|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [2607]
|
Facility
|
IP
|
$16.31
|
|
|
Service Code
|
NDC 0409175550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.98
|
| Rate for Payer: Aetna of WY Medicare |
$10.44
|
| Rate for Payer: Altius Commercial |
$15.66
|
| Rate for Payer: Beech Street Commercial |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.82
|
| Rate for Payer: Cigna of WY Commercial |
$15.98
|
| Rate for Payer: Entrust Commercial |
$15.49
|
| Rate for Payer: First Choice Health Commercial |
$15.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.95
|
| Rate for Payer: HealthUtah PPO |
$16.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.82
|
| Rate for Payer: Multiplan Medicare/VA |
$9.45
|
| Rate for Payer: One Health Plan of WY PPO |
$15.98
|
| Rate for Payer: PacificSource Commercial |
$14.68
|
| Rate for Payer: PHCS PPO |
$15.98
|
| Rate for Payer: Three Rivers PPO |
$12.23
|
| Rate for Payer: TriWest Veterans Administration |
$9.95
|
| Rate for Payer: United Healthcare Commercial |
$15.58
|
| Rate for Payer: United Healthcare Medicare |
$9.95
|
| Rate for Payer: WINHealth Partners Commercial |
$15.49
|
| Rate for Payer: Wise Provider Network Commercial |
$15.49
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [2607]
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
NDC 6332346301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.46
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [2607]
|
Facility
|
OP
|
$16.31
|
|
|
Service Code
|
NDC 0409175550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.98
|
| Rate for Payer: Aetna of WY Medicare |
$10.76
|
| Rate for Payer: Altius Commercial |
$15.66
|
| Rate for Payer: Beech Street Commercial |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.82
|
| Rate for Payer: Cigna of WY Commercial |
$15.98
|
| Rate for Payer: Entrust Commercial |
$15.49
|
| Rate for Payer: First Choice Health Commercial |
$15.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.30
|
| Rate for Payer: HealthUtah PPO |
$16.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.82
|
| Rate for Payer: Multiplan Medicare/VA |
$8.83
|
| Rate for Payer: One Health Plan of WY PPO |
$15.98
|
| Rate for Payer: PacificSource Commercial |
$14.68
|
| Rate for Payer: PHCS PPO |
$15.98
|
| Rate for Payer: Three Rivers PPO |
$12.23
|
| Rate for Payer: TriWest Veterans Administration |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$15.58
|
| Rate for Payer: United Healthcare Medicare |
$9.30
|
| Rate for Payer: WINHealth Partners Commercial |
$15.98
|
| Rate for Payer: Wise Provider Network Commercial |
$15.49
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [2607]
|
Facility
|
OP
|
$16.34
|
|
|
Service Code
|
NDC 6332346301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
OP
|
$16.55
|
|
|
Service Code
|
NDC 0409174630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.92
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.05
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.43
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Multiplan Medicare/VA |
$8.96
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: TriWest Veterans Administration |
$9.43
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$9.43
|
| Rate for Payer: WINHealth Partners Commercial |
$16.22
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
IP
|
$16.55
|
|
|
Service Code
|
NDC 0409174610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.59
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.05
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$15.72
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
OP
|
$16.85
|
|
|
Service Code
|
NDC 0409174670
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Aetna of WY Medicare |
$11.12
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$16.09
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.51
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
IP
|
$16.85
|
|
|
Service Code
|
NDC 0409174670
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.28
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Multiplan Medicare/VA |
$9.76
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: TriWest Veterans Administration |
$10.28
|
| Rate for Payer: United Healthcare Commercial |
$16.09
|
| Rate for Payer: United Healthcare Medicare |
$10.28
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
OP
|
$16.85
|
|
|
Service Code
|
NDC 0409174671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Aetna of WY Medicare |
$11.12
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$16.09
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.51
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
IP
|
$16.85
|
|
|
Service Code
|
NDC 0409174671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.51
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$16.18
|
| Rate for Payer: Beech Street Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.34
|
| Rate for Payer: Cigna of WY Commercial |
$16.51
|
| Rate for Payer: Entrust Commercial |
$16.01
|
| Rate for Payer: First Choice Health Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.28
|
| Rate for Payer: HealthUtah PPO |
$16.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.34
|
| Rate for Payer: Multiplan Medicare/VA |
$9.76
|
| Rate for Payer: One Health Plan of WY PPO |
$16.51
|
| Rate for Payer: PacificSource Commercial |
$15.16
|
| Rate for Payer: PHCS PPO |
$16.51
|
| Rate for Payer: Three Rivers PPO |
$12.64
|
| Rate for Payer: TriWest Veterans Administration |
$10.28
|
| Rate for Payer: United Healthcare Commercial |
$16.09
|
| Rate for Payer: United Healthcare Medicare |
$10.28
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.01
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
IP
|
$16.55
|
|
|
Service Code
|
NDC 0409174630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.59
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.05
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$15.72
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION [28405]
|
Facility
|
OP
|
$16.55
|
|
|
Service Code
|
NDC 0409174610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.92
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.05
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.43
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Multiplan Medicare/VA |
$8.96
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: TriWest Veterans Administration |
$9.43
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$9.43
|
| Rate for Payer: WINHealth Partners Commercial |
$16.22
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
OP
|
$15.79
|
|
|
Service Code
|
NDC 0409174910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Medicare |
$10.42
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.32
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.00
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Multiplan Medicare/VA |
$8.55
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: TriWest Veterans Administration |
$9.00
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
| Rate for Payer: WINHealth Partners Commercial |
$15.47
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
NDC 0409174971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.67
|
| Rate for Payer: Aetna of WY Medicare |
$11.23
|
| Rate for Payer: Altius Commercial |
$16.33
|
| Rate for Payer: Beech Street Commercial |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.50
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.50
|
| Rate for Payer: Cigna of WY Commercial |
$16.67
|
| Rate for Payer: Entrust Commercial |
$16.16
|
| Rate for Payer: First Choice Health Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.70
|
| Rate for Payer: HealthUtah PPO |
$17.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9.21
|
| Rate for Payer: One Health Plan of WY PPO |
$16.67
|
| Rate for Payer: PacificSource Commercial |
$15.31
|
| Rate for Payer: PHCS PPO |
$16.67
|
| Rate for Payer: Three Rivers PPO |
$12.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
| Rate for Payer: United Healthcare Medicare |
$9.70
|
| Rate for Payer: WINHealth Partners Commercial |
$16.67
|
| Rate for Payer: Wise Provider Network Commercial |
$16.16
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
IP
|
$17.01
|
|
|
Service Code
|
NDC 0409174970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.67
|
| Rate for Payer: Aetna of WY Medicare |
$10.89
|
| Rate for Payer: Altius Commercial |
$16.33
|
| Rate for Payer: Beech Street Commercial |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.50
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.50
|
| Rate for Payer: Cigna of WY Commercial |
$16.67
|
| Rate for Payer: Entrust Commercial |
$16.16
|
| Rate for Payer: First Choice Health Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.38
|
| Rate for Payer: HealthUtah PPO |
$17.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9.86
|
| Rate for Payer: One Health Plan of WY PPO |
$16.67
|
| Rate for Payer: PacificSource Commercial |
$15.31
|
| Rate for Payer: PHCS PPO |
$16.67
|
| Rate for Payer: Three Rivers PPO |
$12.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.38
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
| Rate for Payer: United Healthcare Medicare |
$10.38
|
| Rate for Payer: WINHealth Partners Commercial |
$16.16
|
| Rate for Payer: Wise Provider Network Commercial |
$16.16
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
IP
|
$15.79
|
|
|
Service Code
|
NDC 0409174910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.32
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.63
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.15
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: TriWest Veterans Administration |
$9.63
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare |
$9.63
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
NDC 0409174970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.67
|
| Rate for Payer: Aetna of WY Medicare |
$11.23
|
| Rate for Payer: Altius Commercial |
$16.33
|
| Rate for Payer: Beech Street Commercial |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.50
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.50
|
| Rate for Payer: Cigna of WY Commercial |
$16.67
|
| Rate for Payer: Entrust Commercial |
$16.16
|
| Rate for Payer: First Choice Health Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.70
|
| Rate for Payer: HealthUtah PPO |
$17.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9.21
|
| Rate for Payer: One Health Plan of WY PPO |
$16.67
|
| Rate for Payer: PacificSource Commercial |
$15.31
|
| Rate for Payer: PHCS PPO |
$16.67
|
| Rate for Payer: Three Rivers PPO |
$12.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
| Rate for Payer: United Healthcare Medicare |
$9.70
|
| Rate for Payer: WINHealth Partners Commercial |
$16.67
|
| Rate for Payer: Wise Provider Network Commercial |
$16.16
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION [28403]
|
Facility
|
IP
|
$17.01
|
|
|
Service Code
|
NDC 0409174971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.67
|
| Rate for Payer: Aetna of WY Medicare |
$10.89
|
| Rate for Payer: Altius Commercial |
$16.33
|
| Rate for Payer: Beech Street Commercial |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.50
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.50
|
| Rate for Payer: Cigna of WY Commercial |
$16.67
|
| Rate for Payer: Entrust Commercial |
$16.16
|
| Rate for Payer: First Choice Health Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.38
|
| Rate for Payer: HealthUtah PPO |
$17.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.50
|
| Rate for Payer: Multiplan Medicare/VA |
$9.86
|
| Rate for Payer: One Health Plan of WY PPO |
$16.67
|
| Rate for Payer: PacificSource Commercial |
$15.31
|
| Rate for Payer: PHCS PPO |
$16.67
|
| Rate for Payer: Three Rivers PPO |
$12.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.38
|
| Rate for Payer: United Healthcare Commercial |
$16.24
|
| Rate for Payer: United Healthcare Medicare |
$10.38
|
| Rate for Payer: WINHealth Partners Commercial |
$16.16
|
| Rate for Payer: Wise Provider Network Commercial |
$16.16
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION [4728]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 0409116318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.69
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.25
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$8.69
|
| Rate for Payer: United Healthcare Commercial |
$14.55
|
| Rate for Payer: United Healthcare Medicare |
$8.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION [4728]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 0409116318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$9.75
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.30
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.83
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$14.55
|
| Rate for Payer: United Healthcare Medicare |
$9.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION [94701]
|
Facility
|
IP
|
$56.08
|
|
|
Service Code
|
NDC 6525026609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.96
|
| Rate for Payer: Aetna of WY Medicare |
$35.89
|
| Rate for Payer: Altius Commercial |
$53.84
|
| Rate for Payer: Beech Street Commercial |
$54.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$39.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.40
|
| Rate for Payer: Cigna of WY Commercial |
$54.96
|
| Rate for Payer: Entrust Commercial |
$53.28
|
| Rate for Payer: First Choice Health Commercial |
$53.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.21
|
| Rate for Payer: HealthUtah PPO |
$56.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.40
|
| Rate for Payer: Multiplan Medicare/VA |
$32.50
|
| Rate for Payer: One Health Plan of WY PPO |
$54.96
|
| Rate for Payer: PacificSource Commercial |
$50.47
|
| Rate for Payer: PHCS PPO |
$54.96
|
| Rate for Payer: Three Rivers PPO |
$42.06
|
| Rate for Payer: TriWest Veterans Administration |
$34.21
|
| Rate for Payer: United Healthcare Commercial |
$53.56
|
| Rate for Payer: United Healthcare Medicare |
$34.21
|
| Rate for Payer: WINHealth Partners Commercial |
$53.28
|
| Rate for Payer: Wise Provider Network Commercial |
$53.28
|
|
|
BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION [94701]
|
Facility
|
OP
|
$56.08
|
|
|
Service Code
|
NDC 6525026609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.96
|
| Rate for Payer: Aetna of WY Medicare |
$37.01
|
| Rate for Payer: Altius Commercial |
$53.84
|
| Rate for Payer: Beech Street Commercial |
$54.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$39.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.40
|
| Rate for Payer: Cigna of WY Commercial |
$54.96
|
| Rate for Payer: Entrust Commercial |
$53.28
|
| Rate for Payer: First Choice Health Commercial |
$53.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.97
|
| Rate for Payer: HealthUtah PPO |
$56.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.40
|
| Rate for Payer: Multiplan Medicare/VA |
$30.37
|
| Rate for Payer: One Health Plan of WY PPO |
$54.96
|
| Rate for Payer: PacificSource Commercial |
$50.47
|
| Rate for Payer: PHCS PPO |
$54.96
|
| Rate for Payer: Three Rivers PPO |
$42.06
|
| Rate for Payer: TriWest Veterans Administration |
$31.97
|
| Rate for Payer: United Healthcare Commercial |
$53.56
|
| Rate for Payer: United Healthcare Medicare |
$31.97
|
| Rate for Payer: WINHealth Partners Commercial |
$54.96
|
| Rate for Payer: Wise Provider Network Commercial |
$53.28
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
HCPCS J0665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.31
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.59
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.28
|
| Rate for Payer: Aetna of WY Medicare |
$10.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Aetna of WY Medicare |
$10.45
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.50
|
| Rate for Payer: Aetna of WY Medicare |
$10.31
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Aetna of WY Medicare |
$10.96
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Altius Commercial |
$15.95
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.27
|
| Rate for Payer: Altius Commercial |
$14.70
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.59
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Beech Street Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$16.28
|
| Rate for Payer: Beech Street Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.63
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$16.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Cigna of WY Commercial |
$15.59
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.31
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: Entrust Commercial |
$15.78
|
| Rate for Payer: Entrust Commercial |
$15.11
|
| Rate for Payer: Entrust Commercial |
$14.84
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.11
|
| Rate for Payer: First Choice Health Commercial |
$15.78
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$14.84
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.12
|
| Rate for Payer: HealthUtah PPO |
$15.62
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: HealthUtah PPO |
$16.61
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: HealthUtah PPO |
$15.91
|
| Rate for Payer: HealthUtah PPO |
$15.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.66
|
| Rate for Payer: Multiplan Medicare/VA |
$8.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.27
|
| Rate for Payer: Multiplan Medicare/VA |
$8.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.62
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.00
|
| Rate for Payer: One Health Plan of WY PPO |
$15.31
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.59
|
| Rate for Payer: One Health Plan of WY PPO |
$16.28
|
| Rate for Payer: PacificSource Commercial |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$13.78
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PacificSource Commercial |
$14.06
|
| Rate for Payer: PacificSource Commercial |
$14.32
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: PHCS PPO |
$15.59
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: PHCS PPO |
$15.31
|
| Rate for Payer: PHCS PPO |
$15.00
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: PHCS PPO |
$16.28
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: Three Rivers PPO |
$11.93
|
| Rate for Payer: Three Rivers PPO |
$12.46
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.90
|
| Rate for Payer: TriWest Veterans Administration |
$8.73
|
| Rate for Payer: TriWest Veterans Administration |
$9.07
|
| Rate for Payer: TriWest Veterans Administration |
$9.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.47
|
| Rate for Payer: TriWest Veterans Administration |
$9.03
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Commercial |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Commercial |
$15.86
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare |
$9.03
|
| Rate for Payer: United Healthcare Medicare |
$9.07
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
| Rate for Payer: United Healthcare Medicare |
$8.90
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: United Healthcare Medicare |
$9.47
|
| Rate for Payer: WINHealth Partners Commercial |
$15.47
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: WINHealth Partners Commercial |
$15.59
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: WINHealth Partners Commercial |
$16.28
|
| Rate for Payer: WINHealth Partners Commercial |
$15.31
|
| Rate for Payer: Wise Provider Network Commercial |
$15.11
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.84
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15.78
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION [28406]
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
HCPCS J0665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.31
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.59
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.47
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.00
|
| Rate for Payer: Aetna of WY Medicare |
$10.00
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Aetna of WY Medicare |
$9.80
|
| Rate for Payer: Aetna of WY Medicare |
$10.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Aetna of WY Medicare |
$10.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.24
|
| Rate for Payer: Aetna of WY Medicare |
$10.18
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.27
|
| Rate for Payer: Altius Commercial |
$14.70
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Altius Commercial |
$15.95
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Altius Commercial |
$15.16
|
| Rate for Payer: Beech Street Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Beech Street Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.59
|
| Rate for Payer: Beech Street Commercial |
$16.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.85
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cash Price |
$11.63
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.43
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.31
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.59
|
| Rate for Payer: Cigna of WY Commercial |
$15.47
|
| Rate for Payer: Entrust Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.84
|
| Rate for Payer: Entrust Commercial |
$15.78
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: Entrust Commercial |
$15.11
|
| Rate for Payer: First Choice Health Commercial |
$15.78
|
| Rate for Payer: First Choice Health Commercial |
$15.00
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$14.84
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.11
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.63
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: HealthUtah PPO |
$15.79
|
| Rate for Payer: HealthUtah PPO |
$15.91
|
| Rate for Payer: HealthUtah PPO |
$15.31
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: HealthUtah PPO |
$16.61
|
| Rate for Payer: HealthUtah PPO |
$15.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.11
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: Multiplan Medicare/VA |
$9.15
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: Multiplan Medicare/VA |
$9.63
|
| Rate for Payer: Multiplan Medicare/VA |
$9.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.05
|
| Rate for Payer: Multiplan Medicare/VA |
$9.22
|
| Rate for Payer: Multiplan Medicare/VA |
$9.18
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.59
|
| Rate for Payer: One Health Plan of WY PPO |
$16.28
|
| Rate for Payer: One Health Plan of WY PPO |
$15.00
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: One Health Plan of WY PPO |
$15.31
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PacificSource Commercial |
$13.78
|
| Rate for Payer: PacificSource Commercial |
$14.06
|
| Rate for Payer: PacificSource Commercial |
$14.21
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PacificSource Commercial |
$14.32
|
| Rate for Payer: PacificSource Commercial |
$14.95
|
| Rate for Payer: PHCS PPO |
$16.28
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: PHCS PPO |
$15.59
|
| Rate for Payer: PHCS PPO |
$15.00
|
| Rate for Payer: PHCS PPO |
$15.47
|
| Rate for Payer: PHCS PPO |
$15.31
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: Three Rivers PPO |
$12.46
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: Three Rivers PPO |
$11.84
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: Three Rivers PPO |
$11.93
|
| Rate for Payer: TriWest Veterans Administration |
$10.13
|
| Rate for Payer: TriWest Veterans Administration |
$9.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.34
|
| Rate for Payer: TriWest Veterans Administration |
$9.53
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: TriWest Veterans Administration |
$9.63
|
| Rate for Payer: TriWest Veterans Administration |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Commercial |
$15.86
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Commercial |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.53
|
| Rate for Payer: United Healthcare Medicare |
$9.71
|
| Rate for Payer: United Healthcare Medicare |
$9.34
|
| Rate for Payer: United Healthcare Medicare |
$9.63
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: United Healthcare Medicare |
$10.13
|
| Rate for Payer: United Healthcare Medicare |
$9.66
|
| Rate for Payer: United Healthcare Medicare |
$9.76
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: WINHealth Partners Commercial |
$14.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: WINHealth Partners Commercial |
$14.54
|
| Rate for Payer: WINHealth Partners Commercial |
$14.51
|
| Rate for Payer: WINHealth Partners Commercial |
$15.11
|
| Rate for Payer: WINHealth Partners Commercial |
$15.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$14.84
|
| Rate for Payer: Wise Provider Network Commercial |
$15.11
|
| Rate for Payer: Wise Provider Network Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$15.78
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION [28407]
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 5515017030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.56
|
| Rate for Payer: Aetna of WY Medicare |
$11.15
|
| Rate for Payer: Altius Commercial |
$16.22
|
| Rate for Payer: Beech Street Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.39
|
| Rate for Payer: Cigna of WY Commercial |
$16.56
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.63
|
| Rate for Payer: HealthUtah PPO |
$16.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.15
|
| Rate for Payer: One Health Plan of WY PPO |
$16.56
|
| Rate for Payer: PacificSource Commercial |
$15.21
|
| Rate for Payer: PHCS PPO |
$16.56
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$9.63
|
| Rate for Payer: United Healthcare Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare |
$9.63
|
| Rate for Payer: WINHealth Partners Commercial |
$16.56
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
