|
CAVETTO CAGE SM 5MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SM 5MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SM 8MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SM 8MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 4MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 4MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 5MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 5MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 6MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 6MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 7MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 7MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 8MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 8MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 9MM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2800302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CAVETTO CAGE SMALL 9MM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2800302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$34.17
|
| Rate for Payer: Beech Street Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: First Choice Health Commercial |
$48.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.17
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.05
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$51.30
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$54.00
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [454]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.17
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Altius Commercial |
$20.74
|
| Rate for Payer: Beech Street Commercial |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.95
|
| Rate for Payer: Cigna of WY Commercial |
$21.17
|
| Rate for Payer: Entrust Commercial |
$20.52
|
| Rate for Payer: First Choice Health Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.18
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$12.52
|
| Rate for Payer: One Health Plan of WY PPO |
$21.17
|
| Rate for Payer: PacificSource Commercial |
$19.44
|
| Rate for Payer: PHCS PPO |
$21.17
|
| Rate for Payer: Three Rivers PPO |
$16.20
|
| Rate for Payer: TriWest Veterans Administration |
$13.18
|
| Rate for Payer: United Healthcare Commercial |
$20.63
|
| Rate for Payer: United Healthcare Medicare |
$13.18
|
| Rate for Payer: WINHealth Partners Commercial |
$20.52
|
| Rate for Payer: Wise Provider Network Commercial |
$20.52
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [454]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.17
|
| Rate for Payer: Aetna of WY Medicare |
$14.26
|
| Rate for Payer: Altius Commercial |
$20.74
|
| Rate for Payer: Beech Street Commercial |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.95
|
| Rate for Payer: Cigna of WY Commercial |
$21.17
|
| Rate for Payer: Entrust Commercial |
$20.52
|
| Rate for Payer: First Choice Health Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.31
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$11.70
|
| Rate for Payer: One Health Plan of WY PPO |
$21.17
|
| Rate for Payer: PacificSource Commercial |
$19.44
|
| Rate for Payer: PHCS PPO |
$21.17
|
| Rate for Payer: Three Rivers PPO |
$16.20
|
| Rate for Payer: TriWest Veterans Administration |
$12.31
|
| Rate for Payer: United Healthcare Commercial |
$20.63
|
| Rate for Payer: United Healthcare Medicare |
$12.31
|
| Rate for Payer: WINHealth Partners Commercial |
$21.17
|
| Rate for Payer: Wise Provider Network Commercial |
$20.52
|
|
|
CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [97201]
|
Facility
|
IP
|
$55.59
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.21 |
| Max. Negotiated Rate |
$55.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.48
|
| Rate for Payer: Aetna of WY Medicare |
$35.58
|
| Rate for Payer: Altius Commercial |
$53.37
|
| Rate for Payer: Beech Street Commercial |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.92
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.92
|
| Rate for Payer: Cigna of WY Commercial |
$54.48
|
| Rate for Payer: Entrust Commercial |
$52.81
|
| Rate for Payer: First Choice Health Commercial |
$52.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.91
|
| Rate for Payer: HealthUtah PPO |
$55.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.92
|
| Rate for Payer: Multiplan Medicare/VA |
$32.21
|
| Rate for Payer: One Health Plan of WY PPO |
$54.48
|
| Rate for Payer: PacificSource Commercial |
$50.03
|
| Rate for Payer: PHCS PPO |
$54.48
|
| Rate for Payer: Three Rivers PPO |
$41.69
|
| Rate for Payer: TriWest Veterans Administration |
$33.91
|
| Rate for Payer: United Healthcare Commercial |
$53.09
|
| Rate for Payer: United Healthcare Medicare |
$33.91
|
| Rate for Payer: WINHealth Partners Commercial |
$52.81
|
| Rate for Payer: Wise Provider Network Commercial |
$52.81
|
|
|
CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [97201]
|
Facility
|
OP
|
$55.59
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$55.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.48
|
| Rate for Payer: Aetna of WY Medicare |
$36.69
|
| Rate for Payer: Altius Commercial |
$53.37
|
| Rate for Payer: Beech Street Commercial |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.92
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.92
|
| Rate for Payer: Cigna of WY Commercial |
$54.48
|
| Rate for Payer: Entrust Commercial |
$52.81
|
| Rate for Payer: First Choice Health Commercial |
$52.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.69
|
| Rate for Payer: HealthUtah PPO |
$55.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.92
|
| Rate for Payer: Multiplan Medicare/VA |
$30.10
|
| Rate for Payer: One Health Plan of WY PPO |
$54.48
|
| Rate for Payer: PacificSource Commercial |
$50.03
|
| Rate for Payer: PHCS PPO |
$54.48
|
| Rate for Payer: Three Rivers PPO |
$41.69
|
| Rate for Payer: TriWest Veterans Administration |
$31.69
|
| Rate for Payer: United Healthcare Commercial |
$53.09
|
| Rate for Payer: United Healthcare Medicare |
$31.69
|
| Rate for Payer: WINHealth Partners Commercial |
$54.48
|
| Rate for Payer: Wise Provider Network Commercial |
$52.81
|
|
|
CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [164808]
|
Facility
|
IP
|
$35.48
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.77
|
| Rate for Payer: Aetna of WY Medicare |
$22.71
|
| Rate for Payer: Altius Commercial |
$34.06
|
| Rate for Payer: Beech Street Commercial |
$34.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.42
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.42
|
| Rate for Payer: Cigna of WY Commercial |
$34.77
|
| Rate for Payer: Entrust Commercial |
$33.71
|
| Rate for Payer: First Choice Health Commercial |
$33.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.64
|
| Rate for Payer: HealthUtah PPO |
$35.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.42
|
| Rate for Payer: Multiplan Medicare/VA |
$20.56
|
| Rate for Payer: One Health Plan of WY PPO |
$34.77
|
| Rate for Payer: PacificSource Commercial |
$31.93
|
| Rate for Payer: PHCS PPO |
$34.77
|
| Rate for Payer: Three Rivers PPO |
$26.61
|
| Rate for Payer: TriWest Veterans Administration |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$33.88
|
| Rate for Payer: United Healthcare Medicare |
$21.64
|
| Rate for Payer: WINHealth Partners Commercial |
$33.71
|
| Rate for Payer: Wise Provider Network Commercial |
$33.71
|
|
|
CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION [164808]
|
Facility
|
OP
|
$35.48
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.77
|
| Rate for Payer: Aetna of WY Medicare |
$23.42
|
| Rate for Payer: Altius Commercial |
$34.06
|
| Rate for Payer: Beech Street Commercial |
$34.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.42
|
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.42
|
| Rate for Payer: Cigna of WY Commercial |
$34.77
|
| Rate for Payer: Entrust Commercial |
$33.71
|
| Rate for Payer: First Choice Health Commercial |
$33.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.22
|
| Rate for Payer: HealthUtah PPO |
$35.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.42
|
| Rate for Payer: Multiplan Medicare/VA |
$19.21
|
| Rate for Payer: One Health Plan of WY PPO |
$34.77
|
| Rate for Payer: PacificSource Commercial |
$31.93
|
| Rate for Payer: PHCS PPO |
$34.77
|
| Rate for Payer: Three Rivers PPO |
$26.61
|
| Rate for Payer: TriWest Veterans Administration |
$20.22
|
| Rate for Payer: United Healthcare Commercial |
$33.88
|
| Rate for Payer: United Healthcare Medicare |
$20.22
|
| Rate for Payer: WINHealth Partners Commercial |
$34.77
|
| Rate for Payer: Wise Provider Network Commercial |
$33.71
|
|
|
CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [177409]
|
Facility
|
OP
|
$43.53
|
|
|
Service Code
|
NDC 6050562660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$43.53 |
| Rate for Payer: United Healthcare Commercial |
$41.57
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.66
|
| Rate for Payer: Aetna of WY Medicare |
$28.73
|
| Rate for Payer: Altius Commercial |
$41.79
|
| Rate for Payer: Beech Street Commercial |
$42.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.22
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.22
|
| Rate for Payer: Cigna of WY Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$41.35
|
| Rate for Payer: First Choice Health Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.81
|
| Rate for Payer: HealthUtah PPO |
$43.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.22
|
| Rate for Payer: Multiplan Medicare/VA |
$23.57
|
| Rate for Payer: One Health Plan of WY PPO |
$42.66
|
| Rate for Payer: PacificSource Commercial |
$39.18
|
| Rate for Payer: PHCS PPO |
$42.66
|
| Rate for Payer: Three Rivers PPO |
$32.65
|
| Rate for Payer: TriWest Veterans Administration |
$24.81
|
| Rate for Payer: United Healthcare Medicare |
$24.81
|
| Rate for Payer: WINHealth Partners Commercial |
$42.66
|
| Rate for Payer: Wise Provider Network Commercial |
$41.35
|
|
|
CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [177409]
|
Facility
|
IP
|
$43.53
|
|
|
Service Code
|
NDC 6050562660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$43.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.66
|
| Rate for Payer: Aetna of WY Medicare |
$27.86
|
| Rate for Payer: Altius Commercial |
$41.79
|
| Rate for Payer: Beech Street Commercial |
$42.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.22
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.22
|
| Rate for Payer: Cigna of WY Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$41.35
|
| Rate for Payer: First Choice Health Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.55
|
| Rate for Payer: HealthUtah PPO |
$43.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.22
|
| Rate for Payer: Multiplan Medicare/VA |
$25.23
|
| Rate for Payer: One Health Plan of WY PPO |
$42.66
|
| Rate for Payer: PacificSource Commercial |
$39.18
|
| Rate for Payer: PHCS PPO |
$42.66
|
| Rate for Payer: Three Rivers PPO |
$32.65
|
| Rate for Payer: TriWest Veterans Administration |
$26.55
|
| Rate for Payer: United Healthcare Commercial |
$41.57
|
| Rate for Payer: United Healthcare Medicare |
$26.55
|
| Rate for Payer: WINHealth Partners Commercial |
$41.35
|
| Rate for Payer: Wise Provider Network Commercial |
$41.35
|
|
