|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [41274]
|
Facility
|
OP
|
$288.38
|
|
|
Service Code
|
NDC 0006482700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$288.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.61
|
| Rate for Payer: Aetna of WY Medicare |
$190.33
|
| 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 |
$167.26
|
| Rate for Payer: HealthUtah PPO |
$288.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.73
|
| Rate for Payer: Multiplan Medicare/VA |
$158.90
|
| 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 |
$167.26
|
| Rate for Payer: United Healthcare Commercial |
$250.89
|
| Rate for Payer: United Healthcare Medicare |
$167.26
|
| Rate for Payer: WINHealth Partners Commercial |
$282.61
|
| Rate for Payer: Wise Provider Network Commercial |
$273.96
|
|
|
VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [150752]
|
Facility
|
IP
|
$269.38
|
|
|
Service Code
|
NDC 5816082311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.90 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$258.60
|
| Rate for Payer: Altius Commercial |
$258.60
|
| Rate for Payer: Beech Street Commercial |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.30
|
| Rate for Payer: Cigna of WY Commercial |
$263.99
|
| Rate for Payer: Entrust Commercial |
$255.91
|
| Rate for Payer: First Choice Health Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.79
|
| Rate for Payer: HealthUtah PPO |
$269.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.30
|
| Rate for Payer: Multiplan Medicare/VA |
$168.90
|
| Rate for Payer: One Health Plan of WY PPO |
$263.99
|
| Rate for Payer: PacificSource Commercial |
$242.44
|
| Rate for Payer: PHCS PPO |
$263.99
|
| Rate for Payer: Three Rivers PPO |
$202.04
|
| Rate for Payer: TriWest Veterans Administration |
$177.79
|
| Rate for Payer: United Healthcare Commercial |
$234.36
|
| Rate for Payer: United Healthcare Medicare |
$177.79
|
| Rate for Payer: WINHealth Partners Commercial |
$255.91
|
| Rate for Payer: Wise Provider Network Commercial |
$255.91
|
|
|
VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT [150752]
|
Facility
|
OP
|
$269.38
|
|
|
Service Code
|
NDC 5816082311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.43 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.99
|
| Rate for Payer: Aetna of WY Medicare |
$177.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$258.60
|
| Rate for Payer: Altius Commercial |
$258.60
|
| Rate for Payer: Beech Street Commercial |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.30
|
| Rate for Payer: Cigna of WY Commercial |
$263.99
|
| Rate for Payer: Entrust Commercial |
$255.91
|
| Rate for Payer: First Choice Health Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.24
|
| Rate for Payer: HealthUtah PPO |
$269.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.30
|
| Rate for Payer: Multiplan Medicare/VA |
$148.43
|
| Rate for Payer: One Health Plan of WY PPO |
$263.99
|
| Rate for Payer: PacificSource Commercial |
$242.44
|
| Rate for Payer: PHCS PPO |
$263.99
|
| Rate for Payer: Three Rivers PPO |
$202.04
|
| Rate for Payer: TriWest Veterans Administration |
$156.24
|
| Rate for Payer: United Healthcare Commercial |
$234.36
|
| Rate for Payer: United Healthcare Medicare |
$156.24
|
| Rate for Payer: WINHealth Partners Commercial |
$263.99
|
| Rate for Payer: Wise Provider Network Commercial |
$255.91
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [150754]
|
Facility
|
IP
|
$269.38
|
|
|
Service Code
|
NDC 5816082803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.90 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$258.60
|
| Rate for Payer: Altius Commercial |
$258.60
|
| Rate for Payer: Beech Street Commercial |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.30
|
| Rate for Payer: Cigna of WY Commercial |
$263.99
|
| Rate for Payer: Entrust Commercial |
$255.91
|
| Rate for Payer: First Choice Health Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.79
|
| Rate for Payer: HealthUtah PPO |
$269.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.30
|
| Rate for Payer: Multiplan Medicare/VA |
$168.90
|
| Rate for Payer: One Health Plan of WY PPO |
$263.99
|
| Rate for Payer: PacificSource Commercial |
$242.44
|
| Rate for Payer: PHCS PPO |
$263.99
|
| Rate for Payer: Three Rivers PPO |
$202.04
|
| Rate for Payer: TriWest Veterans Administration |
$177.79
|
| Rate for Payer: United Healthcare Commercial |
$234.36
|
| Rate for Payer: United Healthcare Medicare |
$177.79
|
| Rate for Payer: WINHealth Partners Commercial |
$255.91
|
| Rate for Payer: Wise Provider Network Commercial |
$255.91
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [150754]
|
Facility
|
OP
|
$269.38
|
|
|
Service Code
|
NDC 5816082803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.43 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.99
|
| Rate for Payer: Aetna of WY Medicare |
$177.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$258.60
|
| Rate for Payer: Altius Commercial |
$258.60
|
| Rate for Payer: Beech Street Commercial |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.30
|
| Rate for Payer: Cigna of WY Commercial |
$263.99
|
| Rate for Payer: Entrust Commercial |
$255.91
|
| Rate for Payer: First Choice Health Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.24
|
| Rate for Payer: HealthUtah PPO |
$269.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.30
|
| Rate for Payer: Multiplan Medicare/VA |
$148.43
|
| Rate for Payer: One Health Plan of WY PPO |
$263.99
|
| Rate for Payer: PacificSource Commercial |
$242.44
|
| Rate for Payer: PHCS PPO |
$263.99
|
| Rate for Payer: Three Rivers PPO |
$202.04
|
| Rate for Payer: TriWest Veterans Administration |
$156.24
|
| Rate for Payer: United Healthcare Commercial |
$234.36
|
| Rate for Payer: United Healthcare Medicare |
$156.24
|
| Rate for Payer: WINHealth Partners Commercial |
$263.99
|
| Rate for Payer: Wise Provider Network Commercial |
$255.91
|
|
|
VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
90716
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$473.34
|
| Rate for Payer: Beech Street Commercial |
$458.85
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$468.51
|
| Rate for Payer: Cigna of WY Commercial |
$473.34
|
| Rate for Payer: First Choice Health Commercial |
$434.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$458.85
|
| Rate for Payer: HealthUtah PPO |
$483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$468.51
|
| Rate for Payer: One Health Plan of WY PPO |
$473.34
|
| Rate for Payer: PacificSource Commercial |
$434.70
|
| Rate for Payer: PHCS PPO |
$458.85
|
| Rate for Payer: Three Rivers PPO |
$362.25
|
| Rate for Payer: United Healthcare Commercial |
$420.21
|
| Rate for Payer: WINHealth Partners Commercial |
$483.00
|
|
|
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,121.12
|
| Rate for Payer: Beech Street Commercial |
$1,086.80
|
| Rate for Payer: Cash Price |
$800.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,109.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,121.12
|
| Rate for Payer: First Choice Health Commercial |
$1,029.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,086.80
|
| Rate for Payer: HealthUtah PPO |
$1,144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,109.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,121.12
|
| Rate for Payer: PacificSource Commercial |
$1,029.60
|
| Rate for Payer: PHCS PPO |
$1,086.80
|
| Rate for Payer: Three Rivers PPO |
$858.00
|
| Rate for Payer: United Healthcare Commercial |
$995.28
|
| Rate for Payer: WINHealth Partners Commercial |
$972.40
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [138269]
|
Facility
|
IP
|
$172.66
|
|
|
Service Code
|
HCPCS J2599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.26 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.75
|
| Rate for Payer: Altius Commercial |
$165.75
|
| Rate for Payer: Beech Street Commercial |
$169.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.75
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.48
|
| Rate for Payer: Cigna of WY Commercial |
$169.21
|
| Rate for Payer: Entrust Commercial |
$164.03
|
| Rate for Payer: First Choice Health Commercial |
$164.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.96
|
| Rate for Payer: HealthUtah PPO |
$172.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.48
|
| Rate for Payer: Multiplan Medicare/VA |
$108.26
|
| Rate for Payer: One Health Plan of WY PPO |
$169.21
|
| Rate for Payer: PacificSource Commercial |
$155.39
|
| Rate for Payer: PHCS PPO |
$169.21
|
| Rate for Payer: Three Rivers PPO |
$129.50
|
| Rate for Payer: TriWest Veterans Administration |
$113.96
|
| Rate for Payer: United Healthcare Commercial |
$150.21
|
| Rate for Payer: United Healthcare Medicare |
$113.96
|
| Rate for Payer: WINHealth Partners Commercial |
$164.03
|
| Rate for Payer: Wise Provider Network Commercial |
$164.03
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [138269]
|
Facility
|
OP
|
$172.66
|
|
|
Service Code
|
HCPCS J2599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.14 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.21
|
| Rate for Payer: Aetna of WY Medicare |
$113.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.75
|
| Rate for Payer: Altius Commercial |
$165.75
|
| Rate for Payer: Beech Street Commercial |
$169.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.75
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.48
|
| Rate for Payer: Cigna of WY Commercial |
$169.21
|
| Rate for Payer: Entrust Commercial |
$164.03
|
| Rate for Payer: First Choice Health Commercial |
$164.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.14
|
| Rate for Payer: HealthUtah PPO |
$172.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.48
|
| Rate for Payer: Multiplan Medicare/VA |
$95.14
|
| Rate for Payer: One Health Plan of WY PPO |
$169.21
|
| Rate for Payer: PacificSource Commercial |
$155.39
|
| Rate for Payer: PHCS PPO |
$169.21
|
| Rate for Payer: Three Rivers PPO |
$129.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.14
|
| Rate for Payer: United Healthcare Commercial |
$150.21
|
| Rate for Payer: United Healthcare Medicare |
$100.14
|
| Rate for Payer: WINHealth Partners Commercial |
$169.21
|
| Rate for Payer: Wise Provider Network Commercial |
$164.03
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
IP
|
$40.69
|
|
|
Service Code
|
NDC 0409163221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.06
|
| Rate for Payer: Altius Commercial |
$39.06
|
| Rate for Payer: Beech Street Commercial |
$39.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.41
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.47
|
| Rate for Payer: Cigna of WY Commercial |
$39.88
|
| Rate for Payer: Entrust Commercial |
$38.66
|
| Rate for Payer: First Choice Health Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.86
|
| Rate for Payer: HealthUtah PPO |
$40.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.47
|
| Rate for Payer: Multiplan Medicare/VA |
$25.51
|
| Rate for Payer: One Health Plan of WY PPO |
$39.88
|
| Rate for Payer: PacificSource Commercial |
$36.62
|
| Rate for Payer: PHCS PPO |
$39.88
|
| Rate for Payer: Three Rivers PPO |
$30.52
|
| Rate for Payer: TriWest Veterans Administration |
$26.86
|
| Rate for Payer: United Healthcare Commercial |
$35.40
|
| Rate for Payer: United Healthcare Medicare |
$26.86
|
| Rate for Payer: WINHealth Partners Commercial |
$38.66
|
| Rate for Payer: Wise Provider Network Commercial |
$38.66
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
OP
|
$40.69
|
|
|
Service Code
|
NDC 0409163221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.88
|
| Rate for Payer: Aetna of WY Medicare |
$26.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.06
|
| Rate for Payer: Altius Commercial |
$39.06
|
| Rate for Payer: Beech Street Commercial |
$39.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.41
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.47
|
| Rate for Payer: Cigna of WY Commercial |
$39.88
|
| Rate for Payer: Entrust Commercial |
$38.66
|
| Rate for Payer: First Choice Health Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.60
|
| Rate for Payer: HealthUtah PPO |
$40.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.47
|
| Rate for Payer: Multiplan Medicare/VA |
$22.42
|
| Rate for Payer: One Health Plan of WY PPO |
$39.88
|
| Rate for Payer: PacificSource Commercial |
$36.62
|
| Rate for Payer: PHCS PPO |
$39.88
|
| Rate for Payer: Three Rivers PPO |
$30.52
|
| Rate for Payer: TriWest Veterans Administration |
$23.60
|
| Rate for Payer: United Healthcare Commercial |
$35.40
|
| Rate for Payer: United Healthcare Medicare |
$23.60
|
| Rate for Payer: WINHealth Partners Commercial |
$39.88
|
| Rate for Payer: Wise Provider Network Commercial |
$38.66
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
IP
|
$42.62
|
|
|
Service Code
|
NDC 4733593140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.72 |
| Max. Negotiated Rate |
$42.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.92
|
| Rate for Payer: Altius Commercial |
$40.92
|
| Rate for Payer: Beech Street Commercial |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.99
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.34
|
| Rate for Payer: Cigna of WY Commercial |
$41.77
|
| Rate for Payer: Entrust Commercial |
$40.49
|
| Rate for Payer: First Choice Health Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.13
|
| Rate for Payer: HealthUtah PPO |
$42.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.34
|
| Rate for Payer: Multiplan Medicare/VA |
$26.72
|
| Rate for Payer: One Health Plan of WY PPO |
$41.77
|
| Rate for Payer: PacificSource Commercial |
$38.36
|
| Rate for Payer: PHCS PPO |
$41.77
|
| Rate for Payer: Three Rivers PPO |
$31.96
|
| Rate for Payer: TriWest Veterans Administration |
$28.13
|
| Rate for Payer: United Healthcare Commercial |
$37.08
|
| Rate for Payer: United Healthcare Medicare |
$28.13
|
| Rate for Payer: WINHealth Partners Commercial |
$40.49
|
| Rate for Payer: Wise Provider Network Commercial |
$40.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
OP
|
$42.62
|
|
|
Service Code
|
NDC 4733593140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$42.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.77
|
| Rate for Payer: Aetna of WY Medicare |
$28.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.92
|
| Rate for Payer: Altius Commercial |
$40.92
|
| Rate for Payer: Beech Street Commercial |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.99
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.34
|
| Rate for Payer: Cigna of WY Commercial |
$41.77
|
| Rate for Payer: Entrust Commercial |
$40.49
|
| Rate for Payer: First Choice Health Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.72
|
| Rate for Payer: HealthUtah PPO |
$42.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.34
|
| Rate for Payer: Multiplan Medicare/VA |
$23.48
|
| Rate for Payer: One Health Plan of WY PPO |
$41.77
|
| Rate for Payer: PacificSource Commercial |
$38.36
|
| Rate for Payer: PHCS PPO |
$41.77
|
| Rate for Payer: Three Rivers PPO |
$31.96
|
| Rate for Payer: TriWest Veterans Administration |
$24.72
|
| Rate for Payer: United Healthcare Commercial |
$37.08
|
| Rate for Payer: United Healthcare Medicare |
$24.72
|
| Rate for Payer: WINHealth Partners Commercial |
$41.77
|
| Rate for Payer: Wise Provider Network Commercial |
$40.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
NDC 5515023501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.79
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$19.75
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$20.79
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$20.79
|
| Rate for Payer: WINHealth Partners Commercial |
$29.92
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 5515023501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Aetna of WY Medicare |
$20.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.27
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$17.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$30.87
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
NDC 5515023510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.79
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$19.75
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$20.79
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$20.79
|
| Rate for Payer: WINHealth Partners Commercial |
$29.92
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [9046]
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 5515023510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Aetna of WY Medicare |
$20.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.27
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$17.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$30.87
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION (WET SOLR VIAL) [43011634]
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
NDC 5515023501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.79
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$19.75
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$20.79
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$20.79
|
| Rate for Payer: WINHealth Partners Commercial |
$29.92
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION (WET SOLR VIAL) [43011634]
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 5515023501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Aetna of WY Medicare |
$20.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.27
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$17.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$30.87
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION (WET SOLR VIAL) [43011634]
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
NDC 5515023510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.79
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$19.75
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$20.79
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$20.79
|
| Rate for Payer: WINHealth Partners Commercial |
$29.92
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION (WET SOLR VIAL) [43011634]
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
NDC 5515023510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.87
|
| Rate for Payer: Aetna of WY Medicare |
$20.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.24
|
| Rate for Payer: Altius Commercial |
$30.24
|
| Rate for Payer: Beech Street Commercial |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.86
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.56
|
| Rate for Payer: Cigna of WY Commercial |
$30.87
|
| Rate for Payer: Entrust Commercial |
$29.92
|
| Rate for Payer: First Choice Health Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.27
|
| Rate for Payer: HealthUtah PPO |
$31.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.56
|
| Rate for Payer: Multiplan Medicare/VA |
$17.36
|
| Rate for Payer: One Health Plan of WY PPO |
$30.87
|
| Rate for Payer: PacificSource Commercial |
$28.35
|
| Rate for Payer: PHCS PPO |
$30.87
|
| Rate for Payer: Three Rivers PPO |
$23.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Medicare |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$30.87
|
| Rate for Payer: Wise Provider Network Commercial |
$29.92
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [136079]
|
Facility
|
IP
|
$12,279.03
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,698.95 |
| Max. Negotiated Rate |
$12,279.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,033.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,787.87
|
| Rate for Payer: Altius Commercial |
$11,787.87
|
| Rate for Payer: Beech Street Commercial |
$12,033.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,081.08
|
| Rate for Payer: Cash Price |
$8,595.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,910.66
|
| Rate for Payer: Cigna of WY Commercial |
$12,033.45
|
| Rate for Payer: Entrust Commercial |
$11,665.08
|
| Rate for Payer: First Choice Health Commercial |
$11,665.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,665.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,104.16
|
| Rate for Payer: HealthUtah PPO |
$12,279.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,910.66
|
| Rate for Payer: Multiplan Medicare/VA |
$7,698.95
|
| Rate for Payer: One Health Plan of WY PPO |
$12,033.45
|
| Rate for Payer: PacificSource Commercial |
$11,051.13
|
| Rate for Payer: PHCS PPO |
$12,033.45
|
| Rate for Payer: Three Rivers PPO |
$9,209.27
|
| Rate for Payer: TriWest Veterans Administration |
$8,104.16
|
| Rate for Payer: United Healthcare Commercial |
$10,682.76
|
| Rate for Payer: United Healthcare Medicare |
$8,104.16
|
| Rate for Payer: WINHealth Partners Commercial |
$11,665.08
|
| Rate for Payer: Wise Provider Network Commercial |
$11,665.08
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [136079]
|
Facility
|
OP
|
$12,279.03
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,765.75 |
| Max. Negotiated Rate |
$12,279.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,033.45
|
| Rate for Payer: Aetna of WY Medicare |
$8,104.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11,787.87
|
| Rate for Payer: Altius Commercial |
$11,787.87
|
| Rate for Payer: Beech Street Commercial |
$12,033.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,081.08
|
| Rate for Payer: Cash Price |
$8,595.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,910.66
|
| Rate for Payer: Cigna of WY Commercial |
$12,033.45
|
| Rate for Payer: Entrust Commercial |
$11,665.08
|
| Rate for Payer: First Choice Health Commercial |
$11,665.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,665.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,121.84
|
| Rate for Payer: HealthUtah PPO |
$12,279.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,910.66
|
| Rate for Payer: Multiplan Medicare/VA |
$6,765.75
|
| Rate for Payer: One Health Plan of WY PPO |
$12,033.45
|
| Rate for Payer: PacificSource Commercial |
$11,051.13
|
| Rate for Payer: PHCS PPO |
$12,033.45
|
| Rate for Payer: Three Rivers PPO |
$9,209.27
|
| Rate for Payer: TriWest Veterans Administration |
$7,121.84
|
| Rate for Payer: United Healthcare Commercial |
$10,682.76
|
| Rate for Payer: United Healthcare Medicare |
$7,121.84
|
| Rate for Payer: WINHealth Partners Commercial |
$12,033.45
|
| Rate for Payer: Wise Provider Network Commercial |
$11,665.08
|
|
|
VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 36425
|
| Hospital Charge Code |
36425
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$37.37
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.37
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$31.76
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$37.37
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$37.37
|
| Rate for Payer: WINHealth Partners Commercial |
$175.95
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [6033]
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 6808471301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.38
|
| Rate for Payer: Altius Commercial |
$2.38
|
| Rate for Payer: Beech Street Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.41
|
| Rate for Payer: Cigna of WY Commercial |
$2.43
|
| Rate for Payer: Entrust Commercial |
$2.36
|
| Rate for Payer: First Choice Health Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.64
|
| Rate for Payer: HealthUtah PPO |
$2.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.41
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.43
|
| Rate for Payer: PacificSource Commercial |
$2.23
|
| Rate for Payer: PHCS PPO |
$2.43
|
| Rate for Payer: Three Rivers PPO |
$1.86
|
| Rate for Payer: TriWest Veterans Administration |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$1.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2.36
|
| Rate for Payer: Wise Provider Network Commercial |
$2.36
|
|
