|
CABLE ZIMMER 1.8MMX635MM
|
Facility
|
OP
|
$1,085.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.03 |
| Max. Negotiated Rate |
$1,085.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.64
|
| Rate for Payer: Aetna of WY Medicare |
$716.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,041.94
|
| Rate for Payer: Altius Commercial |
$1,041.94
|
| Rate for Payer: Beech Street Commercial |
$1,063.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$891.07
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.64
|
| Rate for Payer: Entrust Commercial |
$1,031.08
|
| Rate for Payer: First Choice Health Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.50
|
| Rate for Payer: HealthUtah PPO |
$1,085.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.79
|
| Rate for Payer: Multiplan Medicare/VA |
$598.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.64
|
| Rate for Payer: PacificSource Commercial |
$976.82
|
| Rate for Payer: PHCS PPO |
$1,063.64
|
| Rate for Payer: Three Rivers PPO |
$814.01
|
| Rate for Payer: TriWest Veterans Administration |
$629.50
|
| Rate for Payer: United Healthcare Commercial |
$944.25
|
| Rate for Payer: United Healthcare Medicare |
$629.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1,031.08
|
|
|
CABLE ZIMMER 1.8MMX635MM
|
Facility
|
IP
|
$1,085.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.51 |
| Max. Negotiated Rate |
$1,085.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,041.94
|
| Rate for Payer: Altius Commercial |
$1,041.94
|
| Rate for Payer: Beech Street Commercial |
$1,063.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$891.07
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.64
|
| Rate for Payer: Entrust Commercial |
$1,031.08
|
| Rate for Payer: First Choice Health Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$716.33
|
| Rate for Payer: HealthUtah PPO |
$1,085.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.79
|
| Rate for Payer: Multiplan Medicare/VA |
$680.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.64
|
| Rate for Payer: PacificSource Commercial |
$976.82
|
| Rate for Payer: PHCS PPO |
$1,063.64
|
| Rate for Payer: Three Rivers PPO |
$814.01
|
| Rate for Payer: TriWest Veterans Administration |
$716.33
|
| Rate for Payer: United Healthcare Commercial |
$944.25
|
| Rate for Payer: United Healthcare Medicare |
$716.33
|
| Rate for Payer: WINHealth Partners Commercial |
$1,031.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1,031.08
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
OP
|
$56.07
|
|
|
Service Code
|
NDC 0517250210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.95
|
| Rate for Payer: Aetna of WY Medicare |
$37.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.83
|
| Rate for Payer: Altius Commercial |
$53.83
|
| Rate for Payer: Beech Street Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.03
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.39
|
| Rate for Payer: Cigna of WY Commercial |
$54.95
|
| Rate for Payer: Entrust Commercial |
$53.27
|
| Rate for Payer: First Choice Health Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.52
|
| Rate for Payer: HealthUtah PPO |
$56.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.39
|
| Rate for Payer: Multiplan Medicare/VA |
$30.89
|
| Rate for Payer: One Health Plan of WY PPO |
$54.95
|
| Rate for Payer: PacificSource Commercial |
$50.46
|
| Rate for Payer: PHCS PPO |
$54.95
|
| Rate for Payer: Three Rivers PPO |
$42.05
|
| Rate for Payer: TriWest Veterans Administration |
$32.52
|
| Rate for Payer: United Healthcare Commercial |
$48.78
|
| Rate for Payer: United Healthcare Medicare |
$32.52
|
| Rate for Payer: WINHealth Partners Commercial |
$54.95
|
| Rate for Payer: Wise Provider Network Commercial |
$53.27
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
OP
|
$56.07
|
|
|
Service Code
|
NDC 0517250201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.95
|
| Rate for Payer: Aetna of WY Medicare |
$37.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.83
|
| Rate for Payer: Altius Commercial |
$53.83
|
| Rate for Payer: Beech Street Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.03
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.39
|
| Rate for Payer: Cigna of WY Commercial |
$54.95
|
| Rate for Payer: Entrust Commercial |
$53.27
|
| Rate for Payer: First Choice Health Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.52
|
| Rate for Payer: HealthUtah PPO |
$56.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.39
|
| Rate for Payer: Multiplan Medicare/VA |
$30.89
|
| Rate for Payer: One Health Plan of WY PPO |
$54.95
|
| Rate for Payer: PacificSource Commercial |
$50.46
|
| Rate for Payer: PHCS PPO |
$54.95
|
| Rate for Payer: Three Rivers PPO |
$42.05
|
| Rate for Payer: TriWest Veterans Administration |
$32.52
|
| Rate for Payer: United Healthcare Commercial |
$48.78
|
| Rate for Payer: United Healthcare Medicare |
$32.52
|
| Rate for Payer: WINHealth Partners Commercial |
$54.95
|
| Rate for Payer: Wise Provider Network Commercial |
$53.27
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
IP
|
$56.07
|
|
|
Service Code
|
NDC 0517250210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.83
|
| Rate for Payer: Altius Commercial |
$53.83
|
| Rate for Payer: Beech Street Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.03
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.39
|
| Rate for Payer: Cigna of WY Commercial |
$54.95
|
| Rate for Payer: Entrust Commercial |
$53.27
|
| Rate for Payer: First Choice Health Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.01
|
| Rate for Payer: HealthUtah PPO |
$56.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.39
|
| Rate for Payer: Multiplan Medicare/VA |
$35.16
|
| Rate for Payer: One Health Plan of WY PPO |
$54.95
|
| Rate for Payer: PacificSource Commercial |
$50.46
|
| Rate for Payer: PHCS PPO |
$54.95
|
| Rate for Payer: Three Rivers PPO |
$42.05
|
| Rate for Payer: TriWest Veterans Administration |
$37.01
|
| Rate for Payer: United Healthcare Commercial |
$48.78
|
| Rate for Payer: United Healthcare Medicare |
$37.01
|
| Rate for Payer: WINHealth Partners Commercial |
$53.27
|
| Rate for Payer: Wise Provider Network Commercial |
$53.27
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
IP
|
$56.07
|
|
|
Service Code
|
NDC 0517250201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.83
|
| Rate for Payer: Altius Commercial |
$53.83
|
| Rate for Payer: Beech Street Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.03
|
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.39
|
| Rate for Payer: Cigna of WY Commercial |
$54.95
|
| Rate for Payer: Entrust Commercial |
$53.27
|
| Rate for Payer: First Choice Health Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.01
|
| Rate for Payer: HealthUtah PPO |
$56.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.39
|
| Rate for Payer: Multiplan Medicare/VA |
$35.16
|
| Rate for Payer: One Health Plan of WY PPO |
$54.95
|
| Rate for Payer: PacificSource Commercial |
$50.46
|
| Rate for Payer: PHCS PPO |
$54.95
|
| Rate for Payer: Three Rivers PPO |
$42.05
|
| Rate for Payer: TriWest Veterans Administration |
$37.01
|
| Rate for Payer: United Healthcare Commercial |
$48.78
|
| Rate for Payer: United Healthcare Medicare |
$37.01
|
| Rate for Payer: WINHealth Partners Commercial |
$53.27
|
| Rate for Payer: Wise Provider Network Commercial |
$53.27
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [20717]
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
HCPCS J0630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.52 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$749.70
|
| Rate for Payer: Aetna of WY Medicare |
$504.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$734.40
|
| Rate for Payer: Altius Commercial |
$734.40
|
| Rate for Payer: Beech Street Commercial |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$628.06
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$742.05
|
| Rate for Payer: Cigna of WY Commercial |
$749.70
|
| Rate for Payer: Entrust Commercial |
$726.75
|
| Rate for Payer: First Choice Health Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.70
|
| Rate for Payer: HealthUtah PPO |
$765.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$742.05
|
| Rate for Payer: Multiplan Medicare/VA |
$421.52
|
| Rate for Payer: One Health Plan of WY PPO |
$749.70
|
| Rate for Payer: PacificSource Commercial |
$688.50
|
| Rate for Payer: PHCS PPO |
$749.70
|
| Rate for Payer: Three Rivers PPO |
$573.75
|
| Rate for Payer: TriWest Veterans Administration |
$443.70
|
| Rate for Payer: United Healthcare Commercial |
$665.55
|
| Rate for Payer: United Healthcare Medicare |
$443.70
|
| Rate for Payer: WINHealth Partners Commercial |
$749.70
|
| Rate for Payer: Wise Provider Network Commercial |
$726.75
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [20717]
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
HCPCS J0630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.66 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$749.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$734.40
|
| Rate for Payer: Altius Commercial |
$734.40
|
| Rate for Payer: Beech Street Commercial |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$628.06
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$742.05
|
| Rate for Payer: Cigna of WY Commercial |
$749.70
|
| Rate for Payer: Entrust Commercial |
$726.75
|
| Rate for Payer: First Choice Health Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.90
|
| Rate for Payer: HealthUtah PPO |
$765.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$742.05
|
| Rate for Payer: Multiplan Medicare/VA |
$479.66
|
| Rate for Payer: One Health Plan of WY PPO |
$749.70
|
| Rate for Payer: PacificSource Commercial |
$688.50
|
| Rate for Payer: PHCS PPO |
$749.70
|
| Rate for Payer: Three Rivers PPO |
$573.75
|
| Rate for Payer: TriWest Veterans Administration |
$504.90
|
| Rate for Payer: United Healthcare Commercial |
$665.55
|
| Rate for Payer: United Healthcare Medicare |
$504.90
|
| Rate for Payer: WINHealth Partners Commercial |
$726.75
|
| Rate for Payer: Wise Provider Network Commercial |
$726.75
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [19410]
|
Facility
|
OP
|
$2.95
|
|
|
Service Code
|
NDC 6068734511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.89
|
| Rate for Payer: Aetna of WY Medicare |
$1.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.83
|
| Rate for Payer: Altius Commercial |
$2.83
|
| Rate for Payer: Beech Street Commercial |
$2.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.86
|
| Rate for Payer: Cigna of WY Commercial |
$2.89
|
| Rate for Payer: Entrust Commercial |
$2.80
|
| Rate for Payer: First Choice Health Commercial |
$2.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.71
|
| Rate for Payer: HealthUtah PPO |
$2.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.86
|
| Rate for Payer: Multiplan Medicare/VA |
$1.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2.89
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.89
|
| Rate for Payer: Three Rivers PPO |
$2.21
|
| Rate for Payer: TriWest Veterans Administration |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$1.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2.89
|
| Rate for Payer: Wise Provider Network Commercial |
$2.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [19410]
|
Facility
|
IP
|
$2.95
|
|
|
Service Code
|
NDC 6068734511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.83
|
| Rate for Payer: Altius Commercial |
$2.83
|
| Rate for Payer: Beech Street Commercial |
$2.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.86
|
| Rate for Payer: Cigna of WY Commercial |
$2.89
|
| Rate for Payer: Entrust Commercial |
$2.80
|
| Rate for Payer: First Choice Health Commercial |
$2.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.95
|
| Rate for Payer: HealthUtah PPO |
$2.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.86
|
| Rate for Payer: Multiplan Medicare/VA |
$1.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2.89
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.89
|
| Rate for Payer: Three Rivers PPO |
$2.21
|
| Rate for Payer: TriWest Veterans Administration |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2.80
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [13579]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6655300401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET [13579]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6655300401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CALCIUM 250 MG (PHOSPHATE)-VIT D3 12.5 MCG (500 UNIT) CHEWABLE TABLET [99786]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 2791721447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.38
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.25
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
CALCIUM 250 MG (PHOSPHATE)-VIT D3 12.5 MCG (500 UNIT) CHEWABLE TABLET [99786]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 2791721447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.38
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.39
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 3680088124
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 3680088124
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 2438559523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 2438559523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 8770143612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
CALCIUM 400 MG (AS CALCIUM CARBONATE 1,000 MG) CHEWABLE TABLET [9718]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 8770143612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [38648]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 1000670038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.18
|
| Rate for Payer: Altius Commercial |
$0.18
|
| Rate for Payer: Beech Street Commercial |
$0.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.18
|
| Rate for Payer: Cigna of WY Commercial |
$0.19
|
| Rate for Payer: Entrust Commercial |
$0.18
|
| Rate for Payer: First Choice Health Commercial |
$0.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.19
|
| Rate for Payer: PacificSource Commercial |
$0.17
|
| Rate for Payer: PHCS PPO |
$0.19
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.18
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET [38648]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 1000670038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.19
|
| Rate for Payer: Aetna of WY Medicare |
$0.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.18
|
| Rate for Payer: Altius Commercial |
$0.18
|
| Rate for Payer: Beech Street Commercial |
$0.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.18
|
| Rate for Payer: Cigna of WY Commercial |
$0.19
|
| Rate for Payer: Entrust Commercial |
$0.18
|
| Rate for Payer: First Choice Health Commercial |
$0.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.19
|
| Rate for Payer: PacificSource Commercial |
$0.17
|
| Rate for Payer: PHCS PPO |
$0.19
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.19
|
| Rate for Payer: Wise Provider Network Commercial |
$0.18
|
|
|
CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET [42441]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 8068113900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Aetna of WY Medicare |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET [42441]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 8068113900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [97619]
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 5707400177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.61
|
| Rate for Payer: Aetna of WY Medicare |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.55
|
| Rate for Payer: Altius Commercial |
$2.55
|
| Rate for Payer: Beech Street Commercial |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.58
|
| Rate for Payer: Cigna of WY Commercial |
$2.61
|
| Rate for Payer: Entrust Commercial |
$2.53
|
| Rate for Payer: First Choice Health Commercial |
$2.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.54
|
| Rate for Payer: HealthUtah PPO |
$2.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.58
|
| Rate for Payer: Multiplan Medicare/VA |
$1.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2.61
|
| Rate for Payer: PacificSource Commercial |
$2.39
|
| Rate for Payer: PHCS PPO |
$2.61
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.54
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Medicare |
$1.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2.61
|
| Rate for Payer: Wise Provider Network Commercial |
$2.53
|
|
