
| Rate for Payer: Three Rivers PPO |
$690.38
|
| Rate for Payer: TriWest Veterans Administration |
$607.53
|
| Rate for Payer: United Healthcare Commercial |
$800.84
|
| Rate for Payer: United Healthcare Medicare |
$607.53
|
| Rate for Payer: WINHealth Partners Commercial |
$874.48
|
| Rate for Payer: Wise Provider Network Commercial |
$874.48
|
|
|
VAPR TRIPOLAR 90 SUCT ELECT
|
Facility
|
OP
|
$1,130.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.91 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.89
|
| Rate for Payer: Aetna of WY Medicare |
$746.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,085.28
|
| Rate for Payer: Altius Commercial |
$1,085.28
|
| Rate for Payer: Beech Street Commercial |
$1,107.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$928.14
|
| Rate for Payer: Cash Price |
$791.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.89
|
| Rate for Payer: Entrust Commercial |
$1,073.98
|
| Rate for Payer: First Choice Health Commercial |
$1,073.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.69
|
| Rate for Payer: HealthUtah PPO |
$1,130.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.58
|
| Rate for Payer: Multiplan Medicare/VA |
$622.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.89
|
| Rate for Payer: PacificSource Commercial |
$1,017.45
|
| Rate for Payer: PHCS PPO |
$1,107.89
|
| Rate for Payer: Three Rivers PPO |
$847.88
|
| Rate for Payer: TriWest Veterans Administration |
$655.69
|
| Rate for Payer: United Healthcare Commercial |
$983.54
|
| Rate for Payer: United Healthcare Medicare |
$655.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.89
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.98
|
|
|
VAPR TRIPOLAR 90 SUCT ELECT
|
Facility
|
IP
|
$1,130.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.82 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,085.28
|
| Rate for Payer: Altius Commercial |
$1,085.28
|
| Rate for Payer: Beech Street Commercial |
$1,107.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$928.14
|
| Rate for Payer: Cash Price |
$791.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.89
|
| Rate for Payer: Entrust Commercial |
$1,073.98
|
| Rate for Payer: First Choice Health Commercial |
$1,073.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$746.13
|
| Rate for Payer: HealthUtah PPO |
$1,130.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.58
|
| Rate for Payer: Multiplan Medicare/VA |
$708.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.89
|
| Rate for Payer: PacificSource Commercial |
$1,017.45
|
| Rate for Payer: PHCS PPO |
$1,107.89
|
| Rate for Payer: Three Rivers PPO |
$847.88
|
| Rate for Payer: TriWest Veterans Administration |
$746.13
|
| Rate for Payer: United Healthcare Commercial |
$983.54
|
| Rate for Payer: United Healthcare Medicare |
$746.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,073.98
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.98
|
|
|
VAPR WEDGE SHORT ELEC 2.3MM
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.85 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$843.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$826.56
|
| Rate for Payer: Altius Commercial |
$826.56
|
| Rate for Payer: Beech Street Commercial |
$843.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$706.88
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$835.17
|
| Rate for Payer: Cigna of WY Commercial |
$843.78
|
| Rate for Payer: Entrust Commercial |
$817.95
|
| Rate for Payer: First Choice Health Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.26
|
| Rate for Payer: HealthUtah PPO |
$861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$835.17
|
| Rate for Payer: Multiplan Medicare/VA |
$539.85
|
| Rate for Payer: One Health Plan of WY PPO |
$843.78
|
| Rate for Payer: PacificSource Commercial |
$774.90
|
| Rate for Payer: PHCS PPO |
$843.78
|
| Rate for Payer: Three Rivers PPO |
$645.75
|
| Rate for Payer: TriWest Veterans Administration |
$568.26
|
| Rate for Payer: United Healthcare Commercial |
$749.07
|
| Rate for Payer: United Healthcare Medicare |
$568.26
|
| Rate for Payer: WINHealth Partners Commercial |
$817.95
|
| Rate for Payer: Wise Provider Network Commercial |
$817.95
|
|
|
VAPR WEDGE SHORT ELEC 2.3MM
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.41 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$843.78
|
| Rate for Payer: Aetna of WY Medicare |
$568.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$826.56
|
| Rate for Payer: Altius Commercial |
$826.56
|
| Rate for Payer: Beech Street Commercial |
$843.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$706.88
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$835.17
|
| Rate for Payer: Cigna of WY Commercial |
$843.78
|
| Rate for Payer: Entrust Commercial |
$817.95
|
| Rate for Payer: First Choice Health Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$499.38
|
| Rate for Payer: HealthUtah PPO |
$861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$835.17
|
| Rate for Payer: Multiplan Medicare/VA |
$474.41
|
| Rate for Payer: One Health Plan of WY PPO |
$843.78
|
| Rate for Payer: PacificSource Commercial |
$774.90
|
| Rate for Payer: PHCS PPO |
$843.78
|
| Rate for Payer: Three Rivers PPO |
$645.75
|
| Rate for Payer: TriWest Veterans Administration |
$499.38
|
| Rate for Payer: United Healthcare Commercial |
$749.07
|
| Rate for Payer: United Healthcare Medicare |
$499.38
|
| Rate for Payer: WINHealth Partners Commercial |
$843.78
|
| Rate for Payer: Wise Provider Network Commercial |
$817.95
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [41274]
|
Facility
|
IP
|
$288.38
|
|
|
Service Code
|
NDC 0006482700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$288.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$276.84
|
| Rate for Payer: Altius Commercial |
$276.84
|
| Rate for Payer: Beech Street Commercial |
$282.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$236.76
|
| Rate for Payer: Cash Price |
$201.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.73
|
| Rate for Payer: Cigna of WY Commercial |
$282.61
|
| Rate for Payer: Entrust Commercial |
$273.96
|
| Rate for Payer: First Choice Health Commercial |
$273.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.33
|
| Rate for Payer: HealthUtah PPO |
$288.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.73
|
| Rate for Payer: Multiplan Medicare/VA |
$180.81
|
| Rate for Payer: One Health Plan of WY PPO |
$282.61
|
| Rate for Payer: PacificSource Commercial |
$259.54
|
| Rate for Payer: PHCS PPO |
$282.61
|
| Rate for Payer: Three Rivers PPO |
$216.28
|
| Rate for Payer: TriWest Veterans Administration |
$190.33
|
| Rate for Payer: United Healthcare Commercial |
$250.89
|
| Rate for Payer: United Healthcare Medicare |
$190.33
|
| Rate for Payer: WINHealth Partners Commercial |
$273.96
|
| Rate for Payer: Wise Provider Network Commercial |
$273.96
|
|
