|
CLARITHROMYCIN 500 MG TABLET [3801]
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 0781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.83
|
| Rate for Payer: Aetna of WY Medicare |
$2.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.75
|
| Rate for Payer: Altius Commercial |
$3.75
|
| Rate for Payer: Beech Street Commercial |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.79
|
| Rate for Payer: Cigna of WY Commercial |
$3.83
|
| Rate for Payer: Entrust Commercial |
$3.71
|
| Rate for Payer: First Choice Health Commercial |
$3.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.27
|
| Rate for Payer: HealthUtah PPO |
$3.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.79
|
| Rate for Payer: Multiplan Medicare/VA |
$2.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3.83
|
| Rate for Payer: PacificSource Commercial |
$3.52
|
| Rate for Payer: PHCS PPO |
$3.83
|
| Rate for Payer: Three Rivers PPO |
$2.93
|
| Rate for Payer: TriWest Veterans Administration |
$2.27
|
| Rate for Payer: United Healthcare Commercial |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$2.27
|
| Rate for Payer: WINHealth Partners Commercial |
$3.83
|
| Rate for Payer: Wise Provider Network Commercial |
$3.71
|
|
|
CLARITHROMYCIN 500 MG TABLET [3801]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 0781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.75
|
| Rate for Payer: Altius Commercial |
$3.75
|
| Rate for Payer: Beech Street Commercial |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.79
|
| Rate for Payer: Cigna of WY Commercial |
$3.83
|
| Rate for Payer: Entrust Commercial |
$3.71
|
| Rate for Payer: First Choice Health Commercial |
$3.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.58
|
| Rate for Payer: HealthUtah PPO |
$3.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.79
|
| Rate for Payer: Multiplan Medicare/VA |
$2.45
|
| Rate for Payer: One Health Plan of WY PPO |
$3.83
|
| Rate for Payer: PacificSource Commercial |
$3.52
|
| Rate for Payer: PHCS PPO |
$3.83
|
| Rate for Payer: Three Rivers PPO |
$2.93
|
| Rate for Payer: TriWest Veterans Administration |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$2.58
|
| Rate for Payer: WINHealth Partners Commercial |
$3.71
|
| Rate for Payer: Wise Provider Network Commercial |
$3.71
|
|
|
CLAVICAL SPLINT LRG
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.48
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.76
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$14.48
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT LRG
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.73
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.09
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.73
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$12.73
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT MED VP10123-03
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.73
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.09
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.73
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$12.73
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT MED VP10123-03
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.48
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.76
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$14.48
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT SM VP10123-020
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.73
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.09
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.73
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$12.73
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT SM VP10123-020
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.06
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.01
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.48
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.76
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$14.48
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare |
$14.48
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT XL
|
Facility
|
IP
|
$17.64
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.93
|
| Rate for Payer: Altius Commercial |
$16.93
|
| Rate for Payer: Beech Street Commercial |
$17.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.11
|
| Rate for Payer: Cigna of WY Commercial |
$17.29
|
| Rate for Payer: Entrust Commercial |
$16.76
|
| Rate for Payer: First Choice Health Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.64
|
| Rate for Payer: HealthUtah PPO |
$17.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.11
|
| Rate for Payer: Multiplan Medicare/VA |
$11.06
|
| Rate for Payer: One Health Plan of WY PPO |
$17.29
|
| Rate for Payer: PacificSource Commercial |
$15.88
|
| Rate for Payer: PHCS PPO |
$17.29
|
| Rate for Payer: Three Rivers PPO |
$13.23
|
| Rate for Payer: TriWest Veterans Administration |
$11.64
|
| Rate for Payer: United Healthcare Commercial |
$15.35
|
| Rate for Payer: United Healthcare Medicare |
$11.64
|
| Rate for Payer: WINHealth Partners Commercial |
$16.76
|
| Rate for Payer: Wise Provider Network Commercial |
$16.76
|
|
|
CLAVICAL SPLINT XL
|
Facility
|
OP
|
$17.64
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.29
|
| Rate for Payer: Aetna of WY Medicare |
$11.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.93
|
| Rate for Payer: Altius Commercial |
$16.93
|
| Rate for Payer: Beech Street Commercial |
$17.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.11
|
| Rate for Payer: Cigna of WY Commercial |
$17.29
|
| Rate for Payer: Entrust Commercial |
$16.76
|
| Rate for Payer: First Choice Health Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.23
|
| Rate for Payer: HealthUtah PPO |
$17.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.11
|
| Rate for Payer: Multiplan Medicare/VA |
$9.72
|
| Rate for Payer: One Health Plan of WY PPO |
$17.29
|
| Rate for Payer: PacificSource Commercial |
$15.88
|
| Rate for Payer: PHCS PPO |
$17.29
|
| Rate for Payer: Three Rivers PPO |
$13.23
|
| Rate for Payer: TriWest Veterans Administration |
$10.23
|
| Rate for Payer: United Healthcare Commercial |
$15.35
|
| Rate for Payer: United Healthcare Medicare |
$10.23
|
| Rate for Payer: WINHealth Partners Commercial |
$17.29
|
| Rate for Payer: Wise Provider Network Commercial |
$16.76
|
|
|
CLAVICAL SPLINT XSM 79-85002
|
Facility
|
OP
|
$15.89
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.57
|
| Rate for Payer: Aetna of WY Medicare |
$10.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.25
|
| Rate for Payer: Altius Commercial |
$15.25
|
| Rate for Payer: Beech Street Commercial |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$15.57
|
| Rate for Payer: Entrust Commercial |
$15.10
|
| Rate for Payer: First Choice Health Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.22
|
| Rate for Payer: HealthUtah PPO |
$15.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.41
|
| Rate for Payer: Multiplan Medicare/VA |
$8.76
|
| Rate for Payer: One Health Plan of WY PPO |
$15.57
|
| Rate for Payer: PacificSource Commercial |
$14.30
|
| Rate for Payer: PHCS PPO |
$15.57
|
| Rate for Payer: Three Rivers PPO |
$11.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.22
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$9.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.57
|
| Rate for Payer: Wise Provider Network Commercial |
$15.10
|
|
|
CLAVICAL SPLINT XSM 79-85002
|
Facility
|
IP
|
$15.89
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.25
|
| Rate for Payer: Altius Commercial |
$15.25
|
| Rate for Payer: Beech Street Commercial |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$15.57
|
| Rate for Payer: Entrust Commercial |
$15.10
|
| Rate for Payer: First Choice Health Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.49
|
| Rate for Payer: HealthUtah PPO |
$15.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.41
|
| Rate for Payer: Multiplan Medicare/VA |
$9.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.57
|
| Rate for Payer: PacificSource Commercial |
$14.30
|
| Rate for Payer: PHCS PPO |
$15.57
|
| Rate for Payer: Three Rivers PPO |
$11.92
|
| Rate for Payer: TriWest Veterans Administration |
$10.49
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$10.49
|
| Rate for Payer: WINHealth Partners Commercial |
$15.10
|
| Rate for Payer: Wise Provider Network Commercial |
$15.10
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 23120 80
|
| Hospital Charge Code |
23120
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$576.49
|
| Rate for Payer: Beech Street Commercial |
$2,849.05
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: First Choice Health Commercial |
$2,699.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.49
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$490.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,849.05
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.49
|
| Rate for Payer: United Healthcare Commercial |
$2,609.13
|
| Rate for Payer: United Healthcare Medicare |
$576.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,549.15
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
23120
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$576.49
|
| Rate for Payer: Beech Street Commercial |
$2,849.05
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: First Choice Health Commercial |
$2,699.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.49
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$490.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,849.05
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.49
|
| Rate for Payer: United Healthcare Commercial |
$2,609.13
|
| Rate for Payer: United Healthcare Medicare |
$576.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,549.15
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 23120 AS
|
| Hospital Charge Code |
23120
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$576.49
|
| Rate for Payer: Beech Street Commercial |
$2,849.05
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: First Choice Health Commercial |
$2,699.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.49
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$490.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,849.05
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.49
|
| Rate for Payer: United Healthcare Commercial |
$2,609.13
|
| Rate for Payer: United Healthcare Medicare |
$576.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,549.15
|
|
|
CLEARVIEW UTERINE MANIPULATOR 7CM
|
Facility
|
IP
|
$302.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$302.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.00
|
| Rate for Payer: Altius Commercial |
$290.00
|
| Rate for Payer: Beech Street Commercial |
$296.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.01
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.02
|
| Rate for Payer: Cigna of WY Commercial |
$296.04
|
| Rate for Payer: Entrust Commercial |
$286.98
|
| Rate for Payer: First Choice Health Commercial |
$286.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.37
|
| Rate for Payer: HealthUtah PPO |
$302.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.02
|
| Rate for Payer: Multiplan Medicare/VA |
$189.40
|
| Rate for Payer: One Health Plan of WY PPO |
$296.04
|
| Rate for Payer: PacificSource Commercial |
$271.87
|
| Rate for Payer: PHCS PPO |
$296.04
|
| Rate for Payer: Three Rivers PPO |
$226.56
|
| Rate for Payer: TriWest Veterans Administration |
$199.37
|
| Rate for Payer: United Healthcare Commercial |
$262.81
|
| Rate for Payer: United Healthcare Medicare |
$199.37
|
| Rate for Payer: WINHealth Partners Commercial |
$286.98
|
| Rate for Payer: Wise Provider Network Commercial |
$286.98
|
|
|
CLEARVIEW UTERINE MANIPULATOR 7CM
|
Facility
|
OP
|
$302.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.45 |
| Max. Negotiated Rate |
$302.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.04
|
| Rate for Payer: Aetna of WY Medicare |
$199.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.00
|
| Rate for Payer: Altius Commercial |
$290.00
|
| Rate for Payer: Beech Street Commercial |
$296.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.01
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.02
|
| Rate for Payer: Cigna of WY Commercial |
$296.04
|
| Rate for Payer: Entrust Commercial |
$286.98
|
| Rate for Payer: First Choice Health Commercial |
$286.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.21
|
| Rate for Payer: HealthUtah PPO |
$302.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.02
|
| Rate for Payer: Multiplan Medicare/VA |
$166.45
|
| Rate for Payer: One Health Plan of WY PPO |
$296.04
|
| Rate for Payer: PacificSource Commercial |
$271.87
|
| Rate for Payer: PHCS PPO |
$296.04
|
| Rate for Payer: Three Rivers PPO |
$226.56
|
| Rate for Payer: TriWest Veterans Administration |
$175.21
|
| Rate for Payer: United Healthcare Commercial |
$262.81
|
| Rate for Payer: United Healthcare Medicare |
$175.21
|
| Rate for Payer: WINHealth Partners Commercial |
$296.04
|
| Rate for Payer: Wise Provider Network Commercial |
$286.98
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
IP
|
$15.95
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.31
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$10.00
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$13.88
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
OP
|
$15.95
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.31
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$13.88
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
NDC 6586259602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.84
|
| Rate for Payer: Aetna of WY Medicare |
$1.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.80
|
| Rate for Payer: Altius Commercial |
$1.80
|
| Rate for Payer: Beech Street Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.82
|
| Rate for Payer: Cigna of WY Commercial |
$1.84
|
| Rate for Payer: Entrust Commercial |
$1.79
|
| Rate for Payer: First Choice Health Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.09
|
| Rate for Payer: HealthUtah PPO |
$1.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1.84
|
| Rate for Payer: PacificSource Commercial |
$1.69
|
| Rate for Payer: PHCS PPO |
$1.84
|
| Rate for Payer: Three Rivers PPO |
$1.41
|
| Rate for Payer: TriWest Veterans Administration |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare |
$1.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1.79
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
NDC 6586259601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.80
|
| Rate for Payer: Altius Commercial |
$1.80
|
| Rate for Payer: Beech Street Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.82
|
| Rate for Payer: Cigna of WY Commercial |
$1.84
|
| Rate for Payer: Entrust Commercial |
$1.79
|
| Rate for Payer: First Choice Health Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.24
|
| Rate for Payer: HealthUtah PPO |
$1.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1.84
|
| Rate for Payer: PacificSource Commercial |
$1.69
|
| Rate for Payer: PHCS PPO |
$1.84
|
| Rate for Payer: Three Rivers PPO |
$1.41
|
| Rate for Payer: TriWest Veterans Administration |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare |
$1.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1.79
|
| Rate for Payer: Wise Provider Network Commercial |
$1.79
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
NDC 6586259601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.84
|
| Rate for Payer: Aetna of WY Medicare |
$1.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.80
|
| Rate for Payer: Altius Commercial |
$1.80
|
| Rate for Payer: Beech Street Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.82
|
| Rate for Payer: Cigna of WY Commercial |
$1.84
|
| Rate for Payer: Entrust Commercial |
$1.79
|
| Rate for Payer: First Choice Health Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.09
|
| Rate for Payer: HealthUtah PPO |
$1.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1.84
|
| Rate for Payer: PacificSource Commercial |
$1.69
|
| Rate for Payer: PHCS PPO |
$1.84
|
| Rate for Payer: Three Rivers PPO |
$1.41
|
| Rate for Payer: TriWest Veterans Administration |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare |
$1.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1.79
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
NDC 6586259602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.80
|
| Rate for Payer: Altius Commercial |
$1.80
|
| Rate for Payer: Beech Street Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.82
|
| Rate for Payer: Cigna of WY Commercial |
$1.84
|
| Rate for Payer: Entrust Commercial |
$1.79
|
| Rate for Payer: First Choice Health Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.24
|
| Rate for Payer: HealthUtah PPO |
$1.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1.84
|
| Rate for Payer: PacificSource Commercial |
$1.69
|
| Rate for Payer: PHCS PPO |
$1.84
|
| Rate for Payer: Three Rivers PPO |
$1.41
|
| Rate for Payer: TriWest Veterans Administration |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare |
$1.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1.79
|
| Rate for Payer: Wise Provider Network Commercial |
$1.79
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [149054]
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
HCPCS J0737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.40
|
| Rate for Payer: Altius Commercial |
$15.40
|
| Rate for Payer: Beech Street Commercial |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.17
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.56
|
| Rate for Payer: Cigna of WY Commercial |
$15.72
|
| Rate for Payer: Entrust Commercial |
$15.24
|
| Rate for Payer: First Choice Health Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$16.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.56
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$15.72
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.72
|
| Rate for Payer: Three Rivers PPO |
$12.03
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$13.95
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$15.24
|
| Rate for Payer: Wise Provider Network Commercial |
$15.24
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [149054]
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Facility
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OP
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$16.04
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Service Code
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HCPCS J0737
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Hospital Revenue Code
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636
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| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.72
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| Rate for Payer: Aetna of WY Medicare |
$10.59
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| Rate for Payer: Altius Auto/Workers Compensation |
$15.40
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| Rate for Payer: Altius Commercial |
$15.40
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| Rate for Payer: Beech Street Commercial |
$15.72
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| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.17
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| Rate for Payer: Cash Price |
$11.23
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| Rate for Payer: ChoiceCare Network Commercial |
$15.56
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| Rate for Payer: Cigna of WY Commercial |
$15.72
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| Rate for Payer: Entrust Commercial |
$15.24
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| Rate for Payer: First Choice Health Commercial |
$15.24
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| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.24
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| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.30
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| Rate for Payer: HealthUtah PPO |
$16.04
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| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.56
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| Rate for Payer: Multiplan Medicare/VA |
$8.84
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| Rate for Payer: One Health Plan of WY PPO |
$15.72
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| Rate for Payer: PacificSource Commercial |
$14.44
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| Rate for Payer: PHCS PPO |
$15.72
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| Rate for Payer: Three Rivers PPO |
$12.03
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| Rate for Payer: TriWest Veterans Administration |
$9.30
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| Rate for Payer: United Healthcare Commercial |
$13.95
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| Rate for Payer: United Healthcare Medicare |
$9.30
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| Rate for Payer: WINHealth Partners Commercial |
$15.72
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| Rate for Payer: Wise Provider Network Commercial |
$15.24
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