|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [41933]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 7733398310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.92
|
| Rate for Payer: Aetna of WY Medicare |
$0.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.90
|
| Rate for Payer: Altius Commercial |
$0.90
|
| Rate for Payer: Beech Street Commercial |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.91
|
| Rate for Payer: Cigna of WY Commercial |
$0.92
|
| Rate for Payer: Entrust Commercial |
$0.89
|
| Rate for Payer: First Choice Health Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$0.92
|
| Rate for Payer: PacificSource Commercial |
$0.85
|
| Rate for Payer: PHCS PPO |
$0.92
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.82
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.92
|
| Rate for Payer: Wise Provider Network Commercial |
$0.89
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [41933]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 7733398325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.90
|
| Rate for Payer: Altius Commercial |
$0.90
|
| Rate for Payer: Beech Street Commercial |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.91
|
| Rate for Payer: Cigna of WY Commercial |
$0.92
|
| Rate for Payer: Entrust Commercial |
$0.89
|
| Rate for Payer: First Choice Health Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.62
|
| Rate for Payer: HealthUtah PPO |
$0.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.59
|
| Rate for Payer: One Health Plan of WY PPO |
$0.92
|
| Rate for Payer: PacificSource Commercial |
$0.85
|
| Rate for Payer: PHCS PPO |
$0.92
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$0.82
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
| Rate for Payer: WINHealth Partners Commercial |
$0.89
|
| Rate for Payer: Wise Provider Network Commercial |
$0.89
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [41933]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 7733398325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.92
|
| Rate for Payer: Aetna of WY Medicare |
$0.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.90
|
| Rate for Payer: Altius Commercial |
$0.90
|
| Rate for Payer: Beech Street Commercial |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.91
|
| Rate for Payer: Cigna of WY Commercial |
$0.92
|
| Rate for Payer: Entrust Commercial |
$0.89
|
| Rate for Payer: First Choice Health Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$0.92
|
| Rate for Payer: PacificSource Commercial |
$0.85
|
| Rate for Payer: PHCS PPO |
$0.92
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.82
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.92
|
| Rate for Payer: Wise Provider Network Commercial |
$0.89
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [129075]
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.31
|
| Rate for Payer: Altius Commercial |
$21.31
|
| Rate for Payer: Beech Street Commercial |
$21.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.53
|
| Rate for Payer: Cigna of WY Commercial |
$21.76
|
| Rate for Payer: Entrust Commercial |
$21.09
|
| Rate for Payer: First Choice Health Commercial |
$21.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.65
|
| Rate for Payer: HealthUtah PPO |
$22.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.53
|
| Rate for Payer: Multiplan Medicare/VA |
$13.92
|
| Rate for Payer: One Health Plan of WY PPO |
$21.76
|
| Rate for Payer: PacificSource Commercial |
$19.98
|
| Rate for Payer: PHCS PPO |
$21.76
|
| Rate for Payer: Three Rivers PPO |
$16.65
|
| Rate for Payer: TriWest Veterans Administration |
$14.65
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Medicare |
$14.65
|
| Rate for Payer: WINHealth Partners Commercial |
$21.09
|
| Rate for Payer: Wise Provider Network Commercial |
$21.09
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [129075]
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.76
|
| Rate for Payer: Aetna of WY Medicare |
$14.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.31
|
| Rate for Payer: Altius Commercial |
$21.31
|
| Rate for Payer: Beech Street Commercial |
$21.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.53
|
| Rate for Payer: Cigna of WY Commercial |
$21.76
|
| Rate for Payer: Entrust Commercial |
$21.09
|
| Rate for Payer: First Choice Health Commercial |
$21.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.88
|
| Rate for Payer: HealthUtah PPO |
$22.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.53
|
| Rate for Payer: Multiplan Medicare/VA |
$12.23
|
| Rate for Payer: One Health Plan of WY PPO |
$21.76
|
| Rate for Payer: PacificSource Commercial |
$19.98
|
| Rate for Payer: PHCS PPO |
$21.76
|
| Rate for Payer: Three Rivers PPO |
$16.65
|
| Rate for Payer: TriWest Veterans Administration |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Medicare |
$12.88
|
| Rate for Payer: WINHealth Partners Commercial |
$21.76
|
| Rate for Payer: Wise Provider Network Commercial |
$21.09
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [43422]
|
Facility
|
OP
|
$19.40
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.01
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Aetna of WY Medicare |
$12.80
|
| Rate for Payer: Aetna of WY Medicare |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
| Rate for Payer: Altius Commercial |
$18.62
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$19.01
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$19.01
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: Entrust Commercial |
$18.43
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.43
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.22
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: HealthUtah PPO |
$19.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.82
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: Multiplan Medicare/VA |
$10.69
|
| Rate for Payer: Multiplan Medicare/VA |
$14.46
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: One Health Plan of WY PPO |
$19.01
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PacificSource Commercial |
$17.46
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$19.01
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$14.55
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$15.22
|
| Rate for Payer: TriWest Veterans Administration |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: United Healthcare Medicare |
$11.25
|
| Rate for Payer: WINHealth Partners Commercial |
$25.72
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: WINHealth Partners Commercial |
$19.01
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
| Rate for Payer: Wise Provider Network Commercial |
$18.43
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [43422]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.01
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
| Rate for Payer: Altius Commercial |
$18.62
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Beech Street Commercial |
$19.01
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.93
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.82
|
| Rate for Payer: Cigna of WY Commercial |
$19.01
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: Entrust Commercial |
$18.43
|
| Rate for Payer: First Choice Health Commercial |
$18.43
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.32
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$19.40
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$16.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: Multiplan Medicare/VA |
$12.16
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: One Health Plan of WY PPO |
$19.01
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PacificSource Commercial |
$17.46
|
| Rate for Payer: PHCS PPO |
$19.01
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$14.55
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.80
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: TriWest Veterans Administration |
$17.32
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$22.84
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: United Healthcare Medicare |
$17.32
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: WINHealth Partners Commercial |
$18.43
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: WINHealth Partners Commercial |
$24.94
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.43
|
|
|
ZOLL ADLT MASIMO SET
|
Facility
|
IP
|
$28.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$28.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.24
|
| Rate for Payer: Altius Commercial |
$27.24
|
| Rate for Payer: Beech Street Commercial |
$27.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.53
|
| Rate for Payer: Cigna of WY Commercial |
$27.81
|
| Rate for Payer: Entrust Commercial |
$26.96
|
| Rate for Payer: First Choice Health Commercial |
$26.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.73
|
| Rate for Payer: HealthUtah PPO |
$28.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.53
|
| Rate for Payer: Multiplan Medicare/VA |
$17.79
|
| Rate for Payer: One Health Plan of WY PPO |
$27.81
|
| Rate for Payer: PacificSource Commercial |
$25.54
|
| Rate for Payer: PHCS PPO |
$27.81
|
| Rate for Payer: Three Rivers PPO |
$21.28
|
| Rate for Payer: TriWest Veterans Administration |
$18.73
|
| Rate for Payer: United Healthcare Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare |
$18.73
|
| Rate for Payer: WINHealth Partners Commercial |
$26.96
|
| Rate for Payer: Wise Provider Network Commercial |
$26.96
|
|
|
ZOLL ADLT MASIMO SET
|
Facility
|
OP
|
$28.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$28.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.81
|
| Rate for Payer: Aetna of WY Medicare |
$18.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.24
|
| Rate for Payer: Altius Commercial |
$27.24
|
| Rate for Payer: Beech Street Commercial |
$27.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.53
|
| Rate for Payer: Cigna of WY Commercial |
$27.81
|
| Rate for Payer: Entrust Commercial |
$26.96
|
| Rate for Payer: First Choice Health Commercial |
$26.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.46
|
| Rate for Payer: HealthUtah PPO |
$28.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.53
|
| Rate for Payer: Multiplan Medicare/VA |
$15.64
|
| Rate for Payer: One Health Plan of WY PPO |
$27.81
|
| Rate for Payer: PacificSource Commercial |
$25.54
|
| Rate for Payer: PHCS PPO |
$27.81
|
| Rate for Payer: Three Rivers PPO |
$21.28
|
| Rate for Payer: TriWest Veterans Administration |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare |
$16.46
|
| Rate for Payer: WINHealth Partners Commercial |
$27.81
|
| Rate for Payer: Wise Provider Network Commercial |
$26.96
|
|
|
ZOLL CPR-D-PADZ FOR AED PLUS
|
Facility
|
IP
|
$483.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.37 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$474.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$464.49
|
| Rate for Payer: Altius Commercial |
$464.49
|
| Rate for Payer: Beech Street Commercial |
$474.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$397.23
|
| Rate for Payer: Cash Price |
$338.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$469.32
|
| Rate for Payer: Cigna of WY Commercial |
$474.16
|
| Rate for Payer: Entrust Commercial |
$459.65
|
| Rate for Payer: First Choice Health Commercial |
$459.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$459.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.33
|
| Rate for Payer: HealthUtah PPO |
$483.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$469.32
|
| Rate for Payer: Multiplan Medicare/VA |
$303.37
|
| Rate for Payer: One Health Plan of WY PPO |
$474.16
|
| Rate for Payer: PacificSource Commercial |
$435.46
|
| Rate for Payer: PHCS PPO |
$474.16
|
| Rate for Payer: Three Rivers PPO |
$362.88
|
| Rate for Payer: TriWest Veterans Administration |
$319.33
|
| Rate for Payer: United Healthcare Commercial |
$420.94
|
| Rate for Payer: United Healthcare Medicare |
$319.33
|
| Rate for Payer: WINHealth Partners Commercial |
$459.65
|
| Rate for Payer: Wise Provider Network Commercial |
$459.65
|
|
|
ZOLL CPR-D-PADZ FOR AED PLUS
|
Facility
|
OP
|
$483.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.60 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$474.16
|
| Rate for Payer: Aetna of WY Medicare |
$319.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$464.49
|
| Rate for Payer: Altius Commercial |
$464.49
|
| Rate for Payer: Beech Street Commercial |
$474.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$397.23
|
| Rate for Payer: Cash Price |
$338.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$469.32
|
| Rate for Payer: Cigna of WY Commercial |
$474.16
|
| Rate for Payer: Entrust Commercial |
$459.65
|
| Rate for Payer: First Choice Health Commercial |
$459.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$459.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$280.63
|
| Rate for Payer: HealthUtah PPO |
$483.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$469.32
|
| Rate for Payer: Multiplan Medicare/VA |
$266.60
|
| Rate for Payer: One Health Plan of WY PPO |
$474.16
|
| Rate for Payer: PacificSource Commercial |
$435.46
|
| Rate for Payer: PHCS PPO |
$474.16
|
| Rate for Payer: Three Rivers PPO |
$362.88
|
| Rate for Payer: TriWest Veterans Administration |
$280.63
|
| Rate for Payer: United Healthcare Commercial |
$420.94
|
| Rate for Payer: United Healthcare Medicare |
$280.63
|
| Rate for Payer: WINHealth Partners Commercial |
$474.16
|
| Rate for Payer: Wise Provider Network Commercial |
$459.65
|
|
|
ZOLL D-FIB PADS CATH LAB
|
Facility
|
IP
|
$156.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$150.38
|
| Rate for Payer: Altius Commercial |
$150.38
|
| Rate for Payer: Beech Street Commercial |
$153.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.61
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.95
|
| Rate for Payer: Cigna of WY Commercial |
$153.52
|
| Rate for Payer: Entrust Commercial |
$148.82
|
| Rate for Payer: First Choice Health Commercial |
$148.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.39
|
| Rate for Payer: HealthUtah PPO |
$156.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.95
|
| Rate for Payer: Multiplan Medicare/VA |
$98.22
|
| Rate for Payer: One Health Plan of WY PPO |
$153.52
|
| Rate for Payer: PacificSource Commercial |
$140.98
|
| Rate for Payer: PHCS PPO |
$153.52
|
| Rate for Payer: Three Rivers PPO |
$117.49
|
| Rate for Payer: TriWest Veterans Administration |
$103.39
|
| Rate for Payer: United Healthcare Commercial |
$136.29
|
| Rate for Payer: United Healthcare Medicare |
$103.39
|
| Rate for Payer: WINHealth Partners Commercial |
$148.82
|
| Rate for Payer: Wise Provider Network Commercial |
$148.82
|
|
|
ZOLL D-FIB PADS CATH LAB
|
Facility
|
OP
|
$156.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.31 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.52
|
| Rate for Payer: Aetna of WY Medicare |
$103.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$150.38
|
| Rate for Payer: Altius Commercial |
$150.38
|
| Rate for Payer: Beech Street Commercial |
$153.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.61
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.95
|
| Rate for Payer: Cigna of WY Commercial |
$153.52
|
| Rate for Payer: Entrust Commercial |
$148.82
|
| Rate for Payer: First Choice Health Commercial |
$148.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.86
|
| Rate for Payer: HealthUtah PPO |
$156.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.95
|
| Rate for Payer: Multiplan Medicare/VA |
$86.31
|
| Rate for Payer: One Health Plan of WY PPO |
$153.52
|
| Rate for Payer: PacificSource Commercial |
$140.98
|
| Rate for Payer: PHCS PPO |
$153.52
|
| Rate for Payer: Three Rivers PPO |
$117.49
|
| Rate for Payer: TriWest Veterans Administration |
$90.86
|
| Rate for Payer: United Healthcare Commercial |
$136.29
|
| Rate for Payer: United Healthcare Medicare |
$90.86
|
| Rate for Payer: WINHealth Partners Commercial |
$153.52
|
| Rate for Payer: Wise Provider Network Commercial |
$148.82
|
|
|
ZOLL NEO NATE/ADULT SENSOR
|
Facility
|
OP
|
$39.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$39.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.70
|
| Rate for Payer: Aetna of WY Medicare |
$26.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.91
|
| Rate for Payer: Altius Commercial |
$37.91
|
| Rate for Payer: Beech Street Commercial |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.31
|
| Rate for Payer: Cigna of WY Commercial |
$38.70
|
| Rate for Payer: Entrust Commercial |
$37.52
|
| Rate for Payer: First Choice Health Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.90
|
| Rate for Payer: HealthUtah PPO |
$39.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.31
|
| Rate for Payer: Multiplan Medicare/VA |
$21.76
|
| Rate for Payer: One Health Plan of WY PPO |
$38.70
|
| Rate for Payer: PacificSource Commercial |
$35.54
|
| Rate for Payer: PHCS PPO |
$38.70
|
| Rate for Payer: Three Rivers PPO |
$29.62
|
| Rate for Payer: TriWest Veterans Administration |
$22.90
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
| Rate for Payer: United Healthcare Medicare |
$22.90
|
| Rate for Payer: WINHealth Partners Commercial |
$38.70
|
| Rate for Payer: Wise Provider Network Commercial |
$37.52
|
|
|
ZOLL NEO NATE/ADULT SENSOR
|
Facility
|
IP
|
$39.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$39.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.91
|
| Rate for Payer: Altius Commercial |
$37.91
|
| Rate for Payer: Beech Street Commercial |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.31
|
| Rate for Payer: Cigna of WY Commercial |
$38.70
|
| Rate for Payer: Entrust Commercial |
$37.52
|
| Rate for Payer: First Choice Health Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.06
|
| Rate for Payer: HealthUtah PPO |
$39.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.31
|
| Rate for Payer: Multiplan Medicare/VA |
$24.76
|
| Rate for Payer: One Health Plan of WY PPO |
$38.70
|
| Rate for Payer: PacificSource Commercial |
$35.54
|
| Rate for Payer: PHCS PPO |
$38.70
|
| Rate for Payer: Three Rivers PPO |
$29.62
|
| Rate for Payer: TriWest Veterans Administration |
$26.06
|
| Rate for Payer: United Healthcare Commercial |
$34.36
|
| Rate for Payer: United Healthcare Medicare |
$26.06
|
| Rate for Payer: WINHealth Partners Commercial |
$37.52
|
| Rate for Payer: Wise Provider Network Commercial |
$37.52
|
|
|
ZOLL PEDI-PADS II FOR AED PLUS
|
Facility
|
IP
|
$272.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$272.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$266.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$261.27
|
| Rate for Payer: Altius Commercial |
$261.27
|
| Rate for Payer: Beech Street Commercial |
$266.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$223.44
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.00
|
| Rate for Payer: Cigna of WY Commercial |
$266.72
|
| Rate for Payer: Entrust Commercial |
$258.55
|
| Rate for Payer: First Choice Health Commercial |
$258.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$258.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.63
|
| Rate for Payer: HealthUtah PPO |
$272.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.00
|
| Rate for Payer: Multiplan Medicare/VA |
$170.64
|
| Rate for Payer: One Health Plan of WY PPO |
$266.72
|
| Rate for Payer: PacificSource Commercial |
$244.94
|
| Rate for Payer: PHCS PPO |
$266.72
|
| Rate for Payer: Three Rivers PPO |
$204.12
|
| Rate for Payer: TriWest Veterans Administration |
$179.63
|
| Rate for Payer: United Healthcare Commercial |
$236.78
|
| Rate for Payer: United Healthcare Medicare |
$179.63
|
| Rate for Payer: WINHealth Partners Commercial |
$258.55
|
| Rate for Payer: Wise Provider Network Commercial |
$258.55
|
|
|
ZOLL PEDI-PADS II FOR AED PLUS
|
Facility
|
OP
|
$272.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.96 |
| Max. Negotiated Rate |
$272.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$266.72
|
| Rate for Payer: Aetna of WY Medicare |
$179.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$261.27
|
| Rate for Payer: Altius Commercial |
$261.27
|
| Rate for Payer: Beech Street Commercial |
$266.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$223.44
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.00
|
| Rate for Payer: Cigna of WY Commercial |
$266.72
|
| Rate for Payer: Entrust Commercial |
$258.55
|
| Rate for Payer: First Choice Health Commercial |
$258.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$258.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.85
|
| Rate for Payer: HealthUtah PPO |
$272.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.00
|
| Rate for Payer: Multiplan Medicare/VA |
$149.96
|
| Rate for Payer: One Health Plan of WY PPO |
$266.72
|
| Rate for Payer: PacificSource Commercial |
$244.94
|
| Rate for Payer: PHCS PPO |
$266.72
|
| Rate for Payer: Three Rivers PPO |
$204.12
|
| Rate for Payer: TriWest Veterans Administration |
$157.85
|
| Rate for Payer: United Healthcare Commercial |
$236.78
|
| Rate for Payer: United Healthcare Medicare |
$157.85
|
| Rate for Payer: WINHealth Partners Commercial |
$266.72
|
| Rate for Payer: Wise Provider Network Commercial |
$258.55
|
|
|
ZOLL STAT PADZ ADULT D-FIB
|
Facility
|
IP
|
$114.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.47
|
| Rate for Payer: Altius Commercial |
$109.47
|
| Rate for Payer: Beech Street Commercial |
$111.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.62
|
| Rate for Payer: Cash Price |
$79.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.61
|
| Rate for Payer: Cigna of WY Commercial |
$111.75
|
| Rate for Payer: Entrust Commercial |
$108.33
|
| Rate for Payer: First Choice Health Commercial |
$108.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.26
|
| Rate for Payer: HealthUtah PPO |
$114.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.61
|
| Rate for Payer: Multiplan Medicare/VA |
$71.50
|
| Rate for Payer: One Health Plan of WY PPO |
$111.75
|
| Rate for Payer: PacificSource Commercial |
$102.63
|
| Rate for Payer: PHCS PPO |
$111.75
|
| Rate for Payer: Three Rivers PPO |
$85.52
|
| Rate for Payer: TriWest Veterans Administration |
$75.26
|
| Rate for Payer: United Healthcare Commercial |
$99.21
|
| Rate for Payer: United Healthcare Medicare |
$75.26
|
| Rate for Payer: WINHealth Partners Commercial |
$108.33
|
| Rate for Payer: Wise Provider Network Commercial |
$108.33
|
|
|
ZOLL STAT PADZ ADULT D-FIB
|
Facility
|
OP
|
$114.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.75
|
| Rate for Payer: Aetna of WY Medicare |
$75.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.47
|
| Rate for Payer: Altius Commercial |
$109.47
|
| Rate for Payer: Beech Street Commercial |
$111.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.62
|
| Rate for Payer: Cash Price |
$79.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.61
|
| Rate for Payer: Cigna of WY Commercial |
$111.75
|
| Rate for Payer: Entrust Commercial |
$108.33
|
| Rate for Payer: First Choice Health Commercial |
$108.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.14
|
| Rate for Payer: HealthUtah PPO |
$114.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.61
|
| Rate for Payer: Multiplan Medicare/VA |
$62.83
|
| Rate for Payer: One Health Plan of WY PPO |
$111.75
|
| Rate for Payer: PacificSource Commercial |
$102.63
|
| Rate for Payer: PHCS PPO |
$111.75
|
| Rate for Payer: Three Rivers PPO |
$85.52
|
| Rate for Payer: TriWest Veterans Administration |
$66.14
|
| Rate for Payer: United Healthcare Commercial |
$99.21
|
| Rate for Payer: United Healthcare Medicare |
$66.14
|
| Rate for Payer: WINHealth Partners Commercial |
$111.75
|
| Rate for Payer: Wise Provider Network Commercial |
$108.33
|
|
|
ZOLL STATZ-PAD PED
|
Facility
|
OP
|
$112.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$112.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.72
|
| Rate for Payer: Aetna of WY Medicare |
$74.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.46
|
| Rate for Payer: Altius Commercial |
$108.46
|
| Rate for Payer: Beech Street Commercial |
$110.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$79.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.59
|
| Rate for Payer: Cigna of WY Commercial |
$110.72
|
| Rate for Payer: Entrust Commercial |
$107.33
|
| Rate for Payer: First Choice Health Commercial |
$107.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.53
|
| Rate for Payer: HealthUtah PPO |
$112.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.59
|
| Rate for Payer: Multiplan Medicare/VA |
$62.25
|
| Rate for Payer: One Health Plan of WY PPO |
$110.72
|
| Rate for Payer: PacificSource Commercial |
$101.68
|
| Rate for Payer: PHCS PPO |
$110.72
|
| Rate for Payer: Three Rivers PPO |
$84.74
|
| Rate for Payer: TriWest Veterans Administration |
$65.53
|
| Rate for Payer: United Healthcare Commercial |
$98.29
|
| Rate for Payer: United Healthcare Medicare |
$65.53
|
| Rate for Payer: WINHealth Partners Commercial |
$110.72
|
| Rate for Payer: Wise Provider Network Commercial |
$107.33
|
|
|
ZOLL STATZ-PAD PED
|
Facility
|
IP
|
$112.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$112.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.46
|
| Rate for Payer: Altius Commercial |
$108.46
|
| Rate for Payer: Beech Street Commercial |
$110.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$79.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.59
|
| Rate for Payer: Cigna of WY Commercial |
$110.72
|
| Rate for Payer: Entrust Commercial |
$107.33
|
| Rate for Payer: First Choice Health Commercial |
$107.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.57
|
| Rate for Payer: HealthUtah PPO |
$112.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.59
|
| Rate for Payer: Multiplan Medicare/VA |
$70.84
|
| Rate for Payer: One Health Plan of WY PPO |
$110.72
|
| Rate for Payer: PacificSource Commercial |
$101.68
|
| Rate for Payer: PHCS PPO |
$110.72
|
| Rate for Payer: Three Rivers PPO |
$84.74
|
| Rate for Payer: TriWest Veterans Administration |
$74.57
|
| Rate for Payer: United Healthcare Commercial |
$98.29
|
| Rate for Payer: United Healthcare Medicare |
$74.57
|
| Rate for Payer: WINHealth Partners Commercial |
$107.33
|
| Rate for Payer: Wise Provider Network Commercial |
$107.33
|
|
|
ZOLPIDEM 5 MG TABLET [16592]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904608261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
ZOLPIDEM 5 MG TABLET [16592]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 6808418911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
ZOLPIDEM 5 MG TABLET [16592]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 6808418911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Aetna of WY Medicare |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
ZOLPIDEM 5 MG TABLET [16592]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904608261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
