|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 6068754401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.31
|
| 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 |
$1.56
|
| Rate for Payer: HealthUtah PPO |
$2.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1.48
|
| 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 |
$1.56
|
| Rate for Payer: United Healthcare Commercial |
$2.05
|
| Rate for Payer: United Healthcare Medicare |
$1.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2.24
|
|
|
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
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 6068754411
|
|
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
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 6068754411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.31
|
| 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 |
$1.56
|
| Rate for Payer: HealthUtah PPO |
$2.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1.48
|
| 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 |
$1.56
|
| Rate for Payer: United Healthcare Commercial |
$2.05
|
| Rate for Payer: United Healthcare Medicare |
$1.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2.24
|
|
|
CLONAZEPAM 0.5 MG TABLET [4805]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 7288815201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.10
|
| Rate for Payer: Altius Commercial |
$0.10
|
| Rate for Payer: Beech Street Commercial |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.10
|
| Rate for Payer: Cigna of WY Commercial |
$0.10
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.10
|
| Rate for Payer: PacificSource Commercial |
$0.09
|
| Rate for Payer: PHCS PPO |
$0.10
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.09
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 6068755511
|
|
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
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 6068755501
|
|
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
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 6068755501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.31
|
| 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 |
$1.56
|
| Rate for Payer: HealthUtah PPO |
$2.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1.48
|
| 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 |
$1.56
|
| Rate for Payer: United Healthcare Commercial |
$2.05
|
| Rate for Payer: United Healthcare Medicare |
$1.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2.24
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 1672913700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.13
|
| Rate for Payer: Altius Commercial |
$0.13
|
| Rate for Payer: Beech Street Commercial |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.14
|
| Rate for Payer: Cigna of WY Commercial |
$0.14
|
| Rate for Payer: Entrust Commercial |
$0.13
|
| Rate for Payer: First Choice Health Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.14
|
| Rate for Payer: PacificSource Commercial |
$0.13
|
| Rate for Payer: PHCS PPO |
$0.14
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.13
|
| Rate for Payer: Wise Provider Network Commercial |
$0.13
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 6068755511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.31
|
| 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 |
$1.56
|
| Rate for Payer: HealthUtah PPO |
$2.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.29
|
| Rate for Payer: Multiplan Medicare/VA |
$1.48
|
| 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 |
$1.56
|
| Rate for Payer: United Healthcare Commercial |
$2.05
|
| Rate for Payer: United Healthcare Medicare |
$1.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2.24
|
|
|
CLONAZEPAM 1 MG TABLET [5534]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 1672913700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.13
|
| Rate for Payer: Altius Commercial |
$0.13
|
| Rate for Payer: Beech Street Commercial |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.14
|
| Rate for Payer: Cigna of WY Commercial |
$0.14
|
| Rate for Payer: Entrust Commercial |
$0.13
|
| Rate for Payer: First Choice Health Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.08
|
| Rate for Payer: HealthUtah PPO |
$0.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.14
|
| Rate for Payer: PacificSource Commercial |
$0.13
|
| Rate for Payer: PHCS PPO |
$0.14
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$0.08
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.13
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 6068711301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 6068711311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 6068711301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.1 MG TABLET [1387]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 6068711311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
NDC 6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 6068712401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLONIDINE HCL 0.2 MG TABLET [9951]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
NDC 6068712411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.17
|
| Rate for Payer: Altius Commercial |
$1.17
|
| Rate for Payer: Beech Street Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.18
|
| Rate for Payer: Cigna of WY Commercial |
$1.20
|
| Rate for Payer: Entrust Commercial |
$1.16
|
| Rate for Payer: First Choice Health Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.18
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.20
|
| Rate for Payer: PacificSource Commercial |
$1.10
|
| Rate for Payer: PHCS PPO |
$1.20
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1.16
|
|
|
CLOPIDOGREL 300 MG TABLET [46089]
|
Facility
|
OP
|
$31.20
|
|
|
Service Code
|
NDC 6808475218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.58
|
| Rate for Payer: Aetna of WY Medicare |
$20.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.95
|
| Rate for Payer: Altius Commercial |
$29.95
|
| Rate for Payer: Beech Street Commercial |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.62
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.26
|
| Rate for Payer: Cigna of WY Commercial |
$30.58
|
| Rate for Payer: Entrust Commercial |
$29.64
|
| Rate for Payer: First Choice Health Commercial |
$29.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.10
|
| Rate for Payer: HealthUtah PPO |
$31.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.26
|
| Rate for Payer: Multiplan Medicare/VA |
$17.19
|
| Rate for Payer: One Health Plan of WY PPO |
$30.58
|
| Rate for Payer: PacificSource Commercial |
$28.08
|
| Rate for Payer: PHCS PPO |
$30.58
|
| Rate for Payer: Three Rivers PPO |
$23.40
|
| Rate for Payer: TriWest Veterans Administration |
$18.10
|
| Rate for Payer: United Healthcare Commercial |
$27.14
|
| Rate for Payer: United Healthcare Medicare |
$18.10
|
| Rate for Payer: WINHealth Partners Commercial |
$30.58
|
| Rate for Payer: Wise Provider Network Commercial |
$29.64
|
|
|
CLOPIDOGREL 300 MG TABLET [46089]
|
Facility
|
IP
|
$31.20
|
|
|
Service Code
|
NDC 6808475218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.95
|
| Rate for Payer: Altius Commercial |
$29.95
|
| Rate for Payer: Beech Street Commercial |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.62
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.26
|
| Rate for Payer: Cigna of WY Commercial |
$30.58
|
| Rate for Payer: Entrust Commercial |
$29.64
|
| Rate for Payer: First Choice Health Commercial |
$29.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.59
|
| Rate for Payer: HealthUtah PPO |
$31.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.26
|
| Rate for Payer: Multiplan Medicare/VA |
$19.56
|
| Rate for Payer: One Health Plan of WY PPO |
$30.58
|
| Rate for Payer: PacificSource Commercial |
$28.08
|
| Rate for Payer: PHCS PPO |
$30.58
|
| Rate for Payer: Three Rivers PPO |
$23.40
|
| Rate for Payer: TriWest Veterans Administration |
$20.59
|
| Rate for Payer: United Healthcare Commercial |
$27.14
|
| Rate for Payer: United Healthcare Medicare |
$20.59
|
| Rate for Payer: WINHealth Partners Commercial |
$29.64
|
| Rate for Payer: Wise Provider Network Commercial |
$29.64
|
|
|
CLOPIDOGREL 75 MG TABLET [7032]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 6808453611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
CLOPIDOGREL 75 MG TABLET [7032]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 6808453601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$0.99
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
CLOPIDOGREL 75 MG TABLET [7032]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 6808453601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
CLOPIDOGREL 75 MG TABLET [7032]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 6808453611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$0.99
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
