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Service Code HCPCS 42960
Hospital Charge Code 7614296001
Hospital Revenue Code 761
Min. Negotiated Rate $264.25
Max. Negotiated Rate $456.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $446.88
Rate for Payer: Aetna of WY Medicare $291.84
Rate for Payer: Altius Commercial $437.76
Rate for Payer: Beech Street Commercial $446.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $442.32
Rate for Payer: Cash Price $319.20
Rate for Payer: ChoiceCare Network Commercial $442.32
Rate for Payer: Cigna of WY Commercial $446.88
Rate for Payer: Entrust Commercial $433.20
Rate for Payer: First Choice Health Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $278.16
Rate for Payer: HealthUtah PPO $456.00
Rate for Payer: Idaho Integrated Healthcare Commercial $442.32
Rate for Payer: Multiplan Medicare/VA $264.25
Rate for Payer: One Health Plan of WY PPO $446.88
Rate for Payer: PacificSource Commercial $410.40
Rate for Payer: PHCS PPO $446.88
Rate for Payer: Three Rivers PPO $342.00
Rate for Payer: TriWest Veterans Administration $278.16
Rate for Payer: United Healthcare Commercial $435.48
Rate for Payer: United Healthcare Medicare $278.16
Rate for Payer: WINHealth Partners Commercial $433.20
Rate for Payer: Wise Provider Network Commercial $433.20
Service Code HCPCS 74249
Hospital Charge Code 3207424901
Hospital Revenue Code 320
Min. Negotiated Rate $611.90
Max. Negotiated Rate $1,130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,107.40
Rate for Payer: Aetna of WY Medicare $745.80
Rate for Payer: Altius Commercial $1,084.80
Rate for Payer: Beech Street Commercial $1,107.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,096.10
Rate for Payer: Cash Price $791.00
Rate for Payer: ChoiceCare Network Commercial $1,096.10
Rate for Payer: Cigna of WY Commercial $1,107.40
Rate for Payer: Entrust Commercial $1,073.50
Rate for Payer: First Choice Health Commercial $1,073.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,073.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $644.10
Rate for Payer: HealthUtah PPO $1,130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,096.10
Rate for Payer: Multiplan Medicare/VA $611.90
Rate for Payer: One Health Plan of WY PPO $1,107.40
Rate for Payer: PacificSource Commercial $1,017.00
Rate for Payer: PHCS PPO $1,107.40
Rate for Payer: Three Rivers PPO $847.50
Rate for Payer: TriWest Veterans Administration $644.10
Rate for Payer: United Healthcare Commercial $1,079.15
Rate for Payer: United Healthcare Medicare $644.10
Rate for Payer: WINHealth Partners Commercial $1,107.40
Rate for Payer: Wise Provider Network Commercial $1,073.50
Service Code HCPCS 74249
Hospital Charge Code 3207424901
Hospital Revenue Code 320
Min. Negotiated Rate $654.84
Max. Negotiated Rate $1,130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,107.40
Rate for Payer: Aetna of WY Medicare $723.20
Rate for Payer: Altius Commercial $1,084.80
Rate for Payer: Beech Street Commercial $1,107.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,096.10
Rate for Payer: Cash Price $791.00
Rate for Payer: ChoiceCare Network Commercial $1,096.10
Rate for Payer: Cigna of WY Commercial $1,107.40
Rate for Payer: Entrust Commercial $1,073.50
Rate for Payer: First Choice Health Commercial $1,073.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,073.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $689.30
Rate for Payer: HealthUtah PPO $1,130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,096.10
Rate for Payer: Multiplan Medicare/VA $654.84
Rate for Payer: One Health Plan of WY PPO $1,107.40
Rate for Payer: PacificSource Commercial $1,017.00
Rate for Payer: PHCS PPO $1,107.40
Rate for Payer: Three Rivers PPO $847.50
Rate for Payer: TriWest Veterans Administration $689.30
Rate for Payer: United Healthcare Commercial $1,079.15
Rate for Payer: United Healthcare Medicare $689.30
Rate for Payer: WINHealth Partners Commercial $1,073.50
Rate for Payer: Wise Provider Network Commercial $1,073.50
Service Code HCPCS 82530
Hospital Charge Code 3018253001
Hospital Revenue Code 301
Min. Negotiated Rate $79.06
Max. Negotiated Rate $146.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $143.08
Rate for Payer: Aetna of WY Medicare $96.36
Rate for Payer: Altius Commercial $140.16
Rate for Payer: Beech Street Commercial $143.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $141.62
Rate for Payer: Cash Price $102.20
Rate for Payer: ChoiceCare Network Commercial $141.62
Rate for Payer: Cigna of WY Commercial $143.08
Rate for Payer: Entrust Commercial $138.70
Rate for Payer: First Choice Health Commercial $138.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $138.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $83.22
Rate for Payer: HealthUtah PPO $146.00
Rate for Payer: Idaho Integrated Healthcare Commercial $141.62
Rate for Payer: Multiplan Medicare/VA $79.06
Rate for Payer: One Health Plan of WY PPO $143.08
Rate for Payer: PacificSource Commercial $131.40
Rate for Payer: PHCS PPO $143.08
Rate for Payer: Three Rivers PPO $109.50
Rate for Payer: TriWest Veterans Administration $83.22
Rate for Payer: United Healthcare Commercial $139.43
Rate for Payer: United Healthcare Medicare $83.22
Rate for Payer: WINHealth Partners Commercial $143.08
Rate for Payer: Wise Provider Network Commercial $138.70
Service Code HCPCS 82530
Hospital Charge Code 3018253001
Hospital Revenue Code 301
Min. Negotiated Rate $84.61
Max. Negotiated Rate $146.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $143.08
Rate for Payer: Aetna of WY Medicare $93.44
Rate for Payer: Altius Commercial $140.16
Rate for Payer: Beech Street Commercial $143.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $141.62
Rate for Payer: Cash Price $102.20
Rate for Payer: ChoiceCare Network Commercial $141.62
Rate for Payer: Cigna of WY Commercial $143.08
Rate for Payer: Entrust Commercial $138.70
Rate for Payer: First Choice Health Commercial $138.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $138.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.06
Rate for Payer: HealthUtah PPO $146.00
Rate for Payer: Idaho Integrated Healthcare Commercial $141.62
Rate for Payer: Multiplan Medicare/VA $84.61
Rate for Payer: One Health Plan of WY PPO $143.08
Rate for Payer: PacificSource Commercial $131.40
Rate for Payer: PHCS PPO $143.08
Rate for Payer: Three Rivers PPO $109.50
Rate for Payer: TriWest Veterans Administration $89.06
Rate for Payer: United Healthcare Commercial $139.43
Rate for Payer: United Healthcare Medicare $89.06
Rate for Payer: WINHealth Partners Commercial $138.70
Rate for Payer: Wise Provider Network Commercial $138.70
Service Code HCPCS 82530
Hospital Charge Code 3018253002
Hospital Revenue Code 301
Min. Negotiated Rate $62.81
Max. Negotiated Rate $116.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $113.68
Rate for Payer: Aetna of WY Medicare $76.56
Rate for Payer: Altius Commercial $111.36
Rate for Payer: Beech Street Commercial $113.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $112.52
Rate for Payer: Cash Price $81.20
Rate for Payer: ChoiceCare Network Commercial $112.52
Rate for Payer: Cigna of WY Commercial $113.68
Rate for Payer: Entrust Commercial $110.20
Rate for Payer: First Choice Health Commercial $110.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $110.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.12
Rate for Payer: HealthUtah PPO $116.00
Rate for Payer: Idaho Integrated Healthcare Commercial $112.52
Rate for Payer: Multiplan Medicare/VA $62.81
Rate for Payer: One Health Plan of WY PPO $113.68
Rate for Payer: PacificSource Commercial $104.40
Rate for Payer: PHCS PPO $113.68
Rate for Payer: Three Rivers PPO $87.00
Rate for Payer: TriWest Veterans Administration $66.12
Rate for Payer: United Healthcare Commercial $110.78
Rate for Payer: United Healthcare Medicare $66.12
Rate for Payer: WINHealth Partners Commercial $113.68
Rate for Payer: Wise Provider Network Commercial $110.20
Service Code HCPCS 82530
Hospital Charge Code 3018253002
Hospital Revenue Code 301
Min. Negotiated Rate $67.22
Max. Negotiated Rate $116.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $113.68
Rate for Payer: Aetna of WY Medicare $74.24
Rate for Payer: Altius Commercial $111.36
Rate for Payer: Beech Street Commercial $113.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $112.52
Rate for Payer: Cash Price $81.20
Rate for Payer: ChoiceCare Network Commercial $112.52
Rate for Payer: Cigna of WY Commercial $113.68
Rate for Payer: Entrust Commercial $110.20
Rate for Payer: First Choice Health Commercial $110.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $110.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $70.76
Rate for Payer: HealthUtah PPO $116.00
Rate for Payer: Idaho Integrated Healthcare Commercial $112.52
Rate for Payer: Multiplan Medicare/VA $67.22
Rate for Payer: One Health Plan of WY PPO $113.68
Rate for Payer: PacificSource Commercial $104.40
Rate for Payer: PHCS PPO $113.68
Rate for Payer: Three Rivers PPO $87.00
Rate for Payer: TriWest Veterans Administration $70.76
Rate for Payer: United Healthcare Commercial $110.78
Rate for Payer: United Healthcare Medicare $70.76
Rate for Payer: WINHealth Partners Commercial $110.20
Rate for Payer: Wise Provider Network Commercial $110.20
Service Code HCPCS 86140
Hospital Charge Code 3028614001
Hospital Revenue Code 302
Min. Negotiated Rate $68.77
Max. Negotiated Rate $127.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $124.46
Rate for Payer: Aetna of WY Medicare $83.82
Rate for Payer: Altius Commercial $121.92
Rate for Payer: Beech Street Commercial $124.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.19
Rate for Payer: Cash Price $88.90
Rate for Payer: ChoiceCare Network Commercial $123.19
Rate for Payer: Cigna of WY Commercial $124.46
Rate for Payer: Entrust Commercial $120.65
Rate for Payer: First Choice Health Commercial $120.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $120.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.39
Rate for Payer: HealthUtah PPO $127.00
Rate for Payer: Idaho Integrated Healthcare Commercial $123.19
Rate for Payer: Multiplan Medicare/VA $68.77
Rate for Payer: One Health Plan of WY PPO $124.46
Rate for Payer: PacificSource Commercial $114.30
Rate for Payer: PHCS PPO $124.46
Rate for Payer: Three Rivers PPO $95.25
Rate for Payer: TriWest Veterans Administration $72.39
Rate for Payer: United Healthcare Commercial $121.28
Rate for Payer: United Healthcare Medicare $72.39
Rate for Payer: WINHealth Partners Commercial $124.46
Rate for Payer: Wise Provider Network Commercial $120.65
Service Code HCPCS 86140
Hospital Charge Code 3028614001
Hospital Revenue Code 302
Min. Negotiated Rate $73.60
Max. Negotiated Rate $127.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $124.46
Rate for Payer: Aetna of WY Medicare $81.28
Rate for Payer: Altius Commercial $121.92
Rate for Payer: Beech Street Commercial $124.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.19
Rate for Payer: Cash Price $88.90
Rate for Payer: ChoiceCare Network Commercial $123.19
Rate for Payer: Cigna of WY Commercial $124.46
Rate for Payer: Entrust Commercial $120.65
Rate for Payer: First Choice Health Commercial $120.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $120.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $77.47
Rate for Payer: HealthUtah PPO $127.00
Rate for Payer: Idaho Integrated Healthcare Commercial $123.19
Rate for Payer: Multiplan Medicare/VA $73.60
Rate for Payer: One Health Plan of WY PPO $124.46
Rate for Payer: PacificSource Commercial $114.30
Rate for Payer: PHCS PPO $124.46
Rate for Payer: Three Rivers PPO $95.25
Rate for Payer: TriWest Veterans Administration $77.47
Rate for Payer: United Healthcare Commercial $121.28
Rate for Payer: United Healthcare Medicare $77.47
Rate for Payer: WINHealth Partners Commercial $120.65
Rate for Payer: Wise Provider Network Commercial $120.65
Service Code HCPCS 86141
Hospital Charge Code 3028614101
Hospital Revenue Code 302
Min. Negotiated Rate $82.85
Max. Negotiated Rate $153.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $149.94
Rate for Payer: Aetna of WY Medicare $100.98
Rate for Payer: Altius Commercial $146.88
Rate for Payer: Beech Street Commercial $149.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $148.41
Rate for Payer: Cash Price $107.10
Rate for Payer: ChoiceCare Network Commercial $148.41
Rate for Payer: Cigna of WY Commercial $149.94
Rate for Payer: Entrust Commercial $145.35
Rate for Payer: First Choice Health Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.21
Rate for Payer: HealthUtah PPO $153.00
Rate for Payer: Idaho Integrated Healthcare Commercial $148.41
Rate for Payer: Multiplan Medicare/VA $82.85
Rate for Payer: One Health Plan of WY PPO $149.94
Rate for Payer: PacificSource Commercial $137.70
Rate for Payer: PHCS PPO $149.94
Rate for Payer: Three Rivers PPO $114.75
Rate for Payer: TriWest Veterans Administration $87.21
Rate for Payer: United Healthcare Commercial $146.12
Rate for Payer: United Healthcare Medicare $87.21
Rate for Payer: WINHealth Partners Commercial $149.94
Rate for Payer: Wise Provider Network Commercial $145.35
Service Code HCPCS 86141
Hospital Charge Code 3028614101
Hospital Revenue Code 302
Min. Negotiated Rate $88.66
Max. Negotiated Rate $153.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $149.94
Rate for Payer: Aetna of WY Medicare $97.92
Rate for Payer: Altius Commercial $146.88
Rate for Payer: Beech Street Commercial $149.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $148.41
Rate for Payer: Cash Price $107.10
Rate for Payer: ChoiceCare Network Commercial $148.41
Rate for Payer: Cigna of WY Commercial $149.94
Rate for Payer: Entrust Commercial $145.35
Rate for Payer: First Choice Health Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $93.33
Rate for Payer: HealthUtah PPO $153.00
Rate for Payer: Idaho Integrated Healthcare Commercial $148.41
Rate for Payer: Multiplan Medicare/VA $88.66
Rate for Payer: One Health Plan of WY PPO $149.94
Rate for Payer: PacificSource Commercial $137.70
Rate for Payer: PHCS PPO $149.94
Rate for Payer: Three Rivers PPO $114.75
Rate for Payer: TriWest Veterans Administration $93.33
Rate for Payer: United Healthcare Commercial $146.12
Rate for Payer: United Healthcare Medicare $93.33
Rate for Payer: WINHealth Partners Commercial $145.35
Rate for Payer: Wise Provider Network Commercial $145.35
Service Code HCPCS 82553
Hospital Charge Code 3018255302
Hospital Revenue Code 301
Min. Negotiated Rate $128.07
Max. Negotiated Rate $221.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $216.58
Rate for Payer: Aetna of WY Medicare $141.44
Rate for Payer: Altius Commercial $212.16
Rate for Payer: Beech Street Commercial $216.58
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $214.37
Rate for Payer: Cash Price $154.70
Rate for Payer: ChoiceCare Network Commercial $214.37
Rate for Payer: Cigna of WY Commercial $216.58
Rate for Payer: Entrust Commercial $209.95
Rate for Payer: First Choice Health Commercial $209.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $209.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $134.81
Rate for Payer: HealthUtah PPO $221.00
Rate for Payer: Idaho Integrated Healthcare Commercial $214.37
Rate for Payer: Multiplan Medicare/VA $128.07
Rate for Payer: One Health Plan of WY PPO $216.58
Rate for Payer: PacificSource Commercial $198.90
Rate for Payer: PHCS PPO $216.58
Rate for Payer: Three Rivers PPO $165.75
Rate for Payer: TriWest Veterans Administration $134.81
Rate for Payer: United Healthcare Commercial $211.06
Rate for Payer: United Healthcare Medicare $134.81
Rate for Payer: WINHealth Partners Commercial $209.95
Rate for Payer: Wise Provider Network Commercial $209.95
Service Code HCPCS 82553
Hospital Charge Code 3018255302
Hospital Revenue Code 301
Min. Negotiated Rate $119.67
Max. Negotiated Rate $221.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $216.58
Rate for Payer: Aetna of WY Medicare $145.86
Rate for Payer: Altius Commercial $212.16
Rate for Payer: Beech Street Commercial $216.58
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $214.37
Rate for Payer: Cash Price $154.70
Rate for Payer: ChoiceCare Network Commercial $214.37
Rate for Payer: Cigna of WY Commercial $216.58
Rate for Payer: Entrust Commercial $209.95
Rate for Payer: First Choice Health Commercial $209.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $209.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $125.97
Rate for Payer: HealthUtah PPO $221.00
Rate for Payer: Idaho Integrated Healthcare Commercial $214.37
Rate for Payer: Multiplan Medicare/VA $119.67
Rate for Payer: One Health Plan of WY PPO $216.58
Rate for Payer: PacificSource Commercial $198.90
Rate for Payer: PHCS PPO $216.58
Rate for Payer: Three Rivers PPO $165.75
Rate for Payer: TriWest Veterans Administration $125.97
Rate for Payer: United Healthcare Commercial $211.06
Rate for Payer: United Healthcare Medicare $125.97
Rate for Payer: WINHealth Partners Commercial $216.58
Rate for Payer: Wise Provider Network Commercial $209.95
Service Code HCPCS 82575
Hospital Charge Code 3018257501
Hospital Revenue Code 301
Min. Negotiated Rate $198.77
Max. Negotiated Rate $343.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $336.14
Rate for Payer: Aetna of WY Medicare $219.52
Rate for Payer: Altius Commercial $329.28
Rate for Payer: Beech Street Commercial $336.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $332.71
Rate for Payer: Cash Price $240.10
Rate for Payer: ChoiceCare Network Commercial $332.71
Rate for Payer: Cigna of WY Commercial $336.14
Rate for Payer: Entrust Commercial $325.85
Rate for Payer: First Choice Health Commercial $325.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $325.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $209.23
Rate for Payer: HealthUtah PPO $343.00
Rate for Payer: Idaho Integrated Healthcare Commercial $332.71
Rate for Payer: Multiplan Medicare/VA $198.77
Rate for Payer: One Health Plan of WY PPO $336.14
Rate for Payer: PacificSource Commercial $308.70
Rate for Payer: PHCS PPO $336.14
Rate for Payer: Three Rivers PPO $257.25
Rate for Payer: TriWest Veterans Administration $209.23
Rate for Payer: United Healthcare Commercial $327.56
Rate for Payer: United Healthcare Medicare $209.23
Rate for Payer: WINHealth Partners Commercial $325.85
Rate for Payer: Wise Provider Network Commercial $325.85
Service Code HCPCS 82575
Hospital Charge Code 3018257501
Hospital Revenue Code 301
Min. Negotiated Rate $185.73
Max. Negotiated Rate $343.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $336.14
Rate for Payer: Aetna of WY Medicare $226.38
Rate for Payer: Altius Commercial $329.28
Rate for Payer: Beech Street Commercial $336.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $332.71
Rate for Payer: Cash Price $240.10
Rate for Payer: ChoiceCare Network Commercial $332.71
Rate for Payer: Cigna of WY Commercial $336.14
Rate for Payer: Entrust Commercial $325.85
Rate for Payer: First Choice Health Commercial $325.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $325.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $195.51
Rate for Payer: HealthUtah PPO $343.00
Rate for Payer: Idaho Integrated Healthcare Commercial $332.71
Rate for Payer: Multiplan Medicare/VA $185.73
Rate for Payer: One Health Plan of WY PPO $336.14
Rate for Payer: PacificSource Commercial $308.70
Rate for Payer: PHCS PPO $336.14
Rate for Payer: Three Rivers PPO $257.25
Rate for Payer: TriWest Veterans Administration $195.51
Rate for Payer: United Healthcare Commercial $327.56
Rate for Payer: United Healthcare Medicare $195.51
Rate for Payer: WINHealth Partners Commercial $336.14
Rate for Payer: Wise Provider Network Commercial $325.85
Service Code HCPCS 99292
Hospital Charge Code 6819929201
Hospital Revenue Code 681
Min. Negotiated Rate $298.91
Max. Negotiated Rate $552.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $540.96
Rate for Payer: Aetna of WY Medicare $364.32
Rate for Payer: Altius Commercial $529.92
Rate for Payer: Beech Street Commercial $540.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $535.44
Rate for Payer: Cash Price $386.40
Rate for Payer: ChoiceCare Network Commercial $535.44
Rate for Payer: Cigna of WY Commercial $540.96
Rate for Payer: Entrust Commercial $524.40
Rate for Payer: First Choice Health Commercial $524.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $524.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $314.64
Rate for Payer: HealthUtah PPO $552.00
Rate for Payer: Idaho Integrated Healthcare Commercial $535.44
Rate for Payer: Multiplan Medicare/VA $298.91
Rate for Payer: One Health Plan of WY PPO $540.96
Rate for Payer: PacificSource Commercial $496.80
Rate for Payer: PHCS PPO $540.96
Rate for Payer: Three Rivers PPO $414.00
Rate for Payer: TriWest Veterans Administration $314.64
Rate for Payer: United Healthcare Commercial $527.16
Rate for Payer: United Healthcare Medicare $314.64
Rate for Payer: WINHealth Partners Commercial $540.96
Rate for Payer: Wise Provider Network Commercial $524.40
Service Code HCPCS 99292
Hospital Charge Code 6819929201
Hospital Revenue Code 681
Min. Negotiated Rate $319.88
Max. Negotiated Rate $552.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $540.96
Rate for Payer: Aetna of WY Medicare $353.28
Rate for Payer: Altius Commercial $529.92
Rate for Payer: Beech Street Commercial $540.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $535.44
Rate for Payer: Cash Price $386.40
Rate for Payer: ChoiceCare Network Commercial $535.44
Rate for Payer: Cigna of WY Commercial $540.96
Rate for Payer: Entrust Commercial $524.40
Rate for Payer: First Choice Health Commercial $524.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $524.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $336.72
Rate for Payer: HealthUtah PPO $552.00
Rate for Payer: Idaho Integrated Healthcare Commercial $535.44
Rate for Payer: Multiplan Medicare/VA $319.88
Rate for Payer: One Health Plan of WY PPO $540.96
Rate for Payer: PacificSource Commercial $496.80
Rate for Payer: PHCS PPO $540.96
Rate for Payer: Three Rivers PPO $414.00
Rate for Payer: TriWest Veterans Administration $336.72
Rate for Payer: United Healthcare Commercial $527.16
Rate for Payer: United Healthcare Medicare $336.72
Rate for Payer: WINHealth Partners Commercial $524.40
Rate for Payer: Wise Provider Network Commercial $524.40
Service Code HCPCS 99291
Hospital Charge Code 6819929101
Hospital Revenue Code 681
Min. Negotiated Rate $2,965.30
Max. Negotiated Rate $5,117.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,014.66
Rate for Payer: Aetna of WY Medicare $3,274.88
Rate for Payer: Altius Commercial $4,912.32
Rate for Payer: Beech Street Commercial $5,014.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,963.49
Rate for Payer: Cash Price $3,581.90
Rate for Payer: ChoiceCare Network Commercial $4,963.49
Rate for Payer: Cigna of WY Commercial $5,014.66
Rate for Payer: Entrust Commercial $4,861.15
Rate for Payer: First Choice Health Commercial $4,861.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,861.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,121.37
Rate for Payer: HealthUtah PPO $5,117.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,963.49
Rate for Payer: Multiplan Medicare/VA $2,965.30
Rate for Payer: One Health Plan of WY PPO $5,014.66
Rate for Payer: PacificSource Commercial $4,605.30
Rate for Payer: PHCS PPO $5,014.66
Rate for Payer: Three Rivers PPO $3,837.75
Rate for Payer: TriWest Veterans Administration $3,121.37
Rate for Payer: United Healthcare Commercial $4,886.74
Rate for Payer: United Healthcare Medicare $3,121.37
Rate for Payer: WINHealth Partners Commercial $4,861.15
Rate for Payer: Wise Provider Network Commercial $4,861.15
Service Code HCPCS 99291
Hospital Charge Code 6819929101
Hospital Revenue Code 681
Min. Negotiated Rate $2,770.86
Max. Negotiated Rate $5,117.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,014.66
Rate for Payer: Aetna of WY Medicare $3,377.22
Rate for Payer: Altius Commercial $4,912.32
Rate for Payer: Beech Street Commercial $5,014.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,963.49
Rate for Payer: Cash Price $3,581.90
Rate for Payer: ChoiceCare Network Commercial $4,963.49
Rate for Payer: Cigna of WY Commercial $5,014.66
Rate for Payer: Entrust Commercial $4,861.15
Rate for Payer: First Choice Health Commercial $4,861.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,861.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,916.69
Rate for Payer: HealthUtah PPO $5,117.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,963.49
Rate for Payer: Multiplan Medicare/VA $2,770.86
Rate for Payer: One Health Plan of WY PPO $5,014.66
Rate for Payer: PacificSource Commercial $4,605.30
Rate for Payer: PHCS PPO $5,014.66
Rate for Payer: Three Rivers PPO $3,837.75
Rate for Payer: TriWest Veterans Administration $2,916.69
Rate for Payer: United Healthcare Commercial $4,886.74
Rate for Payer: United Healthcare Medicare $2,916.69
Rate for Payer: WINHealth Partners Commercial $5,014.66
Rate for Payer: Wise Provider Network Commercial $4,861.15
Service Code HCPCS 86920
Hospital Charge Code 3008692001
Hospital Revenue Code 300
Min. Negotiated Rate $216.06
Max. Negotiated Rate $399.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $391.02
Rate for Payer: Aetna of WY Medicare $263.34
Rate for Payer: Altius Commercial $383.04
Rate for Payer: Beech Street Commercial $391.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $387.03
Rate for Payer: Cash Price $279.30
Rate for Payer: ChoiceCare Network Commercial $387.03
Rate for Payer: Cigna of WY Commercial $391.02
Rate for Payer: Entrust Commercial $379.05
Rate for Payer: First Choice Health Commercial $379.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $379.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $227.43
Rate for Payer: HealthUtah PPO $399.00
Rate for Payer: Idaho Integrated Healthcare Commercial $387.03
Rate for Payer: Multiplan Medicare/VA $216.06
Rate for Payer: One Health Plan of WY PPO $391.02
Rate for Payer: PacificSource Commercial $359.10
Rate for Payer: PHCS PPO $391.02
Rate for Payer: Three Rivers PPO $299.25
Rate for Payer: TriWest Veterans Administration $227.43
Rate for Payer: United Healthcare Commercial $381.04
Rate for Payer: United Healthcare Medicare $227.43
Rate for Payer: WINHealth Partners Commercial $391.02
Rate for Payer: Wise Provider Network Commercial $379.05
Service Code HCPCS 86920
Hospital Charge Code 3008692001
Hospital Revenue Code 300
Min. Negotiated Rate $231.22
Max. Negotiated Rate $399.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $391.02
Rate for Payer: Aetna of WY Medicare $255.36
Rate for Payer: Altius Commercial $383.04
Rate for Payer: Beech Street Commercial $391.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $387.03
Rate for Payer: Cash Price $279.30
Rate for Payer: ChoiceCare Network Commercial $387.03
Rate for Payer: Cigna of WY Commercial $391.02
Rate for Payer: Entrust Commercial $379.05
Rate for Payer: First Choice Health Commercial $379.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $379.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $243.39
Rate for Payer: HealthUtah PPO $399.00
Rate for Payer: Idaho Integrated Healthcare Commercial $387.03
Rate for Payer: Multiplan Medicare/VA $231.22
Rate for Payer: One Health Plan of WY PPO $391.02
Rate for Payer: PacificSource Commercial $359.10
Rate for Payer: PHCS PPO $391.02
Rate for Payer: Three Rivers PPO $299.25
Rate for Payer: TriWest Veterans Administration $243.39
Rate for Payer: United Healthcare Commercial $381.04
Rate for Payer: United Healthcare Medicare $243.39
Rate for Payer: WINHealth Partners Commercial $379.05
Rate for Payer: Wise Provider Network Commercial $379.05
Service Code HCPCS P9012
Hospital Charge Code 390P901201
Hospital Revenue Code 390
Min. Negotiated Rate $399.86
Max. Negotiated Rate $690.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $676.20
Rate for Payer: Aetna of WY Medicare $441.60
Rate for Payer: Altius Commercial $662.40
Rate for Payer: Beech Street Commercial $676.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $669.30
Rate for Payer: Cash Price $483.00
Rate for Payer: ChoiceCare Network Commercial $669.30
Rate for Payer: Cigna of WY Commercial $676.20
Rate for Payer: Entrust Commercial $655.50
Rate for Payer: First Choice Health Commercial $655.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $655.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $420.90
Rate for Payer: HealthUtah PPO $690.00
Rate for Payer: Idaho Integrated Healthcare Commercial $669.30
Rate for Payer: Multiplan Medicare/VA $399.86
Rate for Payer: One Health Plan of WY PPO $676.20
Rate for Payer: PacificSource Commercial $621.00
Rate for Payer: PHCS PPO $676.20
Rate for Payer: Three Rivers PPO $517.50
Rate for Payer: TriWest Veterans Administration $420.90
Rate for Payer: United Healthcare Commercial $658.95
Rate for Payer: United Healthcare Medicare $420.90
Rate for Payer: WINHealth Partners Commercial $655.50
Rate for Payer: Wise Provider Network Commercial $655.50
Service Code HCPCS P9012
Hospital Charge Code 390P901201
Hospital Revenue Code 390
Min. Negotiated Rate $373.64
Max. Negotiated Rate $690.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $676.20
Rate for Payer: Aetna of WY Medicare $455.40
Rate for Payer: Altius Commercial $662.40
Rate for Payer: Beech Street Commercial $676.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $669.30
Rate for Payer: Cash Price $483.00
Rate for Payer: ChoiceCare Network Commercial $669.30
Rate for Payer: Cigna of WY Commercial $676.20
Rate for Payer: Entrust Commercial $655.50
Rate for Payer: First Choice Health Commercial $655.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $655.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $393.30
Rate for Payer: HealthUtah PPO $690.00
Rate for Payer: Idaho Integrated Healthcare Commercial $669.30
Rate for Payer: Multiplan Medicare/VA $373.64
Rate for Payer: One Health Plan of WY PPO $676.20
Rate for Payer: PacificSource Commercial $621.00
Rate for Payer: PHCS PPO $676.20
Rate for Payer: Three Rivers PPO $517.50
Rate for Payer: TriWest Veterans Administration $393.30
Rate for Payer: United Healthcare Commercial $658.95
Rate for Payer: United Healthcare Medicare $393.30
Rate for Payer: WINHealth Partners Commercial $676.20
Rate for Payer: Wise Provider Network Commercial $655.50
Hospital Charge Code 3600000035
Hospital Revenue Code 360
Min. Negotiated Rate $427.78
Max. Negotiated Rate $790.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $774.20
Rate for Payer: Aetna of WY Medicare $521.40
Rate for Payer: Altius Commercial $758.40
Rate for Payer: Beech Street Commercial $774.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $766.30
Rate for Payer: Cash Price $553.00
Rate for Payer: ChoiceCare Network Commercial $766.30
Rate for Payer: Cigna of WY Commercial $774.20
Rate for Payer: Entrust Commercial $750.50
Rate for Payer: First Choice Health Commercial $750.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $750.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $450.30
Rate for Payer: HealthUtah PPO $790.00
Rate for Payer: Idaho Integrated Healthcare Commercial $766.30
Rate for Payer: Multiplan Medicare/VA $427.78
Rate for Payer: One Health Plan of WY PPO $774.20
Rate for Payer: PacificSource Commercial $711.00
Rate for Payer: PHCS PPO $774.20
Rate for Payer: Three Rivers PPO $592.50
Rate for Payer: TriWest Veterans Administration $450.30
Rate for Payer: United Healthcare Commercial $754.45
Rate for Payer: United Healthcare Medicare $450.30
Rate for Payer: WINHealth Partners Commercial $774.20
Rate for Payer: Wise Provider Network Commercial $750.50
Hospital Charge Code 3600000035
Hospital Revenue Code 360
Min. Negotiated Rate $457.80
Max. Negotiated Rate $790.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $774.20
Rate for Payer: Aetna of WY Medicare $505.60
Rate for Payer: Altius Commercial $758.40
Rate for Payer: Beech Street Commercial $774.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $766.30
Rate for Payer: Cash Price $553.00
Rate for Payer: ChoiceCare Network Commercial $766.30
Rate for Payer: Cigna of WY Commercial $774.20
Rate for Payer: Entrust Commercial $750.50
Rate for Payer: First Choice Health Commercial $750.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $750.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $481.90
Rate for Payer: HealthUtah PPO $790.00
Rate for Payer: Idaho Integrated Healthcare Commercial $766.30
Rate for Payer: Multiplan Medicare/VA $457.80
Rate for Payer: One Health Plan of WY PPO $774.20
Rate for Payer: PacificSource Commercial $711.00
Rate for Payer: PHCS PPO $774.20
Rate for Payer: Three Rivers PPO $592.50
Rate for Payer: TriWest Veterans Administration $481.90
Rate for Payer: United Healthcare Commercial $754.45
Rate for Payer: United Healthcare Medicare $481.90
Rate for Payer: WINHealth Partners Commercial $750.50
Rate for Payer: Wise Provider Network Commercial $750.50