|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 0045029604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 5058061201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 0045040704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 4612221126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 8770182470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 8770182470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 4612220926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 0045016604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 0045029604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 5058061201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 4612221126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 4612220926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 0904677361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.14
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: WINHealth Partners Commercial |
$0.20
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 5058045811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 5058045811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5789610410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5789610410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
ACETAMINOPHEN 325 MG TABLET [1446]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 0904677361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.20
|
| Rate for Payer: Altius Commercial |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.20
|
| Rate for Payer: Cigna of WY Commercial |
$0.21
|
| Rate for Payer: Entrust Commercial |
$0.20
|
| Rate for Payer: First Choice Health Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.20
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.21
|
| Rate for Payer: PacificSource Commercial |
$0.19
|
| Rate for Payer: PHCS PPO |
$0.21
|
| Rate for Payer: Three Rivers PPO |
$0.16
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.20
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0904673061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0904672040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 5058045711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 5058045770
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0904673061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 5058045770
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
ACETAMINOPHEN 500 MG TABLET [7875]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0904672040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
