|
TRAY UROLOGIST
|
Facility
|
IP
|
$485.48
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$485.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$466.06
|
| Rate for Payer: Altius Commercial |
$466.06
|
| Rate for Payer: Beech Street Commercial |
$475.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.58
|
| Rate for Payer: Cash Price |
$339.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.92
|
| Rate for Payer: Cigna of WY Commercial |
$475.77
|
| Rate for Payer: Entrust Commercial |
$461.21
|
| Rate for Payer: First Choice Health Commercial |
$461.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$461.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.42
|
| Rate for Payer: HealthUtah PPO |
$485.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.92
|
| Rate for Payer: Multiplan Medicare/VA |
$304.40
|
| Rate for Payer: One Health Plan of WY PPO |
$475.77
|
| Rate for Payer: PacificSource Commercial |
$436.93
|
| Rate for Payer: PHCS PPO |
$475.77
|
| Rate for Payer: Three Rivers PPO |
$364.11
|
| Rate for Payer: TriWest Veterans Administration |
$320.42
|
| Rate for Payer: United Healthcare Commercial |
$422.37
|
| Rate for Payer: United Healthcare Medicare |
$320.42
|
| Rate for Payer: WINHealth Partners Commercial |
$461.21
|
| Rate for Payer: Wise Provider Network Commercial |
$461.21
|
|
|
TRAY UROLOGIST
|
Facility
|
OP
|
$485.48
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$485.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.77
|
| Rate for Payer: Aetna of WY Medicare |
$320.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$466.06
|
| Rate for Payer: Altius Commercial |
$466.06
|
| Rate for Payer: Beech Street Commercial |
$475.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.58
|
| Rate for Payer: Cash Price |
$339.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.92
|
| Rate for Payer: Cigna of WY Commercial |
$475.77
|
| Rate for Payer: Entrust Commercial |
$461.21
|
| Rate for Payer: First Choice Health Commercial |
$461.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$461.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.58
|
| Rate for Payer: HealthUtah PPO |
$485.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.92
|
| Rate for Payer: Multiplan Medicare/VA |
$267.50
|
| Rate for Payer: One Health Plan of WY PPO |
$475.77
|
| Rate for Payer: PacificSource Commercial |
$436.93
|
| Rate for Payer: PHCS PPO |
$475.77
|
| Rate for Payer: Three Rivers PPO |
$364.11
|
| Rate for Payer: TriWest Veterans Administration |
$281.58
|
| Rate for Payer: United Healthcare Commercial |
$422.37
|
| Rate for Payer: United Healthcare Medicare |
$281.58
|
| Rate for Payer: WINHealth Partners Commercial |
$475.77
|
| Rate for Payer: Wise Provider Network Commercial |
$461.21
|
|
|
TRAY WET SKIN PREP (BETADYNE)
|
Facility
|
IP
|
$15.46
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
TRAY WET SKIN PREP (BETADYNE)
|
Facility
|
OP
|
$15.46
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0904686861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.47
|
| Rate for Payer: Altius Commercial |
$0.47
|
| Rate for Payer: Beech Street Commercial |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.48
|
| Rate for Payer: Cigna of WY Commercial |
$0.48
|
| Rate for Payer: Entrust Commercial |
$0.47
|
| Rate for Payer: First Choice Health Commercial |
$0.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.48
|
| Rate for Payer: PacificSource Commercial |
$0.44
|
| Rate for Payer: PHCS PPO |
$0.48
|
| Rate for Payer: Three Rivers PPO |
$0.37
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.47
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 0904686861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.48
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.47
|
| Rate for Payer: Altius Commercial |
$0.47
|
| Rate for Payer: Beech Street Commercial |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.48
|
| Rate for Payer: Cigna of WY Commercial |
$0.48
|
| Rate for Payer: Entrust Commercial |
$0.47
|
| Rate for Payer: First Choice Health Commercial |
$0.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.27
|
| Rate for Payer: One Health Plan of WY PPO |
$0.48
|
| Rate for Payer: PacificSource Commercial |
$0.44
|
| Rate for Payer: PHCS PPO |
$0.48
|
| Rate for Payer: Three Rivers PPO |
$0.37
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.47
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 5011156002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.23
|
| Rate for Payer: Altius Commercial |
$0.23
|
| Rate for Payer: Beech Street Commercial |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.23
|
| Rate for Payer: Cigna of WY Commercial |
$0.24
|
| Rate for Payer: Entrust Commercial |
$0.23
|
| Rate for Payer: First Choice Health Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.24
|
| Rate for Payer: PacificSource Commercial |
$0.22
|
| Rate for Payer: PHCS PPO |
$0.24
|
| Rate for Payer: Three Rivers PPO |
$0.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.21
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.23
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 5011156002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.24
|
| Rate for Payer: Aetna of WY Medicare |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.23
|
| Rate for Payer: Altius Commercial |
$0.23
|
| Rate for Payer: Beech Street Commercial |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.23
|
| Rate for Payer: Cigna of WY Commercial |
$0.24
|
| Rate for Payer: Entrust Commercial |
$0.23
|
| Rate for Payer: First Choice Health Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.14
|
| Rate for Payer: HealthUtah PPO |
$0.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.24
|
| Rate for Payer: PacificSource Commercial |
$0.22
|
| Rate for Payer: PHCS PPO |
$0.24
|
| Rate for Payer: Three Rivers PPO |
$0.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.21
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: WINHealth Partners Commercial |
$0.24
|
| Rate for Payer: Wise Provider Network Commercial |
$0.23
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 6068744301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 6068744301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.51
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 6068744311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TRAZODONE 50 MG TABLET [2739]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 6068744311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.51
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.50
|
| Rate for Payer: Altius Commercial |
$0.50
|
| Rate for Payer: Beech Street Commercial |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.50
|
| Rate for Payer: Cigna of WY Commercial |
$0.51
|
| Rate for Payer: Entrust Commercial |
$0.49
|
| Rate for Payer: First Choice Health Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.50
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.51
|
| Rate for Payer: PacificSource Commercial |
$0.47
|
| Rate for Payer: PHCS PPO |
$0.51
|
| Rate for Payer: Three Rivers PPO |
$0.39
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.51
|
| Rate for Payer: Wise Provider Network Commercial |
$0.49
|
|
|
TREATMENT CLOSED ELBOW DISLOCATION REQ ANES
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
24605
|
| Min. Negotiated Rate |
$401.83 |
| Max. Negotiated Rate |
$1,687.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,653.26
|
| Rate for Payer: Aetna of WY Medicare |
$472.74
|
| Rate for Payer: Beech Street Commercial |
$1,602.65
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: Cash Price |
$1,180.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,636.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,653.26
|
| Rate for Payer: First Choice Health Commercial |
$1,518.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,602.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.74
|
| Rate for Payer: HealthUtah PPO |
$1,687.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,636.39
|
| Rate for Payer: Multiplan Medicare/VA |
$401.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,653.26
|
| Rate for Payer: PacificSource Commercial |
$1,518.30
|
| Rate for Payer: PHCS PPO |
$1,602.65
|
| Rate for Payer: Three Rivers PPO |
$1,265.25
|
| Rate for Payer: TriWest Veterans Administration |
$472.74
|
| Rate for Payer: United Healthcare Commercial |
$1,467.69
|
| Rate for Payer: United Healthcare Medicare |
$472.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,433.95
|
|
|
TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
24600
|
| Min. Negotiated Rate |
$290.09 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,702.26
|
| Rate for Payer: Aetna of WY Medicare |
$341.28
|
| Rate for Payer: Beech Street Commercial |
$1,650.15
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: Cash Price |
$1,215.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,684.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,702.26
|
| Rate for Payer: First Choice Health Commercial |
$1,563.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,650.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.28
|
| Rate for Payer: HealthUtah PPO |
$1,737.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,684.89
|
| Rate for Payer: Multiplan Medicare/VA |
$290.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,702.26
|
| Rate for Payer: PacificSource Commercial |
$1,563.30
|
| Rate for Payer: PHCS PPO |
$1,650.15
|
| Rate for Payer: Three Rivers PPO |
$1,302.75
|
| Rate for Payer: TriWest Veterans Administration |
$341.28
|
| Rate for Payer: United Healthcare Commercial |
$1,511.19
|
| Rate for Payer: United Healthcare Medicare |
$341.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,476.45
|
|
|
TRIAMCINOLONE ACET INJ NOS
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
J3301
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.08
|
| Rate for Payer: Beech Street Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: First Choice Health Commercial |
$6.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.08
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.92
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.65
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$1.08
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [10539]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 3334232715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.59
|
| Rate for Payer: Altius Commercial |
$0.59
|
| Rate for Payer: Beech Street Commercial |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.59
|
| Rate for Payer: Cigna of WY Commercial |
$0.60
|
| Rate for Payer: Entrust Commercial |
$0.58
|
| Rate for Payer: First Choice Health Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.40
|
| Rate for Payer: HealthUtah PPO |
$0.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.59
|
| Rate for Payer: Multiplan Medicare/VA |
$0.38
|
| Rate for Payer: One Health Plan of WY PPO |
$0.60
|
| Rate for Payer: PacificSource Commercial |
$0.55
|
| Rate for Payer: PHCS PPO |
$0.60
|
| Rate for Payer: Three Rivers PPO |
$0.46
|
| Rate for Payer: TriWest Veterans Administration |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.58
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [10539]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 3334232715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.60
|
| Rate for Payer: Aetna of WY Medicare |
$0.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.59
|
| Rate for Payer: Altius Commercial |
$0.59
|
| Rate for Payer: Beech Street Commercial |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.59
|
| Rate for Payer: Cigna of WY Commercial |
$0.60
|
| Rate for Payer: Entrust Commercial |
$0.58
|
| Rate for Payer: First Choice Health Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.59
|
| Rate for Payer: Multiplan Medicare/VA |
$0.34
|
| Rate for Payer: One Health Plan of WY PPO |
$0.60
|
| Rate for Payer: PacificSource Commercial |
$0.55
|
| Rate for Payer: PHCS PPO |
$0.60
|
| Rate for Payer: Three Rivers PPO |
$0.46
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.60
|
| Rate for Payer: Wise Provider Network Commercial |
$0.58
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [10539]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 4580206335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$0.91
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [10539]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 4580206335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Aetna of WY Medicare |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.56
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WINHealth Partners Commercial |
$0.94
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [7965]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 5167212822
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.80
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [7965]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 5167212822
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.82
|
| Rate for Payer: Aetna of WY Medicare |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.81
|
| Rate for Payer: Altius Commercial |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.81
|
| Rate for Payer: Cigna of WY Commercial |
$0.82
|
| Rate for Payer: Entrust Commercial |
$0.80
|
| Rate for Payer: First Choice Health Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.81
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.82
|
| Rate for Payer: PacificSource Commercial |
$0.76
|
| Rate for Payer: PHCS PPO |
$0.82
|
| Rate for Payer: Three Rivers PPO |
$0.63
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.73
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.82
|
| Rate for Payer: Wise Provider Network Commercial |
$0.80
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [7965]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
NDC 6787725130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.78
|
| Rate for Payer: Altius Commercial |
$0.78
|
| Rate for Payer: Beech Street Commercial |
$0.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.79
|
| Rate for Payer: Cigna of WY Commercial |
$0.79
|
| Rate for Payer: Entrust Commercial |
$0.77
|
| Rate for Payer: First Choice Health Commercial |
$0.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.51
|
| Rate for Payer: One Health Plan of WY PPO |
$0.79
|
| Rate for Payer: PacificSource Commercial |
$0.73
|
| Rate for Payer: PHCS PPO |
$0.79
|
| Rate for Payer: Three Rivers PPO |
$0.61
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.77
|
| Rate for Payer: Wise Provider Network Commercial |
$0.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [7965]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 6787725130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.79
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.78
|
| Rate for Payer: Altius Commercial |
$0.78
|
| Rate for Payer: Beech Street Commercial |
$0.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.79
|
| Rate for Payer: Cigna of WY Commercial |
$0.79
|
| Rate for Payer: Entrust Commercial |
$0.77
|
| Rate for Payer: First Choice Health Commercial |
$0.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.47
|
| Rate for Payer: HealthUtah PPO |
$0.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.79
|
| Rate for Payer: PacificSource Commercial |
$0.73
|
| Rate for Payer: PHCS PPO |
$0.79
|
| Rate for Payer: Three Rivers PPO |
$0.61
|
| Rate for Payer: TriWest Veterans Administration |
$0.47
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.47
|
| Rate for Payer: WINHealth Partners Commercial |
$0.79
|
| Rate for Payer: Wise Provider Network Commercial |
$0.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [12717]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 2192206304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [12717]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 2192206304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Aetna of WY Medicare |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
