|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [43709]
|
Facility
|
IP
|
$164.45
|
|
|
Service Code
|
HCPCS 90632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.87
|
| Rate for Payer: Altius Commercial |
$157.87
|
| Rate for Payer: Beech Street Commercial |
$161.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.01
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.52
|
| Rate for Payer: Cigna of WY Commercial |
$161.16
|
| Rate for Payer: Entrust Commercial |
$156.23
|
| Rate for Payer: First Choice Health Commercial |
$156.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.54
|
| Rate for Payer: HealthUtah PPO |
$164.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.52
|
| Rate for Payer: Multiplan Medicare/VA |
$103.11
|
| Rate for Payer: One Health Plan of WY PPO |
$161.16
|
| Rate for Payer: PacificSource Commercial |
$148.00
|
| Rate for Payer: PHCS PPO |
$161.16
|
| Rate for Payer: Three Rivers PPO |
$123.34
|
| Rate for Payer: TriWest Veterans Administration |
$108.54
|
| Rate for Payer: United Healthcare Commercial |
$143.07
|
| Rate for Payer: United Healthcare Medicare |
$108.54
|
| Rate for Payer: WINHealth Partners Commercial |
$156.23
|
| Rate for Payer: Wise Provider Network Commercial |
$156.23
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [43709]
|
Facility
|
OP
|
$164.45
|
|
|
Service Code
|
HCPCS 90632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.61 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.16
|
| Rate for Payer: Aetna of WY Medicare |
$108.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$157.87
|
| Rate for Payer: Altius Commercial |
$157.87
|
| Rate for Payer: Beech Street Commercial |
$161.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.01
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.52
|
| Rate for Payer: Cigna of WY Commercial |
$161.16
|
| Rate for Payer: Entrust Commercial |
$156.23
|
| Rate for Payer: First Choice Health Commercial |
$156.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.38
|
| Rate for Payer: HealthUtah PPO |
$164.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.52
|
| Rate for Payer: Multiplan Medicare/VA |
$90.61
|
| Rate for Payer: One Health Plan of WY PPO |
$161.16
|
| Rate for Payer: PacificSource Commercial |
$148.00
|
| Rate for Payer: PHCS PPO |
$161.16
|
| Rate for Payer: Three Rivers PPO |
$123.34
|
| Rate for Payer: TriWest Veterans Administration |
$95.38
|
| Rate for Payer: United Healthcare Commercial |
$143.07
|
| Rate for Payer: United Healthcare Medicare |
$95.38
|
| Rate for Payer: WINHealth Partners Commercial |
$161.16
|
| Rate for Payer: Wise Provider Network Commercial |
$156.23
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [42775]
|
Facility
|
OP
|
$149.32
|
|
|
Service Code
|
NDC 5816082552
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$149.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.33
|
| Rate for Payer: Aetna of WY Medicare |
$98.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.35
|
| Rate for Payer: Altius Commercial |
$143.35
|
| Rate for Payer: Beech Street Commercial |
$146.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.59
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.84
|
| Rate for Payer: Cigna of WY Commercial |
$146.33
|
| Rate for Payer: Entrust Commercial |
$141.85
|
| Rate for Payer: First Choice Health Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.61
|
| Rate for Payer: HealthUtah PPO |
$149.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.84
|
| Rate for Payer: Multiplan Medicare/VA |
$82.28
|
| Rate for Payer: One Health Plan of WY PPO |
$146.33
|
| Rate for Payer: PacificSource Commercial |
$134.39
|
| Rate for Payer: PHCS PPO |
$146.33
|
| Rate for Payer: Three Rivers PPO |
$111.99
|
| Rate for Payer: TriWest Veterans Administration |
$86.61
|
| Rate for Payer: United Healthcare Commercial |
$129.91
|
| Rate for Payer: United Healthcare Medicare |
$86.61
|
| Rate for Payer: WINHealth Partners Commercial |
$146.33
|
| Rate for Payer: Wise Provider Network Commercial |
$141.85
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [42775]
|
Facility
|
IP
|
$149.32
|
|
|
Service Code
|
NDC 5816082552
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.62 |
| Max. Negotiated Rate |
$149.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.35
|
| Rate for Payer: Altius Commercial |
$143.35
|
| Rate for Payer: Beech Street Commercial |
$146.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.59
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.84
|
| Rate for Payer: Cigna of WY Commercial |
$146.33
|
| Rate for Payer: Entrust Commercial |
$141.85
|
| Rate for Payer: First Choice Health Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.55
|
| Rate for Payer: HealthUtah PPO |
$149.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.84
|
| Rate for Payer: Multiplan Medicare/VA |
$93.62
|
| Rate for Payer: One Health Plan of WY PPO |
$146.33
|
| Rate for Payer: PacificSource Commercial |
$134.39
|
| Rate for Payer: PHCS PPO |
$146.33
|
| Rate for Payer: Three Rivers PPO |
$111.99
|
| Rate for Payer: TriWest Veterans Administration |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$129.91
|
| Rate for Payer: United Healthcare Medicare |
$98.55
|
| Rate for Payer: WINHealth Partners Commercial |
$141.85
|
| Rate for Payer: Wise Provider Network Commercial |
$141.85
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [42775]
|
Facility
|
OP
|
$149.32
|
|
|
Service Code
|
NDC 5816082543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$149.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.33
|
| Rate for Payer: Aetna of WY Medicare |
$98.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.35
|
| Rate for Payer: Altius Commercial |
$143.35
|
| Rate for Payer: Beech Street Commercial |
$146.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.59
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.84
|
| Rate for Payer: Cigna of WY Commercial |
$146.33
|
| Rate for Payer: Entrust Commercial |
$141.85
|
| Rate for Payer: First Choice Health Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.61
|
| Rate for Payer: HealthUtah PPO |
$149.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.84
|
| Rate for Payer: Multiplan Medicare/VA |
$82.28
|
| Rate for Payer: One Health Plan of WY PPO |
$146.33
|
| Rate for Payer: PacificSource Commercial |
$134.39
|
| Rate for Payer: PHCS PPO |
$146.33
|
| Rate for Payer: Three Rivers PPO |
$111.99
|
| Rate for Payer: TriWest Veterans Administration |
$86.61
|
| Rate for Payer: United Healthcare Commercial |
$129.91
|
| Rate for Payer: United Healthcare Medicare |
$86.61
|
| Rate for Payer: WINHealth Partners Commercial |
$146.33
|
| Rate for Payer: Wise Provider Network Commercial |
$141.85
|
|
|
HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE [42775]
|
Facility
|
IP
|
$149.32
|
|
|
Service Code
|
NDC 5816082543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.62 |
| Max. Negotiated Rate |
$149.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.35
|
| Rate for Payer: Altius Commercial |
$143.35
|
| Rate for Payer: Beech Street Commercial |
$146.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.59
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.84
|
| Rate for Payer: Cigna of WY Commercial |
$146.33
|
| Rate for Payer: Entrust Commercial |
$141.85
|
| Rate for Payer: First Choice Health Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.55
|
| Rate for Payer: HealthUtah PPO |
$149.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.84
|
| Rate for Payer: Multiplan Medicare/VA |
$93.62
|
| Rate for Payer: One Health Plan of WY PPO |
$146.33
|
| Rate for Payer: PacificSource Commercial |
$134.39
|
| Rate for Payer: PHCS PPO |
$146.33
|
| Rate for Payer: Three Rivers PPO |
$111.99
|
| Rate for Payer: TriWest Veterans Administration |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$129.91
|
| Rate for Payer: United Healthcare Medicare |
$98.55
|
| Rate for Payer: WINHealth Partners Commercial |
$141.85
|
| Rate for Payer: Wise Provider Network Commercial |
$141.85
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [153173]
|
Facility
|
IP
|
$326.50
|
|
|
Service Code
|
HCPCS 90739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$313.44
|
| Rate for Payer: Altius Commercial |
$313.44
|
| Rate for Payer: Beech Street Commercial |
$319.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$268.06
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.70
|
| Rate for Payer: Cigna of WY Commercial |
$319.97
|
| Rate for Payer: Entrust Commercial |
$310.18
|
| Rate for Payer: First Choice Health Commercial |
$310.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$310.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$215.49
|
| Rate for Payer: HealthUtah PPO |
$326.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.70
|
| Rate for Payer: Multiplan Medicare/VA |
$204.72
|
| Rate for Payer: One Health Plan of WY PPO |
$319.97
|
| Rate for Payer: PacificSource Commercial |
$293.85
|
| Rate for Payer: PHCS PPO |
$319.97
|
| Rate for Payer: Three Rivers PPO |
$244.88
|
| Rate for Payer: TriWest Veterans Administration |
$215.49
|
| Rate for Payer: United Healthcare Commercial |
$284.06
|
| Rate for Payer: United Healthcare Medicare |
$215.49
|
| Rate for Payer: WINHealth Partners Commercial |
$310.18
|
| Rate for Payer: Wise Provider Network Commercial |
$310.18
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [153173]
|
Facility
|
OP
|
$326.50
|
|
|
Service Code
|
HCPCS 90739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.28 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.97
|
| Rate for Payer: Aetna of WY Medicare |
$215.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$313.44
|
| Rate for Payer: Altius Commercial |
$313.44
|
| Rate for Payer: Beech Street Commercial |
$319.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$268.06
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.70
|
| Rate for Payer: Cigna of WY Commercial |
$319.97
|
| Rate for Payer: Entrust Commercial |
$310.18
|
| Rate for Payer: First Choice Health Commercial |
$310.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$310.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.37
|
| Rate for Payer: HealthUtah PPO |
$326.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.70
|
| Rate for Payer: Multiplan Medicare/VA |
$179.90
|
| Rate for Payer: One Health Plan of WY PPO |
$319.97
|
| Rate for Payer: PacificSource Commercial |
$293.85
|
| Rate for Payer: PHCS PPO |
$319.97
|
| Rate for Payer: Three Rivers PPO |
$244.88
|
| Rate for Payer: TriWest Veterans Administration |
$189.37
|
| Rate for Payer: United Healthcare Commercial |
$284.06
|
| Rate for Payer: United Healthcare Medicare |
$160.28
|
| Rate for Payer: WINHealth Partners Commercial |
$319.97
|
| Rate for Payer: Wise Provider Network Commercial |
$310.18
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [43532]
|
Facility
|
IP
|
$114.76
|
|
|
Service Code
|
HCPCS 90744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$114.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.17
|
| Rate for Payer: Altius Commercial |
$110.17
|
| Rate for Payer: Beech Street Commercial |
$112.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.22
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.32
|
| Rate for Payer: Cigna of WY Commercial |
$112.46
|
| Rate for Payer: Entrust Commercial |
$109.02
|
| Rate for Payer: First Choice Health Commercial |
$109.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.74
|
| Rate for Payer: HealthUtah PPO |
$114.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.32
|
| Rate for Payer: Multiplan Medicare/VA |
$71.95
|
| Rate for Payer: One Health Plan of WY PPO |
$112.46
|
| Rate for Payer: PacificSource Commercial |
$103.28
|
| Rate for Payer: PHCS PPO |
$112.46
|
| Rate for Payer: Three Rivers PPO |
$86.07
|
| Rate for Payer: TriWest Veterans Administration |
$75.74
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
| Rate for Payer: United Healthcare Medicare |
$75.74
|
| Rate for Payer: WINHealth Partners Commercial |
$109.02
|
| Rate for Payer: Wise Provider Network Commercial |
$109.02
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [43532]
|
Facility
|
OP
|
$114.76
|
|
|
Service Code
|
HCPCS 90744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$114.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.46
|
| Rate for Payer: Aetna of WY Medicare |
$75.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.17
|
| Rate for Payer: Altius Commercial |
$110.17
|
| Rate for Payer: Beech Street Commercial |
$112.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.22
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.32
|
| Rate for Payer: Cigna of WY Commercial |
$112.46
|
| Rate for Payer: Entrust Commercial |
$109.02
|
| Rate for Payer: First Choice Health Commercial |
$109.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.56
|
| Rate for Payer: HealthUtah PPO |
$114.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.32
|
| Rate for Payer: Multiplan Medicare/VA |
$63.23
|
| Rate for Payer: One Health Plan of WY PPO |
$112.46
|
| Rate for Payer: PacificSource Commercial |
$103.28
|
| Rate for Payer: PHCS PPO |
$112.46
|
| Rate for Payer: Three Rivers PPO |
$86.07
|
| Rate for Payer: TriWest Veterans Administration |
$66.56
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
| Rate for Payer: United Healthcare Medicare |
$30.77
|
| Rate for Payer: WINHealth Partners Commercial |
$112.46
|
| Rate for Payer: Wise Provider Network Commercial |
$109.02
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP [53174]
|
Facility
|
IP
|
$110.05
|
|
|
Service Code
|
HCPCS 90744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$110.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.65
|
| Rate for Payer: Altius Commercial |
$105.65
|
| Rate for Payer: Beech Street Commercial |
$107.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.35
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.75
|
| Rate for Payer: Cigna of WY Commercial |
$107.85
|
| Rate for Payer: Entrust Commercial |
$104.55
|
| Rate for Payer: First Choice Health Commercial |
$104.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.63
|
| Rate for Payer: HealthUtah PPO |
$110.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.75
|
| Rate for Payer: Multiplan Medicare/VA |
$69.00
|
| Rate for Payer: One Health Plan of WY PPO |
$107.85
|
| Rate for Payer: PacificSource Commercial |
$99.04
|
| Rate for Payer: PHCS PPO |
$107.85
|
| Rate for Payer: Three Rivers PPO |
$82.54
|
| Rate for Payer: TriWest Veterans Administration |
$72.63
|
| Rate for Payer: United Healthcare Commercial |
$95.74
|
| Rate for Payer: United Healthcare Medicare |
$72.63
|
| Rate for Payer: WINHealth Partners Commercial |
$104.55
|
| Rate for Payer: Wise Provider Network Commercial |
$104.55
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP [53174]
|
Facility
|
OP
|
$110.05
|
|
|
Service Code
|
HCPCS 90744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$110.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.85
|
| Rate for Payer: Aetna of WY Medicare |
$72.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.65
|
| Rate for Payer: Altius Commercial |
$105.65
|
| Rate for Payer: Beech Street Commercial |
$107.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.35
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: Cash Price |
$77.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.75
|
| Rate for Payer: Cigna of WY Commercial |
$107.85
|
| Rate for Payer: Entrust Commercial |
$104.55
|
| Rate for Payer: First Choice Health Commercial |
$104.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.83
|
| Rate for Payer: HealthUtah PPO |
$110.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.75
|
| Rate for Payer: Multiplan Medicare/VA |
$60.64
|
| Rate for Payer: One Health Plan of WY PPO |
$107.85
|
| Rate for Payer: PacificSource Commercial |
$99.04
|
| Rate for Payer: PHCS PPO |
$107.85
|
| Rate for Payer: Three Rivers PPO |
$82.54
|
| Rate for Payer: TriWest Veterans Administration |
$63.83
|
| Rate for Payer: United Healthcare Commercial |
$95.74
|
| Rate for Payer: United Healthcare Medicare |
$30.77
|
| Rate for Payer: WINHealth Partners Commercial |
$107.85
|
| Rate for Payer: Wise Provider Network Commercial |
$104.55
|
|
|
HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
90633
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Beech Street Commercial |
$126.35
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$126.35
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
90632
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.58
|
| Rate for Payer: Aetna of WY Medicare |
$70.54
|
| Rate for Payer: Beech Street Commercial |
$257.45
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$262.87
|
| Rate for Payer: Cigna of WY Commercial |
$265.58
|
| Rate for Payer: First Choice Health Commercial |
$243.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.54
|
| Rate for Payer: HealthUtah PPO |
$271.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$262.87
|
| Rate for Payer: Multiplan Medicare/VA |
$59.96
|
| Rate for Payer: One Health Plan of WY PPO |
$265.58
|
| Rate for Payer: PacificSource Commercial |
$243.90
|
| Rate for Payer: PHCS PPO |
$257.45
|
| Rate for Payer: Three Rivers PPO |
$203.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.54
|
| Rate for Payer: United Healthcare Commercial |
$235.77
|
| Rate for Payer: United Healthcare Medicare |
$70.54
|
| Rate for Payer: WINHealth Partners Commercial |
$271.00
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [43669]
|
Facility
|
OP
|
$314.61
|
|
|
Service Code
|
NDC 5816081152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.35 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.32
|
| Rate for Payer: Aetna of WY Medicare |
$207.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.03
|
| Rate for Payer: Altius Commercial |
$302.03
|
| Rate for Payer: Beech Street Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.29
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.17
|
| Rate for Payer: Cigna of WY Commercial |
$308.32
|
| Rate for Payer: Entrust Commercial |
$298.88
|
| Rate for Payer: First Choice Health Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.47
|
| Rate for Payer: HealthUtah PPO |
$314.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.17
|
| Rate for Payer: Multiplan Medicare/VA |
$173.35
|
| Rate for Payer: One Health Plan of WY PPO |
$308.32
|
| Rate for Payer: PacificSource Commercial |
$283.15
|
| Rate for Payer: PHCS PPO |
$308.32
|
| Rate for Payer: Three Rivers PPO |
$235.96
|
| Rate for Payer: TriWest Veterans Administration |
$182.47
|
| Rate for Payer: United Healthcare Commercial |
$273.71
|
| Rate for Payer: United Healthcare Medicare |
$182.47
|
| Rate for Payer: WINHealth Partners Commercial |
$308.32
|
| Rate for Payer: Wise Provider Network Commercial |
$298.88
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [43669]
|
Facility
|
IP
|
$314.61
|
|
|
Service Code
|
NDC 5816081152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$197.26 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.03
|
| Rate for Payer: Altius Commercial |
$302.03
|
| Rate for Payer: Beech Street Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.29
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.17
|
| Rate for Payer: Cigna of WY Commercial |
$308.32
|
| Rate for Payer: Entrust Commercial |
$298.88
|
| Rate for Payer: First Choice Health Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.64
|
| Rate for Payer: HealthUtah PPO |
$314.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.17
|
| Rate for Payer: Multiplan Medicare/VA |
$197.26
|
| Rate for Payer: One Health Plan of WY PPO |
$308.32
|
| Rate for Payer: PacificSource Commercial |
$283.15
|
| Rate for Payer: PHCS PPO |
$308.32
|
| Rate for Payer: Three Rivers PPO |
$235.96
|
| Rate for Payer: TriWest Veterans Administration |
$207.64
|
| Rate for Payer: United Healthcare Commercial |
$273.71
|
| Rate for Payer: United Healthcare Medicare |
$207.64
|
| Rate for Payer: WINHealth Partners Commercial |
$298.88
|
| Rate for Payer: Wise Provider Network Commercial |
$298.88
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [43669]
|
Facility
|
OP
|
$314.61
|
|
|
Service Code
|
NDC 5816081143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.35 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.32
|
| Rate for Payer: Aetna of WY Medicare |
$207.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.03
|
| Rate for Payer: Altius Commercial |
$302.03
|
| Rate for Payer: Beech Street Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.29
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.17
|
| Rate for Payer: Cigna of WY Commercial |
$308.32
|
| Rate for Payer: Entrust Commercial |
$298.88
|
| Rate for Payer: First Choice Health Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.47
|
| Rate for Payer: HealthUtah PPO |
$314.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.17
|
| Rate for Payer: Multiplan Medicare/VA |
$173.35
|
| Rate for Payer: One Health Plan of WY PPO |
$308.32
|
| Rate for Payer: PacificSource Commercial |
$283.15
|
| Rate for Payer: PHCS PPO |
$308.32
|
| Rate for Payer: Three Rivers PPO |
$235.96
|
| Rate for Payer: TriWest Veterans Administration |
$182.47
|
| Rate for Payer: United Healthcare Commercial |
$273.71
|
| Rate for Payer: United Healthcare Medicare |
$182.47
|
| Rate for Payer: WINHealth Partners Commercial |
$308.32
|
| Rate for Payer: Wise Provider Network Commercial |
$298.88
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [43669]
|
Facility
|
IP
|
$314.61
|
|
|
Service Code
|
NDC 5816081143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$197.26 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.03
|
| Rate for Payer: Altius Commercial |
$302.03
|
| Rate for Payer: Beech Street Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.29
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.17
|
| Rate for Payer: Cigna of WY Commercial |
$308.32
|
| Rate for Payer: Entrust Commercial |
$298.88
|
| Rate for Payer: First Choice Health Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.64
|
| Rate for Payer: HealthUtah PPO |
$314.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.17
|
| Rate for Payer: Multiplan Medicare/VA |
$197.26
|
| Rate for Payer: One Health Plan of WY PPO |
$308.32
|
| Rate for Payer: PacificSource Commercial |
$283.15
|
| Rate for Payer: PHCS PPO |
$308.32
|
| Rate for Payer: Three Rivers PPO |
$235.96
|
| Rate for Payer: TriWest Veterans Administration |
$207.64
|
| Rate for Payer: United Healthcare Commercial |
$273.71
|
| Rate for Payer: United Healthcare Medicare |
$207.64
|
| Rate for Payer: WINHealth Partners Commercial |
$298.88
|
| Rate for Payer: Wise Provider Network Commercial |
$298.88
|
|
|
HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
90739
|
| Min. Negotiated Rate |
$136.24 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$160.28
|
| Rate for Payer: Beech Street Commercial |
$367.65
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: First Choice Health Commercial |
$348.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.28
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$136.24
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$367.65
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$160.28
|
| Rate for Payer: United Healthcare Commercial |
$336.69
|
| Rate for Payer: United Healthcare Medicare |
$160.28
|
| Rate for Payer: WINHealth Partners Commercial |
$387.00
|
|
|
HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
90746
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$70.38
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.38
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$59.82
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$70.38
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$70.38
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
|
|
HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
90744
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$30.77
|
| Rate for Payer: Beech Street Commercial |
$94.05
|
| 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: First Choice Health Commercial |
$89.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.77
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$26.15
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$94.05
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$30.77
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$30.77
|
| Rate for Payer: WINHealth Partners Commercial |
$99.00
|
|
|
HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 81433
|
| Hospital Charge Code |
81433
|
| Min. Negotiated Rate |
$373.09 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$438.93
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.93
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$373.09
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$438.93
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$438.93
|
| Rate for Payer: WINHealth Partners Commercial |
$488.30
|
|
|
HEREDITARY BRST CA-RLATD DO GEN SEQ ALYS 5+ GEN
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 81432
|
| Hospital Charge Code |
81432
|
| Min. Negotiated Rate |
$577.19 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$778.12
|
| Rate for Payer: Aetna of WY Medicare |
$679.05
|
| Rate for Payer: Beech Street Commercial |
$754.30
|
| Rate for Payer: Cash Price |
$555.80
|
| Rate for Payer: Cash Price |
$555.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$770.18
|
| Rate for Payer: Cigna of WY Commercial |
$778.12
|
| Rate for Payer: First Choice Health Commercial |
$714.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$754.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.05
|
| Rate for Payer: HealthUtah PPO |
$794.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$770.18
|
| Rate for Payer: Multiplan Medicare/VA |
$577.19
|
| Rate for Payer: One Health Plan of WY PPO |
$778.12
|
| Rate for Payer: PacificSource Commercial |
$714.60
|
| Rate for Payer: PHCS PPO |
$754.30
|
| Rate for Payer: Three Rivers PPO |
$595.50
|
| Rate for Payer: TriWest Veterans Administration |
$679.05
|
| Rate for Payer: United Healthcare Commercial |
$690.78
|
| Rate for Payer: United Healthcare Medicare |
$679.05
|
| Rate for Payer: WINHealth Partners Commercial |
$754.30
|
|
|
HETEROPHILE ANTIBODIES SCREEN
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
86308
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Aetna of WY Medicare |
$5.18
|
| Rate for Payer: Beech Street Commercial |
$54.15
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.18
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$4.40
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$54.15
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WINHealth Partners Commercial |
$54.15
|
|
|
HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
L3929
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Beech Street Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: First Choice Health Commercial |
$18.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.00
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
|
