|
HC CAMS MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
6369073401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| 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 |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| 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 |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CAMS METHYLPREDNISOLONE 40 MG INJ
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
636J103001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
HC CAMS METHYLPREDNISOLONE 40 MG INJ
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
636J103001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
HC CAMS MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
6369070701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CAMS MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
6369070701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CAMS MODERNA (COVID-19) SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
6369132201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$359.04
|
| Rate for Payer: Altius Commercial |
$359.04
|
| Rate for Payer: Beech Street Commercial |
$366.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.05
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$362.78
|
| Rate for Payer: Cigna of WY Commercial |
$366.52
|
| Rate for Payer: Entrust Commercial |
$355.30
|
| Rate for Payer: First Choice Health Commercial |
$355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.84
|
| Rate for Payer: HealthUtah PPO |
$374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$362.78
|
| Rate for Payer: Multiplan Medicare/VA |
$234.50
|
| Rate for Payer: One Health Plan of WY PPO |
$366.52
|
| Rate for Payer: PacificSource Commercial |
$336.60
|
| Rate for Payer: PHCS PPO |
$366.52
|
| Rate for Payer: Three Rivers PPO |
$280.50
|
| Rate for Payer: TriWest Veterans Administration |
$246.84
|
| Rate for Payer: United Healthcare Commercial |
$325.38
|
| Rate for Payer: United Healthcare Medicare |
$246.84
|
| Rate for Payer: WINHealth Partners Commercial |
$355.30
|
| Rate for Payer: Wise Provider Network Commercial |
$355.30
|
|
|
HC CAMS MODERNA (COVID-19) SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
6369132201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.07 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.52
|
| Rate for Payer: Aetna of WY Medicare |
$246.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$359.04
|
| Rate for Payer: Altius Commercial |
$359.04
|
| Rate for Payer: Beech Street Commercial |
$366.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.05
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$362.78
|
| Rate for Payer: Cigna of WY Commercial |
$366.52
|
| Rate for Payer: Entrust Commercial |
$355.30
|
| Rate for Payer: First Choice Health Commercial |
$355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$355.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.92
|
| Rate for Payer: HealthUtah PPO |
$374.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$362.78
|
| Rate for Payer: Multiplan Medicare/VA |
$206.07
|
| Rate for Payer: One Health Plan of WY PPO |
$366.52
|
| Rate for Payer: PacificSource Commercial |
$336.60
|
| Rate for Payer: PHCS PPO |
$366.52
|
| Rate for Payer: Three Rivers PPO |
$280.50
|
| Rate for Payer: TriWest Veterans Administration |
$216.92
|
| Rate for Payer: United Healthcare Commercial |
$325.38
|
| Rate for Payer: United Healthcare Medicare |
$216.92
|
| Rate for Payer: WINHealth Partners Commercial |
$366.52
|
| Rate for Payer: Wise Provider Network Commercial |
$355.30
|
|
|
HC CAMS PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
6369067001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$526.26
|
| Rate for Payer: Aetna of WY Medicare |
$354.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$515.52
|
| Rate for Payer: Altius Commercial |
$515.52
|
| Rate for Payer: Beech Street Commercial |
$526.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$440.88
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$520.89
|
| Rate for Payer: Cigna of WY Commercial |
$526.26
|
| Rate for Payer: Entrust Commercial |
$510.15
|
| Rate for Payer: First Choice Health Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$311.46
|
| Rate for Payer: HealthUtah PPO |
$537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$520.89
|
| Rate for Payer: Multiplan Medicare/VA |
$295.89
|
| Rate for Payer: One Health Plan of WY PPO |
$526.26
|
| Rate for Payer: PacificSource Commercial |
$483.30
|
| Rate for Payer: PHCS PPO |
$526.26
|
| Rate for Payer: Three Rivers PPO |
$402.75
|
| Rate for Payer: TriWest Veterans Administration |
$311.46
|
| Rate for Payer: United Healthcare Commercial |
$467.19
|
| Rate for Payer: United Healthcare Medicare |
$257.99
|
| Rate for Payer: WINHealth Partners Commercial |
$526.26
|
| Rate for Payer: Wise Provider Network Commercial |
$510.15
|
|
|
HC CAMS PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
6369067001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$526.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$515.52
|
| Rate for Payer: Altius Commercial |
$515.52
|
| Rate for Payer: Beech Street Commercial |
$526.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$440.88
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$520.89
|
| Rate for Payer: Cigna of WY Commercial |
$526.26
|
| Rate for Payer: Entrust Commercial |
$510.15
|
| Rate for Payer: First Choice Health Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$354.42
|
| Rate for Payer: HealthUtah PPO |
$537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$520.89
|
| Rate for Payer: Multiplan Medicare/VA |
$336.70
|
| Rate for Payer: One Health Plan of WY PPO |
$526.26
|
| Rate for Payer: PacificSource Commercial |
$483.30
|
| Rate for Payer: PHCS PPO |
$526.26
|
| Rate for Payer: Three Rivers PPO |
$402.75
|
| Rate for Payer: TriWest Veterans Administration |
$354.42
|
| Rate for Payer: United Healthcare Commercial |
$467.19
|
| Rate for Payer: United Healthcare Medicare |
$354.42
|
| Rate for Payer: WINHealth Partners Commercial |
$510.15
|
| Rate for Payer: Wise Provider Network Commercial |
$510.15
|
|
|
HC CAMS PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90670 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369067001
|
|
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 PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90670 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369067001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$257.99 |
| 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 |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$257.99
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
6369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$133.47
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC CAMS PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90732 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$133.47 |
| 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 |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$133.47
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90732 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369073201
|
|
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 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
6369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC CAMS RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90680 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369068001
|
|
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 RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
6369068001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC CAMS RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
6369068001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC CAMS RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90680 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369068001
|
|
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 TDAP VACCINE >7 YO, IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071501
|
|
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 TDAP VACCINE >7 YO, IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90715 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071501
|
|
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 TDAP VACCINE >7 YO, IM
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
6369071501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.44
|
| Rate for Payer: Altius Commercial |
$157.44
|
| Rate for Payer: Beech Street Commercial |
$160.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.64
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.08
|
| Rate for Payer: Cigna of WY Commercial |
$160.72
|
| Rate for Payer: Entrust Commercial |
$155.80
|
| Rate for Payer: First Choice Health Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.24
|
| Rate for Payer: HealthUtah PPO |
$164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.08
|
| Rate for Payer: Multiplan Medicare/VA |
$102.83
|
| Rate for Payer: One Health Plan of WY PPO |
$160.72
|
| Rate for Payer: PacificSource Commercial |
$147.60
|
| Rate for Payer: PHCS PPO |
$160.72
|
| Rate for Payer: Three Rivers PPO |
$123.00
|
| Rate for Payer: TriWest Veterans Administration |
$108.24
|
| Rate for Payer: United Healthcare Commercial |
$142.68
|
| Rate for Payer: United Healthcare Medicare |
$108.24
|
| Rate for Payer: WINHealth Partners Commercial |
$155.80
|
| Rate for Payer: Wise Provider Network Commercial |
$155.80
|
|
|
HC CAMS TDAP VACCINE >7 YO, IM
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
6369071501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.36 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.72
|
| Rate for Payer: Aetna of WY Medicare |
$108.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.44
|
| Rate for Payer: Altius Commercial |
$157.44
|
| Rate for Payer: Beech Street Commercial |
$160.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.64
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.08
|
| Rate for Payer: Cigna of WY Commercial |
$160.72
|
| Rate for Payer: Entrust Commercial |
$155.80
|
| Rate for Payer: First Choice Health Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.12
|
| Rate for Payer: HealthUtah PPO |
$164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.08
|
| Rate for Payer: Multiplan Medicare/VA |
$90.36
|
| Rate for Payer: One Health Plan of WY PPO |
$160.72
|
| Rate for Payer: PacificSource Commercial |
$147.60
|
| Rate for Payer: PHCS PPO |
$160.72
|
| Rate for Payer: Three Rivers PPO |
$123.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.12
|
| Rate for Payer: United Healthcare Commercial |
$142.68
|
| Rate for Payer: United Healthcare Medicare |
$95.12
|
| Rate for Payer: WINHealth Partners Commercial |
$160.72
|
| Rate for Payer: Wise Provider Network Commercial |
$155.80
|
|
|
HC CAMS TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90714 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071401
|
|
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 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
6369071401
|
|
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
|
|
