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Service Code HCPCS 86606
Hospital Charge Code 3028660601
Hospital Revenue Code 302
Min. Negotiated Rate $115.71
Max. Negotiated Rate $210.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $205.80
Rate for Payer: Aetna of WY Medicare $138.60
Rate for Payer: Altius Auto/Workers Compensation $201.60
Rate for Payer: Altius Commercial $201.60
Rate for Payer: Beech Street Commercial $205.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $172.41
Rate for Payer: Cash Price $147.00
Rate for Payer: ChoiceCare Network Commercial $203.70
Rate for Payer: Cigna of WY Commercial $205.80
Rate for Payer: Entrust Commercial $199.50
Rate for Payer: First Choice Health Commercial $199.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $199.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $121.80
Rate for Payer: HealthUtah PPO $210.00
Rate for Payer: Idaho Integrated Healthcare Commercial $203.70
Rate for Payer: Multiplan Medicare/VA $115.71
Rate for Payer: One Health Plan of WY PPO $205.80
Rate for Payer: PacificSource Commercial $189.00
Rate for Payer: PHCS PPO $205.80
Rate for Payer: Three Rivers PPO $157.50
Rate for Payer: TriWest Veterans Administration $121.80
Rate for Payer: United Healthcare Commercial $182.70
Rate for Payer: United Healthcare Medicare $121.80
Rate for Payer: WINHealth Partners Commercial $205.80
Rate for Payer: Wise Provider Network Commercial $199.50
Service Code HCPCS 86606
Hospital Charge Code 3028660601
Hospital Revenue Code 302
Min. Negotiated Rate $131.67
Max. Negotiated Rate $210.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $205.80
Rate for Payer: Altius Auto/Workers Compensation $201.60
Rate for Payer: Altius Commercial $201.60
Rate for Payer: Beech Street Commercial $205.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $172.41
Rate for Payer: Cash Price $147.00
Rate for Payer: ChoiceCare Network Commercial $203.70
Rate for Payer: Cigna of WY Commercial $205.80
Rate for Payer: Entrust Commercial $199.50
Rate for Payer: First Choice Health Commercial $199.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $199.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $138.60
Rate for Payer: HealthUtah PPO $210.00
Rate for Payer: Idaho Integrated Healthcare Commercial $203.70
Rate for Payer: Multiplan Medicare/VA $131.67
Rate for Payer: One Health Plan of WY PPO $205.80
Rate for Payer: PacificSource Commercial $189.00
Rate for Payer: PHCS PPO $205.80
Rate for Payer: Three Rivers PPO $157.50
Rate for Payer: TriWest Veterans Administration $138.60
Rate for Payer: United Healthcare Commercial $182.70
Rate for Payer: United Healthcare Medicare $138.60
Rate for Payer: WINHealth Partners Commercial $199.50
Rate for Payer: Wise Provider Network Commercial $199.50
Service Code HCPCS 20612
Hospital Charge Code 5102061201
Hospital Revenue Code 510
Min. Negotiated Rate $25.71
Max. Negotiated Rate $41.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $40.18
Rate for Payer: Altius Auto/Workers Compensation $39.36
Rate for Payer: Altius Commercial $39.36
Rate for Payer: Beech Street Commercial $40.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $33.66
Rate for Payer: Cash Price $28.70
Rate for Payer: ChoiceCare Network Commercial $39.77
Rate for Payer: Cigna of WY Commercial $40.18
Rate for Payer: Entrust Commercial $38.95
Rate for Payer: First Choice Health Commercial $38.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $27.06
Rate for Payer: HealthUtah PPO $41.00
Rate for Payer: Idaho Integrated Healthcare Commercial $39.77
Rate for Payer: Multiplan Medicare/VA $25.71
Rate for Payer: One Health Plan of WY PPO $40.18
Rate for Payer: PacificSource Commercial $36.90
Rate for Payer: PHCS PPO $40.18
Rate for Payer: Three Rivers PPO $30.75
Rate for Payer: TriWest Veterans Administration $27.06
Rate for Payer: United Healthcare Commercial $35.67
Rate for Payer: United Healthcare Medicare $27.06
Rate for Payer: WINHealth Partners Commercial $38.95
Rate for Payer: Wise Provider Network Commercial $38.95
Service Code HCPCS 20612
Hospital Charge Code 3612061201
Hospital Revenue Code 361
Min. Negotiated Rate $207.54
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $218.46
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $207.54
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $218.46
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $218.46
Rate for Payer: WINHealth Partners Commercial $314.45
Rate for Payer: Wise Provider Network Commercial $314.45
Service Code HCPCS 20612
Hospital Charge Code 5102061201
Hospital Revenue Code 510
Min. Negotiated Rate $22.59
Max. Negotiated Rate $41.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $40.18
Rate for Payer: Aetna of WY Medicare $27.06
Rate for Payer: Altius Auto/Workers Compensation $39.36
Rate for Payer: Altius Commercial $39.36
Rate for Payer: Beech Street Commercial $40.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $33.66
Rate for Payer: Cash Price $28.70
Rate for Payer: ChoiceCare Network Commercial $39.77
Rate for Payer: Cigna of WY Commercial $40.18
Rate for Payer: Entrust Commercial $38.95
Rate for Payer: First Choice Health Commercial $38.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $23.78
Rate for Payer: HealthUtah PPO $41.00
Rate for Payer: Idaho Integrated Healthcare Commercial $39.77
Rate for Payer: Multiplan Medicare/VA $22.59
Rate for Payer: One Health Plan of WY PPO $40.18
Rate for Payer: PacificSource Commercial $36.90
Rate for Payer: PHCS PPO $40.18
Rate for Payer: Three Rivers PPO $30.75
Rate for Payer: TriWest Veterans Administration $23.78
Rate for Payer: United Healthcare Commercial $35.67
Rate for Payer: United Healthcare Medicare $23.78
Rate for Payer: WINHealth Partners Commercial $40.18
Rate for Payer: Wise Provider Network Commercial $38.95
Service Code HCPCS 20612
Hospital Charge Code 3612061201
Hospital Revenue Code 361
Min. Negotiated Rate $182.38
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Aetna of WY Medicare $218.46
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $191.98
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $182.38
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $191.98
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $191.98
Rate for Payer: WINHealth Partners Commercial $324.38
Rate for Payer: Wise Provider Network Commercial $314.45
Service Code HCPCS 51102
Hospital Charge Code 5105110201
Hospital Revenue Code 510
Min. Negotiated Rate $94.68
Max. Negotiated Rate $151.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.98
Rate for Payer: Altius Auto/Workers Compensation $144.96
Rate for Payer: Altius Commercial $144.96
Rate for Payer: Beech Street Commercial $147.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.97
Rate for Payer: Cash Price $105.70
Rate for Payer: ChoiceCare Network Commercial $146.47
Rate for Payer: Cigna of WY Commercial $147.98
Rate for Payer: Entrust Commercial $143.45
Rate for Payer: First Choice Health Commercial $143.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $143.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.66
Rate for Payer: HealthUtah PPO $151.00
Rate for Payer: Idaho Integrated Healthcare Commercial $146.47
Rate for Payer: Multiplan Medicare/VA $94.68
Rate for Payer: One Health Plan of WY PPO $147.98
Rate for Payer: PacificSource Commercial $135.90
Rate for Payer: PHCS PPO $147.98
Rate for Payer: Three Rivers PPO $113.25
Rate for Payer: TriWest Veterans Administration $99.66
Rate for Payer: United Healthcare Commercial $131.37
Rate for Payer: United Healthcare Medicare $99.66
Rate for Payer: WINHealth Partners Commercial $143.45
Rate for Payer: Wise Provider Network Commercial $143.45
Service Code HCPCS 51102
Hospital Charge Code 5105110201
Hospital Revenue Code 510
Min. Negotiated Rate $83.20
Max. Negotiated Rate $151.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.98
Rate for Payer: Aetna of WY Medicare $99.66
Rate for Payer: Altius Auto/Workers Compensation $144.96
Rate for Payer: Altius Commercial $144.96
Rate for Payer: Beech Street Commercial $147.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.97
Rate for Payer: Cash Price $105.70
Rate for Payer: ChoiceCare Network Commercial $146.47
Rate for Payer: Cigna of WY Commercial $147.98
Rate for Payer: Entrust Commercial $143.45
Rate for Payer: First Choice Health Commercial $143.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $143.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.58
Rate for Payer: HealthUtah PPO $151.00
Rate for Payer: Idaho Integrated Healthcare Commercial $146.47
Rate for Payer: Multiplan Medicare/VA $83.20
Rate for Payer: One Health Plan of WY PPO $147.98
Rate for Payer: PacificSource Commercial $135.90
Rate for Payer: PHCS PPO $147.98
Rate for Payer: Three Rivers PPO $113.25
Rate for Payer: TriWest Veterans Administration $87.58
Rate for Payer: United Healthcare Commercial $131.37
Rate for Payer: United Healthcare Medicare $87.58
Rate for Payer: WINHealth Partners Commercial $147.98
Rate for Payer: Wise Provider Network Commercial $143.45
Service Code HCPCS 51100
Hospital Charge Code 5105110001
Hospital Revenue Code 510
Min. Negotiated Rate $32.60
Max. Negotiated Rate $52.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $50.96
Rate for Payer: Altius Auto/Workers Compensation $49.92
Rate for Payer: Altius Commercial $49.92
Rate for Payer: Beech Street Commercial $50.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $42.69
Rate for Payer: Cash Price $36.40
Rate for Payer: ChoiceCare Network Commercial $50.44
Rate for Payer: Cigna of WY Commercial $50.96
Rate for Payer: Entrust Commercial $49.40
Rate for Payer: First Choice Health Commercial $49.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $49.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $34.32
Rate for Payer: HealthUtah PPO $52.00
Rate for Payer: Idaho Integrated Healthcare Commercial $50.44
Rate for Payer: Multiplan Medicare/VA $32.60
Rate for Payer: One Health Plan of WY PPO $50.96
Rate for Payer: PacificSource Commercial $46.80
Rate for Payer: PHCS PPO $50.96
Rate for Payer: Three Rivers PPO $39.00
Rate for Payer: TriWest Veterans Administration $34.32
Rate for Payer: United Healthcare Commercial $45.24
Rate for Payer: United Healthcare Medicare $34.32
Rate for Payer: WINHealth Partners Commercial $49.40
Rate for Payer: Wise Provider Network Commercial $49.40
Service Code HCPCS 51100
Hospital Charge Code 5105110001
Hospital Revenue Code 510
Min. Negotiated Rate $28.65
Max. Negotiated Rate $52.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $50.96
Rate for Payer: Aetna of WY Medicare $34.32
Rate for Payer: Altius Auto/Workers Compensation $49.92
Rate for Payer: Altius Commercial $49.92
Rate for Payer: Beech Street Commercial $50.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $42.69
Rate for Payer: Cash Price $36.40
Rate for Payer: ChoiceCare Network Commercial $50.44
Rate for Payer: Cigna of WY Commercial $50.96
Rate for Payer: Entrust Commercial $49.40
Rate for Payer: First Choice Health Commercial $49.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $49.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $30.16
Rate for Payer: HealthUtah PPO $52.00
Rate for Payer: Idaho Integrated Healthcare Commercial $50.44
Rate for Payer: Multiplan Medicare/VA $28.65
Rate for Payer: One Health Plan of WY PPO $50.96
Rate for Payer: PacificSource Commercial $46.80
Rate for Payer: PHCS PPO $50.96
Rate for Payer: Three Rivers PPO $39.00
Rate for Payer: TriWest Veterans Administration $30.16
Rate for Payer: United Healthcare Commercial $45.24
Rate for Payer: United Healthcare Medicare $30.16
Rate for Payer: WINHealth Partners Commercial $50.96
Rate for Payer: Wise Provider Network Commercial $49.40
Service Code HCPCS 83586
Hospital Charge Code 3018358601
Hospital Revenue Code 301
Min. Negotiated Rate $63.36
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Aetna of WY Medicare $75.90
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.70
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $63.36
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $66.70
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $66.70
Rate for Payer: WINHealth Partners Commercial $112.70
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 83586
Hospital Charge Code 3018358601
Hospital Revenue Code 301
Min. Negotiated Rate $72.10
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.90
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $72.10
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $75.90
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $75.90
Rate for Payer: WINHealth Partners Commercial $109.25
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 87301
Hospital Charge Code 3008730101
Hospital Revenue Code 300
Min. Negotiated Rate $66.46
Max. Negotiated Rate $106.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $103.88
Rate for Payer: Altius Auto/Workers Compensation $101.76
Rate for Payer: Altius Commercial $101.76
Rate for Payer: Beech Street Commercial $103.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $87.03
Rate for Payer: Cash Price $74.20
Rate for Payer: ChoiceCare Network Commercial $102.82
Rate for Payer: Cigna of WY Commercial $103.88
Rate for Payer: Entrust Commercial $100.70
Rate for Payer: First Choice Health Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $69.96
Rate for Payer: HealthUtah PPO $106.00
Rate for Payer: Idaho Integrated Healthcare Commercial $102.82
Rate for Payer: Multiplan Medicare/VA $66.46
Rate for Payer: One Health Plan of WY PPO $103.88
Rate for Payer: PacificSource Commercial $95.40
Rate for Payer: PHCS PPO $103.88
Rate for Payer: Three Rivers PPO $79.50
Rate for Payer: TriWest Veterans Administration $69.96
Rate for Payer: United Healthcare Commercial $92.22
Rate for Payer: United Healthcare Medicare $69.96
Rate for Payer: WINHealth Partners Commercial $100.70
Rate for Payer: Wise Provider Network Commercial $100.70
Service Code HCPCS 87301
Hospital Charge Code 3008730101
Hospital Revenue Code 300
Min. Negotiated Rate $58.41
Max. Negotiated Rate $106.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $103.88
Rate for Payer: Aetna of WY Medicare $69.96
Rate for Payer: Altius Auto/Workers Compensation $101.76
Rate for Payer: Altius Commercial $101.76
Rate for Payer: Beech Street Commercial $103.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $87.03
Rate for Payer: Cash Price $74.20
Rate for Payer: ChoiceCare Network Commercial $102.82
Rate for Payer: Cigna of WY Commercial $103.88
Rate for Payer: Entrust Commercial $100.70
Rate for Payer: First Choice Health Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $61.48
Rate for Payer: HealthUtah PPO $106.00
Rate for Payer: Idaho Integrated Healthcare Commercial $102.82
Rate for Payer: Multiplan Medicare/VA $58.41
Rate for Payer: One Health Plan of WY PPO $103.88
Rate for Payer: PacificSource Commercial $95.40
Rate for Payer: PHCS PPO $103.88
Rate for Payer: Three Rivers PPO $79.50
Rate for Payer: TriWest Veterans Administration $61.48
Rate for Payer: United Healthcare Commercial $92.22
Rate for Payer: United Healthcare Medicare $61.48
Rate for Payer: WINHealth Partners Commercial $103.88
Rate for Payer: Wise Provider Network Commercial $100.70
Service Code HCPCS 84075
Hospital Charge Code 3018407501
Hospital Revenue Code 301
Min. Negotiated Rate $37.62
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $39.60
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $37.62
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $39.60
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $39.60
Rate for Payer: WINHealth Partners Commercial $57.00
Rate for Payer: Wise Provider Network Commercial $57.00
Service Code HCPCS 84075
Hospital Charge Code 3018407501
Hospital Revenue Code 301
Min. Negotiated Rate $33.06
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Aetna of WY Medicare $39.60
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $34.80
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $33.06
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $34.80
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $34.80
Rate for Payer: WINHealth Partners Commercial $58.80
Rate for Payer: Wise Provider Network Commercial $57.00
Service Code HCPCS 84075
Hospital Charge Code 3018407504
Hospital Revenue Code 301
Min. Negotiated Rate $37.62
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $39.60
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $37.62
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $39.60
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $39.60
Rate for Payer: WINHealth Partners Commercial $57.00
Rate for Payer: Wise Provider Network Commercial $57.00
Service Code HCPCS 84075
Hospital Charge Code 3018407504
Hospital Revenue Code 301
Min. Negotiated Rate $33.06
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Aetna of WY Medicare $39.60
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $34.80
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $33.06
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $34.80
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $34.80
Rate for Payer: WINHealth Partners Commercial $58.80
Rate for Payer: Wise Provider Network Commercial $57.00
Service Code HCPCS 84080
Hospital Charge Code 3018408001
Hospital Revenue Code 301
Min. Negotiated Rate $72.10
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.90
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $72.10
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $75.90
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $75.90
Rate for Payer: WINHealth Partners Commercial $109.25
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 84080
Hospital Charge Code 3018408001
Hospital Revenue Code 301
Min. Negotiated Rate $63.36
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Aetna of WY Medicare $75.90
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.70
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $63.36
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $66.70
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $66.70
Rate for Payer: WINHealth Partners Commercial $112.70
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 82261
Hospital Charge Code 3018226101
Hospital Revenue Code 301
Min. Negotiated Rate $82.65
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Aetna of WY Medicare $99.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $82.65
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $87.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $87.00
Rate for Payer: WINHealth Partners Commercial $147.00
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 82261
Hospital Charge Code 3018226101
Hospital Revenue Code 301
Min. Negotiated Rate $94.05
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $94.05
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $99.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $99.00
Rate for Payer: WINHealth Partners Commercial $142.50
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 82465
Hospital Charge Code 3018246502
Hospital Revenue Code 301
Min. Negotiated Rate $41.32
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: 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 $43.50
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
Service Code HCPCS 82465
Hospital Charge Code 3018246502
Hospital Revenue Code 301
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
Service Code HCPCS 82374
Hospital Charge Code 3018237401
Hospital Revenue Code 301
Min. Negotiated Rate $27.55
Max. Negotiated Rate $50.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $49.00
Rate for Payer: Aetna of WY Medicare $33.00
Rate for Payer: Altius Auto/Workers Compensation $48.00
Rate for Payer: Altius Commercial $48.00
Rate for Payer: Beech Street Commercial $49.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $41.05
Rate for Payer: Cash Price $35.00
Rate for Payer: ChoiceCare Network Commercial $48.50
Rate for Payer: Cigna of WY Commercial $49.00
Rate for Payer: Entrust Commercial $47.50
Rate for Payer: First Choice Health Commercial $47.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $47.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $29.00
Rate for Payer: HealthUtah PPO $50.00
Rate for Payer: Idaho Integrated Healthcare Commercial $48.50
Rate for Payer: Multiplan Medicare/VA $27.55
Rate for Payer: One Health Plan of WY PPO $49.00
Rate for Payer: PacificSource Commercial $45.00
Rate for Payer: PHCS PPO $49.00
Rate for Payer: Three Rivers PPO $37.50
Rate for Payer: TriWest Veterans Administration $29.00
Rate for Payer: United Healthcare Commercial $43.50
Rate for Payer: United Healthcare Medicare $29.00
Rate for Payer: WINHealth Partners Commercial $49.00
Rate for Payer: Wise Provider Network Commercial $47.50