|
CHLORDIAZEPOXIDE 25 MG CAPSULE [10717]
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0555015902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.63
|
| Rate for Payer: Altius Commercial |
$0.63
|
| Rate for Payer: Beech Street Commercial |
$0.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.64
|
| Rate for Payer: Cigna of WY Commercial |
$0.65
|
| Rate for Payer: Entrust Commercial |
$0.63
|
| Rate for Payer: First Choice Health Commercial |
$0.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.44
|
| Rate for Payer: HealthUtah PPO |
$0.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.64
|
| Rate for Payer: Multiplan Medicare/VA |
$0.41
|
| Rate for Payer: One Health Plan of WY PPO |
$0.65
|
| Rate for Payer: PacificSource Commercial |
$0.59
|
| Rate for Payer: PHCS PPO |
$0.65
|
| Rate for Payer: Three Rivers PPO |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
| Rate for Payer: WINHealth Partners Commercial |
$0.63
|
| Rate for Payer: Wise Provider Network Commercial |
$0.63
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [39510]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 6068761644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [39510]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 6068771444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [39510]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 6068761644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH [39510]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 6068771444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 5026816315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Aetna of WY Medicare |
$5.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.19
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$4.93
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
| Rate for Payer: WINHealth Partners Commercial |
$8.77
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Aetna of WY Medicare |
$5.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.19
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$4.93
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
| Rate for Payer: WINHealth Partners Commercial |
$8.77
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 5026816315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.91
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5.61
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WINHealth Partners Commercial |
$8.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.91
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5.61
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WINHealth Partners Commercial |
$8.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
CHOLANGIOGRAM CATH 20018-M55
|
Facility
|
OP
|
$106.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.55 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.13
|
| Rate for Payer: Aetna of WY Medicare |
$70.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.01
|
| Rate for Payer: Altius Commercial |
$102.01
|
| Rate for Payer: Beech Street Commercial |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.24
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.07
|
| Rate for Payer: Cigna of WY Commercial |
$104.13
|
| Rate for Payer: Entrust Commercial |
$100.95
|
| Rate for Payer: First Choice Health Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.63
|
| Rate for Payer: HealthUtah PPO |
$106.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.07
|
| Rate for Payer: Multiplan Medicare/VA |
$58.55
|
| Rate for Payer: One Health Plan of WY PPO |
$104.13
|
| Rate for Payer: PacificSource Commercial |
$95.63
|
| Rate for Payer: PHCS PPO |
$104.13
|
| Rate for Payer: Three Rivers PPO |
$79.70
|
| Rate for Payer: TriWest Veterans Administration |
$61.63
|
| Rate for Payer: United Healthcare Commercial |
$92.45
|
| Rate for Payer: United Healthcare Medicare |
$61.63
|
| Rate for Payer: WINHealth Partners Commercial |
$104.13
|
| Rate for Payer: Wise Provider Network Commercial |
$100.95
|
|
|
CHOLANGIOGRAM CATH 20018-M55
|
Facility
|
IP
|
$106.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.01
|
| Rate for Payer: Altius Commercial |
$102.01
|
| Rate for Payer: Beech Street Commercial |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.24
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.07
|
| Rate for Payer: Cigna of WY Commercial |
$104.13
|
| Rate for Payer: Entrust Commercial |
$100.95
|
| Rate for Payer: First Choice Health Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.13
|
| Rate for Payer: HealthUtah PPO |
$106.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.07
|
| Rate for Payer: Multiplan Medicare/VA |
$66.63
|
| Rate for Payer: One Health Plan of WY PPO |
$104.13
|
| Rate for Payer: PacificSource Commercial |
$95.63
|
| Rate for Payer: PHCS PPO |
$104.13
|
| Rate for Payer: Three Rivers PPO |
$79.70
|
| Rate for Payer: TriWest Veterans Administration |
$70.13
|
| Rate for Payer: United Healthcare Commercial |
$92.45
|
| Rate for Payer: United Healthcare Medicare |
$70.13
|
| Rate for Payer: WINHealth Partners Commercial |
$100.95
|
| Rate for Payer: Wise Provider Network Commercial |
$100.95
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE [43485]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 7583402001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.58
|
| Rate for Payer: Altius Commercial |
$0.58
|
| Rate for Payer: Beech Street Commercial |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.58
|
| Rate for Payer: Cigna of WY Commercial |
$0.59
|
| Rate for Payer: Entrust Commercial |
$0.57
|
| Rate for Payer: First Choice Health Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.40
|
| Rate for Payer: HealthUtah PPO |
$0.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.58
|
| Rate for Payer: Multiplan Medicare/VA |
$0.38
|
| Rate for Payer: One Health Plan of WY PPO |
$0.59
|
| Rate for Payer: PacificSource Commercial |
$0.54
|
| Rate for Payer: PHCS PPO |
$0.59
|
| Rate for Payer: Three Rivers PPO |
$0.45
|
| Rate for Payer: TriWest Veterans Administration |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.52
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.57
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE [43485]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 7583402001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.59
|
| Rate for Payer: Aetna of WY Medicare |
$0.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.58
|
| Rate for Payer: Altius Commercial |
$0.58
|
| Rate for Payer: Beech Street Commercial |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.58
|
| Rate for Payer: Cigna of WY Commercial |
$0.59
|
| Rate for Payer: Entrust Commercial |
$0.57
|
| Rate for Payer: First Choice Health Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.58
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.59
|
| Rate for Payer: PacificSource Commercial |
$0.54
|
| Rate for Payer: PHCS PPO |
$0.59
|
| Rate for Payer: Three Rivers PPO |
$0.45
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.52
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.59
|
| Rate for Payer: Wise Provider Network Commercial |
$0.57
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
NDC 5026886815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.20
|
| Rate for Payer: Altius Commercial |
$1.20
|
| Rate for Payer: Beech Street Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.21
|
| Rate for Payer: Cigna of WY Commercial |
$1.22
|
| Rate for Payer: Entrust Commercial |
$1.19
|
| Rate for Payer: First Choice Health Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.83
|
| Rate for Payer: HealthUtah PPO |
$1.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.22
|
| Rate for Payer: PacificSource Commercial |
$1.12
|
| Rate for Payer: PHCS PPO |
$1.22
|
| Rate for Payer: Three Rivers PPO |
$0.94
|
| Rate for Payer: TriWest Veterans Administration |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
| Rate for Payer: United Healthcare Medicare |
$0.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1.19
|
| Rate for Payer: Wise Provider Network Commercial |
$1.19
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
NDC 5026886815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.20
|
| Rate for Payer: Altius Commercial |
$1.20
|
| Rate for Payer: Beech Street Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.21
|
| Rate for Payer: Cigna of WY Commercial |
$1.22
|
| Rate for Payer: Entrust Commercial |
$1.19
|
| Rate for Payer: First Choice Health Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.73
|
| Rate for Payer: HealthUtah PPO |
$1.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1.22
|
| Rate for Payer: PacificSource Commercial |
$1.12
|
| Rate for Payer: PHCS PPO |
$1.22
|
| Rate for Payer: Three Rivers PPO |
$0.94
|
| Rate for Payer: TriWest Veterans Administration |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1.19
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
OP
|
$1.25
|
|
|
Service Code
|
NDC 5026886811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.20
|
| Rate for Payer: Altius Commercial |
$1.20
|
| Rate for Payer: Beech Street Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.21
|
| Rate for Payer: Cigna of WY Commercial |
$1.22
|
| Rate for Payer: Entrust Commercial |
$1.19
|
| Rate for Payer: First Choice Health Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.73
|
| Rate for Payer: HealthUtah PPO |
$1.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1.22
|
| Rate for Payer: PacificSource Commercial |
$1.12
|
| Rate for Payer: PHCS PPO |
$1.22
|
| Rate for Payer: Three Rivers PPO |
$0.94
|
| Rate for Payer: TriWest Veterans Administration |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1.19
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
NDC 5026886811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.20
|
| Rate for Payer: Altius Commercial |
$1.20
|
| Rate for Payer: Beech Street Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.21
|
| Rate for Payer: Cigna of WY Commercial |
$1.22
|
| Rate for Payer: Entrust Commercial |
$1.19
|
| Rate for Payer: First Choice Health Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.83
|
| Rate for Payer: HealthUtah PPO |
$1.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.22
|
| Rate for Payer: PacificSource Commercial |
$1.12
|
| Rate for Payer: PHCS PPO |
$1.22
|
| Rate for Payer: Three Rivers PPO |
$0.94
|
| Rate for Payer: TriWest Veterans Administration |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
| Rate for Payer: United Healthcare Medicare |
$0.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1.19
|
| Rate for Payer: Wise Provider Network Commercial |
$1.19
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 5026886615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.04
|
| Rate for Payer: Altius Commercial |
$1.04
|
| Rate for Payer: Beech Street Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.05
|
| Rate for Payer: Cigna of WY Commercial |
$1.06
|
| Rate for Payer: Entrust Commercial |
$1.03
|
| Rate for Payer: First Choice Health Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.06
|
| Rate for Payer: PacificSource Commercial |
$0.97
|
| Rate for Payer: PHCS PPO |
$1.06
|
| Rate for Payer: Three Rivers PPO |
$0.81
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 8770140752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 8770140752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Aetna of WY Medicare |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 5026886611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.04
|
| Rate for Payer: Altius Commercial |
$1.04
|
| Rate for Payer: Beech Street Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.05
|
| Rate for Payer: Cigna of WY Commercial |
$1.06
|
| Rate for Payer: Entrust Commercial |
$1.03
|
| Rate for Payer: First Choice Health Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.06
|
| Rate for Payer: PacificSource Commercial |
$0.97
|
| Rate for Payer: PHCS PPO |
$1.06
|
| Rate for Payer: Three Rivers PPO |
$0.81
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 5026886615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.06
|
| Rate for Payer: Aetna of WY Medicare |
$0.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.04
|
| Rate for Payer: Altius Commercial |
$1.04
|
| Rate for Payer: Beech Street Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.05
|
| Rate for Payer: Cigna of WY Commercial |
$1.06
|
| Rate for Payer: Entrust Commercial |
$1.03
|
| Rate for Payer: First Choice Health Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$1.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1.06
|
| Rate for Payer: PacificSource Commercial |
$0.97
|
| Rate for Payer: PHCS PPO |
$1.06
|
| Rate for Payer: Three Rivers PPO |
$0.81
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 5026886611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.06
|
| Rate for Payer: Aetna of WY Medicare |
$0.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.04
|
| Rate for Payer: Altius Commercial |
$1.04
|
| Rate for Payer: Beech Street Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.05
|
| Rate for Payer: Cigna of WY Commercial |
$1.06
|
| Rate for Payer: Entrust Commercial |
$1.03
|
| Rate for Payer: First Choice Health Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$1.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1.06
|
| Rate for Payer: PacificSource Commercial |
$0.97
|
| Rate for Payer: PHCS PPO |
$1.06
|
| Rate for Payer: Three Rivers PPO |
$0.81
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 2055503300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 4098527139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.05
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.05
|
| Rate for Payer: Beech Street Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.05
|
| Rate for Payer: Cigna of WY Commercial |
$0.05
|
| Rate for Payer: Entrust Commercial |
$0.05
|
| Rate for Payer: First Choice Health Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.05
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.05
|
| Rate for Payer: Three Rivers PPO |
$0.04
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.05
|
| Rate for Payer: Wise Provider Network Commercial |
$0.05
|
|
