|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET [7611]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 6068741811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.35
|
| Rate for Payer: Aetna of WY Medicare |
$1.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.30
|
| Rate for Payer: Altius Commercial |
$2.30
|
| Rate for Payer: Beech Street Commercial |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.33
|
| Rate for Payer: Cigna of WY Commercial |
$2.35
|
| Rate for Payer: Entrust Commercial |
$2.28
|
| Rate for Payer: First Choice Health Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.35
|
| Rate for Payer: PacificSource Commercial |
$2.16
|
| Rate for Payer: PHCS PPO |
$2.35
|
| Rate for Payer: Three Rivers PPO |
$1.80
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.09
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2.28
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
NDC 5026840111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.17
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 6068739611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.01
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 0406012323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 0406012323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 6808489511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Aetna of WY Medicare |
$1.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.23
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 6808489511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.01
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 0406012362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 0406012362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 6068739601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Aetna of WY Medicare |
$1.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.23
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 6068739601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.01
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
NDC 5026840111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Aetna of WY Medicare |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 6068739611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Aetna of WY Medicare |
$1.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.23
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
NDC 5026840115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.17
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET [3902]
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
NDC 5026840115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Aetna of WY Medicare |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [31629]
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 0121154410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.68
|
| Rate for Payer: Aetna of WY Medicare |
$2.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.61
|
| Rate for Payer: Altius Commercial |
$3.61
|
| Rate for Payer: Beech Street Commercial |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.09
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.65
|
| Rate for Payer: Cigna of WY Commercial |
$3.68
|
| Rate for Payer: Entrust Commercial |
$3.57
|
| Rate for Payer: First Choice Health Commercial |
$3.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.18
|
| Rate for Payer: HealthUtah PPO |
$3.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3.68
|
| Rate for Payer: PacificSource Commercial |
$3.38
|
| Rate for Payer: PHCS PPO |
$3.68
|
| Rate for Payer: Three Rivers PPO |
$2.82
|
| Rate for Payer: TriWest Veterans Administration |
$2.18
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
| Rate for Payer: United Healthcare Medicare |
$2.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3.68
|
| Rate for Payer: Wise Provider Network Commercial |
$3.57
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION [31629]
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 0121154410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.61
|
| Rate for Payer: Altius Commercial |
$3.61
|
| Rate for Payer: Beech Street Commercial |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.09
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.65
|
| Rate for Payer: Cigna of WY Commercial |
$3.68
|
| Rate for Payer: Entrust Commercial |
$3.57
|
| Rate for Payer: First Choice Health Commercial |
$3.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.48
|
| Rate for Payer: HealthUtah PPO |
$3.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2.36
|
| Rate for Payer: One Health Plan of WY PPO |
$3.68
|
| Rate for Payer: PacificSource Commercial |
$3.38
|
| Rate for Payer: PHCS PPO |
$3.68
|
| Rate for Payer: Three Rivers PPO |
$2.82
|
| Rate for Payer: TriWest Veterans Administration |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3.57
|
| Rate for Payer: Wise Provider Network Commercial |
$3.57
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
NDC 0406012423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.86
|
| Rate for Payer: Altius Commercial |
$1.86
|
| Rate for Payer: Beech Street Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.88
|
| Rate for Payer: Cigna of WY Commercial |
$1.90
|
| Rate for Payer: Entrust Commercial |
$1.84
|
| Rate for Payer: First Choice Health Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.28
|
| Rate for Payer: HealthUtah PPO |
$1.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1.90
|
| Rate for Payer: PacificSource Commercial |
$1.75
|
| Rate for Payer: PHCS PPO |
$1.90
|
| Rate for Payer: Three Rivers PPO |
$1.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1.84
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
NDC 0406012423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.90
|
| Rate for Payer: Aetna of WY Medicare |
$1.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.86
|
| Rate for Payer: Altius Commercial |
$1.86
|
| Rate for Payer: Beech Street Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.88
|
| Rate for Payer: Cigna of WY Commercial |
$1.90
|
| Rate for Payer: Entrust Commercial |
$1.84
|
| Rate for Payer: First Choice Health Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.13
|
| Rate for Payer: HealthUtah PPO |
$1.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1.90
|
| Rate for Payer: PacificSource Commercial |
$1.75
|
| Rate for Payer: PHCS PPO |
$1.90
|
| Rate for Payer: Three Rivers PPO |
$1.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Medicare |
$1.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1.84
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
IP
|
$2.15
|
|
|
Service Code
|
NDC 6068740711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.06
|
| Rate for Payer: Altius Commercial |
$2.06
|
| Rate for Payer: Beech Street Commercial |
$2.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.09
|
| Rate for Payer: Cigna of WY Commercial |
$2.11
|
| Rate for Payer: Entrust Commercial |
$2.04
|
| Rate for Payer: First Choice Health Commercial |
$2.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.42
|
| Rate for Payer: HealthUtah PPO |
$2.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.09
|
| Rate for Payer: Multiplan Medicare/VA |
$1.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2.11
|
| Rate for Payer: PacificSource Commercial |
$1.94
|
| Rate for Payer: PHCS PPO |
$2.11
|
| Rate for Payer: Three Rivers PPO |
$1.61
|
| Rate for Payer: TriWest Veterans Administration |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.87
|
| Rate for Payer: United Healthcare Medicare |
$1.42
|
| Rate for Payer: WINHealth Partners Commercial |
$2.04
|
| Rate for Payer: Wise Provider Network Commercial |
$2.04
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
OP
|
$2.15
|
|
|
Service Code
|
NDC 6068740711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.11
|
| Rate for Payer: Aetna of WY Medicare |
$1.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.06
|
| Rate for Payer: Altius Commercial |
$2.06
|
| Rate for Payer: Beech Street Commercial |
$2.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.09
|
| Rate for Payer: Cigna of WY Commercial |
$2.11
|
| Rate for Payer: Entrust Commercial |
$2.04
|
| Rate for Payer: First Choice Health Commercial |
$2.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$2.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.09
|
| Rate for Payer: Multiplan Medicare/VA |
$1.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2.11
|
| Rate for Payer: PacificSource Commercial |
$1.94
|
| Rate for Payer: PHCS PPO |
$2.11
|
| Rate for Payer: Three Rivers PPO |
$1.61
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.87
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2.11
|
| Rate for Payer: Wise Provider Network Commercial |
$2.04
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
NDC 0406012462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.86
|
| Rate for Payer: Altius Commercial |
$1.86
|
| Rate for Payer: Beech Street Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.88
|
| Rate for Payer: Cigna of WY Commercial |
$1.90
|
| Rate for Payer: Entrust Commercial |
$1.84
|
| Rate for Payer: First Choice Health Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.28
|
| Rate for Payer: HealthUtah PPO |
$1.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1.90
|
| Rate for Payer: PacificSource Commercial |
$1.75
|
| Rate for Payer: PHCS PPO |
$1.90
|
| Rate for Payer: Three Rivers PPO |
$1.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1.84
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET [12051]
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
NDC 0406012462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.90
|
| Rate for Payer: Aetna of WY Medicare |
$1.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.86
|
| Rate for Payer: Altius Commercial |
$1.86
|
| Rate for Payer: Beech Street Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.88
|
| Rate for Payer: Cigna of WY Commercial |
$1.90
|
| Rate for Payer: Entrust Commercial |
$1.84
|
| Rate for Payer: First Choice Health Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.13
|
| Rate for Payer: HealthUtah PPO |
$1.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1.90
|
| Rate for Payer: PacificSource Commercial |
$1.75
|
| Rate for Payer: PHCS PPO |
$1.90
|
| Rate for Payer: Three Rivers PPO |
$1.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Medicare |
$1.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1.84
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [11862]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 6800147646
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM [11862]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 6800147646
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.27
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.18
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.18
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
