|
OXYBUTYNIN CHLORIDE 5 MG TABLET [18294]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
NDC 6068767001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.76
|
| Rate for Payer: Altius Commercial |
$1.76
|
| Rate for Payer: Beech Street Commercial |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.78
|
| Rate for Payer: Cigna of WY Commercial |
$1.79
|
| Rate for Payer: Entrust Commercial |
$1.74
|
| Rate for Payer: First Choice Health Commercial |
$1.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.21
|
| Rate for Payer: HealthUtah PPO |
$1.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1.79
|
| Rate for Payer: PacificSource Commercial |
$1.65
|
| Rate for Payer: PHCS PPO |
$1.79
|
| Rate for Payer: Three Rivers PPO |
$1.37
|
| Rate for Payer: TriWest Veterans Administration |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Medicare |
$1.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1.74
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [18294]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
NDC 6068767001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.79
|
| Rate for Payer: Aetna of WY Medicare |
$1.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.76
|
| Rate for Payer: Altius Commercial |
$1.76
|
| Rate for Payer: Beech Street Commercial |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.78
|
| Rate for Payer: Cigna of WY Commercial |
$1.79
|
| Rate for Payer: Entrust Commercial |
$1.74
|
| Rate for Payer: First Choice Health Commercial |
$1.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1.79
|
| Rate for Payer: PacificSource Commercial |
$1.65
|
| Rate for Payer: PHCS PPO |
$1.79
|
| Rate for Payer: Three Rivers PPO |
$1.37
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.79
|
| Rate for Payer: Wise Provider Network Commercial |
$1.74
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [3124]
|
Facility
|
OP
|
$11.47
|
|
|
Service Code
|
NDC 5026862815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.24
|
| Rate for Payer: Aetna of WY Medicare |
$7.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.01
|
| Rate for Payer: Altius Commercial |
$11.01
|
| Rate for Payer: Beech Street Commercial |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.13
|
| Rate for Payer: Cigna of WY Commercial |
$11.24
|
| Rate for Payer: Entrust Commercial |
$10.90
|
| Rate for Payer: First Choice Health Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.65
|
| Rate for Payer: HealthUtah PPO |
$11.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.13
|
| Rate for Payer: Multiplan Medicare/VA |
$6.32
|
| Rate for Payer: One Health Plan of WY PPO |
$11.24
|
| Rate for Payer: PacificSource Commercial |
$10.32
|
| Rate for Payer: PHCS PPO |
$11.24
|
| Rate for Payer: Three Rivers PPO |
$8.60
|
| Rate for Payer: TriWest Veterans Administration |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$9.98
|
| Rate for Payer: United Healthcare Medicare |
$6.65
|
| Rate for Payer: WINHealth Partners Commercial |
$11.24
|
| Rate for Payer: Wise Provider Network Commercial |
$10.90
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [3124]
|
Facility
|
IP
|
$11.47
|
|
|
Service Code
|
NDC 5026862811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.01
|
| Rate for Payer: Altius Commercial |
$11.01
|
| Rate for Payer: Beech Street Commercial |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.13
|
| Rate for Payer: Cigna of WY Commercial |
$11.24
|
| Rate for Payer: Entrust Commercial |
$10.90
|
| Rate for Payer: First Choice Health Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.57
|
| Rate for Payer: HealthUtah PPO |
$11.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.13
|
| Rate for Payer: Multiplan Medicare/VA |
$7.19
|
| Rate for Payer: One Health Plan of WY PPO |
$11.24
|
| Rate for Payer: PacificSource Commercial |
$10.32
|
| Rate for Payer: PHCS PPO |
$11.24
|
| Rate for Payer: Three Rivers PPO |
$8.60
|
| Rate for Payer: TriWest Veterans Administration |
$7.57
|
| Rate for Payer: United Healthcare Commercial |
$9.98
|
| Rate for Payer: United Healthcare Medicare |
$7.57
|
| Rate for Payer: WINHealth Partners Commercial |
$10.90
|
| Rate for Payer: Wise Provider Network Commercial |
$10.90
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [3124]
|
Facility
|
IP
|
$11.47
|
|
|
Service Code
|
NDC 5026862815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.01
|
| Rate for Payer: Altius Commercial |
$11.01
|
| Rate for Payer: Beech Street Commercial |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.13
|
| Rate for Payer: Cigna of WY Commercial |
$11.24
|
| Rate for Payer: Entrust Commercial |
$10.90
|
| Rate for Payer: First Choice Health Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.57
|
| Rate for Payer: HealthUtah PPO |
$11.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.13
|
| Rate for Payer: Multiplan Medicare/VA |
$7.19
|
| Rate for Payer: One Health Plan of WY PPO |
$11.24
|
| Rate for Payer: PacificSource Commercial |
$10.32
|
| Rate for Payer: PHCS PPO |
$11.24
|
| Rate for Payer: Three Rivers PPO |
$8.60
|
| Rate for Payer: TriWest Veterans Administration |
$7.57
|
| Rate for Payer: United Healthcare Commercial |
$9.98
|
| Rate for Payer: United Healthcare Medicare |
$7.57
|
| Rate for Payer: WINHealth Partners Commercial |
$10.90
|
| Rate for Payer: Wise Provider Network Commercial |
$10.90
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR [3124]
|
Facility
|
OP
|
$11.47
|
|
|
Service Code
|
NDC 5026862811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.24
|
| Rate for Payer: Aetna of WY Medicare |
$7.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.01
|
| Rate for Payer: Altius Commercial |
$11.01
|
| Rate for Payer: Beech Street Commercial |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.13
|
| Rate for Payer: Cigna of WY Commercial |
$11.24
|
| Rate for Payer: Entrust Commercial |
$10.90
|
| Rate for Payer: First Choice Health Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.65
|
| Rate for Payer: HealthUtah PPO |
$11.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.13
|
| Rate for Payer: Multiplan Medicare/VA |
$6.32
|
| Rate for Payer: One Health Plan of WY PPO |
$11.24
|
| Rate for Payer: PacificSource Commercial |
$10.32
|
| Rate for Payer: PHCS PPO |
$11.24
|
| Rate for Payer: Three Rivers PPO |
$8.60
|
| Rate for Payer: TriWest Veterans Administration |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$9.98
|
| Rate for Payer: United Healthcare Medicare |
$6.65
|
| Rate for Payer: WINHealth Partners Commercial |
$11.24
|
| Rate for Payer: Wise Provider Network Commercial |
$10.90
|
|
|
OXYBUTYNIN CHLORIDE ER 15 MG TABLET,EXTENDED RELEASE 24 HR [1640]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 2724115704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
OXYBUTYNIN CHLORIDE ER 15 MG TABLET,EXTENDED RELEASE 24 HR [1640]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 2724115704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 6808448011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.25
|
| Rate for Payer: Altius Commercial |
$9.25
|
| Rate for Payer: Beech Street Commercial |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.35
|
| Rate for Payer: Cigna of WY Commercial |
$9.45
|
| Rate for Payer: Entrust Commercial |
$9.16
|
| Rate for Payer: First Choice Health Commercial |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.36
|
| Rate for Payer: HealthUtah PPO |
$9.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.35
|
| Rate for Payer: Multiplan Medicare/VA |
$6.04
|
| Rate for Payer: One Health Plan of WY PPO |
$9.45
|
| Rate for Payer: PacificSource Commercial |
$8.68
|
| Rate for Payer: PHCS PPO |
$9.45
|
| Rate for Payer: Three Rivers PPO |
$7.23
|
| Rate for Payer: TriWest Veterans Administration |
$6.36
|
| Rate for Payer: United Healthcare Commercial |
$8.39
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
| Rate for Payer: WINHealth Partners Commercial |
$9.16
|
| Rate for Payer: Wise Provider Network Commercial |
$9.16
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
IP
|
$9.87
|
|
|
Service Code
|
NDC 6808448065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.48
|
| Rate for Payer: Altius Commercial |
$9.48
|
| Rate for Payer: Beech Street Commercial |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.57
|
| Rate for Payer: Cigna of WY Commercial |
$9.67
|
| Rate for Payer: Entrust Commercial |
$9.38
|
| Rate for Payer: First Choice Health Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.51
|
| Rate for Payer: HealthUtah PPO |
$9.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.57
|
| Rate for Payer: Multiplan Medicare/VA |
$6.19
|
| Rate for Payer: One Health Plan of WY PPO |
$9.67
|
| Rate for Payer: PacificSource Commercial |
$8.88
|
| Rate for Payer: PHCS PPO |
$9.67
|
| Rate for Payer: Three Rivers PPO |
$7.40
|
| Rate for Payer: TriWest Veterans Administration |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$8.59
|
| Rate for Payer: United Healthcare Medicare |
$6.51
|
| Rate for Payer: WINHealth Partners Commercial |
$9.38
|
| Rate for Payer: Wise Provider Network Commercial |
$9.38
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
OP
|
$9.87
|
|
|
Service Code
|
NDC 6808448065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.67
|
| Rate for Payer: Aetna of WY Medicare |
$6.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.48
|
| Rate for Payer: Altius Commercial |
$9.48
|
| Rate for Payer: Beech Street Commercial |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.57
|
| Rate for Payer: Cigna of WY Commercial |
$9.67
|
| Rate for Payer: Entrust Commercial |
$9.38
|
| Rate for Payer: First Choice Health Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.72
|
| Rate for Payer: HealthUtah PPO |
$9.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.57
|
| Rate for Payer: Multiplan Medicare/VA |
$5.44
|
| Rate for Payer: One Health Plan of WY PPO |
$9.67
|
| Rate for Payer: PacificSource Commercial |
$8.88
|
| Rate for Payer: PHCS PPO |
$9.67
|
| Rate for Payer: Three Rivers PPO |
$7.40
|
| Rate for Payer: TriWest Veterans Administration |
$5.72
|
| Rate for Payer: United Healthcare Commercial |
$8.59
|
| Rate for Payer: United Healthcare Medicare |
$5.72
|
| Rate for Payer: WINHealth Partners Commercial |
$9.67
|
| Rate for Payer: Wise Provider Network Commercial |
$9.38
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
OP
|
$10.87
|
|
|
Service Code
|
NDC 6373954833
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.65
|
| Rate for Payer: Aetna of WY Medicare |
$7.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.44
|
| Rate for Payer: Altius Commercial |
$10.44
|
| Rate for Payer: Beech Street Commercial |
$10.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.54
|
| Rate for Payer: Cigna of WY Commercial |
$10.65
|
| Rate for Payer: Entrust Commercial |
$10.33
|
| Rate for Payer: First Choice Health Commercial |
$10.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.30
|
| Rate for Payer: HealthUtah PPO |
$10.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.54
|
| Rate for Payer: Multiplan Medicare/VA |
$5.99
|
| Rate for Payer: One Health Plan of WY PPO |
$10.65
|
| Rate for Payer: PacificSource Commercial |
$9.78
|
| Rate for Payer: PHCS PPO |
$10.65
|
| Rate for Payer: Three Rivers PPO |
$8.15
|
| Rate for Payer: TriWest Veterans Administration |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$9.46
|
| Rate for Payer: United Healthcare Medicare |
$6.30
|
| Rate for Payer: WINHealth Partners Commercial |
$10.65
|
| Rate for Payer: Wise Provider Network Commercial |
$10.33
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
OP
|
$9.64
|
|
|
Service Code
|
NDC 6808448011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.45
|
| Rate for Payer: Aetna of WY Medicare |
$6.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.25
|
| Rate for Payer: Altius Commercial |
$9.25
|
| Rate for Payer: Beech Street Commercial |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.35
|
| Rate for Payer: Cigna of WY Commercial |
$9.45
|
| Rate for Payer: Entrust Commercial |
$9.16
|
| Rate for Payer: First Choice Health Commercial |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.59
|
| Rate for Payer: HealthUtah PPO |
$9.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.35
|
| Rate for Payer: Multiplan Medicare/VA |
$5.31
|
| Rate for Payer: One Health Plan of WY PPO |
$9.45
|
| Rate for Payer: PacificSource Commercial |
$8.68
|
| Rate for Payer: PHCS PPO |
$9.45
|
| Rate for Payer: Three Rivers PPO |
$7.23
|
| Rate for Payer: TriWest Veterans Administration |
$5.59
|
| Rate for Payer: United Healthcare Commercial |
$8.39
|
| Rate for Payer: United Healthcare Medicare |
$5.59
|
| Rate for Payer: WINHealth Partners Commercial |
$9.45
|
| Rate for Payer: Wise Provider Network Commercial |
$9.16
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR [14935]
|
Facility
|
IP
|
$10.87
|
|
|
Service Code
|
NDC 6373954833
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.44
|
| Rate for Payer: Altius Commercial |
$10.44
|
| Rate for Payer: Beech Street Commercial |
$10.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.54
|
| Rate for Payer: Cigna of WY Commercial |
$10.65
|
| Rate for Payer: Entrust Commercial |
$10.33
|
| Rate for Payer: First Choice Health Commercial |
$10.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.17
|
| Rate for Payer: HealthUtah PPO |
$10.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.54
|
| Rate for Payer: Multiplan Medicare/VA |
$6.82
|
| Rate for Payer: One Health Plan of WY PPO |
$10.65
|
| Rate for Payer: PacificSource Commercial |
$9.78
|
| Rate for Payer: PHCS PPO |
$10.65
|
| Rate for Payer: Three Rivers PPO |
$8.15
|
| Rate for Payer: TriWest Veterans Administration |
$7.17
|
| Rate for Payer: United Healthcare Commercial |
$9.46
|
| Rate for Payer: United Healthcare Medicare |
$7.17
|
| Rate for Payer: WINHealth Partners Commercial |
$10.33
|
| Rate for Payer: Wise Provider Network Commercial |
$10.33
|
|
|
OXYCODONE 15 MG TABLET [8605]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 0406851501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.22
|
| Rate for Payer: Altius Commercial |
$1.22
|
| Rate for Payer: Beech Street Commercial |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.23
|
| Rate for Payer: Cigna of WY Commercial |
$1.24
|
| Rate for Payer: Entrust Commercial |
$1.21
|
| Rate for Payer: First Choice Health Commercial |
$1.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.84
|
| Rate for Payer: HealthUtah PPO |
$1.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.24
|
| Rate for Payer: PacificSource Commercial |
$1.14
|
| Rate for Payer: PHCS PPO |
$1.24
|
| Rate for Payer: Three Rivers PPO |
$0.95
|
| Rate for Payer: TriWest Veterans Administration |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Medicare |
$0.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1.21
|
|
|
OXYCODONE 15 MG TABLET [8605]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 0406851501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.24
|
| Rate for Payer: Aetna of WY Medicare |
$0.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.22
|
| Rate for Payer: Altius Commercial |
$1.22
|
| Rate for Payer: Beech Street Commercial |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.23
|
| Rate for Payer: Cigna of WY Commercial |
$1.24
|
| Rate for Payer: Entrust Commercial |
$1.21
|
| Rate for Payer: First Choice Health Commercial |
$1.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.74
|
| Rate for Payer: HealthUtah PPO |
$1.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1.24
|
| Rate for Payer: PacificSource Commercial |
$1.14
|
| Rate for Payer: PHCS PPO |
$1.24
|
| Rate for Payer: Three Rivers PPO |
$0.95
|
| Rate for Payer: TriWest Veterans Administration |
$0.74
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Medicare |
$0.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1.24
|
| Rate for Payer: Wise Provider Network Commercial |
$1.21
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
IP
|
$1.82
|
|
|
Service Code
|
NDC 6808435411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 0406055201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
OP
|
$1.82
|
|
|
Service Code
|
NDC 6808435411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Aetna of WY Medicare |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 0406055201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 0406055223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
OXYCODONE 5 MG TABLET [20582]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 0406055223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [10947]
|
Facility
|
OP
|
$6.87
|
|
|
Service Code
|
NDC 6808471011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.73
|
| Rate for Payer: Aetna of WY Medicare |
$4.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.60
|
| Rate for Payer: Altius Commercial |
$6.60
|
| Rate for Payer: Beech Street Commercial |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.66
|
| Rate for Payer: Cigna of WY Commercial |
$6.73
|
| Rate for Payer: Entrust Commercial |
$6.53
|
| Rate for Payer: First Choice Health Commercial |
$6.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.98
|
| Rate for Payer: HealthUtah PPO |
$6.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.79
|
| Rate for Payer: One Health Plan of WY PPO |
$6.73
|
| Rate for Payer: PacificSource Commercial |
$6.18
|
| Rate for Payer: PHCS PPO |
$6.73
|
| Rate for Payer: Three Rivers PPO |
$5.15
|
| Rate for Payer: TriWest Veterans Administration |
$3.98
|
| Rate for Payer: United Healthcare Commercial |
$5.98
|
| Rate for Payer: United Healthcare Medicare |
$3.98
|
| Rate for Payer: WINHealth Partners Commercial |
$6.73
|
| Rate for Payer: Wise Provider Network Commercial |
$6.53
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [10947]
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 5026864611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.83
|
| Rate for Payer: Altius Commercial |
$4.83
|
| Rate for Payer: Beech Street Commercial |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.88
|
| Rate for Payer: Cigna of WY Commercial |
$4.93
|
| Rate for Payer: Entrust Commercial |
$4.78
|
| Rate for Payer: First Choice Health Commercial |
$4.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.32
|
| Rate for Payer: HealthUtah PPO |
$5.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.88
|
| Rate for Payer: Multiplan Medicare/VA |
$3.15
|
| Rate for Payer: One Health Plan of WY PPO |
$4.93
|
| Rate for Payer: PacificSource Commercial |
$4.53
|
| Rate for Payer: PHCS PPO |
$4.93
|
| Rate for Payer: Three Rivers PPO |
$3.77
|
| Rate for Payer: TriWest Veterans Administration |
$3.32
|
| Rate for Payer: United Healthcare Commercial |
$4.38
|
| Rate for Payer: United Healthcare Medicare |
$3.32
|
| Rate for Payer: WINHealth Partners Commercial |
$4.78
|
| Rate for Payer: Wise Provider Network Commercial |
$4.78
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [10947]
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 5026864611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.93
|
| Rate for Payer: Aetna of WY Medicare |
$3.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.83
|
| Rate for Payer: Altius Commercial |
$4.83
|
| Rate for Payer: Beech Street Commercial |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.88
|
| Rate for Payer: Cigna of WY Commercial |
$4.93
|
| Rate for Payer: Entrust Commercial |
$4.78
|
| Rate for Payer: First Choice Health Commercial |
$4.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.92
|
| Rate for Payer: HealthUtah PPO |
$5.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2.77
|
| Rate for Payer: One Health Plan of WY PPO |
$4.93
|
| Rate for Payer: PacificSource Commercial |
$4.53
|
| Rate for Payer: PHCS PPO |
$4.93
|
| Rate for Payer: Three Rivers PPO |
$3.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$4.38
|
| Rate for Payer: United Healthcare Medicare |
$2.92
|
| Rate for Payer: WINHealth Partners Commercial |
$4.93
|
| Rate for Payer: Wise Provider Network Commercial |
$4.78
|
|
