|
CEFAZOLIN SODIUM INJECTION
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0690
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.88
|
| Rate for Payer: Aetna of WY Medicare |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$5.70
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.82
|
| Rate for Payer: Cigna of WY Commercial |
$5.88
|
| Rate for Payer: First Choice Health Commercial |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$6.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.82
|
| Rate for Payer: Multiplan Medicare/VA |
$0.69
|
| Rate for Payer: One Health Plan of WY PPO |
$5.88
|
| Rate for Payer: PacificSource Commercial |
$5.40
|
| Rate for Payer: PHCS PPO |
$5.70
|
| Rate for Payer: Three Rivers PPO |
$4.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$5.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5.70
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 6586221901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.24
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.76
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.27
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.76
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Medicare |
$9.76
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 0093413773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.12
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.66
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 6818072305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.34
|
| Rate for Payer: Aetna of WY Medicare |
$13.02
|
| Rate for Payer: Altius Commercial |
$18.94
|
| Rate for Payer: Beech Street Commercial |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.14
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.14
|
| Rate for Payer: Cigna of WY Commercial |
$19.34
|
| Rate for Payer: Entrust Commercial |
$18.74
|
| Rate for Payer: First Choice Health Commercial |
$18.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.25
|
| Rate for Payer: HealthUtah PPO |
$19.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.14
|
| Rate for Payer: Multiplan Medicare/VA |
$10.68
|
| Rate for Payer: One Health Plan of WY PPO |
$19.34
|
| Rate for Payer: PacificSource Commercial |
$17.76
|
| Rate for Payer: PHCS PPO |
$19.34
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$11.25
|
| Rate for Payer: WINHealth Partners Commercial |
$19.34
|
| Rate for Payer: Wise Provider Network Commercial |
$18.74
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 0093413773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.24
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.76
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.27
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.76
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Medicare |
$9.76
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 6586221901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.52
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.12
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.66
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$15.28
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 6818072305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.34
|
| Rate for Payer: Aetna of WY Medicare |
$12.63
|
| Rate for Payer: Altius Commercial |
$18.94
|
| Rate for Payer: Beech Street Commercial |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.14
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.14
|
| Rate for Payer: Cigna of WY Commercial |
$19.34
|
| Rate for Payer: Entrust Commercial |
$18.74
|
| Rate for Payer: First Choice Health Commercial |
$18.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.04
|
| Rate for Payer: HealthUtah PPO |
$19.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.14
|
| Rate for Payer: Multiplan Medicare/VA |
$11.43
|
| Rate for Payer: One Health Plan of WY PPO |
$19.34
|
| Rate for Payer: PacificSource Commercial |
$17.76
|
| Rate for Payer: PHCS PPO |
$19.34
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$12.04
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$12.04
|
| Rate for Payer: WINHealth Partners Commercial |
$18.74
|
| Rate for Payer: Wise Provider Network Commercial |
$18.74
|
|
|
CEFDINIR 300 MG CAPSULE [18664]
|
Facility
|
OP
|
$19.84
|
|
|
Service Code
|
NDC 6068769911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.44
|
| Rate for Payer: Aetna of WY Medicare |
$13.09
|
| Rate for Payer: Altius Commercial |
$19.05
|
| Rate for Payer: Beech Street Commercial |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.24
|
| Rate for Payer: Cigna of WY Commercial |
$19.44
|
| Rate for Payer: Entrust Commercial |
$18.85
|
| Rate for Payer: First Choice Health Commercial |
$18.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.31
|
| Rate for Payer: HealthUtah PPO |
$19.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.24
|
| Rate for Payer: Multiplan Medicare/VA |
$10.74
|
| Rate for Payer: One Health Plan of WY PPO |
$19.44
|
| Rate for Payer: PacificSource Commercial |
$17.86
|
| Rate for Payer: PHCS PPO |
$19.44
|
| Rate for Payer: Three Rivers PPO |
$14.88
|
| Rate for Payer: TriWest Veterans Administration |
$11.31
|
| Rate for Payer: United Healthcare Commercial |
$18.95
|
| Rate for Payer: United Healthcare Medicare |
$11.31
|
| Rate for Payer: WINHealth Partners Commercial |
$19.44
|
| Rate for Payer: Wise Provider Network Commercial |
$18.85
|
|
|
CEFDINIR 300 MG CAPSULE [18664]
|
Facility
|
IP
|
$27.65
|
|
|
Service Code
|
NDC 6800136206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$27.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.10
|
| Rate for Payer: Aetna of WY Medicare |
$17.70
|
| Rate for Payer: Altius Commercial |
$26.54
|
| Rate for Payer: Beech Street Commercial |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.82
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.82
|
| Rate for Payer: Cigna of WY Commercial |
$27.10
|
| Rate for Payer: Entrust Commercial |
$26.27
|
| Rate for Payer: First Choice Health Commercial |
$26.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.87
|
| Rate for Payer: HealthUtah PPO |
$27.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.82
|
| Rate for Payer: Multiplan Medicare/VA |
$16.02
|
| Rate for Payer: One Health Plan of WY PPO |
$27.10
|
| Rate for Payer: PacificSource Commercial |
$24.88
|
| Rate for Payer: PHCS PPO |
$27.10
|
| Rate for Payer: Three Rivers PPO |
$20.74
|
| Rate for Payer: TriWest Veterans Administration |
$16.87
|
| Rate for Payer: United Healthcare Commercial |
$26.41
|
| Rate for Payer: United Healthcare Medicare |
$16.87
|
| Rate for Payer: WINHealth Partners Commercial |
$26.27
|
| Rate for Payer: Wise Provider Network Commercial |
$26.27
|
|
|
CEFDINIR 300 MG CAPSULE [18664]
|
Facility
|
IP
|
$19.84
|
|
|
Service Code
|
NDC 6068769911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.44
|
| Rate for Payer: Aetna of WY Medicare |
$12.70
|
| Rate for Payer: Altius Commercial |
$19.05
|
| Rate for Payer: Beech Street Commercial |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.24
|
| Rate for Payer: Cigna of WY Commercial |
$19.44
|
| Rate for Payer: Entrust Commercial |
$18.85
|
| Rate for Payer: First Choice Health Commercial |
$18.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.10
|
| Rate for Payer: HealthUtah PPO |
$19.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.24
|
| Rate for Payer: Multiplan Medicare/VA |
$11.50
|
| Rate for Payer: One Health Plan of WY PPO |
$19.44
|
| Rate for Payer: PacificSource Commercial |
$17.86
|
| Rate for Payer: PHCS PPO |
$19.44
|
| Rate for Payer: Three Rivers PPO |
$14.88
|
| Rate for Payer: TriWest Veterans Administration |
$12.10
|
| Rate for Payer: United Healthcare Commercial |
$18.95
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: WINHealth Partners Commercial |
$18.85
|
| Rate for Payer: Wise Provider Network Commercial |
$18.85
|
|
|
CEFDINIR 300 MG CAPSULE [18664]
|
Facility
|
OP
|
$27.65
|
|
|
Service Code
|
NDC 6800136206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$27.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.10
|
| Rate for Payer: Aetna of WY Medicare |
$18.25
|
| Rate for Payer: Altius Commercial |
$26.54
|
| Rate for Payer: Beech Street Commercial |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.82
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.82
|
| Rate for Payer: Cigna of WY Commercial |
$27.10
|
| Rate for Payer: Entrust Commercial |
$26.27
|
| Rate for Payer: First Choice Health Commercial |
$26.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.76
|
| Rate for Payer: HealthUtah PPO |
$27.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.82
|
| Rate for Payer: Multiplan Medicare/VA |
$14.97
|
| Rate for Payer: One Health Plan of WY PPO |
$27.10
|
| Rate for Payer: PacificSource Commercial |
$24.88
|
| Rate for Payer: PHCS PPO |
$27.10
|
| Rate for Payer: Three Rivers PPO |
$20.74
|
| Rate for Payer: TriWest Veterans Administration |
$15.76
|
| Rate for Payer: United Healthcare Commercial |
$26.41
|
| Rate for Payer: United Healthcare Medicare |
$15.76
|
| Rate for Payer: WINHealth Partners Commercial |
$27.10
|
| Rate for Payer: Wise Provider Network Commercial |
$26.27
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION [4564]
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
HCPCS J0692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.91
|
| Rate for Payer: Aetna of WY Medicare |
$29.98
|
| Rate for Payer: Altius Commercial |
$44.98
|
| Rate for Payer: Beech Street Commercial |
$45.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.44
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.44
|
| Rate for Payer: Cigna of WY Commercial |
$45.91
|
| Rate for Payer: Entrust Commercial |
$44.51
|
| Rate for Payer: First Choice Health Commercial |
$44.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.58
|
| Rate for Payer: HealthUtah PPO |
$46.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.44
|
| Rate for Payer: Multiplan Medicare/VA |
$27.15
|
| Rate for Payer: One Health Plan of WY PPO |
$45.91
|
| Rate for Payer: PacificSource Commercial |
$42.16
|
| Rate for Payer: PHCS PPO |
$45.91
|
| Rate for Payer: Three Rivers PPO |
$35.14
|
| Rate for Payer: TriWest Veterans Administration |
$28.58
|
| Rate for Payer: United Healthcare Commercial |
$44.74
|
| Rate for Payer: United Healthcare Medicare |
$28.58
|
| Rate for Payer: WINHealth Partners Commercial |
$44.51
|
| Rate for Payer: Wise Provider Network Commercial |
$44.51
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION [4564]
|
Facility
|
OP
|
$46.85
|
|
|
Service Code
|
HCPCS J0692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.91
|
| Rate for Payer: Aetna of WY Medicare |
$30.92
|
| Rate for Payer: Altius Commercial |
$44.98
|
| Rate for Payer: Beech Street Commercial |
$45.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.44
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.44
|
| Rate for Payer: Cigna of WY Commercial |
$45.91
|
| Rate for Payer: Entrust Commercial |
$44.51
|
| Rate for Payer: First Choice Health Commercial |
$44.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.70
|
| Rate for Payer: HealthUtah PPO |
$46.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.44
|
| Rate for Payer: Multiplan Medicare/VA |
$25.37
|
| Rate for Payer: One Health Plan of WY PPO |
$45.91
|
| Rate for Payer: PacificSource Commercial |
$42.16
|
| Rate for Payer: PHCS PPO |
$45.91
|
| Rate for Payer: Three Rivers PPO |
$35.14
|
| Rate for Payer: TriWest Veterans Administration |
$26.70
|
| Rate for Payer: United Healthcare Commercial |
$44.74
|
| Rate for Payer: United Healthcare Medicare |
$26.70
|
| Rate for Payer: WINHealth Partners Commercial |
$45.91
|
| Rate for Payer: Wise Provider Network Commercial |
$44.51
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [8281]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS J0694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$30.40
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.98
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$27.53
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$28.98
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [8281]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS J0694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.08
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.08
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$25.72
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$27.08
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$27.08
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
OP
|
$16.97
|
|
|
Service Code
|
NDC 5723703501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: United Healthcare Commercial |
$16.21
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.63
|
| Rate for Payer: Aetna of WY Medicare |
$11.20
|
| Rate for Payer: Altius Commercial |
$16.29
|
| Rate for Payer: Beech Street Commercial |
$16.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.46
|
| Rate for Payer: Cigna of WY Commercial |
$16.63
|
| Rate for Payer: Entrust Commercial |
$16.12
|
| Rate for Payer: First Choice Health Commercial |
$16.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.67
|
| Rate for Payer: HealthUtah PPO |
$16.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.19
|
| Rate for Payer: One Health Plan of WY PPO |
$16.63
|
| Rate for Payer: PacificSource Commercial |
$15.27
|
| Rate for Payer: PHCS PPO |
$16.63
|
| Rate for Payer: Three Rivers PPO |
$12.73
|
| Rate for Payer: TriWest Veterans Administration |
$9.67
|
| Rate for Payer: United Healthcare Medicare |
$9.67
|
| Rate for Payer: WINHealth Partners Commercial |
$16.63
|
| Rate for Payer: Wise Provider Network Commercial |
$16.12
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
IP
|
$16.97
|
|
|
Service Code
|
NDC 5723703501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.86
|
| Rate for Payer: Altius Commercial |
$16.29
|
| Rate for Payer: Beech Street Commercial |
$16.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.46
|
| Rate for Payer: Cigna of WY Commercial |
$16.63
|
| Rate for Payer: Entrust Commercial |
$16.12
|
| Rate for Payer: First Choice Health Commercial |
$16.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.35
|
| Rate for Payer: HealthUtah PPO |
$16.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.83
|
| Rate for Payer: One Health Plan of WY PPO |
$16.63
|
| Rate for Payer: PacificSource Commercial |
$15.27
|
| Rate for Payer: PHCS PPO |
$16.63
|
| Rate for Payer: Three Rivers PPO |
$12.73
|
| Rate for Payer: TriWest Veterans Administration |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$16.21
|
| Rate for Payer: United Healthcare Medicare |
$10.35
|
| Rate for Payer: WINHealth Partners Commercial |
$16.12
|
| Rate for Payer: Wise Provider Network Commercial |
$16.12
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
OP
|
$17.27
|
|
|
Service Code
|
NDC 5723703550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.92
|
| Rate for Payer: Aetna of WY Medicare |
$11.40
|
| Rate for Payer: Altius Commercial |
$16.58
|
| Rate for Payer: Beech Street Commercial |
$16.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.75
|
| Rate for Payer: Cigna of WY Commercial |
$16.92
|
| Rate for Payer: Entrust Commercial |
$16.41
|
| Rate for Payer: First Choice Health Commercial |
$16.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.84
|
| Rate for Payer: HealthUtah PPO |
$17.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.75
|
| Rate for Payer: Multiplan Medicare/VA |
$9.35
|
| Rate for Payer: One Health Plan of WY PPO |
$16.92
|
| Rate for Payer: PacificSource Commercial |
$15.54
|
| Rate for Payer: PHCS PPO |
$16.92
|
| Rate for Payer: Three Rivers PPO |
$12.95
|
| Rate for Payer: TriWest Veterans Administration |
$9.84
|
| Rate for Payer: United Healthcare Commercial |
$16.49
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
| Rate for Payer: WINHealth Partners Commercial |
$16.92
|
| Rate for Payer: Wise Provider Network Commercial |
$16.41
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
IP
|
$17.27
|
|
|
Service Code
|
NDC 5723703550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.92
|
| Rate for Payer: Aetna of WY Medicare |
$11.05
|
| Rate for Payer: Altius Commercial |
$16.58
|
| Rate for Payer: Beech Street Commercial |
$16.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.75
|
| Rate for Payer: Cigna of WY Commercial |
$16.92
|
| Rate for Payer: Entrust Commercial |
$16.41
|
| Rate for Payer: First Choice Health Commercial |
$16.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$17.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.75
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$16.92
|
| Rate for Payer: PacificSource Commercial |
$15.54
|
| Rate for Payer: PHCS PPO |
$16.92
|
| Rate for Payer: Three Rivers PPO |
$12.95
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$16.49
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$16.41
|
| Rate for Payer: Wise Provider Network Commercial |
$16.41
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
IP
|
$17.35
|
|
|
Service Code
|
NDC 6818040203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.00
|
| Rate for Payer: Aetna of WY Medicare |
$11.10
|
| Rate for Payer: Altius Commercial |
$16.66
|
| Rate for Payer: Beech Street Commercial |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.83
|
| Rate for Payer: Cash Price |
$12.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.83
|
| Rate for Payer: Cigna of WY Commercial |
$17.00
|
| Rate for Payer: Entrust Commercial |
$16.48
|
| Rate for Payer: First Choice Health Commercial |
$16.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.58
|
| Rate for Payer: HealthUtah PPO |
$17.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.05
|
| Rate for Payer: One Health Plan of WY PPO |
$17.00
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.00
|
| Rate for Payer: Three Rivers PPO |
$13.01
|
| Rate for Payer: TriWest Veterans Administration |
$10.58
|
| Rate for Payer: United Healthcare Commercial |
$16.57
|
| Rate for Payer: United Healthcare Medicare |
$10.58
|
| Rate for Payer: WINHealth Partners Commercial |
$16.48
|
| Rate for Payer: Wise Provider Network Commercial |
$16.48
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSPENSION [5635]
|
Facility
|
OP
|
$17.35
|
|
|
Service Code
|
NDC 6818040203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.00
|
| Rate for Payer: Aetna of WY Medicare |
$11.45
|
| Rate for Payer: Altius Commercial |
$16.66
|
| Rate for Payer: Beech Street Commercial |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.83
|
| Rate for Payer: Cash Price |
$12.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.83
|
| Rate for Payer: Cigna of WY Commercial |
$17.00
|
| Rate for Payer: Entrust Commercial |
$16.48
|
| Rate for Payer: First Choice Health Commercial |
$16.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$17.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.83
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.00
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.00
|
| Rate for Payer: Three Rivers PPO |
$13.01
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$16.57
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$17.00
|
| Rate for Payer: Wise Provider Network Commercial |
$16.48
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [4904]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J0713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.36
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$25.99
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.36
|
| Rate for Payer: United Healthcare Commercial |
$45.84
|
| Rate for Payer: United Healthcare Medicare |
$27.36
|
| Rate for Payer: WINHealth Partners Commercial |
$47.04
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [4904]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J0713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$30.72
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.28
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$27.82
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$29.28
|
| Rate for Payer: United Healthcare Commercial |
$45.84
|
| Rate for Payer: United Healthcare Medicare |
$29.28
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK [38958]
|
Facility
|
OP
|
$59.28
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.09
|
| Rate for Payer: Aetna of WY Medicare |
$39.12
|
| Rate for Payer: Altius Commercial |
$56.91
|
| Rate for Payer: Beech Street Commercial |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.50
|
| Rate for Payer: Cigna of WY Commercial |
$58.09
|
| Rate for Payer: Entrust Commercial |
$56.32
|
| Rate for Payer: First Choice Health Commercial |
$56.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.79
|
| Rate for Payer: HealthUtah PPO |
$59.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.50
|
| Rate for Payer: Multiplan Medicare/VA |
$32.10
|
| Rate for Payer: One Health Plan of WY PPO |
$58.09
|
| Rate for Payer: PacificSource Commercial |
$53.35
|
| Rate for Payer: PHCS PPO |
$58.09
|
| Rate for Payer: Three Rivers PPO |
$44.46
|
| Rate for Payer: TriWest Veterans Administration |
$33.79
|
| Rate for Payer: United Healthcare Commercial |
$56.61
|
| Rate for Payer: United Healthcare Medicare |
$33.79
|
| Rate for Payer: WINHealth Partners Commercial |
$58.09
|
| Rate for Payer: Wise Provider Network Commercial |
$56.32
|
|
|
CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK [38958]
|
Facility
|
IP
|
$59.28
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.09
|
| Rate for Payer: Aetna of WY Medicare |
$37.94
|
| Rate for Payer: Altius Commercial |
$56.91
|
| Rate for Payer: Beech Street Commercial |
$58.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.50
|
| Rate for Payer: Cigna of WY Commercial |
$58.09
|
| Rate for Payer: Entrust Commercial |
$56.32
|
| Rate for Payer: First Choice Health Commercial |
$56.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.16
|
| Rate for Payer: HealthUtah PPO |
$59.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.50
|
| Rate for Payer: Multiplan Medicare/VA |
$34.35
|
| Rate for Payer: One Health Plan of WY PPO |
$58.09
|
| Rate for Payer: PacificSource Commercial |
$53.35
|
| Rate for Payer: PHCS PPO |
$58.09
|
| Rate for Payer: Three Rivers PPO |
$44.46
|
| Rate for Payer: TriWest Veterans Administration |
$36.16
|
| Rate for Payer: United Healthcare Commercial |
$56.61
|
| Rate for Payer: United Healthcare Medicare |
$36.16
|
| Rate for Payer: WINHealth Partners Commercial |
$56.32
|
| Rate for Payer: Wise Provider Network Commercial |
$56.32
|
|
