ZOLPIDEM ER 6.25 MG TABLET,EXTENDED RELEASE,MULTIPHASE [39327]
|
Facility
|
IP
|
$1.00
|
|
Service Code
|
NDC 4733530788
|
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
|
|
ZOLPIDEM ER 6.25 MG TABLET,EXTENDED RELEASE,MULTIPHASE [39327]
|
Facility
|
OP
|
$1.00
|
|
Service Code
|
NDC 4733530788
|
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
|
|
ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$347.00
|
|
Service Code
|
HCPCS 90736
|
Hospital Charge Code |
90736
|
Min. Negotiated Rate |
$260.25 |
Max. Negotiated Rate |
$347.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
Rate for Payer: Beech Street Commercial |
$329.65
|
Rate for Payer: Cash Price |
$242.90
|
Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
Rate for Payer: Cigna of WY Commercial |
$340.06
|
Rate for Payer: First Choice Health Commercial |
$312.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
Rate for Payer: HealthUtah PPO |
$347.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
Rate for Payer: One Health Plan of WY PPO |
$340.06
|
Rate for Payer: PacificSource Commercial |
$312.30
|
Rate for Payer: PHCS PPO |
$329.65
|
Rate for Payer: Three Rivers PPO |
$260.25
|
Rate for Payer: United Healthcare Commercial |
$301.89
|
Rate for Payer: WINHealth Partners Commercial |
$347.00
|
|