|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6800143800
|
|
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
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 6800143896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 5860270283
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.77
|
| Rate for Payer: Aetna of WY Medicare |
$0.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.76
|
| Rate for Payer: Altius Commercial |
$0.76
|
| Rate for Payer: Beech Street Commercial |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.77
|
| Rate for Payer: Cigna of WY Commercial |
$0.77
|
| Rate for Payer: Entrust Commercial |
$0.75
|
| Rate for Payer: First Choice Health Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.77
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.71
|
| Rate for Payer: PHCS PPO |
$0.77
|
| Rate for Payer: Three Rivers PPO |
$0.59
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.69
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.77
|
| Rate for Payer: Wise Provider Network Commercial |
$0.75
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 6800143897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Aetna of WY Medicare |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 6808424801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 6800143897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6800143800
|
|
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
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 6808424811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 6808424811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 6808424801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORAZEPAM 0.5 MG TABLET [10370]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6931590401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
LORAZEPAM 0.5 MG TABLET [10370]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 0904600761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.31
|
| Rate for Payer: Aetna of WY Medicare |
$0.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.31
|
| Rate for Payer: Altius Commercial |
$0.31
|
| Rate for Payer: Beech Street Commercial |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.31
|
| Rate for Payer: Cigna of WY Commercial |
$0.31
|
| Rate for Payer: Entrust Commercial |
$0.30
|
| Rate for Payer: First Choice Health Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.31
|
| Rate for Payer: PacificSource Commercial |
$0.29
|
| Rate for Payer: PHCS PPO |
$0.31
|
| Rate for Payer: Three Rivers PPO |
$0.24
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.28
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.31
|
| Rate for Payer: Wise Provider Network Commercial |
$0.30
|
|
|
LORAZEPAM 0.5 MG TABLET [10370]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 6931590401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
LORAZEPAM 0.5 MG TABLET [10370]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 0904600761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.31
|
| Rate for Payer: Altius Commercial |
$0.31
|
| Rate for Payer: Beech Street Commercial |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.31
|
| Rate for Payer: Cigna of WY Commercial |
$0.31
|
| Rate for Payer: Entrust Commercial |
$0.30
|
| Rate for Payer: First Choice Health Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.31
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.31
|
| Rate for Payer: PacificSource Commercial |
$0.29
|
| Rate for Payer: PHCS PPO |
$0.31
|
| Rate for Payer: Three Rivers PPO |
$0.24
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.28
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.30
|
| Rate for Payer: Wise Provider Network Commercial |
$0.30
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 6068763811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.54
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 6931590501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.28
|
| Rate for Payer: Aetna of WY Medicare |
$2.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.22
|
| Rate for Payer: Altius Commercial |
$3.22
|
| Rate for Payer: Beech Street Commercial |
$3.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.25
|
| Rate for Payer: Cigna of WY Commercial |
$3.28
|
| Rate for Payer: Entrust Commercial |
$3.18
|
| Rate for Payer: First Choice Health Commercial |
$3.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.94
|
| Rate for Payer: HealthUtah PPO |
$3.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1.85
|
| Rate for Payer: One Health Plan of WY PPO |
$3.28
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.28
|
| Rate for Payer: Three Rivers PPO |
$2.51
|
| Rate for Payer: TriWest Veterans Administration |
$1.94
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$1.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3.28
|
| Rate for Payer: Wise Provider Network Commercial |
$3.18
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 6068763811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 6931590501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.22
|
| Rate for Payer: Altius Commercial |
$3.22
|
| Rate for Payer: Beech Street Commercial |
$3.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.25
|
| Rate for Payer: Cigna of WY Commercial |
$3.28
|
| Rate for Payer: Entrust Commercial |
$3.18
|
| Rate for Payer: First Choice Health Commercial |
$3.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.21
|
| Rate for Payer: HealthUtah PPO |
$3.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3.28
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.28
|
| Rate for Payer: Three Rivers PPO |
$2.51
|
| Rate for Payer: TriWest Veterans Administration |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$2.21
|
| Rate for Payer: WINHealth Partners Commercial |
$3.18
|
| Rate for Payer: Wise Provider Network Commercial |
$3.18
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 0904600861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.36
|
| Rate for Payer: Cigna of WY Commercial |
$0.36
|
| Rate for Payer: Entrust Commercial |
$0.35
|
| Rate for Payer: First Choice Health Commercial |
$0.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.36
|
| Rate for Payer: PacificSource Commercial |
$0.33
|
| Rate for Payer: PHCS PPO |
$0.36
|
| Rate for Payer: Three Rivers PPO |
$0.28
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.35
|
| Rate for Payer: Wise Provider Network Commercial |
$0.35
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 0904600861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.36
|
| Rate for Payer: Aetna of WY Medicare |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.36
|
| Rate for Payer: Cigna of WY Commercial |
$0.36
|
| Rate for Payer: Entrust Commercial |
$0.35
|
| Rate for Payer: First Choice Health Commercial |
$0.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.36
|
| Rate for Payer: PacificSource Commercial |
$0.33
|
| Rate for Payer: PHCS PPO |
$0.36
|
| Rate for Payer: Three Rivers PPO |
$0.28
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.36
|
| Rate for Payer: Wise Provider Network Commercial |
$0.35
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 6068763801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.54
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
LORAZEPAM 1 MG TABLET [17107]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 6068763801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.56
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.55
|
| Rate for Payer: Altius Commercial |
$0.55
|
| Rate for Payer: Beech Street Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.55
|
| Rate for Payer: Cigna of WY Commercial |
$0.56
|
| Rate for Payer: Entrust Commercial |
$0.54
|
| Rate for Payer: First Choice Health Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.55
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.56
|
| Rate for Payer: PacificSource Commercial |
$0.51
|
| Rate for Payer: PHCS PPO |
$0.56
|
| Rate for Payer: Three Rivers PPO |
$0.43
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.54
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION [4396]
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
HCPCS J2060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.15
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.23
|
| Rate for Payer: Aetna of WY Medicare |
$13.66
|
| Rate for Payer: Aetna of WY Medicare |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$13.62
|
| Rate for Payer: Aetna of WY Medicare |
$13.32
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.70
|
| Rate for Payer: Altius Commercial |
$21.70
|
| Rate for Payer: Altius Commercial |
$19.37
|
| Rate for Payer: Altius Commercial |
$19.81
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Altius Commercial |
$19.86
|
| Rate for Payer: Beech Street Commercial |
$20.28
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$20.23
|
| Rate for Payer: Beech Street Commercial |
$19.78
|
| Rate for Payer: Beech Street Commercial |
$22.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$19.78
|
| Rate for Payer: Cigna of WY Commercial |
$20.23
|
| Rate for Payer: Cigna of WY Commercial |
$20.28
|
| Rate for Payer: Cigna of WY Commercial |
$22.15
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: Entrust Commercial |
$19.17
|
| Rate for Payer: Entrust Commercial |
$19.61
|
| Rate for Payer: Entrust Commercial |
$21.47
|
| Rate for Payer: Entrust Commercial |
$19.66
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$19.66
|
| Rate for Payer: First Choice Health Commercial |
$21.47
|
| Rate for Payer: First Choice Health Commercial |
$19.61
|
| Rate for Payer: First Choice Health Commercial |
$19.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.70
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$20.64
|
| Rate for Payer: HealthUtah PPO |
$20.18
|
| Rate for Payer: HealthUtah PPO |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$20.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.45
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: Multiplan Medicare/VA |
$11.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.40
|
| Rate for Payer: Multiplan Medicare/VA |
$11.12
|
| Rate for Payer: One Health Plan of WY PPO |
$19.78
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: One Health Plan of WY PPO |
$20.23
|
| Rate for Payer: One Health Plan of WY PPO |
$20.28
|
| Rate for Payer: One Health Plan of WY PPO |
$22.15
|
| Rate for Payer: PacificSource Commercial |
$18.58
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PacificSource Commercial |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$20.34
|
| Rate for Payer: PacificSource Commercial |
$18.16
|
| Rate for Payer: PHCS PPO |
$22.15
|
| Rate for Payer: PHCS PPO |
$19.78
|
| Rate for Payer: PHCS PPO |
$20.23
|
| Rate for Payer: PHCS PPO |
$20.28
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: Three Rivers PPO |
$16.95
|
| Rate for Payer: Three Rivers PPO |
$15.52
|
| Rate for Payer: TriWest Veterans Administration |
$11.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.11
|
| Rate for Payer: TriWest Veterans Administration |
$11.97
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$17.56
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Medicare |
$11.97
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
| Rate for Payer: United Healthcare Medicare |
$13.11
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: WINHealth Partners Commercial |
$20.28
|
| Rate for Payer: WINHealth Partners Commercial |
$22.15
|
| Rate for Payer: WINHealth Partners Commercial |
$20.23
|
| Rate for Payer: WINHealth Partners Commercial |
$19.78
|
| Rate for Payer: Wise Provider Network Commercial |
$19.61
|
| Rate for Payer: Wise Provider Network Commercial |
$21.47
|
| Rate for Payer: Wise Provider Network Commercial |
$19.17
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$19.66
|
|
|
LORAZEPAM 2 MG/ML INJECTION SOLUTION [4396]
|
Facility
|
IP
|
$22.60
|
|
|
Service Code
|
HCPCS J2060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.15
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.23
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.86
|
| Rate for Payer: Altius Commercial |
$19.37
|
| Rate for Payer: Altius Commercial |
$19.81
|
| Rate for Payer: Altius Commercial |
$21.70
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Altius Commercial |
$19.86
|
| Rate for Payer: Beech Street Commercial |
$19.78
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Beech Street Commercial |
$20.28
|
| Rate for Payer: Beech Street Commercial |
$22.15
|
| Rate for Payer: Beech Street Commercial |
$20.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.07
|
| Rate for Payer: Cigna of WY Commercial |
$22.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.78
|
| Rate for Payer: Cigna of WY Commercial |
$20.28
|
| Rate for Payer: Cigna of WY Commercial |
$20.23
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: Entrust Commercial |
$21.47
|
| Rate for Payer: Entrust Commercial |
$19.61
|
| Rate for Payer: Entrust Commercial |
$19.17
|
| Rate for Payer: Entrust Commercial |
$19.66
|
| Rate for Payer: First Choice Health Commercial |
$19.17
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$21.47
|
| Rate for Payer: First Choice Health Commercial |
$19.66
|
| Rate for Payer: First Choice Health Commercial |
$19.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.62
|
| Rate for Payer: HealthUtah PPO |
$20.69
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$20.18
|
| Rate for Payer: HealthUtah PPO |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$20.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.94
|
| Rate for Payer: Multiplan Medicare/VA |
$12.65
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: Multiplan Medicare/VA |
$12.97
|
| Rate for Payer: Multiplan Medicare/VA |
$14.17
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: One Health Plan of WY PPO |
$19.78
|
| Rate for Payer: One Health Plan of WY PPO |
$20.23
|
| Rate for Payer: One Health Plan of WY PPO |
$20.28
|
| Rate for Payer: One Health Plan of WY PPO |
$22.15
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PacificSource Commercial |
$18.58
|
| Rate for Payer: PacificSource Commercial |
$18.16
|
| Rate for Payer: PacificSource Commercial |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$20.34
|
| Rate for Payer: PHCS PPO |
$20.28
|
| Rate for Payer: PHCS PPO |
$22.15
|
| Rate for Payer: PHCS PPO |
$20.23
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: PHCS PPO |
$19.78
|
| Rate for Payer: Three Rivers PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$16.95
|
| Rate for Payer: Three Rivers PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$14.92
|
| Rate for Payer: TriWest Veterans Administration |
$13.62
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: TriWest Veterans Administration |
$13.32
|
| Rate for Payer: TriWest Veterans Administration |
$13.66
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$17.56
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Medicare |
$13.62
|
| Rate for Payer: United Healthcare Medicare |
$13.66
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: United Healthcare Medicare |
$14.92
|
| Rate for Payer: WINHealth Partners Commercial |
$19.17
|
| Rate for Payer: WINHealth Partners Commercial |
$19.66
|
| Rate for Payer: WINHealth Partners Commercial |
$21.47
|
| Rate for Payer: WINHealth Partners Commercial |
$19.61
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$19.17
|
| Rate for Payer: Wise Provider Network Commercial |
$21.47
|
| Rate for Payer: Wise Provider Network Commercial |
$19.66
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$19.61
|
|
|
LORAZEPAM 2 MG/ML ORAL CONCENTRATE [19224]
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 0054353244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.13
|
| Rate for Payer: Aetna of WY Medicare |
$2.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.04
|
| Rate for Payer: Altius Commercial |
$4.04
|
| Rate for Payer: Beech Street Commercial |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.08
|
| Rate for Payer: Cigna of WY Commercial |
$4.13
|
| Rate for Payer: Entrust Commercial |
$4.00
|
| Rate for Payer: First Choice Health Commercial |
$4.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.44
|
| Rate for Payer: HealthUtah PPO |
$4.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.08
|
| Rate for Payer: Multiplan Medicare/VA |
$2.32
|
| Rate for Payer: One Health Plan of WY PPO |
$4.13
|
| Rate for Payer: PacificSource Commercial |
$3.79
|
| Rate for Payer: PHCS PPO |
$4.13
|
| Rate for Payer: Three Rivers PPO |
$3.16
|
| Rate for Payer: TriWest Veterans Administration |
$2.44
|
| Rate for Payer: United Healthcare Commercial |
$3.66
|
| Rate for Payer: United Healthcare Medicare |
$2.44
|
| Rate for Payer: WINHealth Partners Commercial |
$4.13
|
| Rate for Payer: Wise Provider Network Commercial |
$4.00
|
|
