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Service Code HCPCS 75574
Hospital Charge Code 3527557401
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 73706
Hospital Charge Code 3527370601
Hospital Revenue Code 352
Min. Negotiated Rate $733.07
Max. Negotiated Rate $1,265.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,239.70
Rate for Payer: Aetna of WY Medicare $809.60
Rate for Payer: Altius Commercial $1,214.40
Rate for Payer: Beech Street Commercial $1,239.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,227.05
Rate for Payer: Cash Price $885.50
Rate for Payer: ChoiceCare Network Commercial $1,227.05
Rate for Payer: Cigna of WY Commercial $1,239.70
Rate for Payer: Entrust Commercial $1,201.75
Rate for Payer: First Choice Health Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $771.65
Rate for Payer: HealthUtah PPO $1,265.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,227.05
Rate for Payer: Multiplan Medicare/VA $733.07
Rate for Payer: One Health Plan of WY PPO $1,239.70
Rate for Payer: PacificSource Commercial $1,138.50
Rate for Payer: PHCS PPO $1,239.70
Rate for Payer: Three Rivers PPO $948.75
Rate for Payer: TriWest Veterans Administration $771.65
Rate for Payer: United Healthcare Commercial $1,208.08
Rate for Payer: United Healthcare Medicare $771.65
Rate for Payer: WINHealth Partners Commercial $1,201.75
Rate for Payer: Wise Provider Network Commercial $1,201.75
Service Code HCPCS 73706
Hospital Charge Code 3527370601
Hospital Revenue Code 352
Min. Negotiated Rate $685.00
Max. Negotiated Rate $1,265.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,239.70
Rate for Payer: Aetna of WY Medicare $834.90
Rate for Payer: Altius Commercial $1,214.40
Rate for Payer: Beech Street Commercial $1,239.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,227.05
Rate for Payer: Cash Price $885.50
Rate for Payer: ChoiceCare Network Commercial $1,227.05
Rate for Payer: Cigna of WY Commercial $1,239.70
Rate for Payer: Entrust Commercial $1,201.75
Rate for Payer: First Choice Health Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $721.05
Rate for Payer: HealthUtah PPO $1,265.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,227.05
Rate for Payer: Multiplan Medicare/VA $685.00
Rate for Payer: One Health Plan of WY PPO $1,239.70
Rate for Payer: PacificSource Commercial $1,138.50
Rate for Payer: PHCS PPO $1,239.70
Rate for Payer: Three Rivers PPO $948.75
Rate for Payer: TriWest Veterans Administration $721.05
Rate for Payer: United Healthcare Commercial $1,208.08
Rate for Payer: United Healthcare Medicare $721.05
Rate for Payer: WINHealth Partners Commercial $1,239.70
Rate for Payer: Wise Provider Network Commercial $1,201.75
Service Code HCPCS 73706
Hospital Charge Code 3527370602
Hospital Revenue Code 352
Min. Negotiated Rate $733.07
Max. Negotiated Rate $1,265.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,239.70
Rate for Payer: Aetna of WY Medicare $809.60
Rate for Payer: Altius Commercial $1,214.40
Rate for Payer: Beech Street Commercial $1,239.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,227.05
Rate for Payer: Cash Price $885.50
Rate for Payer: ChoiceCare Network Commercial $1,227.05
Rate for Payer: Cigna of WY Commercial $1,239.70
Rate for Payer: Entrust Commercial $1,201.75
Rate for Payer: First Choice Health Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $771.65
Rate for Payer: HealthUtah PPO $1,265.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,227.05
Rate for Payer: Multiplan Medicare/VA $733.07
Rate for Payer: One Health Plan of WY PPO $1,239.70
Rate for Payer: PacificSource Commercial $1,138.50
Rate for Payer: PHCS PPO $1,239.70
Rate for Payer: Three Rivers PPO $948.75
Rate for Payer: TriWest Veterans Administration $771.65
Rate for Payer: United Healthcare Commercial $1,208.08
Rate for Payer: United Healthcare Medicare $771.65
Rate for Payer: WINHealth Partners Commercial $1,201.75
Rate for Payer: Wise Provider Network Commercial $1,201.75
Service Code HCPCS 73706
Hospital Charge Code 3527370602
Hospital Revenue Code 352
Min. Negotiated Rate $685.00
Max. Negotiated Rate $1,265.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,239.70
Rate for Payer: Aetna of WY Medicare $834.90
Rate for Payer: Altius Commercial $1,214.40
Rate for Payer: Beech Street Commercial $1,239.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,227.05
Rate for Payer: Cash Price $885.50
Rate for Payer: ChoiceCare Network Commercial $1,227.05
Rate for Payer: Cigna of WY Commercial $1,239.70
Rate for Payer: Entrust Commercial $1,201.75
Rate for Payer: First Choice Health Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,201.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $721.05
Rate for Payer: HealthUtah PPO $1,265.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,227.05
Rate for Payer: Multiplan Medicare/VA $685.00
Rate for Payer: One Health Plan of WY PPO $1,239.70
Rate for Payer: PacificSource Commercial $1,138.50
Rate for Payer: PHCS PPO $1,239.70
Rate for Payer: Three Rivers PPO $948.75
Rate for Payer: TriWest Veterans Administration $721.05
Rate for Payer: United Healthcare Commercial $1,208.08
Rate for Payer: United Healthcare Medicare $721.05
Rate for Payer: WINHealth Partners Commercial $1,239.70
Rate for Payer: Wise Provider Network Commercial $1,201.75
Service Code HCPCS 70498
Hospital Charge Code 3517049801
Hospital Revenue Code 351
Min. Negotiated Rate $1,345.09
Max. Negotiated Rate $2,484.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,434.32
Rate for Payer: Aetna of WY Medicare $1,639.44
Rate for Payer: Altius Commercial $2,384.64
Rate for Payer: Beech Street Commercial $2,434.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,409.48
Rate for Payer: Cash Price $1,738.80
Rate for Payer: ChoiceCare Network Commercial $2,409.48
Rate for Payer: Cigna of WY Commercial $2,434.32
Rate for Payer: Entrust Commercial $2,359.80
Rate for Payer: First Choice Health Commercial $2,359.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,359.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,415.88
Rate for Payer: HealthUtah PPO $2,484.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,409.48
Rate for Payer: Multiplan Medicare/VA $1,345.09
Rate for Payer: One Health Plan of WY PPO $2,434.32
Rate for Payer: PacificSource Commercial $2,235.60
Rate for Payer: PHCS PPO $2,434.32
Rate for Payer: Three Rivers PPO $1,863.00
Rate for Payer: TriWest Veterans Administration $1,415.88
Rate for Payer: United Healthcare Commercial $2,372.22
Rate for Payer: United Healthcare Medicare $1,415.88
Rate for Payer: WINHealth Partners Commercial $2,434.32
Rate for Payer: Wise Provider Network Commercial $2,359.80
Service Code HCPCS 70498
Hospital Charge Code 3517049801
Hospital Revenue Code 351
Min. Negotiated Rate $1,439.48
Max. Negotiated Rate $2,484.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,434.32
Rate for Payer: Aetna of WY Medicare $1,589.76
Rate for Payer: Altius Commercial $2,384.64
Rate for Payer: Beech Street Commercial $2,434.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,409.48
Rate for Payer: Cash Price $1,738.80
Rate for Payer: ChoiceCare Network Commercial $2,409.48
Rate for Payer: Cigna of WY Commercial $2,434.32
Rate for Payer: Entrust Commercial $2,359.80
Rate for Payer: First Choice Health Commercial $2,359.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,359.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,515.24
Rate for Payer: HealthUtah PPO $2,484.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,409.48
Rate for Payer: Multiplan Medicare/VA $1,439.48
Rate for Payer: One Health Plan of WY PPO $2,434.32
Rate for Payer: PacificSource Commercial $2,235.60
Rate for Payer: PHCS PPO $2,434.32
Rate for Payer: Three Rivers PPO $1,863.00
Rate for Payer: TriWest Veterans Administration $1,515.24
Rate for Payer: United Healthcare Commercial $2,372.22
Rate for Payer: United Healthcare Medicare $1,515.24
Rate for Payer: WINHealth Partners Commercial $2,359.80
Rate for Payer: Wise Provider Network Commercial $2,359.80
Service Code HCPCS 50200
Hospital Charge Code 3505020001
Hospital Revenue Code 350
Min. Negotiated Rate $3,600.43
Max. Negotiated Rate $6,649.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,516.02
Rate for Payer: Aetna of WY Medicare $4,388.34
Rate for Payer: Altius Commercial $6,383.04
Rate for Payer: Beech Street Commercial $6,516.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6,449.53
Rate for Payer: Cash Price $4,654.30
Rate for Payer: ChoiceCare Network Commercial $6,449.53
Rate for Payer: Cigna of WY Commercial $6,516.02
Rate for Payer: Entrust Commercial $6,316.55
Rate for Payer: First Choice Health Commercial $6,316.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,316.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,789.93
Rate for Payer: HealthUtah PPO $6,649.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,449.53
Rate for Payer: Multiplan Medicare/VA $3,600.43
Rate for Payer: One Health Plan of WY PPO $6,516.02
Rate for Payer: PacificSource Commercial $5,984.10
Rate for Payer: PHCS PPO $6,516.02
Rate for Payer: Three Rivers PPO $4,986.75
Rate for Payer: TriWest Veterans Administration $3,789.93
Rate for Payer: United Healthcare Commercial $6,349.80
Rate for Payer: United Healthcare Medicare $3,789.93
Rate for Payer: WINHealth Partners Commercial $6,516.02
Rate for Payer: Wise Provider Network Commercial $6,316.55
Service Code HCPCS 50200
Hospital Charge Code 3505020001
Hospital Revenue Code 350
Min. Negotiated Rate $3,853.10
Max. Negotiated Rate $6,649.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,516.02
Rate for Payer: Aetna of WY Medicare $4,255.36
Rate for Payer: Altius Commercial $6,383.04
Rate for Payer: Beech Street Commercial $6,516.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6,449.53
Rate for Payer: Cash Price $4,654.30
Rate for Payer: ChoiceCare Network Commercial $6,449.53
Rate for Payer: Cigna of WY Commercial $6,516.02
Rate for Payer: Entrust Commercial $6,316.55
Rate for Payer: First Choice Health Commercial $6,316.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,316.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4,055.89
Rate for Payer: HealthUtah PPO $6,649.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,449.53
Rate for Payer: Multiplan Medicare/VA $3,853.10
Rate for Payer: One Health Plan of WY PPO $6,516.02
Rate for Payer: PacificSource Commercial $5,984.10
Rate for Payer: PHCS PPO $6,516.02
Rate for Payer: Three Rivers PPO $4,986.75
Rate for Payer: TriWest Veterans Administration $4,055.89
Rate for Payer: United Healthcare Commercial $6,349.80
Rate for Payer: United Healthcare Medicare $4,055.89
Rate for Payer: WINHealth Partners Commercial $6,316.55
Rate for Payer: Wise Provider Network Commercial $6,316.55
Service Code HCPCS 71271
Hospital Charge Code 3507127101
Hospital Revenue Code 350
Min. Negotiated Rate $474.61
Max. Negotiated Rate $819.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $802.62
Rate for Payer: Aetna of WY Medicare $524.16
Rate for Payer: Altius Commercial $786.24
Rate for Payer: Beech Street Commercial $802.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $794.43
Rate for Payer: Cash Price $573.30
Rate for Payer: ChoiceCare Network Commercial $794.43
Rate for Payer: Cigna of WY Commercial $802.62
Rate for Payer: Entrust Commercial $778.05
Rate for Payer: First Choice Health Commercial $778.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $778.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $499.59
Rate for Payer: HealthUtah PPO $819.00
Rate for Payer: Idaho Integrated Healthcare Commercial $794.43
Rate for Payer: Multiplan Medicare/VA $474.61
Rate for Payer: One Health Plan of WY PPO $802.62
Rate for Payer: PacificSource Commercial $737.10
Rate for Payer: PHCS PPO $802.62
Rate for Payer: Three Rivers PPO $614.25
Rate for Payer: TriWest Veterans Administration $499.59
Rate for Payer: United Healthcare Commercial $782.14
Rate for Payer: United Healthcare Medicare $499.59
Rate for Payer: WINHealth Partners Commercial $778.05
Rate for Payer: Wise Provider Network Commercial $778.05
Service Code HCPCS 71271
Hospital Charge Code 3507127101
Hospital Revenue Code 350
Min. Negotiated Rate $443.49
Max. Negotiated Rate $819.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $802.62
Rate for Payer: Aetna of WY Medicare $540.54
Rate for Payer: Altius Commercial $786.24
Rate for Payer: Beech Street Commercial $802.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $794.43
Rate for Payer: Cash Price $573.30
Rate for Payer: ChoiceCare Network Commercial $794.43
Rate for Payer: Cigna of WY Commercial $802.62
Rate for Payer: Entrust Commercial $778.05
Rate for Payer: First Choice Health Commercial $778.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $778.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $466.83
Rate for Payer: HealthUtah PPO $819.00
Rate for Payer: Idaho Integrated Healthcare Commercial $794.43
Rate for Payer: Multiplan Medicare/VA $443.49
Rate for Payer: One Health Plan of WY PPO $802.62
Rate for Payer: PacificSource Commercial $737.10
Rate for Payer: PHCS PPO $802.62
Rate for Payer: Three Rivers PPO $614.25
Rate for Payer: TriWest Veterans Administration $466.83
Rate for Payer: United Healthcare Commercial $782.14
Rate for Payer: United Healthcare Medicare $466.83
Rate for Payer: WINHealth Partners Commercial $802.62
Rate for Payer: Wise Provider Network Commercial $778.05
Service Code HCPCS 77012
Hospital Charge Code 3507701205
Hospital Revenue Code 350
Min. Negotiated Rate $1,263.32
Max. Negotiated Rate $2,333.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,286.34
Rate for Payer: Aetna of WY Medicare $1,539.78
Rate for Payer: Altius Commercial $2,239.68
Rate for Payer: Beech Street Commercial $2,286.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,263.01
Rate for Payer: Cash Price $1,633.10
Rate for Payer: ChoiceCare Network Commercial $2,263.01
Rate for Payer: Cigna of WY Commercial $2,286.34
Rate for Payer: Entrust Commercial $2,216.35
Rate for Payer: First Choice Health Commercial $2,216.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,216.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,329.81
Rate for Payer: HealthUtah PPO $2,333.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,263.01
Rate for Payer: Multiplan Medicare/VA $1,263.32
Rate for Payer: One Health Plan of WY PPO $2,286.34
Rate for Payer: PacificSource Commercial $2,099.70
Rate for Payer: PHCS PPO $2,286.34
Rate for Payer: Three Rivers PPO $1,749.75
Rate for Payer: TriWest Veterans Administration $1,329.81
Rate for Payer: United Healthcare Commercial $2,228.02
Rate for Payer: United Healthcare Medicare $1,329.81
Rate for Payer: WINHealth Partners Commercial $2,286.34
Rate for Payer: Wise Provider Network Commercial $2,216.35
Service Code HCPCS 77012
Hospital Charge Code 3507701205
Hospital Revenue Code 350
Min. Negotiated Rate $1,351.97
Max. Negotiated Rate $2,333.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,286.34
Rate for Payer: Aetna of WY Medicare $1,493.12
Rate for Payer: Altius Commercial $2,239.68
Rate for Payer: Beech Street Commercial $2,286.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,263.01
Rate for Payer: Cash Price $1,633.10
Rate for Payer: ChoiceCare Network Commercial $2,263.01
Rate for Payer: Cigna of WY Commercial $2,286.34
Rate for Payer: Entrust Commercial $2,216.35
Rate for Payer: First Choice Health Commercial $2,216.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,216.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,423.13
Rate for Payer: HealthUtah PPO $2,333.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,263.01
Rate for Payer: Multiplan Medicare/VA $1,351.97
Rate for Payer: One Health Plan of WY PPO $2,286.34
Rate for Payer: PacificSource Commercial $2,099.70
Rate for Payer: PHCS PPO $2,286.34
Rate for Payer: Three Rivers PPO $1,749.75
Rate for Payer: TriWest Veterans Administration $1,423.13
Rate for Payer: United Healthcare Commercial $2,228.02
Rate for Payer: United Healthcare Medicare $1,423.13
Rate for Payer: WINHealth Partners Commercial $2,216.35
Rate for Payer: Wise Provider Network Commercial $2,216.35
Service Code HCPCS 75571
Hospital Charge Code 3527557101
Hospital Revenue Code 352
Min. Negotiated Rate $195.87
Max. Negotiated Rate $338.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $331.24
Rate for Payer: Aetna of WY Medicare $216.32
Rate for Payer: Altius Commercial $324.48
Rate for Payer: Beech Street Commercial $331.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $327.86
Rate for Payer: Cash Price $236.60
Rate for Payer: ChoiceCare Network Commercial $327.86
Rate for Payer: Cigna of WY Commercial $331.24
Rate for Payer: Entrust Commercial $321.10
Rate for Payer: First Choice Health Commercial $321.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $321.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $206.18
Rate for Payer: HealthUtah PPO $338.00
Rate for Payer: Idaho Integrated Healthcare Commercial $327.86
Rate for Payer: Multiplan Medicare/VA $195.87
Rate for Payer: One Health Plan of WY PPO $331.24
Rate for Payer: PacificSource Commercial $304.20
Rate for Payer: PHCS PPO $331.24
Rate for Payer: Three Rivers PPO $253.50
Rate for Payer: TriWest Veterans Administration $206.18
Rate for Payer: United Healthcare Commercial $322.79
Rate for Payer: United Healthcare Medicare $206.18
Rate for Payer: WINHealth Partners Commercial $321.10
Rate for Payer: Wise Provider Network Commercial $321.10
Service Code HCPCS 75571
Hospital Charge Code 3527557101
Hospital Revenue Code 352
Min. Negotiated Rate $183.03
Max. Negotiated Rate $338.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $331.24
Rate for Payer: Aetna of WY Medicare $223.08
Rate for Payer: Altius Commercial $324.48
Rate for Payer: Beech Street Commercial $331.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $327.86
Rate for Payer: Cash Price $236.60
Rate for Payer: ChoiceCare Network Commercial $327.86
Rate for Payer: Cigna of WY Commercial $331.24
Rate for Payer: Entrust Commercial $321.10
Rate for Payer: First Choice Health Commercial $321.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $321.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $192.66
Rate for Payer: HealthUtah PPO $338.00
Rate for Payer: Idaho Integrated Healthcare Commercial $327.86
Rate for Payer: Multiplan Medicare/VA $183.03
Rate for Payer: One Health Plan of WY PPO $331.24
Rate for Payer: PacificSource Commercial $304.20
Rate for Payer: PHCS PPO $331.24
Rate for Payer: Three Rivers PPO $253.50
Rate for Payer: TriWest Veterans Administration $192.66
Rate for Payer: United Healthcare Commercial $322.79
Rate for Payer: United Healthcare Medicare $192.66
Rate for Payer: WINHealth Partners Commercial $331.24
Rate for Payer: Wise Provider Network Commercial $321.10
Service Code HCPCS 70492
Hospital Charge Code 3517049201
Hospital Revenue Code 351
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 70492
Hospital Charge Code 3517049201
Hospital Revenue Code 351
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 70491
Hospital Charge Code 3517049101
Hospital Revenue Code 351
Min. Negotiated Rate $1,508.44
Max. Negotiated Rate $2,603.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,550.94
Rate for Payer: Aetna of WY Medicare $1,665.92
Rate for Payer: Altius Commercial $2,498.88
Rate for Payer: Beech Street Commercial $2,550.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,524.91
Rate for Payer: Cash Price $1,822.10
Rate for Payer: ChoiceCare Network Commercial $2,524.91
Rate for Payer: Cigna of WY Commercial $2,550.94
Rate for Payer: Entrust Commercial $2,472.85
Rate for Payer: First Choice Health Commercial $2,472.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,472.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,587.83
Rate for Payer: HealthUtah PPO $2,603.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,524.91
Rate for Payer: Multiplan Medicare/VA $1,508.44
Rate for Payer: One Health Plan of WY PPO $2,550.94
Rate for Payer: PacificSource Commercial $2,342.70
Rate for Payer: PHCS PPO $2,550.94
Rate for Payer: Three Rivers PPO $1,952.25
Rate for Payer: TriWest Veterans Administration $1,587.83
Rate for Payer: United Healthcare Commercial $2,485.86
Rate for Payer: United Healthcare Medicare $1,587.83
Rate for Payer: WINHealth Partners Commercial $2,472.85
Rate for Payer: Wise Provider Network Commercial $2,472.85
Service Code HCPCS 70491
Hospital Charge Code 3517049101
Hospital Revenue Code 351
Min. Negotiated Rate $1,409.52
Max. Negotiated Rate $2,603.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,550.94
Rate for Payer: Aetna of WY Medicare $1,717.98
Rate for Payer: Altius Commercial $2,498.88
Rate for Payer: Beech Street Commercial $2,550.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,524.91
Rate for Payer: Cash Price $1,822.10
Rate for Payer: ChoiceCare Network Commercial $2,524.91
Rate for Payer: Cigna of WY Commercial $2,550.94
Rate for Payer: Entrust Commercial $2,472.85
Rate for Payer: First Choice Health Commercial $2,472.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,472.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,483.71
Rate for Payer: HealthUtah PPO $2,603.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,524.91
Rate for Payer: Multiplan Medicare/VA $1,409.52
Rate for Payer: One Health Plan of WY PPO $2,550.94
Rate for Payer: PacificSource Commercial $2,342.70
Rate for Payer: PHCS PPO $2,550.94
Rate for Payer: Three Rivers PPO $1,952.25
Rate for Payer: TriWest Veterans Administration $1,483.71
Rate for Payer: United Healthcare Commercial $2,485.86
Rate for Payer: United Healthcare Medicare $1,483.71
Rate for Payer: WINHealth Partners Commercial $2,550.94
Rate for Payer: Wise Provider Network Commercial $2,472.85
Service Code HCPCS 27520
Hospital Charge Code 5102752001
Hospital Revenue Code 510
Min. Negotiated Rate $138.50
Max. Negotiated Rate $239.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $234.22
Rate for Payer: Aetna of WY Medicare $152.96
Rate for Payer: Altius Commercial $229.44
Rate for Payer: Beech Street Commercial $234.22
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $231.83
Rate for Payer: Cash Price $167.30
Rate for Payer: ChoiceCare Network Commercial $231.83
Rate for Payer: Cigna of WY Commercial $234.22
Rate for Payer: Entrust Commercial $227.05
Rate for Payer: First Choice Health Commercial $227.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $227.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $145.79
Rate for Payer: HealthUtah PPO $239.00
Rate for Payer: Idaho Integrated Healthcare Commercial $231.83
Rate for Payer: Multiplan Medicare/VA $138.50
Rate for Payer: One Health Plan of WY PPO $234.22
Rate for Payer: PacificSource Commercial $215.10
Rate for Payer: PHCS PPO $234.22
Rate for Payer: Three Rivers PPO $179.25
Rate for Payer: TriWest Veterans Administration $145.79
Rate for Payer: United Healthcare Commercial $228.24
Rate for Payer: United Healthcare Medicare $145.79
Rate for Payer: WINHealth Partners Commercial $227.05
Rate for Payer: Wise Provider Network Commercial $227.05
Service Code HCPCS 27520
Hospital Charge Code 5102752001
Hospital Revenue Code 510
Min. Negotiated Rate $129.42
Max. Negotiated Rate $239.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $234.22
Rate for Payer: Aetna of WY Medicare $157.74
Rate for Payer: Altius Commercial $229.44
Rate for Payer: Beech Street Commercial $234.22
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $231.83
Rate for Payer: Cash Price $167.30
Rate for Payer: ChoiceCare Network Commercial $231.83
Rate for Payer: Cigna of WY Commercial $234.22
Rate for Payer: Entrust Commercial $227.05
Rate for Payer: First Choice Health Commercial $227.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $227.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $136.23
Rate for Payer: HealthUtah PPO $239.00
Rate for Payer: Idaho Integrated Healthcare Commercial $231.83
Rate for Payer: Multiplan Medicare/VA $129.42
Rate for Payer: One Health Plan of WY PPO $234.22
Rate for Payer: PacificSource Commercial $215.10
Rate for Payer: PHCS PPO $234.22
Rate for Payer: Three Rivers PPO $179.25
Rate for Payer: TriWest Veterans Administration $136.23
Rate for Payer: United Healthcare Commercial $228.24
Rate for Payer: United Healthcare Medicare $136.23
Rate for Payer: WINHealth Partners Commercial $234.22
Rate for Payer: Wise Provider Network Commercial $227.05
Service Code HCPCS 32405
Hospital Charge Code 3203240501
Hospital Revenue Code 320
Min. Negotiated Rate $1,052.68
Max. Negotiated Rate $1,944.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,905.12
Rate for Payer: Aetna of WY Medicare $1,283.04
Rate for Payer: Altius Commercial $1,866.24
Rate for Payer: Beech Street Commercial $1,905.12
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,885.68
Rate for Payer: Cash Price $1,360.80
Rate for Payer: ChoiceCare Network Commercial $1,885.68
Rate for Payer: Cigna of WY Commercial $1,905.12
Rate for Payer: Entrust Commercial $1,846.80
Rate for Payer: First Choice Health Commercial $1,846.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,846.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,108.08
Rate for Payer: HealthUtah PPO $1,944.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,885.68
Rate for Payer: Multiplan Medicare/VA $1,052.68
Rate for Payer: One Health Plan of WY PPO $1,905.12
Rate for Payer: PacificSource Commercial $1,749.60
Rate for Payer: PHCS PPO $1,905.12
Rate for Payer: Three Rivers PPO $1,458.00
Rate for Payer: TriWest Veterans Administration $1,108.08
Rate for Payer: United Healthcare Commercial $1,856.52
Rate for Payer: United Healthcare Medicare $1,108.08
Rate for Payer: WINHealth Partners Commercial $1,905.12
Rate for Payer: Wise Provider Network Commercial $1,846.80
Service Code HCPCS 32405
Hospital Charge Code 3203240501
Hospital Revenue Code 320
Min. Negotiated Rate $1,126.55
Max. Negotiated Rate $1,944.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,905.12
Rate for Payer: Aetna of WY Medicare $1,244.16
Rate for Payer: Altius Commercial $1,866.24
Rate for Payer: Beech Street Commercial $1,905.12
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,885.68
Rate for Payer: Cash Price $1,360.80
Rate for Payer: ChoiceCare Network Commercial $1,885.68
Rate for Payer: Cigna of WY Commercial $1,905.12
Rate for Payer: Entrust Commercial $1,846.80
Rate for Payer: First Choice Health Commercial $1,846.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,846.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,185.84
Rate for Payer: HealthUtah PPO $1,944.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,885.68
Rate for Payer: Multiplan Medicare/VA $1,126.55
Rate for Payer: One Health Plan of WY PPO $1,905.12
Rate for Payer: PacificSource Commercial $1,749.60
Rate for Payer: PHCS PPO $1,905.12
Rate for Payer: Three Rivers PPO $1,458.00
Rate for Payer: TriWest Veterans Administration $1,185.84
Rate for Payer: United Healthcare Commercial $1,856.52
Rate for Payer: United Healthcare Medicare $1,185.84
Rate for Payer: WINHealth Partners Commercial $1,846.80
Rate for Payer: Wise Provider Network Commercial $1,846.80
Service Code HCPCS 0042T
Hospital Charge Code 3500042T01
Hospital Revenue Code 350
Min. Negotiated Rate $199.27
Max. Negotiated Rate $368.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $360.64
Rate for Payer: Aetna of WY Medicare $242.88
Rate for Payer: Altius Commercial $353.28
Rate for Payer: Beech Street Commercial $360.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $356.96
Rate for Payer: Cash Price $257.60
Rate for Payer: ChoiceCare Network Commercial $356.96
Rate for Payer: Cigna of WY Commercial $360.64
Rate for Payer: Entrust Commercial $349.60
Rate for Payer: First Choice Health Commercial $349.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $349.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $209.76
Rate for Payer: HealthUtah PPO $368.00
Rate for Payer: Idaho Integrated Healthcare Commercial $356.96
Rate for Payer: Multiplan Medicare/VA $199.27
Rate for Payer: One Health Plan of WY PPO $360.64
Rate for Payer: PacificSource Commercial $331.20
Rate for Payer: PHCS PPO $360.64
Rate for Payer: Three Rivers PPO $276.00
Rate for Payer: TriWest Veterans Administration $209.76
Rate for Payer: United Healthcare Commercial $351.44
Rate for Payer: United Healthcare Medicare $209.76
Rate for Payer: WINHealth Partners Commercial $360.64
Rate for Payer: Wise Provider Network Commercial $349.60
Service Code HCPCS 0042T
Hospital Charge Code 3500042T01
Hospital Revenue Code 350
Min. Negotiated Rate $213.26
Max. Negotiated Rate $368.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $360.64
Rate for Payer: Aetna of WY Medicare $235.52
Rate for Payer: Altius Commercial $353.28
Rate for Payer: Beech Street Commercial $360.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $356.96
Rate for Payer: Cash Price $257.60
Rate for Payer: ChoiceCare Network Commercial $356.96
Rate for Payer: Cigna of WY Commercial $360.64
Rate for Payer: Entrust Commercial $349.60
Rate for Payer: First Choice Health Commercial $349.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $349.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $224.48
Rate for Payer: HealthUtah PPO $368.00
Rate for Payer: Idaho Integrated Healthcare Commercial $356.96
Rate for Payer: Multiplan Medicare/VA $213.26
Rate for Payer: One Health Plan of WY PPO $360.64
Rate for Payer: PacificSource Commercial $331.20
Rate for Payer: PHCS PPO $360.64
Rate for Payer: Three Rivers PPO $276.00
Rate for Payer: TriWest Veterans Administration $224.48
Rate for Payer: United Healthcare Commercial $351.44
Rate for Payer: United Healthcare Medicare $224.48
Rate for Payer: WINHealth Partners Commercial $349.60
Rate for Payer: Wise Provider Network Commercial $349.60