|
ESTRADIOL 1 MG TABLET [10391]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 4280608801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
ESTRADIOL 1 MG TABLET [10391]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 4280608801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
ESTRADIOL 1 MG TABLET [10391]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 7095456510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
ESTRADIOL VALERATE 10 MG INJ
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
J1380
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$8.66
|
| Rate for Payer: Beech Street Commercial |
$23.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: First Choice Health Commercial |
$22.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$7.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$23.75
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL [11312]
|
Facility
|
IP
|
$70.63
|
|
|
Service Code
|
HCPCS J1380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$70.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.80
|
| Rate for Payer: Altius Commercial |
$67.80
|
| Rate for Payer: Beech Street Commercial |
$69.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.99
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.51
|
| Rate for Payer: Cigna of WY Commercial |
$69.22
|
| Rate for Payer: Entrust Commercial |
$67.10
|
| Rate for Payer: First Choice Health Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.62
|
| Rate for Payer: HealthUtah PPO |
$70.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.51
|
| Rate for Payer: Multiplan Medicare/VA |
$44.29
|
| Rate for Payer: One Health Plan of WY PPO |
$69.22
|
| Rate for Payer: PacificSource Commercial |
$63.57
|
| Rate for Payer: PHCS PPO |
$69.22
|
| Rate for Payer: Three Rivers PPO |
$52.97
|
| Rate for Payer: TriWest Veterans Administration |
$46.62
|
| Rate for Payer: United Healthcare Commercial |
$61.45
|
| Rate for Payer: United Healthcare Medicare |
$46.62
|
| Rate for Payer: WINHealth Partners Commercial |
$67.10
|
| Rate for Payer: Wise Provider Network Commercial |
$67.10
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL [11312]
|
Facility
|
OP
|
$70.63
|
|
|
Service Code
|
HCPCS J1380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$70.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.22
|
| Rate for Payer: Aetna of WY Medicare |
$46.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.80
|
| Rate for Payer: Altius Commercial |
$67.80
|
| Rate for Payer: Beech Street Commercial |
$69.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.99
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.51
|
| Rate for Payer: Cigna of WY Commercial |
$69.22
|
| Rate for Payer: Entrust Commercial |
$67.10
|
| Rate for Payer: First Choice Health Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.97
|
| Rate for Payer: HealthUtah PPO |
$70.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.51
|
| Rate for Payer: Multiplan Medicare/VA |
$38.92
|
| Rate for Payer: One Health Plan of WY PPO |
$69.22
|
| Rate for Payer: PacificSource Commercial |
$63.57
|
| Rate for Payer: PHCS PPO |
$69.22
|
| Rate for Payer: Three Rivers PPO |
$52.97
|
| Rate for Payer: TriWest Veterans Administration |
$40.97
|
| Rate for Payer: United Healthcare Commercial |
$61.45
|
| Rate for Payer: United Healthcare Medicare |
$40.97
|
| Rate for Payer: WINHealth Partners Commercial |
$69.22
|
| Rate for Payer: Wise Provider Network Commercial |
$67.10
|
|
|
ETHICON LIGACLIP 10MM ER320
|
Facility
|
OP
|
$195.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.22
|
| Rate for Payer: Aetna of WY Medicare |
$128.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.32
|
| Rate for Payer: Altius Commercial |
$187.32
|
| Rate for Payer: Beech Street Commercial |
$191.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.19
|
| Rate for Payer: Cash Price |
$136.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.27
|
| Rate for Payer: Cigna of WY Commercial |
$191.22
|
| Rate for Payer: Entrust Commercial |
$185.36
|
| Rate for Payer: First Choice Health Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.17
|
| Rate for Payer: HealthUtah PPO |
$195.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.27
|
| Rate for Payer: Multiplan Medicare/VA |
$107.51
|
| Rate for Payer: One Health Plan of WY PPO |
$191.22
|
| Rate for Payer: PacificSource Commercial |
$175.61
|
| Rate for Payer: PHCS PPO |
$191.22
|
| Rate for Payer: Three Rivers PPO |
$146.34
|
| Rate for Payer: TriWest Veterans Administration |
$113.17
|
| Rate for Payer: United Healthcare Commercial |
$169.75
|
| Rate for Payer: United Healthcare Medicare |
$113.17
|
| Rate for Payer: WINHealth Partners Commercial |
$191.22
|
| Rate for Payer: Wise Provider Network Commercial |
$185.36
|
|
|
ETHICON LIGACLIP 10MM ER320
|
Facility
|
IP
|
$195.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.32
|
| Rate for Payer: Altius Commercial |
$187.32
|
| Rate for Payer: Beech Street Commercial |
$191.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.19
|
| Rate for Payer: Cash Price |
$136.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.27
|
| Rate for Payer: Cigna of WY Commercial |
$191.22
|
| Rate for Payer: Entrust Commercial |
$185.36
|
| Rate for Payer: First Choice Health Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.78
|
| Rate for Payer: HealthUtah PPO |
$195.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.27
|
| Rate for Payer: Multiplan Medicare/VA |
$122.34
|
| Rate for Payer: One Health Plan of WY PPO |
$191.22
|
| Rate for Payer: PacificSource Commercial |
$175.61
|
| Rate for Payer: PHCS PPO |
$191.22
|
| Rate for Payer: Three Rivers PPO |
$146.34
|
| Rate for Payer: TriWest Veterans Administration |
$128.78
|
| Rate for Payer: United Healthcare Commercial |
$169.75
|
| Rate for Payer: United Healthcare Medicare |
$128.78
|
| Rate for Payer: WINHealth Partners Commercial |
$185.36
|
| Rate for Payer: Wise Provider Network Commercial |
$185.36
|
|
|
ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$5,426.00
|
|
|
Service Code
|
HCPCS 31201 50
|
| Hospital Charge Code |
31201
|
| Min. Negotiated Rate |
$646.37 |
| Max. Negotiated Rate |
$5,426.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,317.48
|
| Rate for Payer: Aetna of WY Medicare |
$760.44
|
| Rate for Payer: Beech Street Commercial |
$5,154.70
|
| Rate for Payer: Cash Price |
$3,798.20
|
| Rate for Payer: Cash Price |
$3,798.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,263.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,317.48
|
| Rate for Payer: First Choice Health Commercial |
$4,883.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,154.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$760.44
|
| Rate for Payer: HealthUtah PPO |
$5,426.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,263.22
|
| Rate for Payer: Multiplan Medicare/VA |
$646.37
|
| Rate for Payer: One Health Plan of WY PPO |
$5,317.48
|
| Rate for Payer: PacificSource Commercial |
$4,883.40
|
| Rate for Payer: PHCS PPO |
$5,154.70
|
| Rate for Payer: Three Rivers PPO |
$4,069.50
|
| Rate for Payer: TriWest Veterans Administration |
$760.44
|
| Rate for Payer: United Healthcare Commercial |
$4,720.62
|
| Rate for Payer: United Healthcare Medicare |
$760.44
|
| Rate for Payer: WINHealth Partners Commercial |
$4,612.10
|
|
|
ETHYL CHLORIDE 100 % TOPICAL SPRAY [43585]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 0386000102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
ETHYL CHLORIDE 100 % TOPICAL SPRAY [43585]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 0386000102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
ETODOLAC 300 MG CAPSULE [2503]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 4229140501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.66
|
| Rate for Payer: Aetna of WY Medicare |
$0.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.64
|
| Rate for Payer: Altius Commercial |
$0.64
|
| Rate for Payer: Beech Street Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.65
|
| Rate for Payer: Cigna of WY Commercial |
$0.66
|
| Rate for Payer: Entrust Commercial |
$0.64
|
| Rate for Payer: First Choice Health Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.65
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.66
|
| Rate for Payer: PacificSource Commercial |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.66
|
| Rate for Payer: Three Rivers PPO |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.58
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.66
|
| Rate for Payer: Wise Provider Network Commercial |
$0.64
|
|
|
ETODOLAC 300 MG CAPSULE [2503]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 4229140501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.64
|
| Rate for Payer: Altius Commercial |
$0.64
|
| Rate for Payer: Beech Street Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.65
|
| Rate for Payer: Cigna of WY Commercial |
$0.66
|
| Rate for Payer: Entrust Commercial |
$0.64
|
| Rate for Payer: First Choice Health Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.44
|
| Rate for Payer: HealthUtah PPO |
$0.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.65
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.66
|
| Rate for Payer: PacificSource Commercial |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.66
|
| Rate for Payer: Three Rivers PPO |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.58
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
| Rate for Payer: WINHealth Partners Commercial |
$0.64
|
| Rate for Payer: Wise Provider Network Commercial |
$0.64
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
NDC 0143950701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.69
|
| 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 |
$13.42
|
| 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 |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| 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 |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
NDC 6521944501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.86
|
| Rate for Payer: Aetna of WY Medicare |
$11.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.51
|
| Rate for Payer: Altius Commercial |
$16.51
|
| Rate for Payer: Beech Street Commercial |
$16.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.68
|
| Rate for Payer: Cigna of WY Commercial |
$16.86
|
| Rate for Payer: Entrust Commercial |
$16.34
|
| Rate for Payer: First Choice Health Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.98
|
| Rate for Payer: HealthUtah PPO |
$17.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.48
|
| Rate for Payer: One Health Plan of WY PPO |
$16.86
|
| Rate for Payer: PacificSource Commercial |
$15.48
|
| Rate for Payer: PHCS PPO |
$16.86
|
| Rate for Payer: Three Rivers PPO |
$12.90
|
| Rate for Payer: TriWest Veterans Administration |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$9.98
|
| Rate for Payer: WINHealth Partners Commercial |
$16.86
|
| Rate for Payer: Wise Provider Network Commercial |
$16.34
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 0143950601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.79
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.14
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$10.14
|
| Rate for Payer: WINHealth Partners Commercial |
$17.14
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$16.34
|
|
|
Service Code
|
NDC 0143950701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| 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 Auto/Workers Compensation |
$15.69
|
| 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 |
$13.42
|
| 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 |
$9.48
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$9.00
|
| 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 |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 0143950610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.79
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.54
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 0143950601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.79
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.54
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 0143950610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.79
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.14
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$10.14
|
| Rate for Payer: WINHealth Partners Commercial |
$17.14
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
NDC 6521944501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.51
|
| Rate for Payer: Altius Commercial |
$16.51
|
| Rate for Payer: Beech Street Commercial |
$16.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.68
|
| Rate for Payer: Cigna of WY Commercial |
$16.86
|
| Rate for Payer: Entrust Commercial |
$16.34
|
| Rate for Payer: First Choice Health Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.35
|
| Rate for Payer: HealthUtah PPO |
$17.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.68
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16.86
|
| Rate for Payer: PacificSource Commercial |
$15.48
|
| Rate for Payer: PHCS PPO |
$16.86
|
| Rate for Payer: Three Rivers PPO |
$12.90
|
| Rate for Payer: TriWest Veterans Administration |
$11.35
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
| Rate for Payer: WINHealth Partners Commercial |
$16.34
|
| Rate for Payer: Wise Provider Network Commercial |
$16.34
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [41762]
|
Facility
|
IP
|
$1,092.48
|
|
|
Service Code
|
HCPCS J7307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$684.98 |
| Max. Negotiated Rate |
$1,092.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,048.78
|
| Rate for Payer: Altius Commercial |
$1,048.78
|
| Rate for Payer: Beech Street Commercial |
$1,070.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$896.93
|
| Rate for Payer: Cash Price |
$764.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.71
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.63
|
| Rate for Payer: Entrust Commercial |
$1,037.86
|
| Rate for Payer: First Choice Health Commercial |
$1,037.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$721.04
|
| Rate for Payer: HealthUtah PPO |
$1,092.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.71
|
| Rate for Payer: Multiplan Medicare/VA |
$684.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.63
|
| Rate for Payer: PacificSource Commercial |
$983.23
|
| Rate for Payer: PHCS PPO |
$1,070.63
|
| Rate for Payer: Three Rivers PPO |
$819.36
|
| Rate for Payer: TriWest Veterans Administration |
$721.04
|
| Rate for Payer: United Healthcare Commercial |
$950.46
|
| Rate for Payer: United Healthcare Medicare |
$721.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,037.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1,037.86
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [41762]
|
Facility
|
OP
|
$1,092.48
|
|
|
Service Code
|
HCPCS J7307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$601.96 |
| Max. Negotiated Rate |
$1,092.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,070.63
|
| Rate for Payer: Aetna of WY Medicare |
$721.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,048.78
|
| Rate for Payer: Altius Commercial |
$1,048.78
|
| Rate for Payer: Beech Street Commercial |
$1,070.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$896.93
|
| Rate for Payer: Cash Price |
$764.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,059.71
|
| Rate for Payer: Cigna of WY Commercial |
$1,070.63
|
| Rate for Payer: Entrust Commercial |
$1,037.86
|
| Rate for Payer: First Choice Health Commercial |
$1,037.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,037.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.64
|
| Rate for Payer: HealthUtah PPO |
$1,092.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,059.71
|
| Rate for Payer: Multiplan Medicare/VA |
$601.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,070.63
|
| Rate for Payer: PacificSource Commercial |
$983.23
|
| Rate for Payer: PHCS PPO |
$1,070.63
|
| Rate for Payer: Three Rivers PPO |
$819.36
|
| Rate for Payer: TriWest Veterans Administration |
$633.64
|
| Rate for Payer: United Healthcare Commercial |
$950.46
|
| Rate for Payer: United Healthcare Medicare |
$633.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,070.63
|
| Rate for Payer: Wise Provider Network Commercial |
$1,037.86
|
|
|
ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
J7307
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Beech Street Commercial |
$884.45
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: First Choice Health Commercial |
$837.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$884.45
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: United Healthcare Commercial |
$809.97
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
|
|
ET TUBE HOLDER ADULT 600-10000
|
Facility
|
IP
|
$8.40
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.06
|
| Rate for Payer: Altius Commercial |
$8.06
|
| Rate for Payer: Beech Street Commercial |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.90
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.15
|
| Rate for Payer: Cigna of WY Commercial |
$8.23
|
| Rate for Payer: Entrust Commercial |
$7.98
|
| Rate for Payer: First Choice Health Commercial |
$7.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.54
|
| Rate for Payer: HealthUtah PPO |
$8.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.15
|
| Rate for Payer: Multiplan Medicare/VA |
$5.27
|
| Rate for Payer: One Health Plan of WY PPO |
$8.23
|
| Rate for Payer: PacificSource Commercial |
$7.56
|
| Rate for Payer: PHCS PPO |
$8.23
|
| Rate for Payer: Three Rivers PPO |
$6.30
|
| Rate for Payer: TriWest Veterans Administration |
$5.54
|
| Rate for Payer: United Healthcare Commercial |
$7.31
|
| Rate for Payer: United Healthcare Medicare |
$5.54
|
| Rate for Payer: WINHealth Partners Commercial |
$7.98
|
| Rate for Payer: Wise Provider Network Commercial |
$7.98
|
|
