|
WARFARIN 1 MG TABLET [17226]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 0832121101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.98
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1.41
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
WARFARIN 1 MG TABLET [17226]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 0832121101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.86
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
WARFARIN 1 MG TABLET [17226]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 0832121189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.98
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1.41
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
WARFARIN 1 MG TABLET [17226]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 0832121189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.86
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
WARFARIN 2.5 MG TABLET [6274]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 0832121389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
WARFARIN 2.5 MG TABLET [6274]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 0832121389
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Aetna of WY Medicare |
$1.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.90
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1.53
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
WARFARIN 2.5 MG TABLET [6274]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 0832121301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
WARFARIN 2.5 MG TABLET [6274]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 0832121301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Aetna of WY Medicare |
$1.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.90
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1.53
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
WARFARIN 3 MG TABLET [8749]
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 0832121401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.53
|
| Rate for Payer: Altius Commercial |
$1.53
|
| Rate for Payer: Beech Street Commercial |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.54
|
| Rate for Payer: Cigna of WY Commercial |
$1.56
|
| Rate for Payer: Entrust Commercial |
$1.51
|
| Rate for Payer: First Choice Health Commercial |
$1.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.05
|
| Rate for Payer: HealthUtah PPO |
$1.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.56
|
| Rate for Payer: PacificSource Commercial |
$1.43
|
| Rate for Payer: PHCS PPO |
$1.56
|
| Rate for Payer: Three Rivers PPO |
$1.19
|
| Rate for Payer: TriWest Veterans Administration |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Medicare |
$1.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1.51
|
| Rate for Payer: Wise Provider Network Commercial |
$1.51
|
|
|
WARFARIN 3 MG TABLET [8749]
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 0832121401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.56
|
| Rate for Payer: Aetna of WY Medicare |
$1.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.53
|
| Rate for Payer: Altius Commercial |
$1.53
|
| Rate for Payer: Beech Street Commercial |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.54
|
| Rate for Payer: Cigna of WY Commercial |
$1.56
|
| Rate for Payer: Entrust Commercial |
$1.51
|
| Rate for Payer: First Choice Health Commercial |
$1.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.56
|
| Rate for Payer: PacificSource Commercial |
$1.43
|
| Rate for Payer: PHCS PPO |
$1.56
|
| Rate for Payer: Three Rivers PPO |
$1.19
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1.51
|
|
|
WARFARIN 3 MG TABLET [8749]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 0832121489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.54
|
| Rate for Payer: Altius Commercial |
$1.54
|
| Rate for Payer: Beech Street Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.55
|
| Rate for Payer: Cigna of WY Commercial |
$1.57
|
| Rate for Payer: Entrust Commercial |
$1.52
|
| Rate for Payer: First Choice Health Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.57
|
| Rate for Payer: PacificSource Commercial |
$1.44
|
| Rate for Payer: PHCS PPO |
$1.57
|
| Rate for Payer: Three Rivers PPO |
$1.20
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.52
|
| Rate for Payer: Wise Provider Network Commercial |
$1.52
|
|
|
WARFARIN 3 MG TABLET [8749]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 0832121489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.57
|
| Rate for Payer: Aetna of WY Medicare |
$1.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.54
|
| Rate for Payer: Altius Commercial |
$1.54
|
| Rate for Payer: Beech Street Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.55
|
| Rate for Payer: Cigna of WY Commercial |
$1.57
|
| Rate for Payer: Entrust Commercial |
$1.52
|
| Rate for Payer: First Choice Health Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.93
|
| Rate for Payer: HealthUtah PPO |
$1.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.57
|
| Rate for Payer: PacificSource Commercial |
$1.44
|
| Rate for Payer: PHCS PPO |
$1.57
|
| Rate for Payer: Three Rivers PPO |
$1.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1.52
|
|
|
WARFARIN 5 MG TABLET [13427]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 0832121601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.56
|
| Rate for Payer: Altius Commercial |
$1.56
|
| Rate for Payer: Beech Street Commercial |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.58
|
| Rate for Payer: Cigna of WY Commercial |
$1.60
|
| Rate for Payer: Entrust Commercial |
$1.55
|
| Rate for Payer: First Choice Health Commercial |
$1.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.08
|
| Rate for Payer: HealthUtah PPO |
$1.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.58
|
| Rate for Payer: Multiplan Medicare/VA |
$1.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1.60
|
| Rate for Payer: PacificSource Commercial |
$1.47
|
| Rate for Payer: PHCS PPO |
$1.60
|
| Rate for Payer: Three Rivers PPO |
$1.22
|
| Rate for Payer: TriWest Veterans Administration |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Medicare |
$1.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1.55
|
|
|
WARFARIN 5 MG TABLET [13427]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 0832121601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.60
|
| Rate for Payer: Aetna of WY Medicare |
$1.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.56
|
| Rate for Payer: Altius Commercial |
$1.56
|
| Rate for Payer: Beech Street Commercial |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.58
|
| Rate for Payer: Cigna of WY Commercial |
$1.60
|
| Rate for Payer: Entrust Commercial |
$1.55
|
| Rate for Payer: First Choice Health Commercial |
$1.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.95
|
| Rate for Payer: HealthUtah PPO |
$1.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.58
|
| Rate for Payer: Multiplan Medicare/VA |
$0.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1.60
|
| Rate for Payer: PacificSource Commercial |
$1.47
|
| Rate for Payer: PHCS PPO |
$1.60
|
| Rate for Payer: Three Rivers PPO |
$1.22
|
| Rate for Payer: TriWest Veterans Administration |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Medicare |
$0.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1.55
|
|
|
WARFARIN 5 MG TABLET [13427]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 0832121689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.57
|
| Rate for Payer: Altius Commercial |
$1.57
|
| Rate for Payer: Beech Street Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.59
|
| Rate for Payer: Cigna of WY Commercial |
$1.61
|
| Rate for Payer: Entrust Commercial |
$1.56
|
| Rate for Payer: First Choice Health Commercial |
$1.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.08
|
| Rate for Payer: HealthUtah PPO |
$1.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1.61
|
| Rate for Payer: PacificSource Commercial |
$1.48
|
| Rate for Payer: PHCS PPO |
$1.61
|
| Rate for Payer: Three Rivers PPO |
$1.23
|
| Rate for Payer: TriWest Veterans Administration |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.43
|
| Rate for Payer: United Healthcare Medicare |
$1.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1.56
|
|
|
WARFARIN 5 MG TABLET [13427]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 0832121689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.61
|
| Rate for Payer: Aetna of WY Medicare |
$1.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.57
|
| Rate for Payer: Altius Commercial |
$1.57
|
| Rate for Payer: Beech Street Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.59
|
| Rate for Payer: Cigna of WY Commercial |
$1.61
|
| Rate for Payer: Entrust Commercial |
$1.56
|
| Rate for Payer: First Choice Health Commercial |
$1.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.95
|
| Rate for Payer: HealthUtah PPO |
$1.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.59
|
| Rate for Payer: Multiplan Medicare/VA |
$0.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1.61
|
| Rate for Payer: PacificSource Commercial |
$1.48
|
| Rate for Payer: PHCS PPO |
$1.61
|
| Rate for Payer: Three Rivers PPO |
$1.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.43
|
| Rate for Payer: United Healthcare Medicare |
$0.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1.61
|
| Rate for Payer: Wise Provider Network Commercial |
$1.56
|
|
|
WASHER SPIKED 18MM AR-1349L
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.85 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$192.85
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$203.00
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
WASHER SPIKED 18MM AR-1349L
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.45 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$219.45
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$231.00
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
NDC 0409488710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
NDC 0409488710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
NDC 0409488717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
NDC 0409488717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
NDC 0409488720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.11
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.61
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$10.11
|
| Rate for Payer: WINHealth Partners Commercial |
$14.55
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.32
|
|
|
Service Code
|
NDC 0409488720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.89
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.44
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
NDC 0409488723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.11
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.61
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$10.11
|
| Rate for Payer: WINHealth Partners Commercial |
$14.55
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
