|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
IP
|
$16.16
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.51
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.27
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.67
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$14.06
|
| Rate for Payer: United Healthcare Medicare |
$10.67
|
| Rate for Payer: WINHealth Partners Commercial |
$15.35
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [11676]
|
Facility
|
OP
|
$16.16
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.84
|
| Rate for Payer: Aetna of WY Medicare |
$10.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.51
|
| Rate for Payer: Altius Commercial |
$15.51
|
| Rate for Payer: Beech Street Commercial |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.27
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.68
|
| Rate for Payer: Cigna of WY Commercial |
$15.84
|
| Rate for Payer: Entrust Commercial |
$15.35
|
| Rate for Payer: First Choice Health Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.37
|
| Rate for Payer: HealthUtah PPO |
$16.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.84
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.84
|
| Rate for Payer: Three Rivers PPO |
$12.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.37
|
| Rate for Payer: United Healthcare Commercial |
$14.06
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WINHealth Partners Commercial |
$15.84
|
| Rate for Payer: Wise Provider Network Commercial |
$15.35
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 6808424311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 6808424301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 6808424301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CLINDAMYCIN HCL 150 MG CAPSULE [6021]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 6808424311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CLIPPER BLADE 3M #9680 NEW
|
Facility
|
IP
|
$7.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.99
|
| Rate for Payer: Altius Commercial |
$6.99
|
| Rate for Payer: Beech Street Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.98
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.06
|
| Rate for Payer: Cigna of WY Commercial |
$7.13
|
| Rate for Payer: Entrust Commercial |
$6.92
|
| Rate for Payer: First Choice Health Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.80
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.56
|
| Rate for Payer: One Health Plan of WY PPO |
$7.13
|
| Rate for Payer: PacificSource Commercial |
$6.55
|
| Rate for Payer: PHCS PPO |
$7.13
|
| Rate for Payer: Three Rivers PPO |
$5.46
|
| Rate for Payer: TriWest Veterans Administration |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.92
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CLIPPER BLADE 3M #9680 NEW
|
Facility
|
OP
|
$7.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.13
|
| Rate for Payer: Aetna of WY Medicare |
$4.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.99
|
| Rate for Payer: Altius Commercial |
$6.99
|
| Rate for Payer: Beech Street Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.98
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.06
|
| Rate for Payer: Cigna of WY Commercial |
$7.13
|
| Rate for Payer: Entrust Commercial |
$6.92
|
| Rate for Payer: First Choice Health Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$7.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7.13
|
| Rate for Payer: PacificSource Commercial |
$6.55
|
| Rate for Payer: PHCS PPO |
$7.13
|
| Rate for Payer: Three Rivers PPO |
$5.46
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$7.13
|
| Rate for Payer: Wise Provider Network Commercial |
$6.92
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 5167212582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.76
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.76
|
| Rate for Payer: WINHealth Partners Commercial |
$2.54
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 6923815323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 5167212582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Aetna of WY Medicare |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.55
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 4229107630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.44
|
| Rate for Payer: Altius Commercial |
$0.44
|
| Rate for Payer: Beech Street Commercial |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.45
|
| Rate for Payer: Cigna of WY Commercial |
$0.45
|
| Rate for Payer: Entrust Commercial |
$0.44
|
| Rate for Payer: First Choice Health Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.27
|
| Rate for Payer: HealthUtah PPO |
$0.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.45
|
| Rate for Payer: Multiplan Medicare/VA |
$0.25
|
| Rate for Payer: One Health Plan of WY PPO |
$0.45
|
| Rate for Payer: PacificSource Commercial |
$0.41
|
| Rate for Payer: PHCS PPO |
$0.45
|
| Rate for Payer: Three Rivers PPO |
$0.35
|
| Rate for Payer: TriWest Veterans Administration |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$0.40
|
| Rate for Payer: United Healthcare Medicare |
$0.27
|
| Rate for Payer: WINHealth Partners Commercial |
$0.45
|
| Rate for Payer: Wise Provider Network Commercial |
$0.44
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 2192201605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.30
|
| Rate for Payer: Aetna of WY Medicare |
$0.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.28
|
| Rate for Payer: Altius Commercial |
$1.28
|
| Rate for Payer: Beech Street Commercial |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.09
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.29
|
| Rate for Payer: Cigna of WY Commercial |
$1.30
|
| Rate for Payer: Entrust Commercial |
$1.26
|
| Rate for Payer: First Choice Health Commercial |
$1.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.30
|
| Rate for Payer: PacificSource Commercial |
$1.20
|
| Rate for Payer: PHCS PPO |
$1.30
|
| Rate for Payer: Three Rivers PPO |
$1.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1.26
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 6923815323
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 4229107630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.44
|
| Rate for Payer: Altius Commercial |
$0.44
|
| Rate for Payer: Beech Street Commercial |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.45
|
| Rate for Payer: Cigna of WY Commercial |
$0.45
|
| Rate for Payer: Entrust Commercial |
$0.44
|
| Rate for Payer: First Choice Health Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.45
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.45
|
| Rate for Payer: PacificSource Commercial |
$0.41
|
| Rate for Payer: PHCS PPO |
$0.45
|
| Rate for Payer: Three Rivers PPO |
$0.35
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.40
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.44
|
| Rate for Payer: Wise Provider Network Commercial |
$0.44
|
|
|
CLOBETASOL 0.05 % TOPICAL CREAM [5876]
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 2192201605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.28
|
| Rate for Payer: Altius Commercial |
$1.28
|
| Rate for Payer: Beech Street Commercial |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.09
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.29
|
| Rate for Payer: Cigna of WY Commercial |
$1.30
|
| Rate for Payer: Entrust Commercial |
$1.26
|
| Rate for Payer: First Choice Health Commercial |
$1.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.88
|
| Rate for Payer: HealthUtah PPO |
$1.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1.30
|
| Rate for Payer: PacificSource Commercial |
$1.20
|
| Rate for Payer: PHCS PPO |
$1.30
|
| Rate for Payer: Three Rivers PPO |
$1.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.16
|
| Rate for Payer: United Healthcare Medicare |
$0.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1.26
|
| Rate for Payer: Wise Provider Network Commercial |
$1.26
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET [28034]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 4988430702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Aetna of WY Medicare |
$2.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.62
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.25 MG DISINTEGRATING TABLET [28034]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 4988430702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.44
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.31
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.44
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3.51
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 4988430802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Aetna of WY Medicare |
$2.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.62
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 6233236606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.66
|
| Rate for Payer: Aetna of WY Medicare |
$2.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.58
|
| Rate for Payer: Altius Commercial |
$3.58
|
| Rate for Payer: Beech Street Commercial |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.06
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.62
|
| Rate for Payer: Cigna of WY Commercial |
$3.66
|
| Rate for Payer: Entrust Commercial |
$3.54
|
| Rate for Payer: First Choice Health Commercial |
$3.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.16
|
| Rate for Payer: HealthUtah PPO |
$3.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.62
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.66
|
| Rate for Payer: PacificSource Commercial |
$3.36
|
| Rate for Payer: PHCS PPO |
$3.66
|
| Rate for Payer: Three Rivers PPO |
$2.80
|
| Rate for Payer: TriWest Veterans Administration |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$3.25
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3.66
|
| Rate for Payer: Wise Provider Network Commercial |
$3.54
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 6233236606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.58
|
| Rate for Payer: Altius Commercial |
$3.58
|
| Rate for Payer: Beech Street Commercial |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.06
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.62
|
| Rate for Payer: Cigna of WY Commercial |
$3.66
|
| Rate for Payer: Entrust Commercial |
$3.54
|
| Rate for Payer: First Choice Health Commercial |
$3.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.46
|
| Rate for Payer: HealthUtah PPO |
$3.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.62
|
| Rate for Payer: Multiplan Medicare/VA |
$2.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3.66
|
| Rate for Payer: PacificSource Commercial |
$3.36
|
| Rate for Payer: PHCS PPO |
$3.66
|
| Rate for Payer: Three Rivers PPO |
$2.80
|
| Rate for Payer: TriWest Veterans Administration |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$3.25
|
| Rate for Payer: United Healthcare Medicare |
$2.46
|
| Rate for Payer: WINHealth Partners Commercial |
$3.54
|
| Rate for Payer: Wise Provider Network Commercial |
$3.54
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 4988430802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.44
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.31
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.44
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3.51
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 4988430852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.44
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.31
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.44
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3.51
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.5 MG DISINTEGRATING TABLET [28035]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 4988430852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.62
|
| Rate for Payer: Aetna of WY Medicare |
$2.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.54
|
| Rate for Payer: Altius Commercial |
$3.54
|
| Rate for Payer: Beech Street Commercial |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.58
|
| Rate for Payer: Cigna of WY Commercial |
$3.62
|
| Rate for Payer: Entrust Commercial |
$3.51
|
| Rate for Payer: First Choice Health Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.58
|
| Rate for Payer: Multiplan Medicare/VA |
$2.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3.62
|
| Rate for Payer: PacificSource Commercial |
$3.32
|
| Rate for Payer: PHCS PPO |
$3.62
|
| Rate for Payer: Three Rivers PPO |
$2.77
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.62
|
| Rate for Payer: Wise Provider Network Commercial |
$3.51
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 6068754401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.31
|
| Rate for Payer: Aetna of WY Medicare |
$1.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.27
|
| Rate for Payer: Altius Commercial |
$2.27
|
| Rate for Payer: Beech Street Commercial |
$2.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.29
|
| Rate for Payer: Cigna of WY Commercial |
$2.31
|
| Rate for Payer: Entrust Commercial |
$2.24
|
| Rate for Payer: First Choice Health Commercial |
$2.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.37
|
| Rate for Payer: HealthUtah PPO |
$2.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2.31
|
| Rate for Payer: PacificSource Commercial |
$2.12
|
| Rate for Payer: PHCS PPO |
$2.31
|
| Rate for Payer: Three Rivers PPO |
$1.77
|
| Rate for Payer: TriWest Veterans Administration |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$2.05
|
| Rate for Payer: United Healthcare Medicare |
$1.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2.31
|
| Rate for Payer: Wise Provider Network Commercial |
$2.24
|
|
