|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
OP
|
$15.95
|
|
|
Service Code
|
NDC 0781328991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
NDC 6586259601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.54
|
| Rate for Payer: Aetna of WY Medicare |
$11.14
|
| Rate for Payer: Altius Commercial |
$16.20
|
| Rate for Payer: Beech Street Commercial |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.37
|
| Rate for Payer: Cigna of WY Commercial |
$16.54
|
| Rate for Payer: Entrust Commercial |
$16.04
|
| Rate for Payer: First Choice Health Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.62
|
| Rate for Payer: HealthUtah PPO |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.14
|
| Rate for Payer: One Health Plan of WY PPO |
$16.54
|
| Rate for Payer: PacificSource Commercial |
$15.19
|
| Rate for Payer: PHCS PPO |
$16.54
|
| Rate for Payer: Three Rivers PPO |
$12.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.62
|
| Rate for Payer: United Healthcare Commercial |
$16.12
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WINHealth Partners Commercial |
$16.54
|
| Rate for Payer: Wise Provider Network Commercial |
$16.04
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
NDC 6586259601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.54
|
| Rate for Payer: Aetna of WY Medicare |
$10.80
|
| Rate for Payer: Altius Commercial |
$16.20
|
| Rate for Payer: Beech Street Commercial |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.37
|
| Rate for Payer: Cigna of WY Commercial |
$16.54
|
| Rate for Payer: Entrust Commercial |
$16.04
|
| Rate for Payer: First Choice Health Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
| Rate for Payer: HealthUtah PPO |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16.54
|
| Rate for Payer: PacificSource Commercial |
$15.19
|
| Rate for Payer: PHCS PPO |
$16.54
|
| Rate for Payer: Three Rivers PPO |
$12.66
|
| Rate for Payer: TriWest Veterans Administration |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$16.12
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: WINHealth Partners Commercial |
$16.04
|
| Rate for Payer: Wise Provider Network Commercial |
$16.04
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
NDC 6586259602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.54
|
| Rate for Payer: Aetna of WY Medicare |
$11.14
|
| Rate for Payer: Altius Commercial |
$16.20
|
| Rate for Payer: Beech Street Commercial |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.37
|
| Rate for Payer: Cigna of WY Commercial |
$16.54
|
| Rate for Payer: Entrust Commercial |
$16.04
|
| Rate for Payer: First Choice Health Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.62
|
| Rate for Payer: HealthUtah PPO |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.14
|
| Rate for Payer: One Health Plan of WY PPO |
$16.54
|
| Rate for Payer: PacificSource Commercial |
$15.19
|
| Rate for Payer: PHCS PPO |
$16.54
|
| Rate for Payer: Three Rivers PPO |
$12.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.62
|
| Rate for Payer: United Healthcare Commercial |
$16.12
|
| Rate for Payer: United Healthcare Medicare |
$9.62
|
| Rate for Payer: WINHealth Partners Commercial |
$16.54
|
| Rate for Payer: Wise Provider Network Commercial |
$16.04
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [10036]
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
NDC 6586259602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.54
|
| Rate for Payer: Aetna of WY Medicare |
$10.80
|
| Rate for Payer: Altius Commercial |
$16.20
|
| Rate for Payer: Beech Street Commercial |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.37
|
| Rate for Payer: Cigna of WY Commercial |
$16.54
|
| Rate for Payer: Entrust Commercial |
$16.04
|
| Rate for Payer: First Choice Health Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
| Rate for Payer: HealthUtah PPO |
$16.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16.54
|
| Rate for Payer: PacificSource Commercial |
$15.19
|
| Rate for Payer: PHCS PPO |
$16.54
|
| Rate for Payer: Three Rivers PPO |
$12.66
|
| Rate for Payer: TriWest Veterans Administration |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$16.12
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: WINHealth Partners Commercial |
$16.04
|
| Rate for Payer: Wise Provider Network Commercial |
$16.04
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [149054]
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
NDC 0338955350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.72
|
| Rate for Payer: Aetna of WY Medicare |
$10.59
|
| Rate for Payer: Altius Commercial |
$15.40
|
| Rate for Payer: Beech Street Commercial |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.56
|
| Rate for Payer: Cigna of WY Commercial |
$15.72
|
| Rate for Payer: Entrust Commercial |
$15.24
|
| Rate for Payer: First Choice Health Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.14
|
| Rate for Payer: HealthUtah PPO |
$16.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.72
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.72
|
| Rate for Payer: Three Rivers PPO |
$12.03
|
| Rate for Payer: TriWest Veterans Administration |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$15.32
|
| Rate for Payer: United Healthcare Medicare |
$9.14
|
| Rate for Payer: WINHealth Partners Commercial |
$15.72
|
| Rate for Payer: Wise Provider Network Commercial |
$15.24
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [149054]
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 0338955350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.72
|
| Rate for Payer: Aetna of WY Medicare |
$10.27
|
| Rate for Payer: Altius Commercial |
$15.40
|
| Rate for Payer: Beech Street Commercial |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.56
|
| Rate for Payer: Cigna of WY Commercial |
$15.72
|
| Rate for Payer: Entrust Commercial |
$15.24
|
| Rate for Payer: First Choice Health Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.78
|
| Rate for Payer: HealthUtah PPO |
$16.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.56
|
| Rate for Payer: Multiplan Medicare/VA |
$9.30
|
| Rate for Payer: One Health Plan of WY PPO |
$15.72
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.72
|
| Rate for Payer: Three Rivers PPO |
$12.03
|
| Rate for Payer: TriWest Veterans Administration |
$9.78
|
| Rate for Payer: United Healthcare Commercial |
$15.32
|
| Rate for Payer: United Healthcare Medicare |
$9.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.24
|
| Rate for Payer: Wise Provider Network Commercial |
$15.24
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
IP
|
$16.16
|
|
|
Service Code
|
NDC 0781329009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.34
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.36
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: WINHealth Partners Commercial |
$15.35
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
OP
|
$16.16
|
|
|
Service Code
|
NDC 0781329091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.67
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.84
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
IP
|
$16.16
|
|
|
Service Code
|
NDC 0781329091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.34
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.36
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: WINHealth Partners Commercial |
$15.35
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
OP
|
$16.16
|
|
|
Service Code
|
NDC 0781329009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.67
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.84
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 6808424301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.73
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 6808424301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.55
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.08
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.55
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$9.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 6808424311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.55
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.08
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.55
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$9.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 6808424311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.73
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.26
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
CLINE ENDO SFT TISSUE REL INST
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
3002207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$448.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$679.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$405.65
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$427.00
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare |
$427.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
CLINE ENDO SFT TISSUE REL INST
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
3002207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.05 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$462.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$679.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$379.05
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare |
$399.00
|
| Rate for Payer: WINHealth Partners Commercial |
$686.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
CLIPPER BLADE 3M #9680 NEW
|
Facility
|
IP
|
$7.28
|
|
| Hospital Charge Code |
4300009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.13
|
| Rate for Payer: Aetna of WY Medicare |
$4.66
|
| 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 |
$7.06
|
| 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 |
$4.44
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.22
|
| 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 |
$4.44
|
| Rate for Payer: United Healthcare Commercial |
$6.95
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WINHealth Partners Commercial |
$6.92
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CLIPPER BLADE 3M #9680 NEW
|
Facility
|
OP
|
$7.28
|
|
| Hospital Charge Code |
4300009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| 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 Commercial |
$6.99
|
| Rate for Payer: Beech Street Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.06
|
| 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 |
$4.15
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$3.94
|
| 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 |
$4.15
|
| Rate for Payer: United Healthcare Commercial |
$6.95
|
| Rate for Payer: United Healthcare Medicare |
$4.15
|
| Rate for Payer: WINHealth Partners Commercial |
$7.13
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CLIPS PEACH JPC-3NS
|
Facility
|
OP
|
$16.33
|
|
| Hospital Charge Code |
2500169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.00
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$15.68
|
| Rate for Payer: Beech Street Commercial |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.84
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.84
|
| Rate for Payer: Cigna of WY Commercial |
$16.00
|
| Rate for Payer: Entrust Commercial |
$15.51
|
| Rate for Payer: First Choice Health Commercial |
$15.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$16.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.84
|
| Rate for Payer: One Health Plan of WY PPO |
$16.00
|
| Rate for Payer: PacificSource Commercial |
$14.70
|
| Rate for Payer: PHCS PPO |
$16.00
|
| Rate for Payer: Three Rivers PPO |
$12.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.00
|
| Rate for Payer: Wise Provider Network Commercial |
$15.51
|
|
|
CLIPS PEACH JPC-3NS
|
Facility
|
IP
|
$16.33
|
|
| Hospital Charge Code |
2500169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.00
|
| Rate for Payer: Aetna of WY Medicare |
$10.45
|
| Rate for Payer: Altius Commercial |
$15.68
|
| Rate for Payer: Beech Street Commercial |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.84
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.84
|
| Rate for Payer: Cigna of WY Commercial |
$16.00
|
| Rate for Payer: Entrust Commercial |
$15.51
|
| Rate for Payer: First Choice Health Commercial |
$15.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.96
|
| Rate for Payer: HealthUtah PPO |
$16.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.46
|
| Rate for Payer: One Health Plan of WY PPO |
$16.00
|
| Rate for Payer: PacificSource Commercial |
$14.70
|
| Rate for Payer: PHCS PPO |
$16.00
|
| Rate for Payer: Three Rivers PPO |
$12.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.96
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.96
|
| Rate for Payer: WINHealth Partners Commercial |
$15.51
|
| Rate for Payer: Wise Provider Network Commercial |
$15.51
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
NDC 2192201605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.81
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.37
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$8.81
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 4229107630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Aetna of WY Medicare |
$10.69
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.71
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$15.47
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$17.67
|
|
|
Service Code
|
NDC 6923815323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.66
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$17.32
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
NDC 2192201605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$9.89
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.43
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.43
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$9.43
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
