|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 5167212582
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
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
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 4229107630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Aetna of WY Medicare |
$10.37
|
| 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 |
$9.88
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$9.39
|
| 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 |
$9.88
|
| Rate for Payer: United Healthcare Commercial |
$15.47
|
| Rate for Payer: United Healthcare Medicare |
$9.88
|
| Rate for Payer: WINHealth Partners Commercial |
$15.39
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
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
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET [28034]
|
Facility
|
OP
|
$18.69
|
|
|
Service Code
|
NDC 4988430702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$18.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.32
|
| Rate for Payer: Aetna of WY Medicare |
$12.34
|
| Rate for Payer: Altius Commercial |
$17.94
|
| Rate for Payer: Beech Street Commercial |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.13
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.13
|
| Rate for Payer: Cigna of WY Commercial |
$18.32
|
| Rate for Payer: Entrust Commercial |
$17.76
|
| Rate for Payer: First Choice Health Commercial |
$17.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.65
|
| Rate for Payer: HealthUtah PPO |
$18.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.13
|
| Rate for Payer: Multiplan Medicare/VA |
$10.12
|
| Rate for Payer: One Health Plan of WY PPO |
$18.32
|
| Rate for Payer: PacificSource Commercial |
$16.82
|
| Rate for Payer: PHCS PPO |
$18.32
|
| Rate for Payer: Three Rivers PPO |
$14.02
|
| Rate for Payer: TriWest Veterans Administration |
$10.65
|
| Rate for Payer: United Healthcare Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare |
$10.65
|
| Rate for Payer: WINHealth Partners Commercial |
$18.32
|
| Rate for Payer: Wise Provider Network Commercial |
$17.76
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET [28034]
|
Facility
|
IP
|
$18.69
|
|
|
Service Code
|
NDC 4988430702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$18.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.96
|
| Rate for Payer: Altius Commercial |
$17.94
|
| Rate for Payer: Beech Street Commercial |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.13
|
| Rate for Payer: Cash Price |
$13.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.13
|
| Rate for Payer: Cigna of WY Commercial |
$18.32
|
| Rate for Payer: Entrust Commercial |
$17.76
|
| Rate for Payer: First Choice Health Commercial |
$17.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.40
|
| Rate for Payer: HealthUtah PPO |
$18.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.13
|
| Rate for Payer: Multiplan Medicare/VA |
$10.83
|
| Rate for Payer: One Health Plan of WY PPO |
$18.32
|
| Rate for Payer: PacificSource Commercial |
$16.82
|
| Rate for Payer: PHCS PPO |
$18.32
|
| Rate for Payer: Three Rivers PPO |
$14.02
|
| Rate for Payer: TriWest Veterans Administration |
$11.40
|
| Rate for Payer: United Healthcare Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare |
$11.40
|
| Rate for Payer: WINHealth Partners Commercial |
$17.76
|
| Rate for Payer: Wise Provider Network Commercial |
$17.76
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
OP
|
$17.36
|
|
|
Service Code
|
NDC 6068754411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.46
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$17.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
IP
|
$17.36
|
|
|
Service Code
|
NDC 6068754401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.11
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$16.49
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
OP
|
$17.36
|
|
|
Service Code
|
NDC 6068754401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.46
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$17.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
IP
|
$17.36
|
|
|
Service Code
|
NDC 6068754411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.11
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$16.49
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$17.36
|
|
|
Service Code
|
NDC 6068755501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.46
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$17.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$15.17
|
|
|
Service Code
|
NDC 1672913700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Medicare |
$9.71
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$17.36
|
|
|
Service Code
|
NDC 6068755501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.11
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$16.49
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$17.36
|
|
|
Service Code
|
NDC 6068755511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.46
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$17.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
NDC 1672913700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.87
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Altius Commercial |
$14.56
|
| Rate for Payer: Beech Street Commercial |
$14.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.87
|
| Rate for Payer: Entrust Commercial |
$14.41
|
| Rate for Payer: First Choice Health Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.65
|
| Rate for Payer: HealthUtah PPO |
$15.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$14.87
|
| Rate for Payer: PacificSource Commercial |
$13.65
|
| Rate for Payer: PHCS PPO |
$14.87
|
| Rate for Payer: Three Rivers PPO |
$11.38
|
| Rate for Payer: TriWest Veterans Administration |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$14.49
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: WINHealth Partners Commercial |
$14.87
|
| Rate for Payer: Wise Provider Network Commercial |
$14.41
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$17.36
|
|
|
Service Code
|
NDC 6068755511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.01
|
| Rate for Payer: Aetna of WY Medicare |
$11.11
|
| Rate for Payer: Altius Commercial |
$16.67
|
| Rate for Payer: Beech Street Commercial |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.84
|
| Rate for Payer: Cigna of WY Commercial |
$17.01
|
| Rate for Payer: Entrust Commercial |
$16.49
|
| Rate for Payer: First Choice Health Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.84
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$17.01
|
| Rate for Payer: PacificSource Commercial |
$15.62
|
| Rate for Payer: PHCS PPO |
$17.01
|
| Rate for Payer: Three Rivers PPO |
$13.02
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$16.58
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$16.49
|
| Rate for Payer: Wise Provider Network Commercial |
$16.49
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 6068711301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.38
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 6068711311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.71
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.90
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 6068711301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.71
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.90
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 6068711311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.38
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.71
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.90
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.38
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.38
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.41
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.71
|
| Rate for Payer: Altius Commercial |
$15.57
|
| Rate for Payer: Beech Street Commercial |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.73
|
| Rate for Payer: Cigna of WY Commercial |
$15.90
|
| Rate for Payer: Entrust Commercial |
$15.41
|
| Rate for Payer: First Choice Health Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$16.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$15.90
|
| Rate for Payer: PacificSource Commercial |
$14.60
|
| Rate for Payer: PHCS PPO |
$15.90
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$15.49
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.90
|
| Rate for Payer: Wise Provider Network Commercial |
$15.41
|
|
|
CLOPIDOGREL 75 MG TABLET [7032]
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 6808453611
|
|
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 |
$11.22
|
| 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
|
|
