|
HC CAMS HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
6369074401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.07 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.34
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$62.07
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$65.34
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HC CAMS HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
6369074401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$65.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$30.77
|
| Rate for Payer: WINHealth Partners Commercial |
$97.02
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HC CAMS HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
6369064801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC CAMS HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
6369064801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$57.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.46
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.94
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
| Rate for Payer: WINHealth Partners Commercial |
$85.26
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC CAMS HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90648 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369064801
|
|
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 HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90648 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369064801
|
|
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 IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CAMS IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90656 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369065601
|
|
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 IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90656 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.00 |
| 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: 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 |
$20.00
|
| 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 IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CAMS IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90653 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.00 |
| 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: 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 |
$20.00
|
| 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 IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC CAMS IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90653 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369065301
|
|
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 IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC CAMS IIV VACCINE PRESERV FREE INCREASED AG COUNT IM
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.36
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$60.19
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$63.36
|
| Rate for Payer: WINHealth Partners Commercial |
$91.20
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC CAMS IIV VACCINE PRESERV FREE INCREASED AG COUNT IM
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.68
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$52.90
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$73.40
|
| Rate for Payer: WINHealth Partners Commercial |
$94.08
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC CAMS INJECTION,ONABOTULINUMTOXINA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636J058501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC CAMS INJECTION,ONABOTULINUMTOXINA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636J058501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$14.42
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC CAMS INTRAUT COPPER CONTRACEPTIVE
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
636J730001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$922.94 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,413.12
|
| Rate for Payer: Altius Commercial |
$1,413.12
|
| Rate for Payer: Beech Street Commercial |
$1,442.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,208.51
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: Entrust Commercial |
$1,398.40
|
| Rate for Payer: First Choice Health Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$971.52
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Medicare/VA |
$922.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,442.56
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration |
$971.52
|
| Rate for Payer: United Healthcare Commercial |
$1,280.64
|
| Rate for Payer: United Healthcare Medicare |
$971.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.40
|
|
|
HC CAMS INTRAUT COPPER CONTRACEPTIVE
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
636J730001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$811.07 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Aetna of WY Medicare |
$971.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,413.12
|
| Rate for Payer: Altius Commercial |
$1,413.12
|
| Rate for Payer: Beech Street Commercial |
$1,442.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,208.51
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: Entrust Commercial |
$1,398.40
|
| Rate for Payer: First Choice Health Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$853.76
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Medicare/VA |
$811.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,442.56
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration |
$853.76
|
| Rate for Payer: United Healthcare Commercial |
$1,280.64
|
| Rate for Payer: United Healthcare Medicare |
$853.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,442.56
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.40
|
|
|
HC CAMS KYLEENA, 19.5 MG
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636J729601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$888.76 |
| Max. Negotiated Rate |
$1,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,580.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,064.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,548.48
|
| Rate for Payer: Altius Commercial |
$1,548.48
|
| Rate for Payer: Beech Street Commercial |
$1,580.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,324.27
|
| Rate for Payer: Cash Price |
$1,129.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,564.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,580.74
|
| Rate for Payer: Entrust Commercial |
$1,532.35
|
| Rate for Payer: First Choice Health Commercial |
$1,532.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,532.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$935.54
|
| Rate for Payer: HealthUtah PPO |
$1,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,564.61
|
| Rate for Payer: Multiplan Medicare/VA |
$888.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,580.74
|
| Rate for Payer: PacificSource Commercial |
$1,451.70
|
| Rate for Payer: PHCS PPO |
$1,580.74
|
| Rate for Payer: Three Rivers PPO |
$1,209.75
|
| Rate for Payer: TriWest Veterans Administration |
$935.54
|
| Rate for Payer: United Healthcare Commercial |
$1,403.31
|
| Rate for Payer: United Healthcare Medicare |
$935.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,580.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,532.35
|
|
|
HC CAMS KYLEENA, 19.5 MG
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636J729601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,011.35 |
| Max. Negotiated Rate |
$1,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,580.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,548.48
|
| Rate for Payer: Altius Commercial |
$1,548.48
|
| Rate for Payer: Beech Street Commercial |
$1,580.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,324.27
|
| Rate for Payer: Cash Price |
$1,129.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,564.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,580.74
|
| Rate for Payer: Entrust Commercial |
$1,532.35
|
| Rate for Payer: First Choice Health Commercial |
$1,532.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,532.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,064.58
|
| Rate for Payer: HealthUtah PPO |
$1,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,564.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,011.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,580.74
|
| Rate for Payer: PacificSource Commercial |
$1,451.70
|
| Rate for Payer: PHCS PPO |
$1,580.74
|
| Rate for Payer: Three Rivers PPO |
$1,209.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,064.58
|
| Rate for Payer: United Healthcare Commercial |
$1,403.31
|
| Rate for Payer: United Healthcare Medicare |
$1,064.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,532.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,532.35
|
|
|
HC CAMS MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
6369073401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CAMS MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90734 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369073401
|
|
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 MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90734 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369073401
|
|
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
|
|
