|
CAUT GROUNDING PAD SPLIT CORD
|
Facility
|
OP
|
$7.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.62
|
| Rate for Payer: Aetna of WY Medicare |
$5.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.47
|
| Rate for Payer: Altius Commercial |
$7.47
|
| Rate for Payer: Beech Street Commercial |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.39
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.55
|
| Rate for Payer: Cigna of WY Commercial |
$7.62
|
| Rate for Payer: Entrust Commercial |
$7.39
|
| Rate for Payer: First Choice Health Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.51
|
| Rate for Payer: HealthUtah PPO |
$7.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.55
|
| Rate for Payer: Multiplan Medicare/VA |
$4.29
|
| Rate for Payer: One Health Plan of WY PPO |
$7.62
|
| Rate for Payer: PacificSource Commercial |
$7.00
|
| Rate for Payer: PHCS PPO |
$7.62
|
| Rate for Payer: Three Rivers PPO |
$5.84
|
| Rate for Payer: TriWest Veterans Administration |
$4.51
|
| Rate for Payer: United Healthcare Commercial |
$6.77
|
| Rate for Payer: United Healthcare Medicare |
$4.51
|
| Rate for Payer: WINHealth Partners Commercial |
$7.62
|
| Rate for Payer: Wise Provider Network Commercial |
$7.39
|
|
|
CAUT PENCIL BUTTON SWITCH
|
Facility
|
OP
|
$8.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.44
|
| Rate for Payer: Aetna of WY Medicare |
$5.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.27
|
| Rate for Payer: Altius Commercial |
$8.27
|
| Rate for Payer: Beech Street Commercial |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.35
|
| Rate for Payer: Cigna of WY Commercial |
$8.44
|
| Rate for Payer: Entrust Commercial |
$8.18
|
| Rate for Payer: First Choice Health Commercial |
$8.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.99
|
| Rate for Payer: HealthUtah PPO |
$8.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.35
|
| Rate for Payer: Multiplan Medicare/VA |
$4.74
|
| Rate for Payer: One Health Plan of WY PPO |
$8.44
|
| Rate for Payer: PacificSource Commercial |
$7.75
|
| Rate for Payer: PHCS PPO |
$8.44
|
| Rate for Payer: Three Rivers PPO |
$6.46
|
| Rate for Payer: TriWest Veterans Administration |
$4.99
|
| Rate for Payer: United Healthcare Commercial |
$7.49
|
| Rate for Payer: United Healthcare Medicare |
$4.99
|
| Rate for Payer: WINHealth Partners Commercial |
$8.44
|
| Rate for Payer: Wise Provider Network Commercial |
$8.18
|
|
|
CAUT PENCIL BUTTON SWITCH
|
Facility
|
IP
|
$8.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.27
|
| Rate for Payer: Altius Commercial |
$8.27
|
| Rate for Payer: Beech Street Commercial |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.35
|
| Rate for Payer: Cigna of WY Commercial |
$8.44
|
| Rate for Payer: Entrust Commercial |
$8.18
|
| Rate for Payer: First Choice Health Commercial |
$8.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.68
|
| Rate for Payer: HealthUtah PPO |
$8.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.35
|
| Rate for Payer: Multiplan Medicare/VA |
$5.40
|
| Rate for Payer: One Health Plan of WY PPO |
$8.44
|
| Rate for Payer: PacificSource Commercial |
$7.75
|
| Rate for Payer: PHCS PPO |
$8.44
|
| Rate for Payer: Three Rivers PPO |
$6.46
|
| Rate for Payer: TriWest Veterans Administration |
$5.68
|
| Rate for Payer: United Healthcare Commercial |
$7.49
|
| Rate for Payer: United Healthcare Medicare |
$5.68
|
| Rate for Payer: WINHealth Partners Commercial |
$8.18
|
| Rate for Payer: Wise Provider Network Commercial |
$8.18
|
|
|
CAUT SMOKE EVAC PENCIL 70MM
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Aetna of WY Medicare |
$50.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$73.92
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.66
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$42.43
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$44.66
|
| Rate for Payer: United Healthcare Commercial |
$66.99
|
| Rate for Payer: United Healthcare Medicare |
$44.66
|
| Rate for Payer: WINHealth Partners Commercial |
$75.46
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
CAUT SMOKE EVAC PENCIL 70MM
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$73.92
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.82
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$48.28
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$50.82
|
| Rate for Payer: United Healthcare Commercial |
$66.99
|
| Rate for Payer: United Healthcare Medicare |
$50.82
|
| Rate for Payer: WINHealth Partners Commercial |
$73.15
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
90661
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Beech Street Commercial |
$33.25
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: First Choice Health Commercial |
$31.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$33.25
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: WINHealth Partners Commercial |
$35.00
|
|
|
CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
90674
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$34.17
|
| Rate for Payer: Beech Street Commercial |
$59.85
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: First Choice Health Commercial |
$56.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.17
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$29.05
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$59.85
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$34.17
|
| Rate for Payer: WINHealth Partners Commercial |
$63.00
|
|
|
CEFACLOR 250 MG CAPSULE [10914]
|
Facility
|
OP
|
$7.28
|
|
|
Service Code
|
NDC 6144217130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.13
|
| Rate for Payer: Aetna of WY Medicare |
$4.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.99
|
| Rate for Payer: Altius Commercial |
$6.99
|
| Rate for Payer: Beech Street Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.98
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.06
|
| Rate for Payer: Cigna of WY Commercial |
$7.13
|
| Rate for Payer: Entrust Commercial |
$6.92
|
| Rate for Payer: First Choice Health Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7.13
|
| Rate for Payer: PacificSource Commercial |
$6.55
|
| Rate for Payer: PHCS PPO |
$7.13
|
| Rate for Payer: Three Rivers PPO |
$5.46
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$7.13
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CEFACLOR 250 MG CAPSULE [10914]
|
Facility
|
IP
|
$7.28
|
|
|
Service Code
|
NDC 6144217130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.99
|
| Rate for Payer: Altius Commercial |
$6.99
|
| Rate for Payer: Beech Street Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.98
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.06
|
| Rate for Payer: Cigna of WY Commercial |
$7.13
|
| Rate for Payer: Entrust Commercial |
$6.92
|
| Rate for Payer: First Choice Health Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.80
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.56
|
| Rate for Payer: One Health Plan of WY PPO |
$7.13
|
| Rate for Payer: PacificSource Commercial |
$6.55
|
| Rate for Payer: PHCS PPO |
$7.13
|
| Rate for Payer: Three Rivers PPO |
$5.46
|
| Rate for Payer: TriWest Veterans Administration |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.92
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [454]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.74
|
| 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 |
$17.73
|
| 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 |
$14.26
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$13.54
|
| 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 |
$14.26
|
| Rate for Payer: United Healthcare Commercial |
$18.79
|
| Rate for Payer: United Healthcare Medicare |
$14.26
|
| 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 |
$11.90 |
| 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 Auto/Workers Compensation |
$20.74
|
| 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 |
$17.73
|
| 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 |
$12.53
|
| Rate for Payer: HealthUtah PPO |
$21.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.95
|
| Rate for Payer: Multiplan Medicare/VA |
$11.90
|
| 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 |
$12.53
|
| Rate for Payer: United Healthcare Commercial |
$18.79
|
| Rate for Payer: United Healthcare Medicare |
$12.53
|
| 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
|
OP
|
$55.59
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.63 |
| 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 Auto/Workers Compensation |
$53.37
|
| 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 |
$45.64
|
| 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 |
$32.24
|
| Rate for Payer: HealthUtah PPO |
$55.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.92
|
| Rate for Payer: Multiplan Medicare/VA |
$30.63
|
| 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 |
$32.24
|
| Rate for Payer: United Healthcare Commercial |
$48.36
|
| Rate for Payer: United Healthcare Medicare |
$32.24
|
| Rate for Payer: WINHealth Partners Commercial |
$54.48
|
| Rate for Payer: Wise Provider Network Commercial |
$52.81
|
|
|
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 |
$34.85 |
| Max. Negotiated Rate |
$55.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.37
|
| 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 |
$45.64
|
| 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 |
$36.69
|
| Rate for Payer: HealthUtah PPO |
$55.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.92
|
| Rate for Payer: Multiplan Medicare/VA |
$34.85
|
| 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 |
$36.69
|
| Rate for Payer: United Healthcare Commercial |
$48.36
|
| Rate for Payer: United Healthcare Medicare |
$36.69
|
| Rate for Payer: WINHealth Partners Commercial |
$52.81
|
| 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 |
$22.25 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.06
|
| 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 |
$29.13
|
| 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 |
$23.42
|
| Rate for Payer: HealthUtah PPO |
$35.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.42
|
| Rate for Payer: Multiplan Medicare/VA |
$22.25
|
| 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 |
$23.42
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Medicare |
$23.42
|
| 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 |
$19.55 |
| 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 Auto/Workers Compensation |
$34.06
|
| 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 |
$29.13
|
| 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 |
$20.58
|
| Rate for Payer: HealthUtah PPO |
$35.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.42
|
| Rate for Payer: Multiplan Medicare/VA |
$19.55
|
| 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 |
$20.58
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Medicare |
$20.58
|
| Rate for Payer: WINHealth Partners Commercial |
$34.77
|
| Rate for Payer: Wise Provider Network Commercial |
$33.71
|
|
|
CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [177409]
|
Facility
|
IP
|
$43.52
|
|
|
Service Code
|
HCPCS J0688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$43.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.78
|
| Rate for Payer: Altius Commercial |
$41.78
|
| Rate for Payer: Beech Street Commercial |
$42.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.21
|
| Rate for Payer: Cigna of WY Commercial |
$42.65
|
| Rate for Payer: Entrust Commercial |
$41.34
|
| Rate for Payer: First Choice Health Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.72
|
| Rate for Payer: HealthUtah PPO |
$43.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.21
|
| Rate for Payer: Multiplan Medicare/VA |
$27.29
|
| Rate for Payer: One Health Plan of WY PPO |
$42.65
|
| Rate for Payer: PacificSource Commercial |
$39.17
|
| Rate for Payer: PHCS PPO |
$42.65
|
| Rate for Payer: Three Rivers PPO |
$32.64
|
| Rate for Payer: TriWest Veterans Administration |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$37.86
|
| Rate for Payer: United Healthcare Medicare |
$28.72
|
| Rate for Payer: WINHealth Partners Commercial |
$41.34
|
| Rate for Payer: Wise Provider Network Commercial |
$41.34
|
|
|
CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION [177409]
|
Facility
|
OP
|
$43.52
|
|
|
Service Code
|
HCPCS J0688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$43.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.65
|
| Rate for Payer: Aetna of WY Medicare |
$28.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.78
|
| Rate for Payer: Altius Commercial |
$41.78
|
| Rate for Payer: Beech Street Commercial |
$42.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.21
|
| Rate for Payer: Cigna of WY Commercial |
$42.65
|
| Rate for Payer: Entrust Commercial |
$41.34
|
| Rate for Payer: First Choice Health Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.24
|
| Rate for Payer: HealthUtah PPO |
$43.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.21
|
| Rate for Payer: Multiplan Medicare/VA |
$23.98
|
| Rate for Payer: One Health Plan of WY PPO |
$42.65
|
| Rate for Payer: PacificSource Commercial |
$39.17
|
| Rate for Payer: PHCS PPO |
$42.65
|
| Rate for Payer: Three Rivers PPO |
$32.64
|
| Rate for Payer: TriWest Veterans Administration |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$37.86
|
| Rate for Payer: United Healthcare Medicare |
$25.24
|
| Rate for Payer: WINHealth Partners Commercial |
$42.65
|
| Rate for Payer: Wise Provider Network Commercial |
$41.34
|
|
|
CEFAZOLIN 3 GRAM SOLUTION FOR INJECTION [185858]
|
Facility
|
IP
|
$43.53
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$43.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.78
|
| Rate for Payer: Altius Commercial |
$41.78
|
| Rate for Payer: Altius Commercial |
$41.79
|
| Rate for Payer: Beech Street Commercial |
$42.66
|
| Rate for Payer: Beech Street Commercial |
$42.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.74
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.22
|
| Rate for Payer: Cigna of WY Commercial |
$42.66
|
| Rate for Payer: Cigna of WY Commercial |
$42.65
|
| Rate for Payer: Entrust Commercial |
$41.34
|
| Rate for Payer: Entrust Commercial |
$41.35
|
| Rate for Payer: First Choice Health Commercial |
$41.34
|
| Rate for Payer: First Choice Health Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.72
|
| Rate for Payer: HealthUtah PPO |
$43.53
|
| Rate for Payer: HealthUtah PPO |
$43.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.22
|
| Rate for Payer: Multiplan Medicare/VA |
$27.29
|
| Rate for Payer: Multiplan Medicare/VA |
$27.29
|
| Rate for Payer: One Health Plan of WY PPO |
$42.66
|
| Rate for Payer: One Health Plan of WY PPO |
$42.65
|
| Rate for Payer: PacificSource Commercial |
$39.18
|
| Rate for Payer: PacificSource Commercial |
$39.17
|
| Rate for Payer: PHCS PPO |
$42.65
|
| Rate for Payer: PHCS PPO |
$42.66
|
| Rate for Payer: Three Rivers PPO |
$32.64
|
| Rate for Payer: Three Rivers PPO |
$32.65
|
| Rate for Payer: TriWest Veterans Administration |
$28.73
|
| Rate for Payer: TriWest Veterans Administration |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$37.86
|
| Rate for Payer: United Healthcare Commercial |
$37.87
|
| Rate for Payer: United Healthcare Medicare |
$28.73
|
| Rate for Payer: United Healthcare Medicare |
$28.72
|
| Rate for Payer: WINHealth Partners Commercial |
$41.34
|
| Rate for Payer: WINHealth Partners Commercial |
$41.35
|
| Rate for Payer: Wise Provider Network Commercial |
$41.34
|
| Rate for Payer: Wise Provider Network Commercial |
$41.35
|
|
|
CEFAZOLIN 3 GRAM SOLUTION FOR INJECTION [185858]
|
Facility
|
OP
|
$43.53
|
|
|
Service Code
|
HCPCS J0690
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$43.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.65
|
| Rate for Payer: Aetna of WY Medicare |
$28.73
|
| Rate for Payer: Aetna of WY Medicare |
$28.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.79
|
| Rate for Payer: Altius Commercial |
$41.79
|
| Rate for Payer: Altius Commercial |
$41.78
|
| Rate for Payer: Beech Street Commercial |
$42.65
|
| Rate for Payer: Beech Street Commercial |
$42.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.21
|
| Rate for Payer: Cigna of WY Commercial |
$42.65
|
| Rate for Payer: Cigna of WY Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$41.35
|
| Rate for Payer: Entrust Commercial |
$41.34
|
| Rate for Payer: First Choice Health Commercial |
$41.34
|
| Rate for Payer: First Choice Health Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.24
|
| Rate for Payer: HealthUtah PPO |
$43.52
|
| Rate for Payer: HealthUtah PPO |
$43.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.22
|
| Rate for Payer: Multiplan Medicare/VA |
$23.99
|
| Rate for Payer: Multiplan Medicare/VA |
$23.98
|
| Rate for Payer: One Health Plan of WY PPO |
$42.65
|
| Rate for Payer: One Health Plan of WY PPO |
$42.66
|
| Rate for Payer: PacificSource Commercial |
$39.18
|
| Rate for Payer: PacificSource Commercial |
$39.17
|
| Rate for Payer: PHCS PPO |
$42.65
|
| Rate for Payer: PHCS PPO |
$42.66
|
| Rate for Payer: Three Rivers PPO |
$32.64
|
| Rate for Payer: Three Rivers PPO |
$32.65
|
| Rate for Payer: TriWest Veterans Administration |
$25.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$37.86
|
| Rate for Payer: United Healthcare Commercial |
$37.87
|
| Rate for Payer: United Healthcare Medicare |
$25.25
|
| Rate for Payer: United Healthcare Medicare |
$25.24
|
| Rate for Payer: WINHealth Partners Commercial |
$42.65
|
| Rate for Payer: WINHealth Partners Commercial |
$42.66
|
| Rate for Payer: Wise Provider Network Commercial |
$41.34
|
| Rate for Payer: Wise Provider Network Commercial |
$41.35
|
|
|
CEFAZOLIN SODIUM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
J0690
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Aetna of WY Medicare |
$0.82
|
| Rate for Payer: Beech Street Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: First Choice Health Commercial |
$6.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.69
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.65
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6818072305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6586221901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
NDC 0093413773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.64
|
| Rate for Payer: Aetna of WY Medicare |
$3.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.54
|
| Rate for Payer: Altius Commercial |
$4.54
|
| Rate for Payer: Beech Street Commercial |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.59
|
| Rate for Payer: Cigna of WY Commercial |
$4.64
|
| Rate for Payer: Entrust Commercial |
$4.49
|
| Rate for Payer: First Choice Health Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.74
|
| Rate for Payer: HealthUtah PPO |
$4.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.59
|
| Rate for Payer: Multiplan Medicare/VA |
$2.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4.64
|
| Rate for Payer: PacificSource Commercial |
$4.26
|
| Rate for Payer: PHCS PPO |
$4.64
|
| Rate for Payer: Three Rivers PPO |
$3.55
|
| Rate for Payer: TriWest Veterans Administration |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$2.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4.64
|
| Rate for Payer: Wise Provider Network Commercial |
$4.49
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
NDC 0093413773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.54
|
| Rate for Payer: Altius Commercial |
$4.54
|
| Rate for Payer: Beech Street Commercial |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.59
|
| Rate for Payer: Cigna of WY Commercial |
$4.64
|
| Rate for Payer: Entrust Commercial |
$4.49
|
| Rate for Payer: First Choice Health Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.12
|
| Rate for Payer: HealthUtah PPO |
$4.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.59
|
| Rate for Payer: Multiplan Medicare/VA |
$2.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4.64
|
| Rate for Payer: PacificSource Commercial |
$4.26
|
| Rate for Payer: PHCS PPO |
$4.64
|
| Rate for Payer: Three Rivers PPO |
$3.55
|
| Rate for Payer: TriWest Veterans Administration |
$3.12
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4.49
|
| Rate for Payer: Wise Provider Network Commercial |
$4.49
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [36743]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6818072305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
