|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [4824]
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.17
|
| Rate for Payer: Aetna of WY Medicare |
$14.36
|
| Rate for Payer: Aetna of WY Medicare |
$13.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.89
|
| Rate for Payer: Altius Commercial |
$20.89
|
| Rate for Payer: Altius Commercial |
$19.76
|
| Rate for Payer: Beech Street Commercial |
$20.17
|
| Rate for Payer: Beech Street Commercial |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.90
|
| Rate for Payer: Cash Price |
$14.41
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.96
|
| Rate for Payer: Cigna of WY Commercial |
$20.17
|
| Rate for Payer: Cigna of WY Commercial |
$21.32
|
| Rate for Payer: Entrust Commercial |
$20.67
|
| Rate for Payer: Entrust Commercial |
$19.55
|
| Rate for Payer: First Choice Health Commercial |
$19.55
|
| Rate for Payer: First Choice Health Commercial |
$20.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.94
|
| Rate for Payer: HealthUtah PPO |
$20.58
|
| Rate for Payer: HealthUtah PPO |
$21.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.11
|
| Rate for Payer: Multiplan Medicare/VA |
$11.99
|
| Rate for Payer: Multiplan Medicare/VA |
$11.34
|
| Rate for Payer: One Health Plan of WY PPO |
$20.17
|
| Rate for Payer: One Health Plan of WY PPO |
$21.32
|
| Rate for Payer: PacificSource Commercial |
$19.58
|
| Rate for Payer: PacificSource Commercial |
$18.52
|
| Rate for Payer: PHCS PPO |
$20.17
|
| Rate for Payer: PHCS PPO |
$21.32
|
| Rate for Payer: Three Rivers PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$16.32
|
| Rate for Payer: TriWest Veterans Administration |
$12.62
|
| Rate for Payer: TriWest Veterans Administration |
$11.94
|
| Rate for Payer: United Healthcare Commercial |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$18.93
|
| Rate for Payer: United Healthcare Medicare |
$12.62
|
| Rate for Payer: United Healthcare Medicare |
$11.94
|
| Rate for Payer: WINHealth Partners Commercial |
$20.17
|
| Rate for Payer: WINHealth Partners Commercial |
$21.32
|
| Rate for Payer: Wise Provider Network Commercial |
$19.55
|
| Rate for Payer: Wise Provider Network Commercial |
$20.67
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [4824]
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.76
|
| Rate for Payer: Altius Commercial |
$19.76
|
| Rate for Payer: Altius Commercial |
$20.89
|
| Rate for Payer: Beech Street Commercial |
$21.32
|
| Rate for Payer: Beech Street Commercial |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.86
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cash Price |
$14.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.11
|
| Rate for Payer: Cigna of WY Commercial |
$21.32
|
| Rate for Payer: Cigna of WY Commercial |
$20.17
|
| Rate for Payer: Entrust Commercial |
$19.55
|
| Rate for Payer: Entrust Commercial |
$20.67
|
| Rate for Payer: First Choice Health Commercial |
$19.55
|
| Rate for Payer: First Choice Health Commercial |
$20.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.58
|
| Rate for Payer: HealthUtah PPO |
$21.76
|
| Rate for Payer: HealthUtah PPO |
$20.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.11
|
| Rate for Payer: Multiplan Medicare/VA |
$13.64
|
| Rate for Payer: Multiplan Medicare/VA |
$12.90
|
| Rate for Payer: One Health Plan of WY PPO |
$21.32
|
| Rate for Payer: One Health Plan of WY PPO |
$20.17
|
| Rate for Payer: PacificSource Commercial |
$19.58
|
| Rate for Payer: PacificSource Commercial |
$18.52
|
| Rate for Payer: PHCS PPO |
$20.17
|
| Rate for Payer: PHCS PPO |
$21.32
|
| Rate for Payer: Three Rivers PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$16.32
|
| Rate for Payer: TriWest Veterans Administration |
$14.36
|
| Rate for Payer: TriWest Veterans Administration |
$13.58
|
| Rate for Payer: United Healthcare Commercial |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$18.93
|
| Rate for Payer: United Healthcare Medicare |
$14.36
|
| Rate for Payer: United Healthcare Medicare |
$13.58
|
| Rate for Payer: WINHealth Partners Commercial |
$19.55
|
| Rate for Payer: WINHealth Partners Commercial |
$20.67
|
| Rate for Payer: Wise Provider Network Commercial |
$19.55
|
| Rate for Payer: Wise Provider Network Commercial |
$20.67
|
|
|
CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK [38959]
|
Facility
|
OP
|
$67.48
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$67.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$66.13
|
| Rate for Payer: Aetna of WY Medicare |
$44.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.78
|
| Rate for Payer: Altius Commercial |
$64.78
|
| Rate for Payer: Beech Street Commercial |
$66.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$65.46
|
| Rate for Payer: Cigna of WY Commercial |
$66.13
|
| Rate for Payer: Entrust Commercial |
$64.11
|
| Rate for Payer: First Choice Health Commercial |
$64.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$64.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.14
|
| Rate for Payer: HealthUtah PPO |
$67.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$65.46
|
| Rate for Payer: Multiplan Medicare/VA |
$37.18
|
| Rate for Payer: One Health Plan of WY PPO |
$66.13
|
| Rate for Payer: PacificSource Commercial |
$60.73
|
| Rate for Payer: PHCS PPO |
$66.13
|
| Rate for Payer: Three Rivers PPO |
$50.61
|
| Rate for Payer: TriWest Veterans Administration |
$39.14
|
| Rate for Payer: United Healthcare Commercial |
$58.71
|
| Rate for Payer: United Healthcare Medicare |
$39.14
|
| Rate for Payer: WINHealth Partners Commercial |
$66.13
|
| Rate for Payer: Wise Provider Network Commercial |
$64.11
|
|
|
CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK [38959]
|
Facility
|
IP
|
$67.48
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$67.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$66.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.78
|
| Rate for Payer: Altius Commercial |
$64.78
|
| Rate for Payer: Beech Street Commercial |
$66.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$65.46
|
| Rate for Payer: Cigna of WY Commercial |
$66.13
|
| Rate for Payer: Entrust Commercial |
$64.11
|
| Rate for Payer: First Choice Health Commercial |
$64.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$64.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.54
|
| Rate for Payer: HealthUtah PPO |
$67.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$65.46
|
| Rate for Payer: Multiplan Medicare/VA |
$42.31
|
| Rate for Payer: One Health Plan of WY PPO |
$66.13
|
| Rate for Payer: PacificSource Commercial |
$60.73
|
| Rate for Payer: PHCS PPO |
$66.13
|
| Rate for Payer: Three Rivers PPO |
$50.61
|
| Rate for Payer: TriWest Veterans Administration |
$44.54
|
| Rate for Payer: United Healthcare Commercial |
$58.71
|
| Rate for Payer: United Healthcare Medicare |
$44.54
|
| Rate for Payer: WINHealth Partners Commercial |
$64.11
|
| Rate for Payer: Wise Provider Network Commercial |
$64.11
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [16208]
|
Facility
|
OP
|
$25.27
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$25.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.76
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Aetna of WY Medicare |
$16.68
|
| Rate for Payer: Aetna of WY Medicare |
$15.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.26
|
| Rate for Payer: Altius Commercial |
$24.26
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Cigna of WY Commercial |
$24.76
|
| Rate for Payer: Entrust Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$24.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.92
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: HealthUtah PPO |
$25.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.51
|
| Rate for Payer: Multiplan Medicare/VA |
$13.92
|
| Rate for Payer: Multiplan Medicare/VA |
$13.22
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: One Health Plan of WY PPO |
$24.76
|
| Rate for Payer: PacificSource Commercial |
$22.74
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: PHCS PPO |
$24.76
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: Three Rivers PPO |
$18.95
|
| Rate for Payer: TriWest Veterans Administration |
$14.66
|
| Rate for Payer: TriWest Veterans Administration |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$21.98
|
| Rate for Payer: United Healthcare Medicare |
$14.66
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: WINHealth Partners Commercial |
$23.52
|
| Rate for Payer: WINHealth Partners Commercial |
$24.76
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$24.01
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [16208]
|
Facility
|
IP
|
$25.27
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$25.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.76
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Altius Commercial |
$24.26
|
| Rate for Payer: Beech Street Commercial |
$24.76
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.75
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.51
|
| Rate for Payer: Cigna of WY Commercial |
$24.76
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: Entrust Commercial |
$24.01
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$24.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.84
|
| Rate for Payer: HealthUtah PPO |
$25.27
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.51
|
| Rate for Payer: Multiplan Medicare/VA |
$15.84
|
| Rate for Payer: Multiplan Medicare/VA |
$15.05
|
| Rate for Payer: One Health Plan of WY PPO |
$24.76
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: PacificSource Commercial |
$22.74
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: PHCS PPO |
$24.76
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: Three Rivers PPO |
$18.95
|
| Rate for Payer: TriWest Veterans Administration |
$16.68
|
| Rate for Payer: TriWest Veterans Administration |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$21.98
|
| Rate for Payer: United Healthcare Medicare |
$16.68
|
| Rate for Payer: United Healthcare Medicare |
$15.84
|
| Rate for Payer: WINHealth Partners Commercial |
$22.80
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$24.01
|
|
|
CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
J0696
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Aetna of WY Medicare |
$0.45
|
| Rate for Payer: Beech Street Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: First Choice Health Commercial |
$10.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$0.39
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.40
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$11.40
|
|
|
CEFUROXIME AXETIL 500 MG TABLET [17555]
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 6586270020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.52
|
| Rate for Payer: Aetna of WY Medicare |
$4.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.38
|
| Rate for Payer: Altius Commercial |
$6.38
|
| Rate for Payer: Beech Street Commercial |
$6.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.45
|
| Rate for Payer: Cigna of WY Commercial |
$6.52
|
| Rate for Payer: Entrust Commercial |
$6.32
|
| Rate for Payer: First Choice Health Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.86
|
| Rate for Payer: HealthUtah PPO |
$6.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.45
|
| Rate for Payer: Multiplan Medicare/VA |
$3.66
|
| Rate for Payer: One Health Plan of WY PPO |
$6.52
|
| Rate for Payer: PacificSource Commercial |
$5.98
|
| Rate for Payer: PHCS PPO |
$6.52
|
| Rate for Payer: Three Rivers PPO |
$4.99
|
| Rate for Payer: TriWest Veterans Administration |
$3.86
|
| Rate for Payer: United Healthcare Commercial |
$5.79
|
| Rate for Payer: United Healthcare Medicare |
$3.86
|
| Rate for Payer: WINHealth Partners Commercial |
$6.52
|
| Rate for Payer: Wise Provider Network Commercial |
$6.32
|
|
|
CEFUROXIME AXETIL 500 MG TABLET [17555]
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 6586270020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.38
|
| Rate for Payer: Altius Commercial |
$6.38
|
| Rate for Payer: Beech Street Commercial |
$6.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.45
|
| Rate for Payer: Cigna of WY Commercial |
$6.52
|
| Rate for Payer: Entrust Commercial |
$6.32
|
| Rate for Payer: First Choice Health Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.39
|
| Rate for Payer: HealthUtah PPO |
$6.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.45
|
| Rate for Payer: Multiplan Medicare/VA |
$4.17
|
| Rate for Payer: One Health Plan of WY PPO |
$6.52
|
| Rate for Payer: PacificSource Commercial |
$5.98
|
| Rate for Payer: PHCS PPO |
$6.52
|
| Rate for Payer: Three Rivers PPO |
$4.99
|
| Rate for Payer: TriWest Veterans Administration |
$4.39
|
| Rate for Payer: United Healthcare Commercial |
$5.79
|
| Rate for Payer: United Healthcare Medicare |
$4.39
|
| Rate for Payer: WINHealth Partners Commercial |
$6.32
|
| Rate for Payer: Wise Provider Network Commercial |
$6.32
|
|
|
CEFUROXIME AXETIL 500 MG TABLET [17555]
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
NDC 6787721620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.52
|
| Rate for Payer: Aetna of WY Medicare |
$4.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.38
|
| Rate for Payer: Altius Commercial |
$6.38
|
| Rate for Payer: Beech Street Commercial |
$6.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.45
|
| Rate for Payer: Cigna of WY Commercial |
$6.52
|
| Rate for Payer: Entrust Commercial |
$6.32
|
| Rate for Payer: First Choice Health Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.86
|
| Rate for Payer: HealthUtah PPO |
$6.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.45
|
| Rate for Payer: Multiplan Medicare/VA |
$3.66
|
| Rate for Payer: One Health Plan of WY PPO |
$6.52
|
| Rate for Payer: PacificSource Commercial |
$5.98
|
| Rate for Payer: PHCS PPO |
$6.52
|
| Rate for Payer: Three Rivers PPO |
$4.99
|
| Rate for Payer: TriWest Veterans Administration |
$3.86
|
| Rate for Payer: United Healthcare Commercial |
$5.79
|
| Rate for Payer: United Healthcare Medicare |
$3.86
|
| Rate for Payer: WINHealth Partners Commercial |
$6.52
|
| Rate for Payer: Wise Provider Network Commercial |
$6.32
|
|
|
CEFUROXIME AXETIL 500 MG TABLET [17555]
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
NDC 6787721620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.38
|
| Rate for Payer: Altius Commercial |
$6.38
|
| Rate for Payer: Beech Street Commercial |
$6.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.45
|
| Rate for Payer: Cigna of WY Commercial |
$6.52
|
| Rate for Payer: Entrust Commercial |
$6.32
|
| Rate for Payer: First Choice Health Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.39
|
| Rate for Payer: HealthUtah PPO |
$6.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.45
|
| Rate for Payer: Multiplan Medicare/VA |
$4.17
|
| Rate for Payer: One Health Plan of WY PPO |
$6.52
|
| Rate for Payer: PacificSource Commercial |
$5.98
|
| Rate for Payer: PHCS PPO |
$6.52
|
| Rate for Payer: Three Rivers PPO |
$4.99
|
| Rate for Payer: TriWest Veterans Administration |
$4.39
|
| Rate for Payer: United Healthcare Commercial |
$5.79
|
| Rate for Payer: United Healthcare Medicare |
$4.39
|
| Rate for Payer: WINHealth Partners Commercial |
$6.32
|
| Rate for Payer: Wise Provider Network Commercial |
$6.32
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [16955]
|
Facility
|
OP
|
$33.99
|
|
|
Service Code
|
HCPCS J0697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$33.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.31
|
| Rate for Payer: Aetna of WY Medicare |
$22.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.63
|
| Rate for Payer: Altius Commercial |
$32.63
|
| Rate for Payer: Beech Street Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.97
|
| Rate for Payer: Cigna of WY Commercial |
$33.31
|
| Rate for Payer: Entrust Commercial |
$32.29
|
| Rate for Payer: First Choice Health Commercial |
$32.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.71
|
| Rate for Payer: HealthUtah PPO |
$33.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.97
|
| Rate for Payer: Multiplan Medicare/VA |
$18.73
|
| Rate for Payer: One Health Plan of WY PPO |
$33.31
|
| Rate for Payer: PacificSource Commercial |
$30.59
|
| Rate for Payer: PHCS PPO |
$33.31
|
| Rate for Payer: Three Rivers PPO |
$25.49
|
| Rate for Payer: TriWest Veterans Administration |
$19.71
|
| Rate for Payer: United Healthcare Commercial |
$29.57
|
| Rate for Payer: United Healthcare Medicare |
$19.71
|
| Rate for Payer: WINHealth Partners Commercial |
$33.31
|
| Rate for Payer: Wise Provider Network Commercial |
$32.29
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [16955]
|
Facility
|
IP
|
$33.99
|
|
|
Service Code
|
HCPCS J0697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$33.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.63
|
| Rate for Payer: Altius Commercial |
$32.63
|
| Rate for Payer: Beech Street Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.97
|
| Rate for Payer: Cigna of WY Commercial |
$33.31
|
| Rate for Payer: Entrust Commercial |
$32.29
|
| Rate for Payer: First Choice Health Commercial |
$32.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.43
|
| Rate for Payer: HealthUtah PPO |
$33.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.97
|
| Rate for Payer: Multiplan Medicare/VA |
$21.31
|
| Rate for Payer: One Health Plan of WY PPO |
$33.31
|
| Rate for Payer: PacificSource Commercial |
$30.59
|
| Rate for Payer: PHCS PPO |
$33.31
|
| Rate for Payer: Three Rivers PPO |
$25.49
|
| Rate for Payer: TriWest Veterans Administration |
$22.43
|
| Rate for Payer: United Healthcare Commercial |
$29.57
|
| Rate for Payer: United Healthcare Medicare |
$22.43
|
| Rate for Payer: WINHealth Partners Commercial |
$32.29
|
| Rate for Payer: Wise Provider Network Commercial |
$32.29
|
|
|
CELECOXIB 100 MG CAPSULE [18181]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 6233214131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
CELECOXIB 100 MG CAPSULE [18181]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 6233214131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
CELECOXIB 200 MG CAPSULE [160]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 6068744701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Aetna of WY Medicare |
$5.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.69
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$4.46
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$4.69
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$4.69
|
| Rate for Payer: WINHealth Partners Commercial |
$7.93
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
CELECOXIB 200 MG CAPSULE [160]
|
Facility
|
IP
|
$8.09
|
|
|
Service Code
|
NDC 6068744711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.34
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$5.07
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$5.34
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WINHealth Partners Commercial |
$7.69
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
CELECOXIB 200 MG CAPSULE [160]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 6068744711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Aetna of WY Medicare |
$5.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.69
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$4.46
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$4.69
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$4.69
|
| Rate for Payer: WINHealth Partners Commercial |
$7.93
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
CELECOXIB 200 MG CAPSULE [160]
|
Facility
|
IP
|
$8.09
|
|
|
Service Code
|
NDC 6068744701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.34
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$5.07
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$5.34
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WINHealth Partners Commercial |
$7.69
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
CEMENT BOWL W/SPATULA
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.99
|
| Rate for Payer: Aetna of WY Medicare |
$21.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.33
|
| Rate for Payer: Altius Commercial |
$31.33
|
| Rate for Payer: Beech Street Commercial |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.66
|
| Rate for Payer: Cigna of WY Commercial |
$31.99
|
| Rate for Payer: Entrust Commercial |
$31.01
|
| Rate for Payer: First Choice Health Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.93
|
| Rate for Payer: HealthUtah PPO |
$32.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.66
|
| Rate for Payer: Multiplan Medicare/VA |
$17.98
|
| Rate for Payer: One Health Plan of WY PPO |
$31.99
|
| Rate for Payer: PacificSource Commercial |
$29.38
|
| Rate for Payer: PHCS PPO |
$31.99
|
| Rate for Payer: Three Rivers PPO |
$24.48
|
| Rate for Payer: TriWest Veterans Administration |
$18.93
|
| Rate for Payer: United Healthcare Commercial |
$28.40
|
| Rate for Payer: United Healthcare Medicare |
$18.93
|
| Rate for Payer: WINHealth Partners Commercial |
$31.99
|
| Rate for Payer: Wise Provider Network Commercial |
$31.01
|
|
|
CEMENT BOWL W/SPATULA
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.33
|
| Rate for Payer: Altius Commercial |
$31.33
|
| Rate for Payer: Beech Street Commercial |
$31.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.66
|
| Rate for Payer: Cigna of WY Commercial |
$31.99
|
| Rate for Payer: Entrust Commercial |
$31.01
|
| Rate for Payer: First Choice Health Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.54
|
| Rate for Payer: HealthUtah PPO |
$32.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.66
|
| Rate for Payer: Multiplan Medicare/VA |
$20.47
|
| Rate for Payer: One Health Plan of WY PPO |
$31.99
|
| Rate for Payer: PacificSource Commercial |
$29.38
|
| Rate for Payer: PHCS PPO |
$31.99
|
| Rate for Payer: Three Rivers PPO |
$24.48
|
| Rate for Payer: TriWest Veterans Administration |
$21.54
|
| Rate for Payer: United Healthcare Commercial |
$28.40
|
| Rate for Payer: United Healthcare Medicare |
$21.54
|
| Rate for Payer: WINHealth Partners Commercial |
$31.01
|
| Rate for Payer: Wise Provider Network Commercial |
$31.01
|
|
|
CEMENT MIXER CLEARMIX DOUBLE
|
Facility
|
OP
|
$390.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.07 |
| Max. Negotiated Rate |
$390.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.51
|
| Rate for Payer: Aetna of WY Medicare |
$257.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.71
|
| Rate for Payer: Altius Commercial |
$374.71
|
| Rate for Payer: Beech Street Commercial |
$382.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.45
|
| Rate for Payer: Cash Price |
$273.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.61
|
| Rate for Payer: Cigna of WY Commercial |
$382.51
|
| Rate for Payer: Entrust Commercial |
$370.80
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.39
|
| Rate for Payer: HealthUtah PPO |
$390.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.61
|
| Rate for Payer: Multiplan Medicare/VA |
$215.07
|
| Rate for Payer: One Health Plan of WY PPO |
$382.51
|
| Rate for Payer: PacificSource Commercial |
$351.29
|
| Rate for Payer: PHCS PPO |
$382.51
|
| Rate for Payer: Three Rivers PPO |
$292.74
|
| Rate for Payer: TriWest Veterans Administration |
$226.39
|
| Rate for Payer: United Healthcare Commercial |
$339.58
|
| Rate for Payer: United Healthcare Medicare |
$226.39
|
| Rate for Payer: WINHealth Partners Commercial |
$382.51
|
| Rate for Payer: Wise Provider Network Commercial |
$370.80
|
|
|
CEMENT MIXER CLEARMIX DOUBLE
|
Facility
|
IP
|
$390.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.73 |
| Max. Negotiated Rate |
$390.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.71
|
| Rate for Payer: Altius Commercial |
$374.71
|
| Rate for Payer: Beech Street Commercial |
$382.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.45
|
| Rate for Payer: Cash Price |
$273.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.61
|
| Rate for Payer: Cigna of WY Commercial |
$382.51
|
| Rate for Payer: Entrust Commercial |
$370.80
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.61
|
| Rate for Payer: HealthUtah PPO |
$390.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.61
|
| Rate for Payer: Multiplan Medicare/VA |
$244.73
|
| Rate for Payer: One Health Plan of WY PPO |
$382.51
|
| Rate for Payer: PacificSource Commercial |
$351.29
|
| Rate for Payer: PHCS PPO |
$382.51
|
| Rate for Payer: Three Rivers PPO |
$292.74
|
| Rate for Payer: TriWest Veterans Administration |
$257.61
|
| Rate for Payer: United Healthcare Commercial |
$339.58
|
| Rate for Payer: United Healthcare Medicare |
$257.61
|
| Rate for Payer: WINHealth Partners Commercial |
$370.80
|
| Rate for Payer: Wise Provider Network Commercial |
$370.80
|
|
|
CEMENT PLUG FEMORAL REPAIR KIT ZIMMER
|
Facility
|
IP
|
$1,155.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.18 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.26
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$762.30
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$724.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$762.30
|
| Rate for Payer: United Healthcare Commercial |
$1,004.85
|
| Rate for Payer: United Healthcare Medicare |
$762.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
CEMENT PLUG FEMORAL REPAIR KIT ZIMMER
|
Facility
|
OP
|
$1,155.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.40 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$762.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.26
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$636.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$1,004.85
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,131.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
