|
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [1874]
|
Facility
|
OP
|
$19.40
|
|
|
Service Code
|
HCPCS J2765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.01
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.13
|
| Rate for Payer: Aetna of WY Medicare |
$12.80
|
| Rate for Payer: Aetna of WY Medicare |
$11.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.62
|
| Rate for Payer: Altius Commercial |
$18.62
|
| Rate for Payer: Altius Commercial |
$16.78
|
| Rate for Payer: Beech Street Commercial |
$17.13
|
| Rate for Payer: Beech Street Commercial |
$19.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.35
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.96
|
| Rate for Payer: Cigna of WY Commercial |
$17.13
|
| Rate for Payer: Cigna of WY Commercial |
$19.01
|
| Rate for Payer: Entrust Commercial |
$18.43
|
| Rate for Payer: Entrust Commercial |
$16.61
|
| Rate for Payer: First Choice Health Commercial |
$16.61
|
| Rate for Payer: First Choice Health Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.14
|
| Rate for Payer: HealthUtah PPO |
$17.48
|
| Rate for Payer: HealthUtah PPO |
$19.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.82
|
| Rate for Payer: Multiplan Medicare/VA |
$10.69
|
| Rate for Payer: Multiplan Medicare/VA |
$9.63
|
| Rate for Payer: One Health Plan of WY PPO |
$17.13
|
| Rate for Payer: One Health Plan of WY PPO |
$19.01
|
| Rate for Payer: PacificSource Commercial |
$17.46
|
| Rate for Payer: PacificSource Commercial |
$15.73
|
| Rate for Payer: PHCS PPO |
$17.13
|
| Rate for Payer: PHCS PPO |
$19.01
|
| Rate for Payer: Three Rivers PPO |
$13.11
|
| Rate for Payer: Three Rivers PPO |
$14.55
|
| Rate for Payer: TriWest Veterans Administration |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$15.21
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
| Rate for Payer: United Healthcare Medicare |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$10.14
|
| Rate for Payer: WINHealth Partners Commercial |
$17.13
|
| Rate for Payer: WINHealth Partners Commercial |
$19.01
|
| Rate for Payer: Wise Provider Network Commercial |
$16.61
|
| Rate for Payer: Wise Provider Network Commercial |
$18.43
|
|
|
METOCLOPRAMIDE HCL INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
J2765
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Aetna of WY Medicare |
$1.04
|
| Rate for Payer: Beech Street Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: First Choice Health Commercial |
$3.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.80
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$3.80
|
|
|
METOLAZONE 5 MG TABLET [5825]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 7638513701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.88
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.98
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.88
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.98
|
| Rate for Payer: United Healthcare Commercial |
$2.61
|
| Rate for Payer: United Healthcare Medicare |
$1.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
METOLAZONE 5 MG TABLET [5825]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 7638513701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.88
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.74
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.61
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2.94
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [4507]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 5026854315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.42
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.42
|
| Rate for Payer: WINHealth Partners Commercial |
$3.48
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [4507]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 5026854315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Aetna of WY Medicare |
$2.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.12
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.12
|
| Rate for Payer: WINHealth Partners Commercial |
$3.59
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [4507]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 5026854311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Aetna of WY Medicare |
$2.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.12
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.12
|
| Rate for Payer: WINHealth Partners Commercial |
$3.59
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [4507]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 5026854311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.42
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.42
|
| Rate for Payer: WINHealth Partners Commercial |
$3.48
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [16809]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 6068739011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.26
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3.81
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [16809]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 6068739001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.44
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [16809]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 6068739011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.44
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [16809]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 6068739001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.26
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3.81
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [3579]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 6068740201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.26
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3.81
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [3579]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 6068740211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.26
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
| Rate for Payer: WINHealth Partners Commercial |
$3.81
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [3579]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 6068740211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.44
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [3579]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 6068740201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.73
|
| Rate for Payer: Altius Commercial |
$3.73
|
| Rate for Payer: Beech Street Commercial |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.77
|
| Rate for Payer: Cigna of WY Commercial |
$3.81
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.57
|
| Rate for Payer: HealthUtah PPO |
$3.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.44
|
| Rate for Payer: One Health Plan of WY PPO |
$3.81
|
| Rate for Payer: PacificSource Commercial |
$3.50
|
| Rate for Payer: PHCS PPO |
$3.81
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.57
|
| Rate for Payer: United Healthcare Commercial |
$3.38
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
METOPROLOL TARTRATE 25 MG TABLET [31442]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6258426501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
METOPROLOL TARTRATE 25 MG TABLET [31442]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 6258426501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
METOPROLOL TARTRATE 25 MG TABLET [31442]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 6258426511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
METOPROLOL TARTRATE 25 MG TABLET [31442]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 6258426511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
METOPROLOL TARTRATE 50 MG TABLET [14061]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 6258426611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Aetna of WY Medicare |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.43
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
METOPROLOL TARTRATE 50 MG TABLET [14061]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 6258426611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.42
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
METOPROLOL TARTRATE 50 MG TABLET [14061]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 6258426601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Aetna of WY Medicare |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.43
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
METOPROLOL TARTRATE 50 MG TABLET [14061]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 6258426601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.42
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION [20449]
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
NDC 3600003310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.40
|
| Rate for Payer: Altius Commercial |
$15.40
|
| Rate for Payer: Beech Street Commercial |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.17
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.56
|
| Rate for Payer: Cigna of WY Commercial |
$15.72
|
| Rate for Payer: Entrust Commercial |
$15.24
|
| Rate for Payer: First Choice Health Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.59
|
| Rate for Payer: HealthUtah PPO |
$16.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.56
|
| Rate for Payer: Multiplan Medicare/VA |
$10.06
|
| Rate for Payer: One Health Plan of WY PPO |
$15.72
|
| Rate for Payer: PacificSource Commercial |
$14.44
|
| Rate for Payer: PHCS PPO |
$15.72
|
| Rate for Payer: Three Rivers PPO |
$12.03
|
| Rate for Payer: TriWest Veterans Administration |
$10.59
|
| Rate for Payer: United Healthcare Commercial |
$13.95
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
| Rate for Payer: WINHealth Partners Commercial |
$15.24
|
| Rate for Payer: Wise Provider Network Commercial |
$15.24
|
|
