|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 6800143696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 2438599875
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Aetna of WY Medicare |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.35
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 5107959701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 5107959701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 6800143616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 6800143697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.66
|
| Rate for Payer: Aetna of WY Medicare |
$0.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.64
|
| Rate for Payer: Altius Commercial |
$0.64
|
| Rate for Payer: Beech Street Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.65
|
| Rate for Payer: Cigna of WY Commercial |
$0.66
|
| Rate for Payer: Entrust Commercial |
$0.64
|
| Rate for Payer: First Choice Health Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.65
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.66
|
| Rate for Payer: PacificSource Commercial |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.66
|
| Rate for Payer: Three Rivers PPO |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.58
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.66
|
| Rate for Payer: Wise Provider Network Commercial |
$0.64
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 6800143696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 6800143616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 8770140653
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Aetna of WY Medicare |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.35
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 2438599875
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 8770140653
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.35
|
| Rate for Payer: Altius Commercial |
$0.35
|
| Rate for Payer: Beech Street Commercial |
$0.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.35
|
| Rate for Payer: Cigna of WY Commercial |
$0.35
|
| Rate for Payer: Entrust Commercial |
$0.34
|
| Rate for Payer: First Choice Health Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.35
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.35
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.35
|
| Rate for Payer: Three Rivers PPO |
$0.27
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.34
|
|
|
CETIRIZINE 5 MG TABLET [3234]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0378363501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
| Rate for Payer: Aetna of WY Medicare |
$0.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
| Rate for Payer: Altius Commercial |
$0.51
|
| Rate for Payer: Beech Street Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
| Rate for Payer: Cigna of WY Commercial |
$0.52
|
| Rate for Payer: Entrust Commercial |
$0.50
|
| Rate for Payer: First Choice Health Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.31
|
| Rate for Payer: HealthUtah PPO |
$0.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.52
|
| Rate for Payer: PacificSource Commercial |
$0.48
|
| Rate for Payer: PHCS PPO |
$0.52
|
| Rate for Payer: Three Rivers PPO |
$0.40
|
| Rate for Payer: TriWest Veterans Administration |
$0.31
|
| Rate for Payer: United Healthcare Commercial |
$0.46
|
| Rate for Payer: United Healthcare Medicare |
$0.31
|
| Rate for Payer: WINHealth Partners Commercial |
$0.52
|
| Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
|
CETIRIZINE 5 MG TABLET [3234]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0378363501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
| Rate for Payer: Altius Commercial |
$0.51
|
| Rate for Payer: Beech Street Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
| Rate for Payer: Cigna of WY Commercial |
$0.52
|
| Rate for Payer: Entrust Commercial |
$0.50
|
| Rate for Payer: First Choice Health Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.52
|
| Rate for Payer: PacificSource Commercial |
$0.48
|
| Rate for Payer: PHCS PPO |
$0.52
|
| Rate for Payer: Three Rivers PPO |
$0.40
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.46
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.50
|
| Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
|
CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$304.78
|
| Rate for Payer: Beech Street Commercial |
$295.45
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$301.67
|
| Rate for Payer: Cigna of WY Commercial |
$304.78
|
| Rate for Payer: First Choice Health Commercial |
$279.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$295.45
|
| Rate for Payer: HealthUtah PPO |
$311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$301.67
|
| Rate for Payer: One Health Plan of WY PPO |
$304.78
|
| Rate for Payer: PacificSource Commercial |
$279.90
|
| Rate for Payer: PHCS PPO |
$295.45
|
| Rate for Payer: Three Rivers PPO |
$233.25
|
| Rate for Payer: United Healthcare Commercial |
$270.57
|
| Rate for Payer: WINHealth Partners Commercial |
$264.35
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
17250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$36.32
|
| Rate for Payer: Beech Street Commercial |
$175.75
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: First Choice Health Commercial |
$166.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.32
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$30.87
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$175.75
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$36.32
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$36.32
|
| Rate for Payer: WINHealth Partners Commercial |
$157.25
|
|
|
CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 64643
|
| Hospital Charge Code |
64643
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$359.66
|
| Rate for Payer: Aetna of WY Medicare |
$66.38
|
| Rate for Payer: Beech Street Commercial |
$348.65
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.99
|
| Rate for Payer: Cigna of WY Commercial |
$359.66
|
| Rate for Payer: First Choice Health Commercial |
$330.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$348.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.38
|
| Rate for Payer: HealthUtah PPO |
$367.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.99
|
| Rate for Payer: Multiplan Medicare/VA |
$56.42
|
| Rate for Payer: One Health Plan of WY PPO |
$359.66
|
| Rate for Payer: PacificSource Commercial |
$330.30
|
| Rate for Payer: PHCS PPO |
$348.65
|
| Rate for Payer: Three Rivers PPO |
$275.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.38
|
| Rate for Payer: United Healthcare Commercial |
$319.29
|
| Rate for Payer: United Healthcare Medicare |
$66.38
|
| Rate for Payer: WINHealth Partners Commercial |
$311.95
|
|
|
CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
64616
|
| Min. Negotiated Rate |
$88.35 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$103.94
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.94
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$88.35
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$103.94
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$103.94
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
|
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
64647
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$825.16
|
| Rate for Payer: Aetna of WY Medicare |
$126.59
|
| Rate for Payer: Beech Street Commercial |
$799.90
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$816.74
|
| Rate for Payer: Cigna of WY Commercial |
$825.16
|
| Rate for Payer: First Choice Health Commercial |
$757.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.59
|
| Rate for Payer: HealthUtah PPO |
$842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$816.74
|
| Rate for Payer: Multiplan Medicare/VA |
$107.60
|
| Rate for Payer: One Health Plan of WY PPO |
$825.16
|
| Rate for Payer: PacificSource Commercial |
$757.80
|
| Rate for Payer: PHCS PPO |
$799.90
|
| Rate for Payer: Three Rivers PPO |
$631.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.59
|
| Rate for Payer: United Healthcare Commercial |
$732.54
|
| Rate for Payer: United Healthcare Medicare |
$126.59
|
| Rate for Payer: WINHealth Partners Commercial |
$715.70
|
|
|
CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 64646
|
| Hospital Charge Code |
64646
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.28
|
| Rate for Payer: Aetna of WY Medicare |
$110.09
|
| Rate for Payer: Beech Street Commercial |
$699.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.92
|
| Rate for Payer: Cigna of WY Commercial |
$721.28
|
| Rate for Payer: First Choice Health Commercial |
$662.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.09
|
| Rate for Payer: HealthUtah PPO |
$736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.92
|
| Rate for Payer: Multiplan Medicare/VA |
$93.58
|
| Rate for Payer: One Health Plan of WY PPO |
$721.28
|
| Rate for Payer: PacificSource Commercial |
$662.40
|
| Rate for Payer: PHCS PPO |
$699.20
|
| Rate for Payer: Three Rivers PPO |
$552.00
|
| Rate for Payer: TriWest Veterans Administration |
$110.09
|
| Rate for Payer: United Healthcare Commercial |
$640.32
|
| Rate for Payer: United Healthcare Medicare |
$110.09
|
| Rate for Payer: WINHealth Partners Commercial |
$625.60
|
|
|
CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 64642
|
| Hospital Charge Code |
64642
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$102.02
|
| Rate for Payer: Beech Street Commercial |
$522.50
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: First Choice Health Commercial |
$495.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.02
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$86.72
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$522.50
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$102.02
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$102.02
|
| Rate for Payer: WINHealth Partners Commercial |
$467.50
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
64615
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$115.77
|
| Rate for Payer: Beech Street Commercial |
$597.55
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: First Choice Health Commercial |
$566.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.77
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$98.40
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$597.55
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$115.77
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Medicare |
$115.77
|
| Rate for Payer: WINHealth Partners Commercial |
$534.65
|
|
|
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 64612 50
|
| Hospital Charge Code |
64612
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,321.04
|
| Rate for Payer: Aetna of WY Medicare |
$115.32
|
| Rate for Payer: Beech Street Commercial |
$1,280.60
|
| Rate for Payer: Cash Price |
$943.60
|
| Rate for Payer: Cash Price |
$943.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,307.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,321.04
|
| Rate for Payer: First Choice Health Commercial |
$1,213.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,280.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.32
|
| Rate for Payer: HealthUtah PPO |
$1,348.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,307.56
|
| Rate for Payer: Multiplan Medicare/VA |
$98.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,321.04
|
| Rate for Payer: PacificSource Commercial |
$1,213.20
|
| Rate for Payer: PHCS PPO |
$1,280.60
|
| Rate for Payer: Three Rivers PPO |
$1,011.00
|
| Rate for Payer: TriWest Veterans Administration |
$115.32
|
| Rate for Payer: United Healthcare Commercial |
$1,172.76
|
| Rate for Payer: United Healthcare Medicare |
$115.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.80
|
|
|
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 64612
|
| Hospital Charge Code |
64612
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Medicare |
$115.32
|
| Rate for Payer: Beech Street Commercial |
$640.30
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: First Choice Health Commercial |
$606.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.32
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Multiplan Medicare/VA |
$98.02
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$640.30
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.32
|
| Rate for Payer: United Healthcare Commercial |
$586.38
|
| Rate for Payer: United Healthcare Medicare |
$115.32
|
| Rate for Payer: WINHealth Partners Commercial |
$572.90
|
|
|
CHEMO LOW-SORB 20 DROP
|
Facility
|
IP
|
$16.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.70
|
| Rate for Payer: Altius Commercial |
$15.70
|
| Rate for Payer: Beech Street Commercial |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.02
|
| Rate for Payer: Entrust Commercial |
$15.53
|
| Rate for Payer: First Choice Health Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.79
|
| Rate for Payer: HealthUtah PPO |
$16.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.86
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$16.02
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.02
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
| Rate for Payer: WINHealth Partners Commercial |
$15.53
|
| Rate for Payer: Wise Provider Network Commercial |
$15.53
|
|
|
CHEMO LOW-SORB 20 DROP
|
Facility
|
OP
|
$16.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.02
|
| Rate for Payer: Aetna of WY Medicare |
$10.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.70
|
| Rate for Payer: Altius Commercial |
$15.70
|
| Rate for Payer: Beech Street Commercial |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.02
|
| Rate for Payer: Entrust Commercial |
$15.53
|
| Rate for Payer: First Choice Health Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.48
|
| Rate for Payer: HealthUtah PPO |
$16.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.01
|
| Rate for Payer: One Health Plan of WY PPO |
$16.02
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.02
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WINHealth Partners Commercial |
$16.02
|
| Rate for Payer: Wise Provider Network Commercial |
$15.53
|
|
