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Service Code HCPCS 69000
Hospital Charge Code 7616900001
Hospital Revenue Code 761
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 69000
Hospital Charge Code 7616900001
Hospital Revenue Code 761
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 26011
Hospital Charge Code 7612601101
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 26011
Hospital Charge Code 7612601101
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 26010
Hospital Charge Code 7612601001
Hospital Revenue Code 761
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 26010
Hospital Charge Code 7612601001
Hospital Revenue Code 761
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 10080
Hospital Charge Code 7611008001
Hospital Revenue Code 761
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 10080
Hospital Charge Code 7611008001
Hospital Revenue Code 761
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 10061
Hospital Charge Code 7611006101
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 10061
Hospital Charge Code 7611006101
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 16030
Hospital Charge Code 5101603001
Hospital Revenue Code 510
Min. Negotiated Rate $73.28
Max. Negotiated Rate $133.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $130.34
Rate for Payer: Aetna of WY Medicare $87.78
Rate for Payer: Altius Auto/Workers Compensation $127.68
Rate for Payer: Altius Commercial $127.68
Rate for Payer: Beech Street Commercial $130.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $109.19
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: Entrust Commercial $126.35
Rate for Payer: First Choice Health Commercial $126.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $126.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $77.14
Rate for Payer: HealthUtah PPO $133.00
Rate for Payer: Idaho Integrated Healthcare Commercial $129.01
Rate for Payer: Multiplan Medicare/VA $73.28
Rate for Payer: One Health Plan of WY PPO $130.34
Rate for Payer: PacificSource Commercial $119.70
Rate for Payer: PHCS PPO $130.34
Rate for Payer: Three Rivers PPO $99.75
Rate for Payer: TriWest Veterans Administration $77.14
Rate for Payer: United Healthcare Commercial $115.71
Rate for Payer: United Healthcare Medicare $77.14
Rate for Payer: WINHealth Partners Commercial $130.34
Rate for Payer: Wise Provider Network Commercial $126.35
Service Code HCPCS 16030
Hospital Charge Code 5101603001
Hospital Revenue Code 510
Min. Negotiated Rate $83.39
Max. Negotiated Rate $133.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $130.34
Rate for Payer: Altius Auto/Workers Compensation $127.68
Rate for Payer: Altius Commercial $127.68
Rate for Payer: Beech Street Commercial $130.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $109.19
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: Entrust Commercial $126.35
Rate for Payer: First Choice Health Commercial $126.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $126.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.78
Rate for Payer: HealthUtah PPO $133.00
Rate for Payer: Idaho Integrated Healthcare Commercial $129.01
Rate for Payer: Multiplan Medicare/VA $83.39
Rate for Payer: One Health Plan of WY PPO $130.34
Rate for Payer: PacificSource Commercial $119.70
Rate for Payer: PHCS PPO $130.34
Rate for Payer: Three Rivers PPO $99.75
Rate for Payer: TriWest Veterans Administration $87.78
Rate for Payer: United Healthcare Commercial $115.71
Rate for Payer: United Healthcare Medicare $87.78
Rate for Payer: WINHealth Partners Commercial $126.35
Rate for Payer: Wise Provider Network Commercial $126.35
Service Code HCPCS 16025
Hospital Charge Code 5101602501
Hospital Revenue Code 510
Min. Negotiated Rate $69.60
Max. Negotiated Rate $111.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $108.78
Rate for Payer: Altius Auto/Workers Compensation $106.56
Rate for Payer: Altius Commercial $106.56
Rate for Payer: Beech Street Commercial $108.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $91.13
Rate for Payer: Cash Price $77.70
Rate for Payer: ChoiceCare Network Commercial $107.67
Rate for Payer: Cigna of WY Commercial $108.78
Rate for Payer: Entrust Commercial $105.45
Rate for Payer: First Choice Health Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $73.26
Rate for Payer: HealthUtah PPO $111.00
Rate for Payer: Idaho Integrated Healthcare Commercial $107.67
Rate for Payer: Multiplan Medicare/VA $69.60
Rate for Payer: One Health Plan of WY PPO $108.78
Rate for Payer: PacificSource Commercial $99.90
Rate for Payer: PHCS PPO $108.78
Rate for Payer: Three Rivers PPO $83.25
Rate for Payer: TriWest Veterans Administration $73.26
Rate for Payer: United Healthcare Commercial $96.57
Rate for Payer: United Healthcare Medicare $73.26
Rate for Payer: WINHealth Partners Commercial $105.45
Rate for Payer: Wise Provider Network Commercial $105.45
Service Code HCPCS 16025
Hospital Charge Code 5101602501
Hospital Revenue Code 510
Min. Negotiated Rate $61.16
Max. Negotiated Rate $111.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $108.78
Rate for Payer: Aetna of WY Medicare $73.26
Rate for Payer: Altius Auto/Workers Compensation $106.56
Rate for Payer: Altius Commercial $106.56
Rate for Payer: Beech Street Commercial $108.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $91.13
Rate for Payer: Cash Price $77.70
Rate for Payer: ChoiceCare Network Commercial $107.67
Rate for Payer: Cigna of WY Commercial $108.78
Rate for Payer: Entrust Commercial $105.45
Rate for Payer: First Choice Health Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $64.38
Rate for Payer: HealthUtah PPO $111.00
Rate for Payer: Idaho Integrated Healthcare Commercial $107.67
Rate for Payer: Multiplan Medicare/VA $61.16
Rate for Payer: One Health Plan of WY PPO $108.78
Rate for Payer: PacificSource Commercial $99.90
Rate for Payer: PHCS PPO $108.78
Rate for Payer: Three Rivers PPO $83.25
Rate for Payer: TriWest Veterans Administration $64.38
Rate for Payer: United Healthcare Commercial $96.57
Rate for Payer: United Healthcare Medicare $64.38
Rate for Payer: WINHealth Partners Commercial $108.78
Rate for Payer: Wise Provider Network Commercial $105.45
Service Code HCPCS 16025
Hospital Charge Code 7611602501
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 16025
Hospital Charge Code 7611602501
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 16020
Hospital Charge Code 5101602001
Hospital Revenue Code 510
Min. Negotiated Rate $29.75
Max. Negotiated Rate $54.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $52.92
Rate for Payer: Aetna of WY Medicare $35.64
Rate for Payer: Altius Auto/Workers Compensation $51.84
Rate for Payer: Altius Commercial $51.84
Rate for Payer: Beech Street Commercial $52.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $44.33
Rate for Payer: Cash Price $37.80
Rate for Payer: ChoiceCare Network Commercial $52.38
Rate for Payer: Cigna of WY Commercial $52.92
Rate for Payer: Entrust Commercial $51.30
Rate for Payer: First Choice Health Commercial $51.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $51.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $31.32
Rate for Payer: HealthUtah PPO $54.00
Rate for Payer: Idaho Integrated Healthcare Commercial $52.38
Rate for Payer: Multiplan Medicare/VA $29.75
Rate for Payer: One Health Plan of WY PPO $52.92
Rate for Payer: PacificSource Commercial $48.60
Rate for Payer: PHCS PPO $52.92
Rate for Payer: Three Rivers PPO $40.50
Rate for Payer: TriWest Veterans Administration $31.32
Rate for Payer: United Healthcare Commercial $46.98
Rate for Payer: United Healthcare Medicare $31.32
Rate for Payer: WINHealth Partners Commercial $52.92
Rate for Payer: Wise Provider Network Commercial $51.30
Service Code HCPCS 16020
Hospital Charge Code 5101602001
Hospital Revenue Code 510
Min. Negotiated Rate $33.86
Max. Negotiated Rate $54.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $52.92
Rate for Payer: Altius Auto/Workers Compensation $51.84
Rate for Payer: Altius Commercial $51.84
Rate for Payer: Beech Street Commercial $52.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $44.33
Rate for Payer: Cash Price $37.80
Rate for Payer: ChoiceCare Network Commercial $52.38
Rate for Payer: Cigna of WY Commercial $52.92
Rate for Payer: Entrust Commercial $51.30
Rate for Payer: First Choice Health Commercial $51.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $51.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $35.64
Rate for Payer: HealthUtah PPO $54.00
Rate for Payer: Idaho Integrated Healthcare Commercial $52.38
Rate for Payer: Multiplan Medicare/VA $33.86
Rate for Payer: One Health Plan of WY PPO $52.92
Rate for Payer: PacificSource Commercial $48.60
Rate for Payer: PHCS PPO $52.92
Rate for Payer: Three Rivers PPO $40.50
Rate for Payer: TriWest Veterans Administration $35.64
Rate for Payer: United Healthcare Commercial $46.98
Rate for Payer: United Healthcare Medicare $35.64
Rate for Payer: WINHealth Partners Commercial $51.30
Rate for Payer: Wise Provider Network Commercial $51.30
Service Code HCPCS 16020
Hospital Charge Code 7611602001
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 16020
Hospital Charge Code 7611602001
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 41800
Hospital Charge Code 5104180001
Hospital Revenue Code 510
Min. Negotiated Rate $127.91
Max. Negotiated Rate $204.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $199.92
Rate for Payer: Altius Auto/Workers Compensation $195.84
Rate for Payer: Altius Commercial $195.84
Rate for Payer: Beech Street Commercial $199.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $167.48
Rate for Payer: Cash Price $142.80
Rate for Payer: ChoiceCare Network Commercial $197.88
Rate for Payer: Cigna of WY Commercial $199.92
Rate for Payer: Entrust Commercial $193.80
Rate for Payer: First Choice Health Commercial $193.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $193.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $134.64
Rate for Payer: HealthUtah PPO $204.00
Rate for Payer: Idaho Integrated Healthcare Commercial $197.88
Rate for Payer: Multiplan Medicare/VA $127.91
Rate for Payer: One Health Plan of WY PPO $199.92
Rate for Payer: PacificSource Commercial $183.60
Rate for Payer: PHCS PPO $199.92
Rate for Payer: Three Rivers PPO $153.00
Rate for Payer: TriWest Veterans Administration $134.64
Rate for Payer: United Healthcare Commercial $177.48
Rate for Payer: United Healthcare Medicare $134.64
Rate for Payer: WINHealth Partners Commercial $193.80
Rate for Payer: Wise Provider Network Commercial $193.80
Service Code HCPCS 41800
Hospital Charge Code 5104180001
Hospital Revenue Code 510
Min. Negotiated Rate $112.40
Max. Negotiated Rate $204.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $199.92
Rate for Payer: Aetna of WY Medicare $134.64
Rate for Payer: Altius Auto/Workers Compensation $195.84
Rate for Payer: Altius Commercial $195.84
Rate for Payer: Beech Street Commercial $199.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $167.48
Rate for Payer: Cash Price $142.80
Rate for Payer: ChoiceCare Network Commercial $197.88
Rate for Payer: Cigna of WY Commercial $199.92
Rate for Payer: Entrust Commercial $193.80
Rate for Payer: First Choice Health Commercial $193.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $193.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $118.32
Rate for Payer: HealthUtah PPO $204.00
Rate for Payer: Idaho Integrated Healthcare Commercial $197.88
Rate for Payer: Multiplan Medicare/VA $112.40
Rate for Payer: One Health Plan of WY PPO $199.92
Rate for Payer: PacificSource Commercial $183.60
Rate for Payer: PHCS PPO $199.92
Rate for Payer: Three Rivers PPO $153.00
Rate for Payer: TriWest Veterans Administration $118.32
Rate for Payer: United Healthcare Commercial $177.48
Rate for Payer: United Healthcare Medicare $118.32
Rate for Payer: WINHealth Partners Commercial $199.92
Rate for Payer: Wise Provider Network Commercial $193.80
Service Code HCPCS 80307
Hospital Charge Code 3018030730
Hospital Revenue Code 301
Min. Negotiated Rate $896.61
Max. Negotiated Rate $1,430.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,401.40
Rate for Payer: Altius Auto/Workers Compensation $1,372.80
Rate for Payer: Altius Commercial $1,372.80
Rate for Payer: Beech Street Commercial $1,401.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,174.03
Rate for Payer: Cash Price $1,001.00
Rate for Payer: ChoiceCare Network Commercial $1,387.10
Rate for Payer: Cigna of WY Commercial $1,401.40
Rate for Payer: Entrust Commercial $1,358.50
Rate for Payer: First Choice Health Commercial $1,358.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,358.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $943.80
Rate for Payer: HealthUtah PPO $1,430.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,387.10
Rate for Payer: Multiplan Medicare/VA $896.61
Rate for Payer: One Health Plan of WY PPO $1,401.40
Rate for Payer: PacificSource Commercial $1,287.00
Rate for Payer: PHCS PPO $1,401.40
Rate for Payer: Three Rivers PPO $1,072.50
Rate for Payer: TriWest Veterans Administration $943.80
Rate for Payer: United Healthcare Commercial $1,244.10
Rate for Payer: United Healthcare Medicare $943.80
Rate for Payer: WINHealth Partners Commercial $1,358.50
Rate for Payer: Wise Provider Network Commercial $1,358.50
Service Code HCPCS 80307
Hospital Charge Code 3018030730
Hospital Revenue Code 301
Min. Negotiated Rate $787.93
Max. Negotiated Rate $1,430.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,401.40
Rate for Payer: Aetna of WY Medicare $943.80
Rate for Payer: Altius Auto/Workers Compensation $1,372.80
Rate for Payer: Altius Commercial $1,372.80
Rate for Payer: Beech Street Commercial $1,401.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,174.03
Rate for Payer: Cash Price $1,001.00
Rate for Payer: ChoiceCare Network Commercial $1,387.10
Rate for Payer: Cigna of WY Commercial $1,401.40
Rate for Payer: Entrust Commercial $1,358.50
Rate for Payer: First Choice Health Commercial $1,358.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,358.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $829.40
Rate for Payer: HealthUtah PPO $1,430.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,387.10
Rate for Payer: Multiplan Medicare/VA $787.93
Rate for Payer: One Health Plan of WY PPO $1,401.40
Rate for Payer: PacificSource Commercial $1,287.00
Rate for Payer: PHCS PPO $1,401.40
Rate for Payer: Three Rivers PPO $1,072.50
Rate for Payer: TriWest Veterans Administration $829.40
Rate for Payer: United Healthcare Commercial $1,244.10
Rate for Payer: United Healthcare Medicare $829.40
Rate for Payer: WINHealth Partners Commercial $1,401.40
Rate for Payer: Wise Provider Network Commercial $1,358.50
Service Code HCPCS 80143
Hospital Charge Code 3018014301
Hospital Revenue Code 301
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