|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [2844]
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 0168000215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.37
|
| Rate for Payer: Altius Commercial |
$2.37
|
| Rate for Payer: Beech Street Commercial |
$2.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.03
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.40
|
| Rate for Payer: Cigna of WY Commercial |
$2.42
|
| Rate for Payer: Entrust Commercial |
$2.35
|
| Rate for Payer: First Choice Health Commercial |
$2.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.63
|
| Rate for Payer: HealthUtah PPO |
$2.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.42
|
| Rate for Payer: PacificSource Commercial |
$2.22
|
| Rate for Payer: PHCS PPO |
$2.42
|
| Rate for Payer: Three Rivers PPO |
$1.85
|
| Rate for Payer: TriWest Veterans Administration |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$2.15
|
| Rate for Payer: United Healthcare Medicare |
$1.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2.35
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [2844]
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 0168000215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.42
|
| Rate for Payer: Aetna of WY Medicare |
$1.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.37
|
| Rate for Payer: Altius Commercial |
$2.37
|
| Rate for Payer: Beech Street Commercial |
$2.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.03
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.40
|
| Rate for Payer: Cigna of WY Commercial |
$2.42
|
| Rate for Payer: Entrust Commercial |
$2.35
|
| Rate for Payer: First Choice Health Commercial |
$2.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.43
|
| Rate for Payer: HealthUtah PPO |
$2.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2.42
|
| Rate for Payer: PacificSource Commercial |
$2.22
|
| Rate for Payer: PHCS PPO |
$2.42
|
| Rate for Payer: Three Rivers PPO |
$1.85
|
| Rate for Payer: TriWest Veterans Administration |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$2.15
|
| Rate for Payer: United Healthcare Medicare |
$1.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2.42
|
| Rate for Payer: Wise Provider Network Commercial |
$2.35
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [2844]
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
NDC 4580206535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.09
|
| Rate for Payer: Altius Commercial |
$2.09
|
| Rate for Payer: Beech Street Commercial |
$2.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.11
|
| Rate for Payer: Cigna of WY Commercial |
$2.14
|
| Rate for Payer: Entrust Commercial |
$2.07
|
| Rate for Payer: First Choice Health Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.44
|
| Rate for Payer: HealthUtah PPO |
$2.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.14
|
| Rate for Payer: PacificSource Commercial |
$1.96
|
| Rate for Payer: PHCS PPO |
$2.14
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2.07
|
| Rate for Payer: Wise Provider Network Commercial |
$2.07
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [2844]
|
Facility
|
OP
|
$2.18
|
|
|
Service Code
|
NDC 4580206535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.14
|
| Rate for Payer: Aetna of WY Medicare |
$1.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.09
|
| Rate for Payer: Altius Commercial |
$2.09
|
| Rate for Payer: Beech Street Commercial |
$2.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.11
|
| Rate for Payer: Cigna of WY Commercial |
$2.14
|
| Rate for Payer: Entrust Commercial |
$2.07
|
| Rate for Payer: First Choice Health Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.26
|
| Rate for Payer: HealthUtah PPO |
$2.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2.14
|
| Rate for Payer: PacificSource Commercial |
$1.96
|
| Rate for Payer: PHCS PPO |
$2.14
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2.14
|
| Rate for Payer: Wise Provider Network Commercial |
$2.07
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [17466]
|
Facility
|
IP
|
$24.67
|
|
|
Service Code
|
HCPCS J3301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.68
|
| Rate for Payer: Altius Commercial |
$23.68
|
| Rate for Payer: Beech Street Commercial |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.25
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.93
|
| Rate for Payer: Cigna of WY Commercial |
$24.18
|
| Rate for Payer: Entrust Commercial |
$23.44
|
| Rate for Payer: First Choice Health Commercial |
$23.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.28
|
| Rate for Payer: HealthUtah PPO |
$24.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.93
|
| Rate for Payer: Multiplan Medicare/VA |
$15.47
|
| Rate for Payer: One Health Plan of WY PPO |
$24.18
|
| Rate for Payer: PacificSource Commercial |
$22.20
|
| Rate for Payer: PHCS PPO |
$24.18
|
| Rate for Payer: Three Rivers PPO |
$18.50
|
| Rate for Payer: TriWest Veterans Administration |
$16.28
|
| Rate for Payer: United Healthcare Commercial |
$21.46
|
| Rate for Payer: United Healthcare Medicare |
$16.28
|
| Rate for Payer: WINHealth Partners Commercial |
$23.44
|
| Rate for Payer: Wise Provider Network Commercial |
$23.44
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [17466]
|
Facility
|
OP
|
$24.67
|
|
|
Service Code
|
HCPCS J3301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.18
|
| Rate for Payer: Aetna of WY Medicare |
$16.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.68
|
| Rate for Payer: Altius Commercial |
$23.68
|
| Rate for Payer: Beech Street Commercial |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.25
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.93
|
| Rate for Payer: Cigna of WY Commercial |
$24.18
|
| Rate for Payer: Entrust Commercial |
$23.44
|
| Rate for Payer: First Choice Health Commercial |
$23.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.31
|
| Rate for Payer: HealthUtah PPO |
$24.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.93
|
| Rate for Payer: Multiplan Medicare/VA |
$13.59
|
| Rate for Payer: One Health Plan of WY PPO |
$24.18
|
| Rate for Payer: PacificSource Commercial |
$22.20
|
| Rate for Payer: PHCS PPO |
$24.18
|
| Rate for Payer: Three Rivers PPO |
$18.50
|
| Rate for Payer: TriWest Veterans Administration |
$14.31
|
| Rate for Payer: United Healthcare Commercial |
$21.46
|
| Rate for Payer: United Healthcare Medicare |
$14.31
|
| Rate for Payer: WINHealth Partners Commercial |
$24.18
|
| Rate for Payer: Wise Provider Network Commercial |
$23.44
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [11971]
|
Facility
|
IP
|
$42.62
|
|
|
Service Code
|
HCPCS J3301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.72 |
| Max. Negotiated Rate |
$42.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.77
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.71
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.12
|
| Rate for Payer: Altius Commercial |
$36.15
|
| Rate for Payer: Altius Commercial |
$37.05
|
| Rate for Payer: Altius Commercial |
$40.92
|
| Rate for Payer: Altius Commercial |
$32.04
|
| Rate for Payer: Altius Commercial |
$39.12
|
| Rate for Payer: Beech Street Commercial |
$36.91
|
| Rate for Payer: Beech Street Commercial |
$32.71
|
| Rate for Payer: Beech Street Commercial |
$39.94
|
| Rate for Payer: Beech Street Commercial |
$41.77
|
| Rate for Payer: Beech Street Commercial |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.99
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cash Price |
$23.36
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.53
|
| Rate for Payer: Cigna of WY Commercial |
$41.77
|
| Rate for Payer: Cigna of WY Commercial |
$36.91
|
| Rate for Payer: Cigna of WY Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$37.82
|
| Rate for Payer: Cigna of WY Commercial |
$32.71
|
| Rate for Payer: Entrust Commercial |
$31.71
|
| Rate for Payer: Entrust Commercial |
$40.49
|
| Rate for Payer: Entrust Commercial |
$36.66
|
| Rate for Payer: Entrust Commercial |
$35.78
|
| Rate for Payer: Entrust Commercial |
$38.71
|
| Rate for Payer: First Choice Health Commercial |
$35.78
|
| Rate for Payer: First Choice Health Commercial |
$31.71
|
| Rate for Payer: First Choice Health Commercial |
$40.49
|
| Rate for Payer: First Choice Health Commercial |
$38.71
|
| Rate for Payer: First Choice Health Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.47
|
| Rate for Payer: HealthUtah PPO |
$40.75
|
| Rate for Payer: HealthUtah PPO |
$33.38
|
| Rate for Payer: HealthUtah PPO |
$37.66
|
| Rate for Payer: HealthUtah PPO |
$42.62
|
| Rate for Payer: HealthUtah PPO |
$38.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.43
|
| Rate for Payer: Multiplan Medicare/VA |
$24.20
|
| Rate for Payer: Multiplan Medicare/VA |
$23.61
|
| Rate for Payer: Multiplan Medicare/VA |
$20.93
|
| Rate for Payer: Multiplan Medicare/VA |
$25.55
|
| Rate for Payer: Multiplan Medicare/VA |
$26.72
|
| Rate for Payer: One Health Plan of WY PPO |
$32.71
|
| Rate for Payer: One Health Plan of WY PPO |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$37.82
|
| Rate for Payer: One Health Plan of WY PPO |
$39.94
|
| Rate for Payer: One Health Plan of WY PPO |
$41.77
|
| Rate for Payer: PacificSource Commercial |
$30.04
|
| Rate for Payer: PacificSource Commercial |
$34.73
|
| Rate for Payer: PacificSource Commercial |
$33.89
|
| Rate for Payer: PacificSource Commercial |
$36.68
|
| Rate for Payer: PacificSource Commercial |
$38.36
|
| Rate for Payer: PHCS PPO |
$39.94
|
| Rate for Payer: PHCS PPO |
$41.77
|
| Rate for Payer: PHCS PPO |
$37.82
|
| Rate for Payer: PHCS PPO |
$32.71
|
| Rate for Payer: PHCS PPO |
$36.91
|
| Rate for Payer: Three Rivers PPO |
$28.24
|
| Rate for Payer: Three Rivers PPO |
$31.96
|
| Rate for Payer: Three Rivers PPO |
$30.56
|
| Rate for Payer: Three Rivers PPO |
$28.94
|
| Rate for Payer: Three Rivers PPO |
$25.04
|
| Rate for Payer: TriWest Veterans Administration |
$28.13
|
| Rate for Payer: TriWest Veterans Administration |
$25.47
|
| Rate for Payer: TriWest Veterans Administration |
$22.03
|
| Rate for Payer: TriWest Veterans Administration |
$24.86
|
| Rate for Payer: TriWest Veterans Administration |
$26.90
|
| Rate for Payer: United Healthcare Commercial |
$35.45
|
| Rate for Payer: United Healthcare Commercial |
$37.08
|
| Rate for Payer: United Healthcare Commercial |
$29.04
|
| Rate for Payer: United Healthcare Commercial |
$32.76
|
| Rate for Payer: United Healthcare Commercial |
$33.57
|
| Rate for Payer: United Healthcare Medicare |
$25.47
|
| Rate for Payer: United Healthcare Medicare |
$26.90
|
| Rate for Payer: United Healthcare Medicare |
$24.86
|
| Rate for Payer: United Healthcare Medicare |
$22.03
|
| Rate for Payer: United Healthcare Medicare |
$28.13
|
| Rate for Payer: WINHealth Partners Commercial |
$35.78
|
| Rate for Payer: WINHealth Partners Commercial |
$38.71
|
| Rate for Payer: WINHealth Partners Commercial |
$40.49
|
| Rate for Payer: WINHealth Partners Commercial |
$36.66
|
| Rate for Payer: WINHealth Partners Commercial |
$31.71
|
| Rate for Payer: Wise Provider Network Commercial |
$35.78
|
| Rate for Payer: Wise Provider Network Commercial |
$40.49
|
| Rate for Payer: Wise Provider Network Commercial |
$38.71
|
| Rate for Payer: Wise Provider Network Commercial |
$31.71
|
| Rate for Payer: Wise Provider Network Commercial |
$36.66
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [11971]
|
Facility
|
OP
|
$40.75
|
|
|
Service Code
|
HCPCS J3301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$40.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.91
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.71
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.77
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.82
|
| Rate for Payer: Aetna of WY Medicare |
$26.90
|
| Rate for Payer: Aetna of WY Medicare |
$28.13
|
| Rate for Payer: Aetna of WY Medicare |
$25.47
|
| Rate for Payer: Aetna of WY Medicare |
$24.86
|
| Rate for Payer: Aetna of WY Medicare |
$22.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.92
|
| Rate for Payer: Altius Commercial |
$40.92
|
| Rate for Payer: Altius Commercial |
$36.15
|
| Rate for Payer: Altius Commercial |
$37.05
|
| Rate for Payer: Altius Commercial |
$32.04
|
| Rate for Payer: Altius Commercial |
$39.12
|
| Rate for Payer: Beech Street Commercial |
$39.94
|
| Rate for Payer: Beech Street Commercial |
$32.71
|
| Rate for Payer: Beech Street Commercial |
$37.82
|
| Rate for Payer: Beech Street Commercial |
$36.91
|
| Rate for Payer: Beech Street Commercial |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.99
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cash Price |
$23.36
|
| Rate for Payer: Cash Price |
$27.02
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.38
|
| Rate for Payer: Cigna of WY Commercial |
$32.71
|
| Rate for Payer: Cigna of WY Commercial |
$36.91
|
| Rate for Payer: Cigna of WY Commercial |
$37.82
|
| Rate for Payer: Cigna of WY Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$41.77
|
| Rate for Payer: Entrust Commercial |
$31.71
|
| Rate for Payer: Entrust Commercial |
$35.78
|
| Rate for Payer: Entrust Commercial |
$36.66
|
| Rate for Payer: Entrust Commercial |
$40.49
|
| Rate for Payer: Entrust Commercial |
$38.71
|
| Rate for Payer: First Choice Health Commercial |
$31.71
|
| Rate for Payer: First Choice Health Commercial |
$38.71
|
| Rate for Payer: First Choice Health Commercial |
$40.49
|
| Rate for Payer: First Choice Health Commercial |
$36.66
|
| Rate for Payer: First Choice Health Commercial |
$35.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.84
|
| Rate for Payer: HealthUtah PPO |
$33.38
|
| Rate for Payer: HealthUtah PPO |
$38.59
|
| Rate for Payer: HealthUtah PPO |
$37.66
|
| Rate for Payer: HealthUtah PPO |
$42.62
|
| Rate for Payer: HealthUtah PPO |
$40.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.43
|
| Rate for Payer: Multiplan Medicare/VA |
$23.48
|
| Rate for Payer: Multiplan Medicare/VA |
$18.39
|
| Rate for Payer: Multiplan Medicare/VA |
$21.26
|
| Rate for Payer: Multiplan Medicare/VA |
$22.45
|
| Rate for Payer: Multiplan Medicare/VA |
$20.75
|
| Rate for Payer: One Health Plan of WY PPO |
$36.91
|
| Rate for Payer: One Health Plan of WY PPO |
$32.71
|
| Rate for Payer: One Health Plan of WY PPO |
$37.82
|
| Rate for Payer: One Health Plan of WY PPO |
$39.94
|
| Rate for Payer: One Health Plan of WY PPO |
$41.77
|
| Rate for Payer: PacificSource Commercial |
$34.73
|
| Rate for Payer: PacificSource Commercial |
$30.04
|
| Rate for Payer: PacificSource Commercial |
$36.68
|
| Rate for Payer: PacificSource Commercial |
$38.36
|
| Rate for Payer: PacificSource Commercial |
$33.89
|
| Rate for Payer: PHCS PPO |
$41.77
|
| Rate for Payer: PHCS PPO |
$36.91
|
| Rate for Payer: PHCS PPO |
$37.82
|
| Rate for Payer: PHCS PPO |
$39.94
|
| Rate for Payer: PHCS PPO |
$32.71
|
| Rate for Payer: Three Rivers PPO |
$28.24
|
| Rate for Payer: Three Rivers PPO |
$28.94
|
| Rate for Payer: Three Rivers PPO |
$25.04
|
| Rate for Payer: Three Rivers PPO |
$31.96
|
| Rate for Payer: Three Rivers PPO |
$30.56
|
| Rate for Payer: TriWest Veterans Administration |
$21.84
|
| Rate for Payer: TriWest Veterans Administration |
$23.64
|
| Rate for Payer: TriWest Veterans Administration |
$24.72
|
| Rate for Payer: TriWest Veterans Administration |
$22.38
|
| Rate for Payer: TriWest Veterans Administration |
$19.36
|
| Rate for Payer: United Healthcare Commercial |
$35.45
|
| Rate for Payer: United Healthcare Commercial |
$32.76
|
| Rate for Payer: United Healthcare Commercial |
$29.04
|
| Rate for Payer: United Healthcare Commercial |
$33.57
|
| Rate for Payer: United Healthcare Commercial |
$37.08
|
| Rate for Payer: United Healthcare Medicare |
$22.38
|
| Rate for Payer: United Healthcare Medicare |
$23.64
|
| Rate for Payer: United Healthcare Medicare |
$19.36
|
| Rate for Payer: United Healthcare Medicare |
$21.84
|
| Rate for Payer: United Healthcare Medicare |
$24.72
|
| Rate for Payer: WINHealth Partners Commercial |
$32.71
|
| Rate for Payer: WINHealth Partners Commercial |
$39.94
|
| Rate for Payer: WINHealth Partners Commercial |
$41.77
|
| Rate for Payer: WINHealth Partners Commercial |
$37.82
|
| Rate for Payer: WINHealth Partners Commercial |
$36.91
|
| Rate for Payer: Wise Provider Network Commercial |
$36.66
|
| Rate for Payer: Wise Provider Network Commercial |
$40.49
|
| Rate for Payer: Wise Provider Network Commercial |
$35.78
|
| Rate for Payer: Wise Provider Network Commercial |
$31.71
|
| Rate for Payer: Wise Provider Network Commercial |
$38.71
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [15121]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 6808475025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.16
|
| Rate for Payer: Altius Commercial |
$3.16
|
| Rate for Payer: Beech Street Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.19
|
| Rate for Payer: Cigna of WY Commercial |
$3.22
|
| Rate for Payer: Entrust Commercial |
$3.13
|
| Rate for Payer: First Choice Health Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.17
|
| Rate for Payer: HealthUtah PPO |
$3.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.19
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.22
|
| Rate for Payer: PacificSource Commercial |
$2.96
|
| Rate for Payer: PHCS PPO |
$3.22
|
| Rate for Payer: Three Rivers PPO |
$2.47
|
| Rate for Payer: TriWest Veterans Administration |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$2.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3.13
|
| Rate for Payer: Wise Provider Network Commercial |
$3.13
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [15121]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 6808475025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.16
|
| Rate for Payer: Altius Commercial |
$3.16
|
| Rate for Payer: Beech Street Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.19
|
| Rate for Payer: Cigna of WY Commercial |
$3.22
|
| Rate for Payer: Entrust Commercial |
$3.13
|
| Rate for Payer: First Choice Health Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.91
|
| Rate for Payer: HealthUtah PPO |
$3.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.19
|
| Rate for Payer: Multiplan Medicare/VA |
$1.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3.22
|
| Rate for Payer: PacificSource Commercial |
$2.96
|
| Rate for Payer: PHCS PPO |
$3.22
|
| Rate for Payer: Three Rivers PPO |
$2.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$1.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3.22
|
| Rate for Payer: Wise Provider Network Commercial |
$3.13
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [15121]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 6808475095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.16
|
| Rate for Payer: Altius Commercial |
$3.16
|
| Rate for Payer: Beech Street Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.19
|
| Rate for Payer: Cigna of WY Commercial |
$3.22
|
| Rate for Payer: Entrust Commercial |
$3.13
|
| Rate for Payer: First Choice Health Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.17
|
| Rate for Payer: HealthUtah PPO |
$3.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.19
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.22
|
| Rate for Payer: PacificSource Commercial |
$2.96
|
| Rate for Payer: PHCS PPO |
$3.22
|
| Rate for Payer: Three Rivers PPO |
$2.47
|
| Rate for Payer: TriWest Veterans Administration |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$2.17
|
| Rate for Payer: WINHealth Partners Commercial |
$3.13
|
| Rate for Payer: Wise Provider Network Commercial |
$3.13
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [15121]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 6808475095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.16
|
| Rate for Payer: Altius Commercial |
$3.16
|
| Rate for Payer: Beech Street Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.19
|
| Rate for Payer: Cigna of WY Commercial |
$3.22
|
| Rate for Payer: Entrust Commercial |
$3.13
|
| Rate for Payer: First Choice Health Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.91
|
| Rate for Payer: HealthUtah PPO |
$3.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.19
|
| Rate for Payer: Multiplan Medicare/VA |
$1.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3.22
|
| Rate for Payer: PacificSource Commercial |
$2.96
|
| Rate for Payer: PHCS PPO |
$3.22
|
| Rate for Payer: Three Rivers PPO |
$2.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$1.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3.22
|
| Rate for Payer: Wise Provider Network Commercial |
$3.13
|
|
|
TRIMMING NONDYSTROPHIC NAILS ANY NUMBER
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
11719
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.12
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$6.05
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.12
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$7.12
|
| Rate for Payer: WINHealth Partners Commercial |
$33.15
|
|
|
TRIM NAIL(S)
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
G0127
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Aetna of WY Medicare |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: First Choice Health Commercial |
$81.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.12
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: Multiplan Medicare/VA |
$6.05
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$86.45
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.12
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: United Healthcare Medicare |
$7.12
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
|
|
TROCAR SPACEMAKER OVAL BALLOON
|
Facility
|
IP
|
$1,501.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$941.48 |
| Max. Negotiated Rate |
$1,501.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,441.51
|
| Rate for Payer: Altius Commercial |
$1,441.51
|
| Rate for Payer: Beech Street Commercial |
$1,471.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,232.79
|
| Rate for Payer: Cash Price |
$1,051.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,456.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,471.54
|
| Rate for Payer: Entrust Commercial |
$1,426.49
|
| Rate for Payer: First Choice Health Commercial |
$1,426.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.04
|
| Rate for Payer: HealthUtah PPO |
$1,501.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.52
|
| Rate for Payer: Multiplan Medicare/VA |
$941.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,471.54
|
| Rate for Payer: PacificSource Commercial |
$1,351.41
|
| Rate for Payer: PHCS PPO |
$1,471.54
|
| Rate for Payer: Three Rivers PPO |
$1,126.18
|
| Rate for Payer: TriWest Veterans Administration |
$991.04
|
| Rate for Payer: United Healthcare Commercial |
$1,306.37
|
| Rate for Payer: United Healthcare Medicare |
$991.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,426.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,426.49
|
|
|
TROCAR SPACEMAKER OVAL BALLOON
|
Facility
|
OP
|
$1,501.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.37 |
| Max. Negotiated Rate |
$1,501.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,471.54
|
| Rate for Payer: Aetna of WY Medicare |
$991.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,441.51
|
| Rate for Payer: Altius Commercial |
$1,441.51
|
| Rate for Payer: Beech Street Commercial |
$1,471.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,232.79
|
| Rate for Payer: Cash Price |
$1,051.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,456.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,471.54
|
| Rate for Payer: Entrust Commercial |
$1,426.49
|
| Rate for Payer: First Choice Health Commercial |
$1,426.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,426.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.91
|
| Rate for Payer: HealthUtah PPO |
$1,501.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,456.52
|
| Rate for Payer: Multiplan Medicare/VA |
$827.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,471.54
|
| Rate for Payer: PacificSource Commercial |
$1,351.41
|
| Rate for Payer: PHCS PPO |
$1,471.54
|
| Rate for Payer: Three Rivers PPO |
$1,126.18
|
| Rate for Payer: TriWest Veterans Administration |
$870.91
|
| Rate for Payer: United Healthcare Commercial |
$1,306.37
|
| Rate for Payer: United Healthcare Medicare |
$870.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,471.54
|
| Rate for Payer: Wise Provider Network Commercial |
$1,426.49
|
|
|
TROCAR SWABS SCOPE CLEAN OR
|
Facility
|
OP
|
$29.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$29.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.57
|
| Rate for Payer: Aetna of WY Medicare |
$19.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.98
|
| Rate for Payer: Altius Commercial |
$27.98
|
| Rate for Payer: Beech Street Commercial |
$28.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.93
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.28
|
| Rate for Payer: Cigna of WY Commercial |
$28.57
|
| Rate for Payer: Entrust Commercial |
$27.69
|
| Rate for Payer: First Choice Health Commercial |
$27.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.91
|
| Rate for Payer: HealthUtah PPO |
$29.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.28
|
| Rate for Payer: Multiplan Medicare/VA |
$16.06
|
| Rate for Payer: One Health Plan of WY PPO |
$28.57
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.57
|
| Rate for Payer: Three Rivers PPO |
$21.86
|
| Rate for Payer: TriWest Veterans Administration |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$25.36
|
| Rate for Payer: United Healthcare Medicare |
$16.91
|
| Rate for Payer: WINHealth Partners Commercial |
$28.57
|
| Rate for Payer: Wise Provider Network Commercial |
$27.69
|
|
|
TROCAR SWABS SCOPE CLEAN OR
|
Facility
|
IP
|
$29.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$29.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.98
|
| Rate for Payer: Altius Commercial |
$27.98
|
| Rate for Payer: Beech Street Commercial |
$28.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.93
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.28
|
| Rate for Payer: Cigna of WY Commercial |
$28.57
|
| Rate for Payer: Entrust Commercial |
$27.69
|
| Rate for Payer: First Choice Health Commercial |
$27.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.24
|
| Rate for Payer: HealthUtah PPO |
$29.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.28
|
| Rate for Payer: Multiplan Medicare/VA |
$18.28
|
| Rate for Payer: One Health Plan of WY PPO |
$28.57
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.57
|
| Rate for Payer: Three Rivers PPO |
$21.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.24
|
| Rate for Payer: United Healthcare Commercial |
$25.36
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WINHealth Partners Commercial |
$27.69
|
| Rate for Payer: Wise Provider Network Commercial |
$27.69
|
|
|
TROPICAMIDE 1 % EYE DROPS [6884]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 7006912101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.18
|
| Rate for Payer: Altius Commercial |
$2.18
|
| Rate for Payer: Beech Street Commercial |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.20
|
| Rate for Payer: Cigna of WY Commercial |
$2.22
|
| Rate for Payer: Entrust Commercial |
$2.16
|
| Rate for Payer: First Choice Health Commercial |
$2.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.50
|
| Rate for Payer: HealthUtah PPO |
$2.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2.22
|
| Rate for Payer: PacificSource Commercial |
$2.04
|
| Rate for Payer: PHCS PPO |
$2.22
|
| Rate for Payer: Three Rivers PPO |
$1.70
|
| Rate for Payer: TriWest Veterans Administration |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2.16
|
| Rate for Payer: Wise Provider Network Commercial |
$2.16
|
|
|
TROPICAMIDE 1 % EYE DROPS [6884]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 7006912101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.22
|
| Rate for Payer: Aetna of WY Medicare |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.18
|
| Rate for Payer: Altius Commercial |
$2.18
|
| Rate for Payer: Beech Street Commercial |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.20
|
| Rate for Payer: Cigna of WY Commercial |
$2.22
|
| Rate for Payer: Entrust Commercial |
$2.16
|
| Rate for Payer: First Choice Health Commercial |
$2.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
| Rate for Payer: HealthUtah PPO |
$2.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2.22
|
| Rate for Payer: PacificSource Commercial |
$2.04
|
| Rate for Payer: PHCS PPO |
$2.22
|
| Rate for Payer: Three Rivers PPO |
$1.70
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2.22
|
| Rate for Payer: Wise Provider Network Commercial |
$2.16
|
|
|
TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 27691 80
|
| Hospital Charge Code |
27691
|
| Min. Negotiated Rate |
$614.07 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$722.44
|
| Rate for Payer: Beech Street Commercial |
$2,451.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: First Choice Health Commercial |
$2,322.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$722.44
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,451.00
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$722.44
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$722.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,193.00
|
|
|
TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 27691 AS
|
| Hospital Charge Code |
27691
|
| Min. Negotiated Rate |
$614.07 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$722.44
|
| Rate for Payer: Beech Street Commercial |
$2,451.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: First Choice Health Commercial |
$2,322.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$722.44
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,451.00
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$722.44
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$722.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,193.00
|
|
|
TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 27691
|
| Hospital Charge Code |
27691
|
| Min. Negotiated Rate |
$614.07 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$722.44
|
| Rate for Payer: Beech Street Commercial |
$2,451.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: First Choice Health Commercial |
$2,322.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$722.44
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,451.00
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$722.44
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$722.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,193.00
|
|
|
TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC
|
Professional
|
Both
|
$3,302.00
|
|
|
Service Code
|
HCPCS 27690 80
|
| Hospital Charge Code |
27690
|
| Min. Negotiated Rate |
$528.69 |
| Max. Negotiated Rate |
$3,302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,235.96
|
| Rate for Payer: Aetna of WY Medicare |
$621.99
|
| Rate for Payer: Beech Street Commercial |
$3,136.90
|
| Rate for Payer: Cash Price |
$2,311.40
|
| Rate for Payer: Cash Price |
$2,311.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,202.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,235.96
|
| Rate for Payer: First Choice Health Commercial |
$2,971.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,136.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$621.99
|
| Rate for Payer: HealthUtah PPO |
$3,302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,202.94
|
| Rate for Payer: Multiplan Medicare/VA |
$528.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,235.96
|
| Rate for Payer: PacificSource Commercial |
$2,971.80
|
| Rate for Payer: PHCS PPO |
$3,136.90
|
| Rate for Payer: Three Rivers PPO |
$2,476.50
|
| Rate for Payer: TriWest Veterans Administration |
$621.99
|
| Rate for Payer: United Healthcare Commercial |
$2,872.74
|
| Rate for Payer: United Healthcare Medicare |
$621.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,806.70
|
|
|
TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC
|
Professional
|
Both
|
$3,302.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
27690
|
| Min. Negotiated Rate |
$528.69 |
| Max. Negotiated Rate |
$3,302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,235.96
|
| Rate for Payer: Aetna of WY Medicare |
$621.99
|
| Rate for Payer: Beech Street Commercial |
$3,136.90
|
| Rate for Payer: Cash Price |
$2,311.40
|
| Rate for Payer: Cash Price |
$2,311.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,202.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,235.96
|
| Rate for Payer: First Choice Health Commercial |
$2,971.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,136.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$621.99
|
| Rate for Payer: HealthUtah PPO |
$3,302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,202.94
|
| Rate for Payer: Multiplan Medicare/VA |
$528.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,235.96
|
| Rate for Payer: PacificSource Commercial |
$2,971.80
|
| Rate for Payer: PHCS PPO |
$3,136.90
|
| Rate for Payer: Three Rivers PPO |
$2,476.50
|
| Rate for Payer: TriWest Veterans Administration |
$621.99
|
| Rate for Payer: United Healthcare Commercial |
$2,872.74
|
| Rate for Payer: United Healthcare Medicare |
$621.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,806.70
|
|
