|
CEM PALACOS LV+G 1X40 W/GENT
|
Facility
|
OP
|
$681.48
|
|
| Hospital Charge Code |
3003176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$681.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$667.85
|
| Rate for Payer: Aetna of WY Medicare |
$449.78
|
| Rate for Payer: Altius Commercial |
$654.22
|
| Rate for Payer: Beech Street Commercial |
$667.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$661.04
|
| Rate for Payer: Cash Price |
$477.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$661.04
|
| Rate for Payer: Cigna of WY Commercial |
$667.85
|
| Rate for Payer: Entrust Commercial |
$647.41
|
| Rate for Payer: First Choice Health Commercial |
$647.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$647.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$388.44
|
| Rate for Payer: HealthUtah PPO |
$681.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$661.04
|
| Rate for Payer: Multiplan Medicare/VA |
$369.02
|
| Rate for Payer: One Health Plan of WY PPO |
$667.85
|
| Rate for Payer: PacificSource Commercial |
$613.33
|
| Rate for Payer: PHCS PPO |
$667.85
|
| Rate for Payer: Three Rivers PPO |
$511.11
|
| Rate for Payer: TriWest Veterans Administration |
$388.44
|
| Rate for Payer: United Healthcare Commercial |
$650.81
|
| Rate for Payer: United Healthcare Medicare |
$388.44
|
| Rate for Payer: WINHealth Partners Commercial |
$667.85
|
| Rate for Payer: Wise Provider Network Commercial |
$647.41
|
|
|
CEM PALACOS RG 1X40 WGENT
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
3000294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$367.36
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.14
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$332.63
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.14
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$350.14
|
| Rate for Payer: WINHealth Partners Commercial |
$545.30
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
CEM PALACOS RG 1X40 WGENT
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
3000294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.82 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$378.84
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.18
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$310.82
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$327.18
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$327.18
|
| Rate for Payer: WINHealth Partners Commercial |
$562.52
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
CEM PALACOS WOGENTAMIA
|
Facility
|
IP
|
$298.20
|
|
| Hospital Charge Code |
3000293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.81 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.24
|
| Rate for Payer: Aetna of WY Medicare |
$190.85
|
| Rate for Payer: Altius Commercial |
$286.27
|
| Rate for Payer: Beech Street Commercial |
$292.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.25
|
| Rate for Payer: Cash Price |
$208.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.25
|
| Rate for Payer: Cigna of WY Commercial |
$292.24
|
| Rate for Payer: Entrust Commercial |
$283.29
|
| Rate for Payer: First Choice Health Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.90
|
| Rate for Payer: HealthUtah PPO |
$298.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.25
|
| Rate for Payer: Multiplan Medicare/VA |
$172.81
|
| Rate for Payer: One Health Plan of WY PPO |
$292.24
|
| Rate for Payer: PacificSource Commercial |
$268.38
|
| Rate for Payer: PHCS PPO |
$292.24
|
| Rate for Payer: Three Rivers PPO |
$223.65
|
| Rate for Payer: TriWest Veterans Administration |
$181.90
|
| Rate for Payer: United Healthcare Commercial |
$284.78
|
| Rate for Payer: United Healthcare Medicare |
$181.90
|
| Rate for Payer: WINHealth Partners Commercial |
$283.29
|
| Rate for Payer: Wise Provider Network Commercial |
$283.29
|
|
|
CEM PALACOS WOGENTAMIA
|
Facility
|
OP
|
$298.20
|
|
| Hospital Charge Code |
3000293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.48 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.24
|
| Rate for Payer: Aetna of WY Medicare |
$196.81
|
| Rate for Payer: Altius Commercial |
$286.27
|
| Rate for Payer: Beech Street Commercial |
$292.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.25
|
| Rate for Payer: Cash Price |
$208.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.25
|
| Rate for Payer: Cigna of WY Commercial |
$292.24
|
| Rate for Payer: Entrust Commercial |
$283.29
|
| Rate for Payer: First Choice Health Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.97
|
| Rate for Payer: HealthUtah PPO |
$298.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.25
|
| Rate for Payer: Multiplan Medicare/VA |
$161.48
|
| Rate for Payer: One Health Plan of WY PPO |
$292.24
|
| Rate for Payer: PacificSource Commercial |
$268.38
|
| Rate for Payer: PHCS PPO |
$292.24
|
| Rate for Payer: Three Rivers PPO |
$223.65
|
| Rate for Payer: TriWest Veterans Administration |
$169.97
|
| Rate for Payer: United Healthcare Commercial |
$284.78
|
| Rate for Payer: United Healthcare Medicare |
$169.97
|
| Rate for Payer: WINHealth Partners Commercial |
$292.24
|
| Rate for Payer: Wise Provider Network Commercial |
$283.29
|
|
|
CEM PALOCOS LV 1X140 ZIM
|
Facility
|
IP
|
$298.20
|
|
| Hospital Charge Code |
3000295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.81 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.24
|
| Rate for Payer: Aetna of WY Medicare |
$190.85
|
| Rate for Payer: Altius Commercial |
$286.27
|
| Rate for Payer: Beech Street Commercial |
$292.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.25
|
| Rate for Payer: Cash Price |
$208.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.25
|
| Rate for Payer: Cigna of WY Commercial |
$292.24
|
| Rate for Payer: Entrust Commercial |
$283.29
|
| Rate for Payer: First Choice Health Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.90
|
| Rate for Payer: HealthUtah PPO |
$298.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.25
|
| Rate for Payer: Multiplan Medicare/VA |
$172.81
|
| Rate for Payer: One Health Plan of WY PPO |
$292.24
|
| Rate for Payer: PacificSource Commercial |
$268.38
|
| Rate for Payer: PHCS PPO |
$292.24
|
| Rate for Payer: Three Rivers PPO |
$223.65
|
| Rate for Payer: TriWest Veterans Administration |
$181.90
|
| Rate for Payer: United Healthcare Commercial |
$284.78
|
| Rate for Payer: United Healthcare Medicare |
$181.90
|
| Rate for Payer: WINHealth Partners Commercial |
$283.29
|
| Rate for Payer: Wise Provider Network Commercial |
$283.29
|
|
|
CEM PALOCOS LV 1X140 ZIM
|
Facility
|
OP
|
$298.20
|
|
| Hospital Charge Code |
3000295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.48 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.24
|
| Rate for Payer: Aetna of WY Medicare |
$196.81
|
| Rate for Payer: Altius Commercial |
$286.27
|
| Rate for Payer: Beech Street Commercial |
$292.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.25
|
| Rate for Payer: Cash Price |
$208.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.25
|
| Rate for Payer: Cigna of WY Commercial |
$292.24
|
| Rate for Payer: Entrust Commercial |
$283.29
|
| Rate for Payer: First Choice Health Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.97
|
| Rate for Payer: HealthUtah PPO |
$298.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.25
|
| Rate for Payer: Multiplan Medicare/VA |
$161.48
|
| Rate for Payer: One Health Plan of WY PPO |
$292.24
|
| Rate for Payer: PacificSource Commercial |
$268.38
|
| Rate for Payer: PHCS PPO |
$292.24
|
| Rate for Payer: Three Rivers PPO |
$223.65
|
| Rate for Payer: TriWest Veterans Administration |
$169.97
|
| Rate for Payer: United Healthcare Commercial |
$284.78
|
| Rate for Payer: United Healthcare Medicare |
$169.97
|
| Rate for Payer: WINHealth Partners Commercial |
$292.24
|
| Rate for Payer: Wise Provider Network Commercial |
$283.29
|
|
|
CENTRAL 1 LUMEN CATH CORDIS
|
Facility
|
IP
|
$291.31
|
|
| Hospital Charge Code |
2400222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.81 |
| Max. Negotiated Rate |
$291.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$285.48
|
| Rate for Payer: Aetna of WY Medicare |
$186.44
|
| Rate for Payer: Altius Commercial |
$279.66
|
| Rate for Payer: Beech Street Commercial |
$285.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.57
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$282.57
|
| Rate for Payer: Cigna of WY Commercial |
$285.48
|
| Rate for Payer: Entrust Commercial |
$276.74
|
| Rate for Payer: First Choice Health Commercial |
$276.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$276.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.70
|
| Rate for Payer: HealthUtah PPO |
$291.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$282.57
|
| Rate for Payer: Multiplan Medicare/VA |
$168.81
|
| Rate for Payer: One Health Plan of WY PPO |
$285.48
|
| Rate for Payer: PacificSource Commercial |
$262.18
|
| Rate for Payer: PHCS PPO |
$285.48
|
| Rate for Payer: Three Rivers PPO |
$218.48
|
| Rate for Payer: TriWest Veterans Administration |
$177.70
|
| Rate for Payer: United Healthcare Commercial |
$278.20
|
| Rate for Payer: United Healthcare Medicare |
$177.70
|
| Rate for Payer: WINHealth Partners Commercial |
$276.74
|
| Rate for Payer: Wise Provider Network Commercial |
$276.74
|
|
|
CENTRAL 1 LUMEN CATH CORDIS
|
Facility
|
OP
|
$291.31
|
|
| Hospital Charge Code |
2400222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$291.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$285.48
|
| Rate for Payer: Aetna of WY Medicare |
$192.26
|
| Rate for Payer: Altius Commercial |
$279.66
|
| Rate for Payer: Beech Street Commercial |
$285.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.57
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$282.57
|
| Rate for Payer: Cigna of WY Commercial |
$285.48
|
| Rate for Payer: Entrust Commercial |
$276.74
|
| Rate for Payer: First Choice Health Commercial |
$276.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$276.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.05
|
| Rate for Payer: HealthUtah PPO |
$291.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$282.57
|
| Rate for Payer: Multiplan Medicare/VA |
$157.74
|
| Rate for Payer: One Health Plan of WY PPO |
$285.48
|
| Rate for Payer: PacificSource Commercial |
$262.18
|
| Rate for Payer: PHCS PPO |
$285.48
|
| Rate for Payer: Three Rivers PPO |
$218.48
|
| Rate for Payer: TriWest Veterans Administration |
$166.05
|
| Rate for Payer: United Healthcare Commercial |
$278.20
|
| Rate for Payer: United Healthcare Medicare |
$166.05
|
| Rate for Payer: WINHealth Partners Commercial |
$285.48
|
| Rate for Payer: Wise Provider Network Commercial |
$276.74
|
|
|
CENTRAL 3 LUMEN CATH PEDIATRIC
|
Facility
|
OP
|
$396.72
|
|
| Hospital Charge Code |
2400245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.82 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$388.79
|
| Rate for Payer: Aetna of WY Medicare |
$261.84
|
| Rate for Payer: Altius Commercial |
$380.85
|
| Rate for Payer: Beech Street Commercial |
$388.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$384.82
|
| Rate for Payer: Cash Price |
$277.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$384.82
|
| Rate for Payer: Cigna of WY Commercial |
$388.79
|
| Rate for Payer: Entrust Commercial |
$376.88
|
| Rate for Payer: First Choice Health Commercial |
$376.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$376.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.13
|
| Rate for Payer: HealthUtah PPO |
$396.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$384.82
|
| Rate for Payer: Multiplan Medicare/VA |
$214.82
|
| Rate for Payer: One Health Plan of WY PPO |
$388.79
|
| Rate for Payer: PacificSource Commercial |
$357.05
|
| Rate for Payer: PHCS PPO |
$388.79
|
| Rate for Payer: Three Rivers PPO |
$297.54
|
| Rate for Payer: TriWest Veterans Administration |
$226.13
|
| Rate for Payer: United Healthcare Commercial |
$378.87
|
| Rate for Payer: United Healthcare Medicare |
$226.13
|
| Rate for Payer: WINHealth Partners Commercial |
$388.79
|
| Rate for Payer: Wise Provider Network Commercial |
$376.88
|
|
|
CENTRAL 3 LUMEN CATH PEDIATRIC
|
Facility
|
IP
|
$396.72
|
|
| Hospital Charge Code |
2400245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$388.79
|
| Rate for Payer: Aetna of WY Medicare |
$253.90
|
| Rate for Payer: Altius Commercial |
$380.85
|
| Rate for Payer: Beech Street Commercial |
$388.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$384.82
|
| Rate for Payer: Cash Price |
$277.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$384.82
|
| Rate for Payer: Cigna of WY Commercial |
$388.79
|
| Rate for Payer: Entrust Commercial |
$376.88
|
| Rate for Payer: First Choice Health Commercial |
$376.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$376.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$242.00
|
| Rate for Payer: HealthUtah PPO |
$396.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$384.82
|
| Rate for Payer: Multiplan Medicare/VA |
$229.90
|
| Rate for Payer: One Health Plan of WY PPO |
$388.79
|
| Rate for Payer: PacificSource Commercial |
$357.05
|
| Rate for Payer: PHCS PPO |
$388.79
|
| Rate for Payer: Three Rivers PPO |
$297.54
|
| Rate for Payer: TriWest Veterans Administration |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$378.87
|
| Rate for Payer: United Healthcare Medicare |
$242.00
|
| Rate for Payer: WINHealth Partners Commercial |
$376.88
|
| Rate for Payer: Wise Provider Network Commercial |
$376.88
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [12451]
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
NDC 0093417773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Aetna of WY Medicare |
$10.19
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.71
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare |
$9.71
|
| Rate for Payer: WINHealth Partners Commercial |
$15.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [12451]
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
NDC 0093417773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Aetna of WY Medicare |
$10.51
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.44
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.07
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$8.62
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$9.07
|
| Rate for Payer: United Healthcare Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicare |
$9.07
|
| Rate for Payer: WINHealth Partners Commercial |
$15.60
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
CEPHALEXIN 250 MG CAPSULE [3879]
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
NDC 5026815111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.27
|
| Rate for Payer: Aetna of WY Medicare |
$10.62
|
| Rate for Payer: Altius Commercial |
$15.94
|
| Rate for Payer: Beech Street Commercial |
$16.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.10
|
| Rate for Payer: Cigna of WY Commercial |
$16.27
|
| Rate for Payer: Entrust Commercial |
$15.77
|
| Rate for Payer: First Choice Health Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.13
|
| Rate for Payer: HealthUtah PPO |
$16.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.10
|
| Rate for Payer: Multiplan Medicare/VA |
$9.62
|
| Rate for Payer: One Health Plan of WY PPO |
$16.27
|
| Rate for Payer: PacificSource Commercial |
$14.94
|
| Rate for Payer: PHCS PPO |
$16.27
|
| Rate for Payer: Three Rivers PPO |
$12.45
|
| Rate for Payer: TriWest Veterans Administration |
$10.13
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
| Rate for Payer: United Healthcare Medicare |
$10.13
|
| Rate for Payer: WINHealth Partners Commercial |
$15.77
|
| Rate for Payer: Wise Provider Network Commercial |
$15.77
|
|
|
CEPHALEXIN 250 MG CAPSULE [3879]
|
Facility
|
OP
|
$16.60
|
|
|
Service Code
|
NDC 5026815111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.27
|
| Rate for Payer: Aetna of WY Medicare |
$10.96
|
| Rate for Payer: Altius Commercial |
$15.94
|
| Rate for Payer: Beech Street Commercial |
$16.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.10
|
| Rate for Payer: Cigna of WY Commercial |
$16.27
|
| Rate for Payer: Entrust Commercial |
$15.77
|
| Rate for Payer: First Choice Health Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.46
|
| Rate for Payer: HealthUtah PPO |
$16.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.10
|
| Rate for Payer: Multiplan Medicare/VA |
$8.99
|
| Rate for Payer: One Health Plan of WY PPO |
$16.27
|
| Rate for Payer: PacificSource Commercial |
$14.94
|
| Rate for Payer: PHCS PPO |
$16.27
|
| Rate for Payer: Three Rivers PPO |
$12.45
|
| Rate for Payer: TriWest Veterans Administration |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
| Rate for Payer: WINHealth Partners Commercial |
$16.27
|
| Rate for Payer: Wise Provider Network Commercial |
$15.77
|
|
|
CEPHALEXIN 250 MG CAPSULE [3879]
|
Facility
|
OP
|
$16.60
|
|
|
Service Code
|
NDC 5026815115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.27
|
| Rate for Payer: Aetna of WY Medicare |
$10.96
|
| Rate for Payer: Altius Commercial |
$15.94
|
| Rate for Payer: Beech Street Commercial |
$16.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.10
|
| Rate for Payer: Cigna of WY Commercial |
$16.27
|
| Rate for Payer: Entrust Commercial |
$15.77
|
| Rate for Payer: First Choice Health Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.46
|
| Rate for Payer: HealthUtah PPO |
$16.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.10
|
| Rate for Payer: Multiplan Medicare/VA |
$8.99
|
| Rate for Payer: One Health Plan of WY PPO |
$16.27
|
| Rate for Payer: PacificSource Commercial |
$14.94
|
| Rate for Payer: PHCS PPO |
$16.27
|
| Rate for Payer: Three Rivers PPO |
$12.45
|
| Rate for Payer: TriWest Veterans Administration |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
| Rate for Payer: WINHealth Partners Commercial |
$16.27
|
| Rate for Payer: Wise Provider Network Commercial |
$15.77
|
|
|
CEPHALEXIN 250 MG CAPSULE [3879]
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
NDC 5026815115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$16.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.27
|
| Rate for Payer: Aetna of WY Medicare |
$10.62
|
| Rate for Payer: Altius Commercial |
$15.94
|
| Rate for Payer: Beech Street Commercial |
$16.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.10
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.10
|
| Rate for Payer: Cigna of WY Commercial |
$16.27
|
| Rate for Payer: Entrust Commercial |
$15.77
|
| Rate for Payer: First Choice Health Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.13
|
| Rate for Payer: HealthUtah PPO |
$16.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.10
|
| Rate for Payer: Multiplan Medicare/VA |
$9.62
|
| Rate for Payer: One Health Plan of WY PPO |
$16.27
|
| Rate for Payer: PacificSource Commercial |
$14.94
|
| Rate for Payer: PHCS PPO |
$16.27
|
| Rate for Payer: Three Rivers PPO |
$12.45
|
| Rate for Payer: TriWest Veterans Administration |
$10.13
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
| Rate for Payer: United Healthcare Medicare |
$10.13
|
| Rate for Payer: WINHealth Partners Commercial |
$15.77
|
| Rate for Payer: Wise Provider Network Commercial |
$15.77
|
|
|
CEPHALEXIN 500 MG CAPSULE [12107]
|
Facility
|
OP
|
$16.45
|
|
|
Service Code
|
NDC 6068716301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.86
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$16.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
CEPHALEXIN 500 MG CAPSULE [12107]
|
Facility
|
IP
|
$16.45
|
|
|
Service Code
|
NDC 6068716301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.03
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$9.53
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$10.03
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$10.03
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
CEPHALEXIN 500 MG CAPSULE [12107]
|
Facility
|
IP
|
$16.45
|
|
|
Service Code
|
NDC 6068716311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.03
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$9.53
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$10.03
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$10.03
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
CEPHALEXIN 500 MG CAPSULE [12107]
|
Facility
|
OP
|
$16.45
|
|
|
Service Code
|
NDC 6068716311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.12
|
| Rate for Payer: Aetna of WY Medicare |
$10.86
|
| Rate for Payer: Altius Commercial |
$15.79
|
| Rate for Payer: Beech Street Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.96
|
| Rate for Payer: Cigna of WY Commercial |
$16.12
|
| Rate for Payer: Entrust Commercial |
$15.63
|
| Rate for Payer: First Choice Health Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.96
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$16.12
|
| Rate for Payer: PacificSource Commercial |
$14.80
|
| Rate for Payer: PHCS PPO |
$16.12
|
| Rate for Payer: Three Rivers PPO |
$12.34
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$16.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15.63
|
|
|
CERAMENT BONE VOID FILLER 10CC
|
Facility
|
IP
|
$8,750.00
|
|
| Hospital Charge Code |
3003438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.62 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,575.00
|
| Rate for Payer: Aetna of WY Medicare |
$5,600.00
|
| Rate for Payer: Altius Commercial |
$8,400.00
|
| Rate for Payer: Beech Street Commercial |
$8,575.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,487.50
|
| Rate for Payer: Cash Price |
$6,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,487.50
|
| Rate for Payer: Cigna of WY Commercial |
$8,575.00
|
| Rate for Payer: Entrust Commercial |
$8,312.50
|
| Rate for Payer: First Choice Health Commercial |
$8,312.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,312.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,337.50
|
| Rate for Payer: HealthUtah PPO |
$8,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,487.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,070.62
|
| Rate for Payer: One Health Plan of WY PPO |
$8,575.00
|
| Rate for Payer: PacificSource Commercial |
$7,875.00
|
| Rate for Payer: PHCS PPO |
$8,575.00
|
| Rate for Payer: Three Rivers PPO |
$6,562.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,337.50
|
| Rate for Payer: United Healthcare Commercial |
$8,356.25
|
| Rate for Payer: United Healthcare Medicare |
$5,337.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,312.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,312.50
|
|
|
CERAMENT BONE VOID FILLER 10CC
|
Facility
|
OP
|
$8,750.00
|
|
| Hospital Charge Code |
3003438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,738.12 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,575.00
|
| Rate for Payer: Aetna of WY Medicare |
$5,775.00
|
| Rate for Payer: Altius Commercial |
$8,400.00
|
| Rate for Payer: Beech Street Commercial |
$8,575.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,487.50
|
| Rate for Payer: Cash Price |
$6,125.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,487.50
|
| Rate for Payer: Cigna of WY Commercial |
$8,575.00
|
| Rate for Payer: Entrust Commercial |
$8,312.50
|
| Rate for Payer: First Choice Health Commercial |
$8,312.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,312.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,987.50
|
| Rate for Payer: HealthUtah PPO |
$8,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,487.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,738.12
|
| Rate for Payer: One Health Plan of WY PPO |
$8,575.00
|
| Rate for Payer: PacificSource Commercial |
$7,875.00
|
| Rate for Payer: PHCS PPO |
$8,575.00
|
| Rate for Payer: Three Rivers PPO |
$6,562.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,987.50
|
| Rate for Payer: United Healthcare Commercial |
$8,356.25
|
| Rate for Payer: United Healthcare Medicare |
$4,987.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,575.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,312.50
|
|
|
CERAMENT BONE VOID FILLER 5 ML
|
Facility
|
IP
|
$4,375.00
|
|
| Hospital Charge Code |
3003551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,535.31 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,287.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,800.00
|
| Rate for Payer: Altius Commercial |
$4,200.00
|
| Rate for Payer: Beech Street Commercial |
$4,287.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,243.75
|
| Rate for Payer: Cash Price |
$3,062.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,243.75
|
| Rate for Payer: Cigna of WY Commercial |
$4,287.50
|
| Rate for Payer: Entrust Commercial |
$4,156.25
|
| Rate for Payer: First Choice Health Commercial |
$4,156.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,156.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,668.75
|
| Rate for Payer: HealthUtah PPO |
$4,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,243.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,535.31
|
| Rate for Payer: One Health Plan of WY PPO |
$4,287.50
|
| Rate for Payer: PacificSource Commercial |
$3,937.50
|
| Rate for Payer: PHCS PPO |
$4,287.50
|
| Rate for Payer: Three Rivers PPO |
$3,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,668.75
|
| Rate for Payer: United Healthcare Commercial |
$4,178.12
|
| Rate for Payer: United Healthcare Medicare |
$2,668.75
|
| Rate for Payer: WINHealth Partners Commercial |
$4,156.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,156.25
|
|
|
CERAMENT BONE VOID FILLER 5 ML
|
Facility
|
OP
|
$4,375.00
|
|
| Hospital Charge Code |
3003551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.06 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,287.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,887.50
|
| Rate for Payer: Altius Commercial |
$4,200.00
|
| Rate for Payer: Beech Street Commercial |
$4,287.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,243.75
|
| Rate for Payer: Cash Price |
$3,062.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,243.75
|
| Rate for Payer: Cigna of WY Commercial |
$4,287.50
|
| Rate for Payer: Entrust Commercial |
$4,156.25
|
| Rate for Payer: First Choice Health Commercial |
$4,156.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,156.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,493.75
|
| Rate for Payer: HealthUtah PPO |
$4,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,243.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,369.06
|
| Rate for Payer: One Health Plan of WY PPO |
$4,287.50
|
| Rate for Payer: PacificSource Commercial |
$3,937.50
|
| Rate for Payer: PHCS PPO |
$4,287.50
|
| Rate for Payer: Three Rivers PPO |
$3,281.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,493.75
|
| Rate for Payer: United Healthcare Commercial |
$4,178.12
|
| Rate for Payer: United Healthcare Medicare |
$2,493.75
|
| Rate for Payer: WINHealth Partners Commercial |
$4,287.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,156.25
|
|
