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Charge Type Setting Price  
Service Code HCPCS 74160
Hospital Charge Code 3527416001
Hospital Revenue Code 352
Min. Negotiated Rate $1,047.74
Max. Negotiated Rate $1,808.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,771.84
Rate for Payer: Aetna of WY Medicare $1,157.12
Rate for Payer: Altius Commercial $1,735.68
Rate for Payer: Beech Street Commercial $1,771.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,753.76
Rate for Payer: Cash Price $1,265.60
Rate for Payer: ChoiceCare Network Commercial $1,753.76
Rate for Payer: Cigna of WY Commercial $1,771.84
Rate for Payer: Entrust Commercial $1,717.60
Rate for Payer: First Choice Health Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,102.88
Rate for Payer: HealthUtah PPO $1,808.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,753.76
Rate for Payer: Multiplan Medicare/VA $1,047.74
Rate for Payer: One Health Plan of WY PPO $1,771.84
Rate for Payer: PacificSource Commercial $1,627.20
Rate for Payer: PHCS PPO $1,771.84
Rate for Payer: Three Rivers PPO $1,356.00
Rate for Payer: TriWest Veterans Administration $1,102.88
Rate for Payer: United Healthcare Commercial $1,726.64
Rate for Payer: United Healthcare Medicare $1,102.88
Rate for Payer: WINHealth Partners Commercial $1,717.60
Rate for Payer: Wise Provider Network Commercial $1,717.60
Service Code HCPCS 74160
Hospital Charge Code 3527416001
Hospital Revenue Code 352
Min. Negotiated Rate $979.03
Max. Negotiated Rate $1,808.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,771.84
Rate for Payer: Aetna of WY Medicare $1,193.28
Rate for Payer: Altius Commercial $1,735.68
Rate for Payer: Beech Street Commercial $1,771.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,753.76
Rate for Payer: Cash Price $1,265.60
Rate for Payer: ChoiceCare Network Commercial $1,753.76
Rate for Payer: Cigna of WY Commercial $1,771.84
Rate for Payer: Entrust Commercial $1,717.60
Rate for Payer: First Choice Health Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,030.56
Rate for Payer: HealthUtah PPO $1,808.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,753.76
Rate for Payer: Multiplan Medicare/VA $979.03
Rate for Payer: One Health Plan of WY PPO $1,771.84
Rate for Payer: PacificSource Commercial $1,627.20
Rate for Payer: PHCS PPO $1,771.84
Rate for Payer: Three Rivers PPO $1,356.00
Rate for Payer: TriWest Veterans Administration $1,030.56
Rate for Payer: United Healthcare Commercial $1,726.64
Rate for Payer: United Healthcare Medicare $1,030.56
Rate for Payer: WINHealth Partners Commercial $1,771.84
Rate for Payer: Wise Provider Network Commercial $1,717.60
Service Code HCPCS 74150
Hospital Charge Code 3527415001
Hospital Revenue Code 352
Min. Negotiated Rate $1,015.28
Max. Negotiated Rate $1,752.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,716.96
Rate for Payer: Aetna of WY Medicare $1,121.28
Rate for Payer: Altius Commercial $1,681.92
Rate for Payer: Beech Street Commercial $1,716.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,699.44
Rate for Payer: Cash Price $1,226.40
Rate for Payer: ChoiceCare Network Commercial $1,699.44
Rate for Payer: Cigna of WY Commercial $1,716.96
Rate for Payer: Entrust Commercial $1,664.40
Rate for Payer: First Choice Health Commercial $1,664.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,664.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,068.72
Rate for Payer: HealthUtah PPO $1,752.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,699.44
Rate for Payer: Multiplan Medicare/VA $1,015.28
Rate for Payer: One Health Plan of WY PPO $1,716.96
Rate for Payer: PacificSource Commercial $1,576.80
Rate for Payer: PHCS PPO $1,716.96
Rate for Payer: Three Rivers PPO $1,314.00
Rate for Payer: TriWest Veterans Administration $1,068.72
Rate for Payer: United Healthcare Commercial $1,673.16
Rate for Payer: United Healthcare Medicare $1,068.72
Rate for Payer: WINHealth Partners Commercial $1,664.40
Rate for Payer: Wise Provider Network Commercial $1,664.40
Service Code HCPCS 74150
Hospital Charge Code 3527415001
Hospital Revenue Code 352
Min. Negotiated Rate $948.71
Max. Negotiated Rate $1,752.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,716.96
Rate for Payer: Aetna of WY Medicare $1,156.32
Rate for Payer: Altius Commercial $1,681.92
Rate for Payer: Beech Street Commercial $1,716.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,699.44
Rate for Payer: Cash Price $1,226.40
Rate for Payer: ChoiceCare Network Commercial $1,699.44
Rate for Payer: Cigna of WY Commercial $1,716.96
Rate for Payer: Entrust Commercial $1,664.40
Rate for Payer: First Choice Health Commercial $1,664.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,664.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $998.64
Rate for Payer: HealthUtah PPO $1,752.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,699.44
Rate for Payer: Multiplan Medicare/VA $948.71
Rate for Payer: One Health Plan of WY PPO $1,716.96
Rate for Payer: PacificSource Commercial $1,576.80
Rate for Payer: PHCS PPO $1,716.96
Rate for Payer: Three Rivers PPO $1,314.00
Rate for Payer: TriWest Veterans Administration $998.64
Rate for Payer: United Healthcare Commercial $1,673.16
Rate for Payer: United Healthcare Medicare $998.64
Rate for Payer: WINHealth Partners Commercial $1,716.96
Rate for Payer: Wise Provider Network Commercial $1,664.40
Service Code HCPCS 74170
Hospital Charge Code 3527417001
Hospital Revenue Code 352
Min. Negotiated Rate $1,147.44
Max. Negotiated Rate $2,119.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,076.62
Rate for Payer: Aetna of WY Medicare $1,398.54
Rate for Payer: Altius Commercial $2,034.24
Rate for Payer: Beech Street Commercial $2,076.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,055.43
Rate for Payer: Cash Price $1,483.30
Rate for Payer: ChoiceCare Network Commercial $2,055.43
Rate for Payer: Cigna of WY Commercial $2,076.62
Rate for Payer: Entrust Commercial $2,013.05
Rate for Payer: First Choice Health Commercial $2,013.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,013.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,207.83
Rate for Payer: HealthUtah PPO $2,119.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,055.43
Rate for Payer: Multiplan Medicare/VA $1,147.44
Rate for Payer: One Health Plan of WY PPO $2,076.62
Rate for Payer: PacificSource Commercial $1,907.10
Rate for Payer: PHCS PPO $2,076.62
Rate for Payer: Three Rivers PPO $1,589.25
Rate for Payer: TriWest Veterans Administration $1,207.83
Rate for Payer: United Healthcare Commercial $2,023.64
Rate for Payer: United Healthcare Medicare $1,207.83
Rate for Payer: WINHealth Partners Commercial $2,076.62
Rate for Payer: Wise Provider Network Commercial $2,013.05
Service Code HCPCS 74170
Hospital Charge Code 3527417001
Hospital Revenue Code 352
Min. Negotiated Rate $1,227.96
Max. Negotiated Rate $2,119.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,076.62
Rate for Payer: Aetna of WY Medicare $1,356.16
Rate for Payer: Altius Commercial $2,034.24
Rate for Payer: Beech Street Commercial $2,076.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,055.43
Rate for Payer: Cash Price $1,483.30
Rate for Payer: ChoiceCare Network Commercial $2,055.43
Rate for Payer: Cigna of WY Commercial $2,076.62
Rate for Payer: Entrust Commercial $2,013.05
Rate for Payer: First Choice Health Commercial $2,013.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,013.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,292.59
Rate for Payer: HealthUtah PPO $2,119.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,055.43
Rate for Payer: Multiplan Medicare/VA $1,227.96
Rate for Payer: One Health Plan of WY PPO $2,076.62
Rate for Payer: PacificSource Commercial $1,907.10
Rate for Payer: PHCS PPO $2,076.62
Rate for Payer: Three Rivers PPO $1,589.25
Rate for Payer: TriWest Veterans Administration $1,292.59
Rate for Payer: United Healthcare Commercial $2,023.64
Rate for Payer: United Healthcare Medicare $1,292.59
Rate for Payer: WINHealth Partners Commercial $2,013.05
Rate for Payer: Wise Provider Network Commercial $2,013.05
Service Code HCPCS 74178
Hospital Charge Code 3527417801
Hospital Revenue Code 352
Min. Negotiated Rate $3,006.95
Max. Negotiated Rate $5,553.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,441.94
Rate for Payer: Aetna of WY Medicare $3,664.98
Rate for Payer: Altius Commercial $5,330.88
Rate for Payer: Beech Street Commercial $5,441.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,386.41
Rate for Payer: Cash Price $3,887.10
Rate for Payer: ChoiceCare Network Commercial $5,386.41
Rate for Payer: Cigna of WY Commercial $5,441.94
Rate for Payer: Entrust Commercial $5,275.35
Rate for Payer: First Choice Health Commercial $5,275.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,275.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,165.21
Rate for Payer: HealthUtah PPO $5,553.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,386.41
Rate for Payer: Multiplan Medicare/VA $3,006.95
Rate for Payer: One Health Plan of WY PPO $5,441.94
Rate for Payer: PacificSource Commercial $4,997.70
Rate for Payer: PHCS PPO $5,441.94
Rate for Payer: Three Rivers PPO $4,164.75
Rate for Payer: TriWest Veterans Administration $3,165.21
Rate for Payer: United Healthcare Commercial $5,303.12
Rate for Payer: United Healthcare Medicare $3,165.21
Rate for Payer: WINHealth Partners Commercial $5,441.94
Rate for Payer: Wise Provider Network Commercial $5,275.35
Service Code HCPCS 74178
Hospital Charge Code 3527417801
Hospital Revenue Code 352
Min. Negotiated Rate $3,217.96
Max. Negotiated Rate $5,553.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,441.94
Rate for Payer: Aetna of WY Medicare $3,553.92
Rate for Payer: Altius Commercial $5,330.88
Rate for Payer: Beech Street Commercial $5,441.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,386.41
Rate for Payer: Cash Price $3,887.10
Rate for Payer: ChoiceCare Network Commercial $5,386.41
Rate for Payer: Cigna of WY Commercial $5,441.94
Rate for Payer: Entrust Commercial $5,275.35
Rate for Payer: First Choice Health Commercial $5,275.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,275.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,387.33
Rate for Payer: HealthUtah PPO $5,553.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,386.41
Rate for Payer: Multiplan Medicare/VA $3,217.96
Rate for Payer: One Health Plan of WY PPO $5,441.94
Rate for Payer: PacificSource Commercial $4,997.70
Rate for Payer: PHCS PPO $5,441.94
Rate for Payer: Three Rivers PPO $4,164.75
Rate for Payer: TriWest Veterans Administration $3,387.33
Rate for Payer: United Healthcare Commercial $5,303.12
Rate for Payer: United Healthcare Medicare $3,387.33
Rate for Payer: WINHealth Partners Commercial $5,275.35
Rate for Payer: Wise Provider Network Commercial $5,275.35
Service Code HCPCS 74176
Hospital Charge Code 3527417601
Hospital Revenue Code 352
Min. Negotiated Rate $2,322.64
Max. Negotiated Rate $4,008.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,927.84
Rate for Payer: Aetna of WY Medicare $2,565.12
Rate for Payer: Altius Commercial $3,847.68
Rate for Payer: Beech Street Commercial $3,927.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,887.76
Rate for Payer: Cash Price $2,805.60
Rate for Payer: ChoiceCare Network Commercial $3,887.76
Rate for Payer: Cigna of WY Commercial $3,927.84
Rate for Payer: Entrust Commercial $3,807.60
Rate for Payer: First Choice Health Commercial $3,807.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,807.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,444.88
Rate for Payer: HealthUtah PPO $4,008.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,887.76
Rate for Payer: Multiplan Medicare/VA $2,322.64
Rate for Payer: One Health Plan of WY PPO $3,927.84
Rate for Payer: PacificSource Commercial $3,607.20
Rate for Payer: PHCS PPO $3,927.84
Rate for Payer: Three Rivers PPO $3,006.00
Rate for Payer: TriWest Veterans Administration $2,444.88
Rate for Payer: United Healthcare Commercial $3,827.64
Rate for Payer: United Healthcare Medicare $2,444.88
Rate for Payer: WINHealth Partners Commercial $3,807.60
Rate for Payer: Wise Provider Network Commercial $3,807.60
Service Code HCPCS 74176
Hospital Charge Code 3527417601
Hospital Revenue Code 352
Min. Negotiated Rate $2,170.33
Max. Negotiated Rate $4,008.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,927.84
Rate for Payer: Aetna of WY Medicare $2,645.28
Rate for Payer: Altius Commercial $3,847.68
Rate for Payer: Beech Street Commercial $3,927.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,887.76
Rate for Payer: Cash Price $2,805.60
Rate for Payer: ChoiceCare Network Commercial $3,887.76
Rate for Payer: Cigna of WY Commercial $3,927.84
Rate for Payer: Entrust Commercial $3,807.60
Rate for Payer: First Choice Health Commercial $3,807.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,807.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,284.56
Rate for Payer: HealthUtah PPO $4,008.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,887.76
Rate for Payer: Multiplan Medicare/VA $2,170.33
Rate for Payer: One Health Plan of WY PPO $3,927.84
Rate for Payer: PacificSource Commercial $3,607.20
Rate for Payer: PHCS PPO $3,927.84
Rate for Payer: Three Rivers PPO $3,006.00
Rate for Payer: TriWest Veterans Administration $2,284.56
Rate for Payer: United Healthcare Commercial $3,827.64
Rate for Payer: United Healthcare Medicare $2,284.56
Rate for Payer: WINHealth Partners Commercial $3,927.84
Rate for Payer: Wise Provider Network Commercial $3,807.60
Service Code HCPCS 74177
Hospital Charge Code 3527417701
Hospital Revenue Code 352
Min. Negotiated Rate $2,535.84
Max. Negotiated Rate $4,683.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,589.34
Rate for Payer: Aetna of WY Medicare $3,090.78
Rate for Payer: Altius Commercial $4,495.68
Rate for Payer: Beech Street Commercial $4,589.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,542.51
Rate for Payer: Cash Price $3,278.10
Rate for Payer: ChoiceCare Network Commercial $4,542.51
Rate for Payer: Cigna of WY Commercial $4,589.34
Rate for Payer: Entrust Commercial $4,448.85
Rate for Payer: First Choice Health Commercial $4,448.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,448.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,669.31
Rate for Payer: HealthUtah PPO $4,683.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,542.51
Rate for Payer: Multiplan Medicare/VA $2,535.84
Rate for Payer: One Health Plan of WY PPO $4,589.34
Rate for Payer: PacificSource Commercial $4,214.70
Rate for Payer: PHCS PPO $4,589.34
Rate for Payer: Three Rivers PPO $3,512.25
Rate for Payer: TriWest Veterans Administration $2,669.31
Rate for Payer: United Healthcare Commercial $4,472.26
Rate for Payer: United Healthcare Medicare $2,669.31
Rate for Payer: WINHealth Partners Commercial $4,589.34
Rate for Payer: Wise Provider Network Commercial $4,448.85
Service Code HCPCS 74177
Hospital Charge Code 3527417701
Hospital Revenue Code 352
Min. Negotiated Rate $2,713.80
Max. Negotiated Rate $4,683.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,589.34
Rate for Payer: Aetna of WY Medicare $2,997.12
Rate for Payer: Altius Commercial $4,495.68
Rate for Payer: Beech Street Commercial $4,589.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,542.51
Rate for Payer: Cash Price $3,278.10
Rate for Payer: ChoiceCare Network Commercial $4,542.51
Rate for Payer: Cigna of WY Commercial $4,589.34
Rate for Payer: Entrust Commercial $4,448.85
Rate for Payer: First Choice Health Commercial $4,448.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,448.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,856.63
Rate for Payer: HealthUtah PPO $4,683.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,542.51
Rate for Payer: Multiplan Medicare/VA $2,713.80
Rate for Payer: One Health Plan of WY PPO $4,589.34
Rate for Payer: PacificSource Commercial $4,214.70
Rate for Payer: PHCS PPO $4,589.34
Rate for Payer: Three Rivers PPO $3,512.25
Rate for Payer: TriWest Veterans Administration $2,856.63
Rate for Payer: United Healthcare Commercial $4,472.26
Rate for Payer: United Healthcare Medicare $2,856.63
Rate for Payer: WINHealth Partners Commercial $4,448.85
Rate for Payer: Wise Provider Network Commercial $4,448.85
Service Code HCPCS 75635
Hospital Charge Code 3527563501
Hospital Revenue Code 352
Min. Negotiated Rate $1,854.64
Max. Negotiated Rate $3,425.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,356.50
Rate for Payer: Aetna of WY Medicare $2,260.50
Rate for Payer: Altius Commercial $3,288.00
Rate for Payer: Beech Street Commercial $3,356.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,322.25
Rate for Payer: Cash Price $2,397.50
Rate for Payer: ChoiceCare Network Commercial $3,322.25
Rate for Payer: Cigna of WY Commercial $3,356.50
Rate for Payer: Entrust Commercial $3,253.75
Rate for Payer: First Choice Health Commercial $3,253.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,253.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,952.25
Rate for Payer: HealthUtah PPO $3,425.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,322.25
Rate for Payer: Multiplan Medicare/VA $1,854.64
Rate for Payer: One Health Plan of WY PPO $3,356.50
Rate for Payer: PacificSource Commercial $3,082.50
Rate for Payer: PHCS PPO $3,356.50
Rate for Payer: Three Rivers PPO $2,568.75
Rate for Payer: TriWest Veterans Administration $1,952.25
Rate for Payer: United Healthcare Commercial $3,270.88
Rate for Payer: United Healthcare Medicare $1,952.25
Rate for Payer: WINHealth Partners Commercial $3,356.50
Rate for Payer: Wise Provider Network Commercial $3,253.75
Service Code HCPCS 75635
Hospital Charge Code 3527563501
Hospital Revenue Code 352
Min. Negotiated Rate $1,984.79
Max. Negotiated Rate $3,425.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,356.50
Rate for Payer: Aetna of WY Medicare $2,192.00
Rate for Payer: Altius Commercial $3,288.00
Rate for Payer: Beech Street Commercial $3,356.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,322.25
Rate for Payer: Cash Price $2,397.50
Rate for Payer: ChoiceCare Network Commercial $3,322.25
Rate for Payer: Cigna of WY Commercial $3,356.50
Rate for Payer: Entrust Commercial $3,253.75
Rate for Payer: First Choice Health Commercial $3,253.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,253.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,089.25
Rate for Payer: HealthUtah PPO $3,425.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,322.25
Rate for Payer: Multiplan Medicare/VA $1,984.79
Rate for Payer: One Health Plan of WY PPO $3,356.50
Rate for Payer: PacificSource Commercial $3,082.50
Rate for Payer: PHCS PPO $3,356.50
Rate for Payer: Three Rivers PPO $2,568.75
Rate for Payer: TriWest Veterans Administration $2,089.25
Rate for Payer: United Healthcare Commercial $3,270.88
Rate for Payer: United Healthcare Medicare $2,089.25
Rate for Payer: WINHealth Partners Commercial $3,253.75
Rate for Payer: Wise Provider Network Commercial $3,253.75
Service Code HCPCS 74175
Hospital Charge Code 3527417501
Hospital Revenue Code 352
Min. Negotiated Rate $1,047.74
Max. Negotiated Rate $1,808.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,771.84
Rate for Payer: Aetna of WY Medicare $1,157.12
Rate for Payer: Altius Commercial $1,735.68
Rate for Payer: Beech Street Commercial $1,771.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,753.76
Rate for Payer: Cash Price $1,265.60
Rate for Payer: ChoiceCare Network Commercial $1,753.76
Rate for Payer: Cigna of WY Commercial $1,771.84
Rate for Payer: Entrust Commercial $1,717.60
Rate for Payer: First Choice Health Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,102.88
Rate for Payer: HealthUtah PPO $1,808.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,753.76
Rate for Payer: Multiplan Medicare/VA $1,047.74
Rate for Payer: One Health Plan of WY PPO $1,771.84
Rate for Payer: PacificSource Commercial $1,627.20
Rate for Payer: PHCS PPO $1,771.84
Rate for Payer: Three Rivers PPO $1,356.00
Rate for Payer: TriWest Veterans Administration $1,102.88
Rate for Payer: United Healthcare Commercial $1,726.64
Rate for Payer: United Healthcare Medicare $1,102.88
Rate for Payer: WINHealth Partners Commercial $1,717.60
Rate for Payer: Wise Provider Network Commercial $1,717.60
Service Code HCPCS 74175
Hospital Charge Code 3527417501
Hospital Revenue Code 352
Min. Negotiated Rate $979.03
Max. Negotiated Rate $1,808.00
Rate for Payer: United Healthcare Commercial $1,726.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,771.84
Rate for Payer: Aetna of WY Medicare $1,193.28
Rate for Payer: Altius Commercial $1,735.68
Rate for Payer: Beech Street Commercial $1,771.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,753.76
Rate for Payer: Cash Price $1,265.60
Rate for Payer: ChoiceCare Network Commercial $1,753.76
Rate for Payer: Cigna of WY Commercial $1,771.84
Rate for Payer: Entrust Commercial $1,717.60
Rate for Payer: First Choice Health Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,030.56
Rate for Payer: HealthUtah PPO $1,808.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,753.76
Rate for Payer: Multiplan Medicare/VA $979.03
Rate for Payer: One Health Plan of WY PPO $1,771.84
Rate for Payer: PacificSource Commercial $1,627.20
Rate for Payer: PHCS PPO $1,771.84
Rate for Payer: Three Rivers PPO $1,356.00
Rate for Payer: TriWest Veterans Administration $1,030.56
Rate for Payer: United Healthcare Medicare $1,030.56
Rate for Payer: WINHealth Partners Commercial $1,771.84
Rate for Payer: Wise Provider Network Commercial $1,717.60
Service Code HCPCS 74174
Hospital Charge Code 3527417401
Hospital Revenue Code 352
Min. Negotiated Rate $2,345.24
Max. Negotiated Rate $4,331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,244.38
Rate for Payer: Aetna of WY Medicare $2,858.46
Rate for Payer: Altius Commercial $4,157.76
Rate for Payer: Beech Street Commercial $4,244.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,201.07
Rate for Payer: Cash Price $3,031.70
Rate for Payer: ChoiceCare Network Commercial $4,201.07
Rate for Payer: Cigna of WY Commercial $4,244.38
Rate for Payer: Entrust Commercial $4,114.45
Rate for Payer: First Choice Health Commercial $4,114.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,114.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,468.67
Rate for Payer: HealthUtah PPO $4,331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,201.07
Rate for Payer: Multiplan Medicare/VA $2,345.24
Rate for Payer: One Health Plan of WY PPO $4,244.38
Rate for Payer: PacificSource Commercial $3,897.90
Rate for Payer: PHCS PPO $4,244.38
Rate for Payer: Three Rivers PPO $3,248.25
Rate for Payer: TriWest Veterans Administration $2,468.67
Rate for Payer: United Healthcare Commercial $4,136.10
Rate for Payer: United Healthcare Medicare $2,468.67
Rate for Payer: WINHealth Partners Commercial $4,244.38
Rate for Payer: Wise Provider Network Commercial $4,114.45
Service Code HCPCS 74174
Hospital Charge Code 3527417401
Hospital Revenue Code 352
Min. Negotiated Rate $2,509.81
Max. Negotiated Rate $4,331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,244.38
Rate for Payer: Aetna of WY Medicare $2,771.84
Rate for Payer: Altius Commercial $4,157.76
Rate for Payer: Beech Street Commercial $4,244.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,201.07
Rate for Payer: Cash Price $3,031.70
Rate for Payer: ChoiceCare Network Commercial $4,201.07
Rate for Payer: Cigna of WY Commercial $4,244.38
Rate for Payer: Entrust Commercial $4,114.45
Rate for Payer: First Choice Health Commercial $4,114.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,114.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,641.91
Rate for Payer: HealthUtah PPO $4,331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,201.07
Rate for Payer: Multiplan Medicare/VA $2,509.81
Rate for Payer: One Health Plan of WY PPO $4,244.38
Rate for Payer: PacificSource Commercial $3,897.90
Rate for Payer: PHCS PPO $4,244.38
Rate for Payer: Three Rivers PPO $3,248.25
Rate for Payer: TriWest Veterans Administration $2,641.91
Rate for Payer: United Healthcare Commercial $4,136.10
Rate for Payer: United Healthcare Medicare $2,641.91
Rate for Payer: WINHealth Partners Commercial $4,114.45
Rate for Payer: Wise Provider Network Commercial $4,114.45
Service Code HCPCS 71275
Hospital Charge Code 3527127501
Hospital Revenue Code 352
Min. Negotiated Rate $1,425.57
Max. Negotiated Rate $2,460.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,410.80
Rate for Payer: Aetna of WY Medicare $1,574.40
Rate for Payer: Altius Commercial $2,361.60
Rate for Payer: Beech Street Commercial $2,410.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,386.20
Rate for Payer: Cash Price $1,722.00
Rate for Payer: ChoiceCare Network Commercial $2,386.20
Rate for Payer: Cigna of WY Commercial $2,410.80
Rate for Payer: Entrust Commercial $2,337.00
Rate for Payer: First Choice Health Commercial $2,337.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,337.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,500.60
Rate for Payer: HealthUtah PPO $2,460.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,386.20
Rate for Payer: Multiplan Medicare/VA $1,425.57
Rate for Payer: One Health Plan of WY PPO $2,410.80
Rate for Payer: PacificSource Commercial $2,214.00
Rate for Payer: PHCS PPO $2,410.80
Rate for Payer: Three Rivers PPO $1,845.00
Rate for Payer: TriWest Veterans Administration $1,500.60
Rate for Payer: United Healthcare Commercial $2,349.30
Rate for Payer: United Healthcare Medicare $1,500.60
Rate for Payer: WINHealth Partners Commercial $2,337.00
Rate for Payer: Wise Provider Network Commercial $2,337.00
Service Code HCPCS 71275
Hospital Charge Code 3527127501
Hospital Revenue Code 352
Min. Negotiated Rate $1,332.09
Max. Negotiated Rate $2,460.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,410.80
Rate for Payer: Aetna of WY Medicare $1,623.60
Rate for Payer: Altius Commercial $2,361.60
Rate for Payer: Beech Street Commercial $2,410.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,386.20
Rate for Payer: Cash Price $1,722.00
Rate for Payer: ChoiceCare Network Commercial $2,386.20
Rate for Payer: Cigna of WY Commercial $2,410.80
Rate for Payer: Entrust Commercial $2,337.00
Rate for Payer: First Choice Health Commercial $2,337.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,337.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,402.20
Rate for Payer: HealthUtah PPO $2,460.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,386.20
Rate for Payer: Multiplan Medicare/VA $1,332.09
Rate for Payer: One Health Plan of WY PPO $2,410.80
Rate for Payer: PacificSource Commercial $2,214.00
Rate for Payer: PHCS PPO $2,410.80
Rate for Payer: Three Rivers PPO $1,845.00
Rate for Payer: TriWest Veterans Administration $1,402.20
Rate for Payer: United Healthcare Commercial $2,349.30
Rate for Payer: United Healthcare Medicare $1,402.20
Rate for Payer: WINHealth Partners Commercial $2,410.80
Rate for Payer: Wise Provider Network Commercial $2,337.00
Service Code HCPCS 70496
Hospital Charge Code 3517049601
Hospital Revenue Code 351
Min. Negotiated Rate $1,154.48
Max. Negotiated Rate $2,132.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,089.36
Rate for Payer: Aetna of WY Medicare $1,407.12
Rate for Payer: Altius Commercial $2,046.72
Rate for Payer: Beech Street Commercial $2,089.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,068.04
Rate for Payer: Cash Price $1,492.40
Rate for Payer: ChoiceCare Network Commercial $2,068.04
Rate for Payer: Cigna of WY Commercial $2,089.36
Rate for Payer: Entrust Commercial $2,025.40
Rate for Payer: First Choice Health Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,215.24
Rate for Payer: HealthUtah PPO $2,132.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,068.04
Rate for Payer: Multiplan Medicare/VA $1,154.48
Rate for Payer: One Health Plan of WY PPO $2,089.36
Rate for Payer: PacificSource Commercial $1,918.80
Rate for Payer: PHCS PPO $2,089.36
Rate for Payer: Three Rivers PPO $1,599.00
Rate for Payer: TriWest Veterans Administration $1,215.24
Rate for Payer: United Healthcare Commercial $2,036.06
Rate for Payer: United Healthcare Medicare $1,215.24
Rate for Payer: WINHealth Partners Commercial $2,089.36
Rate for Payer: Wise Provider Network Commercial $2,025.40
Service Code HCPCS 70496
Hospital Charge Code 3517049601
Hospital Revenue Code 351
Min. Negotiated Rate $1,235.49
Max. Negotiated Rate $2,132.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,089.36
Rate for Payer: Aetna of WY Medicare $1,364.48
Rate for Payer: Altius Commercial $2,046.72
Rate for Payer: Beech Street Commercial $2,089.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,068.04
Rate for Payer: Cash Price $1,492.40
Rate for Payer: ChoiceCare Network Commercial $2,068.04
Rate for Payer: Cigna of WY Commercial $2,089.36
Rate for Payer: Entrust Commercial $2,025.40
Rate for Payer: First Choice Health Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,300.52
Rate for Payer: HealthUtah PPO $2,132.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,068.04
Rate for Payer: Multiplan Medicare/VA $1,235.49
Rate for Payer: One Health Plan of WY PPO $2,089.36
Rate for Payer: PacificSource Commercial $1,918.80
Rate for Payer: PHCS PPO $2,089.36
Rate for Payer: Three Rivers PPO $1,599.00
Rate for Payer: TriWest Veterans Administration $1,300.52
Rate for Payer: United Healthcare Commercial $2,036.06
Rate for Payer: United Healthcare Medicare $1,300.52
Rate for Payer: WINHealth Partners Commercial $2,025.40
Rate for Payer: Wise Provider Network Commercial $2,025.40
Service Code HCPCS 70496
Hospital Charge Code 3517049602
Hospital Revenue Code 351
Min. Negotiated Rate $1,235.49
Max. Negotiated Rate $2,132.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,089.36
Rate for Payer: Aetna of WY Medicare $1,364.48
Rate for Payer: Altius Commercial $2,046.72
Rate for Payer: Beech Street Commercial $2,089.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,068.04
Rate for Payer: Cash Price $1,492.40
Rate for Payer: ChoiceCare Network Commercial $2,068.04
Rate for Payer: Cigna of WY Commercial $2,089.36
Rate for Payer: Entrust Commercial $2,025.40
Rate for Payer: First Choice Health Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,300.52
Rate for Payer: HealthUtah PPO $2,132.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,068.04
Rate for Payer: Multiplan Medicare/VA $1,235.49
Rate for Payer: One Health Plan of WY PPO $2,089.36
Rate for Payer: PacificSource Commercial $1,918.80
Rate for Payer: PHCS PPO $2,089.36
Rate for Payer: Three Rivers PPO $1,599.00
Rate for Payer: TriWest Veterans Administration $1,300.52
Rate for Payer: United Healthcare Commercial $2,036.06
Rate for Payer: United Healthcare Medicare $1,300.52
Rate for Payer: WINHealth Partners Commercial $2,025.40
Rate for Payer: Wise Provider Network Commercial $2,025.40
Service Code HCPCS 70496
Hospital Charge Code 3517049602
Hospital Revenue Code 351
Min. Negotiated Rate $1,154.48
Max. Negotiated Rate $2,132.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,089.36
Rate for Payer: Aetna of WY Medicare $1,407.12
Rate for Payer: Altius Commercial $2,046.72
Rate for Payer: Beech Street Commercial $2,089.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,068.04
Rate for Payer: Cash Price $1,492.40
Rate for Payer: ChoiceCare Network Commercial $2,068.04
Rate for Payer: Cigna of WY Commercial $2,089.36
Rate for Payer: Entrust Commercial $2,025.40
Rate for Payer: First Choice Health Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,025.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,215.24
Rate for Payer: HealthUtah PPO $2,132.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,068.04
Rate for Payer: Multiplan Medicare/VA $1,154.48
Rate for Payer: One Health Plan of WY PPO $2,089.36
Rate for Payer: PacificSource Commercial $1,918.80
Rate for Payer: PHCS PPO $2,089.36
Rate for Payer: Three Rivers PPO $1,599.00
Rate for Payer: TriWest Veterans Administration $1,215.24
Rate for Payer: United Healthcare Commercial $2,036.06
Rate for Payer: United Healthcare Medicare $1,215.24
Rate for Payer: WINHealth Partners Commercial $2,089.36
Rate for Payer: Wise Provider Network Commercial $2,025.40
Service Code HCPCS 75574
Hospital Charge Code 3527557401
Hospital Revenue Code 352
Min. Negotiated Rate $979.03
Max. Negotiated Rate $1,808.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,771.84
Rate for Payer: Aetna of WY Medicare $1,193.28
Rate for Payer: Altius Commercial $1,735.68
Rate for Payer: Beech Street Commercial $1,771.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,753.76
Rate for Payer: Cash Price $1,265.60
Rate for Payer: ChoiceCare Network Commercial $1,753.76
Rate for Payer: Cigna of WY Commercial $1,771.84
Rate for Payer: Entrust Commercial $1,717.60
Rate for Payer: First Choice Health Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,717.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,030.56
Rate for Payer: HealthUtah PPO $1,808.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,753.76
Rate for Payer: Multiplan Medicare/VA $979.03
Rate for Payer: One Health Plan of WY PPO $1,771.84
Rate for Payer: PacificSource Commercial $1,627.20
Rate for Payer: PHCS PPO $1,771.84
Rate for Payer: Three Rivers PPO $1,356.00
Rate for Payer: TriWest Veterans Administration $1,030.56
Rate for Payer: United Healthcare Commercial $1,726.64
Rate for Payer: United Healthcare Medicare $1,030.56
Rate for Payer: WINHealth Partners Commercial $1,771.84
Rate for Payer: Wise Provider Network Commercial $1,717.60