|
HC CAMS BETAMETHASONE ACET&SOD PHOSP
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
HC CAMS COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.53 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.96
|
| Rate for Payer: Altius Commercial |
$672.96
|
| Rate for Payer: Beech Street Commercial |
$686.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$575.52
|
| Rate for Payer: Cash Price |
$490.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.97
|
| Rate for Payer: Cigna of WY Commercial |
$686.98
|
| Rate for Payer: Entrust Commercial |
$665.95
|
| Rate for Payer: First Choice Health Commercial |
$665.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.66
|
| Rate for Payer: HealthUtah PPO |
$701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.97
|
| Rate for Payer: Multiplan Medicare/VA |
$439.53
|
| Rate for Payer: One Health Plan of WY PPO |
$686.98
|
| Rate for Payer: PacificSource Commercial |
$630.90
|
| Rate for Payer: PHCS PPO |
$686.98
|
| Rate for Payer: Three Rivers PPO |
$525.75
|
| Rate for Payer: TriWest Veterans Administration |
$462.66
|
| Rate for Payer: United Healthcare Commercial |
$609.87
|
| Rate for Payer: United Healthcare Medicare |
$462.66
|
| Rate for Payer: WINHealth Partners Commercial |
$665.95
|
| Rate for Payer: Wise Provider Network Commercial |
$665.95
|
|
|
HC CAMS COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90710 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90710 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
6369071001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.25 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.98
|
| Rate for Payer: Aetna of WY Medicare |
$462.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.96
|
| Rate for Payer: Altius Commercial |
$672.96
|
| Rate for Payer: Beech Street Commercial |
$686.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$575.52
|
| Rate for Payer: Cash Price |
$490.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.97
|
| Rate for Payer: Cigna of WY Commercial |
$686.98
|
| Rate for Payer: Entrust Commercial |
$665.95
|
| Rate for Payer: First Choice Health Commercial |
$665.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.58
|
| Rate for Payer: HealthUtah PPO |
$701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.97
|
| Rate for Payer: Multiplan Medicare/VA |
$386.25
|
| Rate for Payer: One Health Plan of WY PPO |
$686.98
|
| Rate for Payer: PacificSource Commercial |
$630.90
|
| Rate for Payer: PHCS PPO |
$686.98
|
| Rate for Payer: Three Rivers PPO |
$525.75
|
| Rate for Payer: TriWest Veterans Administration |
$406.58
|
| Rate for Payer: United Healthcare Commercial |
$609.87
|
| Rate for Payer: United Healthcare Medicare |
$406.58
|
| Rate for Payer: WINHealth Partners Commercial |
$686.98
|
| Rate for Payer: Wise Provider Network Commercial |
$665.95
|
|
|
HC CAMS DEXAMETHASONE SODIUM PHOS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC CAMS DEXAMETHASONE SODIUM PHOS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC CAMS DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90723 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.79 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.78
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$208.79
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.78
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC CAMS DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$219.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.14
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.48
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.14
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$193.14
|
| Rate for Payer: WINHealth Partners Commercial |
$326.34
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC CAMS DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90723 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369072301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP IMMUNIZATION, IM, <7 YO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
6369070001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.96
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.66
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$63.33
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.66
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$66.66
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC CAMS DTAP IMMUNIZATION, IM, <7 YO
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369070001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP IMMUNIZATION, IM, <7 YO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
6369070001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$66.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.96
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.58
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$55.65
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$58.58
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$58.58
|
| Rate for Payer: WINHealth Partners Commercial |
$98.98
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC CAMS DTAP IMMUNIZATION, IM, <7 YO
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90700 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369070001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
6369069801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.54
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$137.31
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.54
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$144.54
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC CAMS DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90698 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369069801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90698 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369069801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
6369069801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$144.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.02
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$120.67
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.02
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$214.62
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC CAMS DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
6369069601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
| Rate for Payer: Altius Commercial |
$175.68
|
| Rate for Payer: Beech Street Commercial |
$179.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: Entrust Commercial |
$173.85
|
| Rate for Payer: First Choice Health Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.78
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$114.74
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$179.34
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$120.78
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$120.78
|
| Rate for Payer: WINHealth Partners Commercial |
$173.85
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC CAMS DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
6369069601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Aetna of WY Medicare |
$120.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
| Rate for Payer: Altius Commercial |
$175.68
|
| Rate for Payer: Beech Street Commercial |
$179.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: Entrust Commercial |
$173.85
|
| Rate for Payer: First Choice Health Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$179.34
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.14
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$106.14
|
| Rate for Payer: WINHealth Partners Commercial |
$179.34
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC CAMS ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
636J730701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$583.74 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$893.76
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$764.35
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$614.46
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$583.74
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$614.46
|
| Rate for Payer: United Healthcare Commercial |
$809.97
|
| Rate for Payer: United Healthcare Medicare |
$614.46
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CAMS ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
636J730701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$512.98 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$614.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$893.76
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$764.35
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.98
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$512.98
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$539.98
|
| Rate for Payer: United Healthcare Commercial |
$809.97
|
| Rate for Payer: United Healthcare Medicare |
$539.98
|
| Rate for Payer: WINHealth Partners Commercial |
$912.38
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CAMS HEPA/HEPB VACCINE ADULT IM
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
6369063601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.87 |
| Max. Negotiated Rate |
$419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$410.62
|
| Rate for Payer: Aetna of WY Medicare |
$276.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$402.24
|
| Rate for Payer: Altius Commercial |
$402.24
|
| Rate for Payer: Beech Street Commercial |
$410.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.00
|
| Rate for Payer: Cash Price |
$293.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$406.43
|
| Rate for Payer: Cigna of WY Commercial |
$410.62
|
| Rate for Payer: Entrust Commercial |
$398.05
|
| Rate for Payer: First Choice Health Commercial |
$398.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$398.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.02
|
| Rate for Payer: HealthUtah PPO |
$419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$406.43
|
| Rate for Payer: Multiplan Medicare/VA |
$230.87
|
| Rate for Payer: One Health Plan of WY PPO |
$410.62
|
| Rate for Payer: PacificSource Commercial |
$377.10
|
| Rate for Payer: PHCS PPO |
$410.62
|
| Rate for Payer: Three Rivers PPO |
$314.25
|
| Rate for Payer: TriWest Veterans Administration |
$243.02
|
| Rate for Payer: United Healthcare Commercial |
$364.53
|
| Rate for Payer: United Healthcare Medicare |
$243.02
|
| Rate for Payer: WINHealth Partners Commercial |
$410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$398.05
|
|
|
HC CAMS HEPA/HEPB VACCINE ADULT IM
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
6369063601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$410.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$402.24
|
| Rate for Payer: Altius Commercial |
$402.24
|
| Rate for Payer: Beech Street Commercial |
$410.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.00
|
| Rate for Payer: Cash Price |
$293.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$406.43
|
| Rate for Payer: Cigna of WY Commercial |
$410.62
|
| Rate for Payer: Entrust Commercial |
$398.05
|
| Rate for Payer: First Choice Health Commercial |
$398.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$398.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$276.54
|
| Rate for Payer: HealthUtah PPO |
$419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$406.43
|
| Rate for Payer: Multiplan Medicare/VA |
$262.71
|
| Rate for Payer: One Health Plan of WY PPO |
$410.62
|
| Rate for Payer: PacificSource Commercial |
$377.10
|
| Rate for Payer: PHCS PPO |
$410.62
|
| Rate for Payer: Three Rivers PPO |
$314.25
|
| Rate for Payer: TriWest Veterans Administration |
$276.54
|
| Rate for Payer: United Healthcare Commercial |
$364.53
|
| Rate for Payer: United Healthcare Medicare |
$276.54
|
| Rate for Payer: WINHealth Partners Commercial |
$398.05
|
| Rate for Payer: Wise Provider Network Commercial |
$398.05
|
|
