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Service Code HCPCS 87541
Hospital Charge Code 3068754101
Hospital Revenue Code 306
Min. Negotiated Rate $126.73
Max. Negotiated Rate $230.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $225.40
Rate for Payer: Aetna of WY Medicare $151.80
Rate for Payer: Altius Auto/Workers Compensation $220.80
Rate for Payer: Altius Commercial $220.80
Rate for Payer: Beech Street Commercial $225.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $188.83
Rate for Payer: Cash Price $161.00
Rate for Payer: ChoiceCare Network Commercial $223.10
Rate for Payer: Cigna of WY Commercial $225.40
Rate for Payer: Entrust Commercial $218.50
Rate for Payer: First Choice Health Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $133.40
Rate for Payer: HealthUtah PPO $230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $223.10
Rate for Payer: Multiplan Medicare/VA $126.73
Rate for Payer: One Health Plan of WY PPO $225.40
Rate for Payer: PacificSource Commercial $207.00
Rate for Payer: PHCS PPO $225.40
Rate for Payer: Three Rivers PPO $172.50
Rate for Payer: TriWest Veterans Administration $133.40
Rate for Payer: United Healthcare Commercial $200.10
Rate for Payer: United Healthcare Medicare $133.40
Rate for Payer: WINHealth Partners Commercial $225.40
Rate for Payer: Wise Provider Network Commercial $218.50
Service Code HCPCS 87541
Hospital Charge Code 3068754101
Hospital Revenue Code 306
Min. Negotiated Rate $144.21
Max. Negotiated Rate $230.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $225.40
Rate for Payer: Altius Auto/Workers Compensation $220.80
Rate for Payer: Altius Commercial $220.80
Rate for Payer: Beech Street Commercial $225.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $188.83
Rate for Payer: Cash Price $161.00
Rate for Payer: ChoiceCare Network Commercial $223.10
Rate for Payer: Cigna of WY Commercial $225.40
Rate for Payer: Entrust Commercial $218.50
Rate for Payer: First Choice Health Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $151.80
Rate for Payer: HealthUtah PPO $230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $223.10
Rate for Payer: Multiplan Medicare/VA $144.21
Rate for Payer: One Health Plan of WY PPO $225.40
Rate for Payer: PacificSource Commercial $207.00
Rate for Payer: PHCS PPO $225.40
Rate for Payer: Three Rivers PPO $172.50
Rate for Payer: TriWest Veterans Administration $151.80
Rate for Payer: United Healthcare Commercial $200.10
Rate for Payer: United Healthcare Medicare $151.80
Rate for Payer: WINHealth Partners Commercial $218.50
Rate for Payer: Wise Provider Network Commercial $218.50
Service Code HCPCS 86713
Hospital Charge Code 3028671301
Hospital Revenue Code 302
Min. Negotiated Rate $74.38
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Aetna of WY Medicare $89.10
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $78.30
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $74.38
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $78.30
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $78.30
Rate for Payer: WINHealth Partners Commercial $132.30
Rate for Payer: Wise Provider Network Commercial $128.25
Service Code HCPCS 86713
Hospital Charge Code 3028671301
Hospital Revenue Code 302
Min. Negotiated Rate $84.64
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.10
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $84.64
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $89.10
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $89.10
Rate for Payer: WINHealth Partners Commercial $128.25
Rate for Payer: Wise Provider Network Commercial $128.25
Hospital Charge Code 3600000008
Hospital Revenue Code 360
Min. Negotiated Rate $680.30
Max. Negotiated Rate $1,085.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,063.30
Rate for Payer: Altius Auto/Workers Compensation $1,041.60
Rate for Payer: Altius Commercial $1,041.60
Rate for Payer: Beech Street Commercial $1,063.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $890.78
Rate for Payer: Cash Price $759.50
Rate for Payer: ChoiceCare Network Commercial $1,052.45
Rate for Payer: Cigna of WY Commercial $1,063.30
Rate for Payer: Entrust Commercial $1,030.75
Rate for Payer: First Choice Health Commercial $1,030.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,030.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $716.10
Rate for Payer: HealthUtah PPO $1,085.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,052.45
Rate for Payer: Multiplan Medicare/VA $680.30
Rate for Payer: One Health Plan of WY PPO $1,063.30
Rate for Payer: PacificSource Commercial $976.50
Rate for Payer: PHCS PPO $1,063.30
Rate for Payer: Three Rivers PPO $813.75
Rate for Payer: TriWest Veterans Administration $716.10
Rate for Payer: United Healthcare Commercial $943.95
Rate for Payer: United Healthcare Medicare $716.10
Rate for Payer: WINHealth Partners Commercial $1,030.75
Rate for Payer: Wise Provider Network Commercial $1,030.75
Hospital Charge Code 3600000008
Hospital Revenue Code 360
Min. Negotiated Rate $597.84
Max. Negotiated Rate $1,085.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,063.30
Rate for Payer: Aetna of WY Medicare $716.10
Rate for Payer: Altius Auto/Workers Compensation $1,041.60
Rate for Payer: Altius Commercial $1,041.60
Rate for Payer: Beech Street Commercial $1,063.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $890.78
Rate for Payer: Cash Price $759.50
Rate for Payer: ChoiceCare Network Commercial $1,052.45
Rate for Payer: Cigna of WY Commercial $1,063.30
Rate for Payer: Entrust Commercial $1,030.75
Rate for Payer: First Choice Health Commercial $1,030.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,030.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $629.30
Rate for Payer: HealthUtah PPO $1,085.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,052.45
Rate for Payer: Multiplan Medicare/VA $597.84
Rate for Payer: One Health Plan of WY PPO $1,063.30
Rate for Payer: PacificSource Commercial $976.50
Rate for Payer: PHCS PPO $1,063.30
Rate for Payer: Three Rivers PPO $813.75
Rate for Payer: TriWest Veterans Administration $629.30
Rate for Payer: United Healthcare Commercial $943.95
Rate for Payer: United Healthcare Medicare $629.30
Rate for Payer: WINHealth Partners Commercial $1,063.30
Rate for Payer: Wise Provider Network Commercial $1,030.75
Service Code HCPCS 80061
Hospital Charge Code 3018006101
Hospital Revenue Code 301
Min. Negotiated Rate $68.88
Max. Negotiated Rate $125.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $122.50
Rate for Payer: Aetna of WY Medicare $82.50
Rate for Payer: Altius Auto/Workers Compensation $120.00
Rate for Payer: Altius Commercial $120.00
Rate for Payer: Beech Street Commercial $122.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.62
Rate for Payer: Cash Price $87.50
Rate for Payer: ChoiceCare Network Commercial $121.25
Rate for Payer: Cigna of WY Commercial $122.50
Rate for Payer: Entrust Commercial $118.75
Rate for Payer: First Choice Health Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.50
Rate for Payer: HealthUtah PPO $125.00
Rate for Payer: Idaho Integrated Healthcare Commercial $121.25
Rate for Payer: Multiplan Medicare/VA $68.88
Rate for Payer: One Health Plan of WY PPO $122.50
Rate for Payer: PacificSource Commercial $112.50
Rate for Payer: PHCS PPO $122.50
Rate for Payer: Three Rivers PPO $93.75
Rate for Payer: TriWest Veterans Administration $72.50
Rate for Payer: United Healthcare Commercial $108.75
Rate for Payer: United Healthcare Medicare $72.50
Rate for Payer: WINHealth Partners Commercial $122.50
Rate for Payer: Wise Provider Network Commercial $118.75
Service Code HCPCS 80061
Hospital Charge Code 3018006101
Hospital Revenue Code 301
Min. Negotiated Rate $78.38
Max. Negotiated Rate $125.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $122.50
Rate for Payer: Altius Auto/Workers Compensation $120.00
Rate for Payer: Altius Commercial $120.00
Rate for Payer: Beech Street Commercial $122.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.62
Rate for Payer: Cash Price $87.50
Rate for Payer: ChoiceCare Network Commercial $121.25
Rate for Payer: Cigna of WY Commercial $122.50
Rate for Payer: Entrust Commercial $118.75
Rate for Payer: First Choice Health Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $82.50
Rate for Payer: HealthUtah PPO $125.00
Rate for Payer: Idaho Integrated Healthcare Commercial $121.25
Rate for Payer: Multiplan Medicare/VA $78.38
Rate for Payer: One Health Plan of WY PPO $122.50
Rate for Payer: PacificSource Commercial $112.50
Rate for Payer: PHCS PPO $122.50
Rate for Payer: Three Rivers PPO $93.75
Rate for Payer: TriWest Veterans Administration $82.50
Rate for Payer: United Healthcare Commercial $108.75
Rate for Payer: United Healthcare Medicare $82.50
Rate for Payer: WINHealth Partners Commercial $118.75
Rate for Payer: Wise Provider Network Commercial $118.75
Service Code HCPCS 83704
Hospital Charge Code 3018370401
Hospital Revenue Code 301
Min. Negotiated Rate $176.32
Max. Negotiated Rate $320.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $313.60
Rate for Payer: Aetna of WY Medicare $211.20
Rate for Payer: Altius Auto/Workers Compensation $307.20
Rate for Payer: Altius Commercial $307.20
Rate for Payer: Beech Street Commercial $313.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $262.72
Rate for Payer: Cash Price $224.00
Rate for Payer: ChoiceCare Network Commercial $310.40
Rate for Payer: Cigna of WY Commercial $313.60
Rate for Payer: Entrust Commercial $304.00
Rate for Payer: First Choice Health Commercial $304.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $304.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $185.60
Rate for Payer: HealthUtah PPO $320.00
Rate for Payer: Idaho Integrated Healthcare Commercial $310.40
Rate for Payer: Multiplan Medicare/VA $176.32
Rate for Payer: One Health Plan of WY PPO $313.60
Rate for Payer: PacificSource Commercial $288.00
Rate for Payer: PHCS PPO $313.60
Rate for Payer: Three Rivers PPO $240.00
Rate for Payer: TriWest Veterans Administration $185.60
Rate for Payer: United Healthcare Commercial $278.40
Rate for Payer: United Healthcare Medicare $185.60
Rate for Payer: WINHealth Partners Commercial $313.60
Rate for Payer: Wise Provider Network Commercial $304.00
Service Code HCPCS 83704
Hospital Charge Code 3018370401
Hospital Revenue Code 301
Min. Negotiated Rate $200.64
Max. Negotiated Rate $320.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $313.60
Rate for Payer: Altius Auto/Workers Compensation $307.20
Rate for Payer: Altius Commercial $307.20
Rate for Payer: Beech Street Commercial $313.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $262.72
Rate for Payer: Cash Price $224.00
Rate for Payer: ChoiceCare Network Commercial $310.40
Rate for Payer: Cigna of WY Commercial $313.60
Rate for Payer: Entrust Commercial $304.00
Rate for Payer: First Choice Health Commercial $304.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $304.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $211.20
Rate for Payer: HealthUtah PPO $320.00
Rate for Payer: Idaho Integrated Healthcare Commercial $310.40
Rate for Payer: Multiplan Medicare/VA $200.64
Rate for Payer: One Health Plan of WY PPO $313.60
Rate for Payer: PacificSource Commercial $288.00
Rate for Payer: PHCS PPO $313.60
Rate for Payer: Three Rivers PPO $240.00
Rate for Payer: TriWest Veterans Administration $211.20
Rate for Payer: United Healthcare Commercial $278.40
Rate for Payer: United Healthcare Medicare $211.20
Rate for Payer: WINHealth Partners Commercial $304.00
Rate for Payer: Wise Provider Network Commercial $304.00
Service Code HCPCS 83701
Hospital Charge Code 3018370101
Hospital Revenue Code 301
Min. Negotiated Rate $165.30
Max. Negotiated Rate $300.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.00
Rate for Payer: Aetna of WY Medicare $198.00
Rate for Payer: Altius Auto/Workers Compensation $288.00
Rate for Payer: Altius Commercial $288.00
Rate for Payer: Beech Street Commercial $294.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.30
Rate for Payer: Cash Price $210.00
Rate for Payer: ChoiceCare Network Commercial $291.00
Rate for Payer: Cigna of WY Commercial $294.00
Rate for Payer: Entrust Commercial $285.00
Rate for Payer: First Choice Health Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $174.00
Rate for Payer: HealthUtah PPO $300.00
Rate for Payer: Idaho Integrated Healthcare Commercial $291.00
Rate for Payer: Multiplan Medicare/VA $165.30
Rate for Payer: One Health Plan of WY PPO $294.00
Rate for Payer: PacificSource Commercial $270.00
Rate for Payer: PHCS PPO $294.00
Rate for Payer: Three Rivers PPO $225.00
Rate for Payer: TriWest Veterans Administration $174.00
Rate for Payer: United Healthcare Commercial $261.00
Rate for Payer: United Healthcare Medicare $174.00
Rate for Payer: WINHealth Partners Commercial $294.00
Rate for Payer: Wise Provider Network Commercial $285.00
Service Code HCPCS 83701
Hospital Charge Code 3018370101
Hospital Revenue Code 301
Min. Negotiated Rate $188.10
Max. Negotiated Rate $300.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.00
Rate for Payer: Altius Auto/Workers Compensation $288.00
Rate for Payer: Altius Commercial $288.00
Rate for Payer: Beech Street Commercial $294.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.30
Rate for Payer: Cash Price $210.00
Rate for Payer: ChoiceCare Network Commercial $291.00
Rate for Payer: Cigna of WY Commercial $294.00
Rate for Payer: Entrust Commercial $285.00
Rate for Payer: First Choice Health Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $198.00
Rate for Payer: HealthUtah PPO $300.00
Rate for Payer: Idaho Integrated Healthcare Commercial $291.00
Rate for Payer: Multiplan Medicare/VA $188.10
Rate for Payer: One Health Plan of WY PPO $294.00
Rate for Payer: PacificSource Commercial $270.00
Rate for Payer: PHCS PPO $294.00
Rate for Payer: Three Rivers PPO $225.00
Rate for Payer: TriWest Veterans Administration $198.00
Rate for Payer: United Healthcare Commercial $261.00
Rate for Payer: United Healthcare Medicare $198.00
Rate for Payer: WINHealth Partners Commercial $285.00
Rate for Payer: Wise Provider Network Commercial $285.00
Hospital Charge Code 3600000027
Hospital Revenue Code 360
Min. Negotiated Rate $1,542.80
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Aetna of WY Medicare $1,848.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,624.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,542.80
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,624.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,624.00
Rate for Payer: WINHealth Partners Commercial $2,744.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Hospital Charge Code 3600000027
Hospital Revenue Code 360
Min. Negotiated Rate $1,755.60
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,848.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,755.60
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,848.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,848.00
Rate for Payer: WINHealth Partners Commercial $2,660.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Hospital Charge Code 3600000018
Hospital Revenue Code 360
Min. Negotiated Rate $8,191.76
Max. Negotiated Rate $13,065.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $12,803.70
Rate for Payer: Altius Auto/Workers Compensation $12,542.40
Rate for Payer: Altius Commercial $12,542.40
Rate for Payer: Beech Street Commercial $12,803.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10,726.36
Rate for Payer: Cash Price $9,145.50
Rate for Payer: ChoiceCare Network Commercial $12,673.05
Rate for Payer: Cigna of WY Commercial $12,803.70
Rate for Payer: Entrust Commercial $12,411.75
Rate for Payer: First Choice Health Commercial $12,411.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12,411.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8,622.90
Rate for Payer: HealthUtah PPO $13,065.00
Rate for Payer: Idaho Integrated Healthcare Commercial $12,673.05
Rate for Payer: Multiplan Medicare/VA $8,191.76
Rate for Payer: One Health Plan of WY PPO $12,803.70
Rate for Payer: PacificSource Commercial $11,758.50
Rate for Payer: PHCS PPO $12,803.70
Rate for Payer: Three Rivers PPO $9,798.75
Rate for Payer: TriWest Veterans Administration $8,622.90
Rate for Payer: United Healthcare Commercial $11,366.55
Rate for Payer: United Healthcare Medicare $8,622.90
Rate for Payer: WINHealth Partners Commercial $12,411.75
Rate for Payer: Wise Provider Network Commercial $12,411.75
Hospital Charge Code 3600000018
Hospital Revenue Code 360
Min. Negotiated Rate $7,198.82
Max. Negotiated Rate $13,065.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $12,803.70
Rate for Payer: Aetna of WY Medicare $8,622.90
Rate for Payer: Altius Auto/Workers Compensation $12,542.40
Rate for Payer: Altius Commercial $12,542.40
Rate for Payer: Beech Street Commercial $12,803.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10,726.36
Rate for Payer: Cash Price $9,145.50
Rate for Payer: ChoiceCare Network Commercial $12,673.05
Rate for Payer: Cigna of WY Commercial $12,803.70
Rate for Payer: Entrust Commercial $12,411.75
Rate for Payer: First Choice Health Commercial $12,411.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12,411.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $7,577.70
Rate for Payer: HealthUtah PPO $13,065.00
Rate for Payer: Idaho Integrated Healthcare Commercial $12,673.05
Rate for Payer: Multiplan Medicare/VA $7,198.82
Rate for Payer: One Health Plan of WY PPO $12,803.70
Rate for Payer: PacificSource Commercial $11,758.50
Rate for Payer: PHCS PPO $12,803.70
Rate for Payer: Three Rivers PPO $9,798.75
Rate for Payer: TriWest Veterans Administration $7,577.70
Rate for Payer: United Healthcare Commercial $11,366.55
Rate for Payer: United Healthcare Medicare $7,577.70
Rate for Payer: WINHealth Partners Commercial $12,803.70
Rate for Payer: Wise Provider Network Commercial $12,411.75
Service Code HCPCS 78830
Hospital Charge Code 3497883001
Hospital Revenue Code 349
Min. Negotiated Rate $2,135.12
Max. Negotiated Rate $3,875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,797.50
Rate for Payer: Aetna of WY Medicare $2,557.50
Rate for Payer: Altius Auto/Workers Compensation $3,720.00
Rate for Payer: Altius Commercial $3,720.00
Rate for Payer: Beech Street Commercial $3,797.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,181.38
Rate for Payer: Cash Price $2,712.50
Rate for Payer: ChoiceCare Network Commercial $3,758.75
Rate for Payer: Cigna of WY Commercial $3,797.50
Rate for Payer: Entrust Commercial $3,681.25
Rate for Payer: First Choice Health Commercial $3,681.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,681.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,247.50
Rate for Payer: HealthUtah PPO $3,875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,758.75
Rate for Payer: Multiplan Medicare/VA $2,135.12
Rate for Payer: One Health Plan of WY PPO $3,797.50
Rate for Payer: PacificSource Commercial $3,487.50
Rate for Payer: PHCS PPO $3,797.50
Rate for Payer: Three Rivers PPO $2,906.25
Rate for Payer: TriWest Veterans Administration $2,247.50
Rate for Payer: United Healthcare Commercial $3,371.25
Rate for Payer: United Healthcare Medicare $2,247.50
Rate for Payer: WINHealth Partners Commercial $3,797.50
Rate for Payer: Wise Provider Network Commercial $3,681.25
Service Code HCPCS 78830
Hospital Charge Code 3497883001
Hospital Revenue Code 349
Min. Negotiated Rate $2,429.62
Max. Negotiated Rate $3,875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,797.50
Rate for Payer: Altius Auto/Workers Compensation $3,720.00
Rate for Payer: Altius Commercial $3,720.00
Rate for Payer: Beech Street Commercial $3,797.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,181.38
Rate for Payer: Cash Price $2,712.50
Rate for Payer: ChoiceCare Network Commercial $3,758.75
Rate for Payer: Cigna of WY Commercial $3,797.50
Rate for Payer: Entrust Commercial $3,681.25
Rate for Payer: First Choice Health Commercial $3,681.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,681.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,557.50
Rate for Payer: HealthUtah PPO $3,875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,758.75
Rate for Payer: Multiplan Medicare/VA $2,429.62
Rate for Payer: One Health Plan of WY PPO $3,797.50
Rate for Payer: PacificSource Commercial $3,487.50
Rate for Payer: PHCS PPO $3,797.50
Rate for Payer: Three Rivers PPO $2,906.25
Rate for Payer: TriWest Veterans Administration $2,557.50
Rate for Payer: United Healthcare Commercial $3,371.25
Rate for Payer: United Healthcare Medicare $2,557.50
Rate for Payer: WINHealth Partners Commercial $3,681.25
Rate for Payer: Wise Provider Network Commercial $3,681.25
Service Code HCPCS Q9965
Hospital Charge Code 255Q996501
Hospital Revenue Code 255
Min. Negotiated Rate $2.76
Max. Negotiated Rate $5.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4.90
Rate for Payer: Aetna of WY Medicare $3.30
Rate for Payer: Altius Auto/Workers Compensation $4.80
Rate for Payer: Altius Commercial $4.80
Rate for Payer: Beech Street Commercial $4.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.10
Rate for Payer: Cash Price $3.50
Rate for Payer: ChoiceCare Network Commercial $4.85
Rate for Payer: Cigna of WY Commercial $4.90
Rate for Payer: Entrust Commercial $4.75
Rate for Payer: First Choice Health Commercial $4.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.90
Rate for Payer: HealthUtah PPO $5.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4.85
Rate for Payer: Multiplan Medicare/VA $2.76
Rate for Payer: One Health Plan of WY PPO $4.90
Rate for Payer: PacificSource Commercial $4.50
Rate for Payer: PHCS PPO $4.90
Rate for Payer: Three Rivers PPO $3.75
Rate for Payer: TriWest Veterans Administration $2.90
Rate for Payer: United Healthcare Commercial $4.35
Rate for Payer: United Healthcare Medicare $2.90
Rate for Payer: WINHealth Partners Commercial $4.90
Rate for Payer: Wise Provider Network Commercial $4.75
Service Code HCPCS Q9965
Hospital Charge Code 255Q996501
Hospital Revenue Code 255
Min. Negotiated Rate $3.14
Max. Negotiated Rate $5.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4.90
Rate for Payer: Altius Auto/Workers Compensation $4.80
Rate for Payer: Altius Commercial $4.80
Rate for Payer: Beech Street Commercial $4.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.10
Rate for Payer: Cash Price $3.50
Rate for Payer: ChoiceCare Network Commercial $4.85
Rate for Payer: Cigna of WY Commercial $4.90
Rate for Payer: Entrust Commercial $4.75
Rate for Payer: First Choice Health Commercial $4.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.30
Rate for Payer: HealthUtah PPO $5.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4.85
Rate for Payer: Multiplan Medicare/VA $3.14
Rate for Payer: One Health Plan of WY PPO $4.90
Rate for Payer: PacificSource Commercial $4.50
Rate for Payer: PHCS PPO $4.90
Rate for Payer: Three Rivers PPO $3.75
Rate for Payer: TriWest Veterans Administration $3.30
Rate for Payer: United Healthcare Commercial $4.35
Rate for Payer: United Healthcare Medicare $3.30
Rate for Payer: WINHealth Partners Commercial $4.75
Rate for Payer: Wise Provider Network Commercial $4.75
Service Code HCPCS Q9966
Hospital Charge Code 255Q996601
Hospital Revenue Code 255
Min. Negotiated Rate $13.22
Max. Negotiated Rate $24.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $23.52
Rate for Payer: Aetna of WY Medicare $15.84
Rate for Payer: Altius Auto/Workers Compensation $23.04
Rate for Payer: Altius Commercial $23.04
Rate for Payer: Beech Street Commercial $23.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $19.70
Rate for Payer: Cash Price $16.80
Rate for Payer: ChoiceCare Network Commercial $23.28
Rate for Payer: Cigna of WY Commercial $23.52
Rate for Payer: Entrust Commercial $22.80
Rate for Payer: First Choice Health Commercial $22.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $22.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.92
Rate for Payer: HealthUtah PPO $24.00
Rate for Payer: Idaho Integrated Healthcare Commercial $23.28
Rate for Payer: Multiplan Medicare/VA $13.22
Rate for Payer: One Health Plan of WY PPO $23.52
Rate for Payer: PacificSource Commercial $21.60
Rate for Payer: PHCS PPO $23.52
Rate for Payer: Three Rivers PPO $18.00
Rate for Payer: TriWest Veterans Administration $13.92
Rate for Payer: United Healthcare Commercial $20.88
Rate for Payer: United Healthcare Medicare $13.92
Rate for Payer: WINHealth Partners Commercial $23.52
Rate for Payer: Wise Provider Network Commercial $22.80
Service Code HCPCS Q9966
Hospital Charge Code 255Q996601
Hospital Revenue Code 255
Min. Negotiated Rate $15.05
Max. Negotiated Rate $24.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $23.52
Rate for Payer: Altius Auto/Workers Compensation $23.04
Rate for Payer: Altius Commercial $23.04
Rate for Payer: Beech Street Commercial $23.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $19.70
Rate for Payer: Cash Price $16.80
Rate for Payer: ChoiceCare Network Commercial $23.28
Rate for Payer: Cigna of WY Commercial $23.52
Rate for Payer: Entrust Commercial $22.80
Rate for Payer: First Choice Health Commercial $22.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $22.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.84
Rate for Payer: HealthUtah PPO $24.00
Rate for Payer: Idaho Integrated Healthcare Commercial $23.28
Rate for Payer: Multiplan Medicare/VA $15.05
Rate for Payer: One Health Plan of WY PPO $23.52
Rate for Payer: PacificSource Commercial $21.60
Rate for Payer: PHCS PPO $23.52
Rate for Payer: Three Rivers PPO $18.00
Rate for Payer: TriWest Veterans Administration $15.84
Rate for Payer: United Healthcare Commercial $20.88
Rate for Payer: United Healthcare Medicare $15.84
Rate for Payer: WINHealth Partners Commercial $22.80
Rate for Payer: Wise Provider Network Commercial $22.80
Service Code HCPCS Q9967
Hospital Charge Code 255Q996701
Hospital Revenue Code 255
Min. Negotiated Rate $2.20
Max. Negotiated Rate $4.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.92
Rate for Payer: Aetna of WY Medicare $2.64
Rate for Payer: Altius Auto/Workers Compensation $3.84
Rate for Payer: Altius Commercial $3.84
Rate for Payer: Beech Street Commercial $3.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3.28
Rate for Payer: Cash Price $2.80
Rate for Payer: ChoiceCare Network Commercial $3.88
Rate for Payer: Cigna of WY Commercial $3.92
Rate for Payer: Entrust Commercial $3.80
Rate for Payer: First Choice Health Commercial $3.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.32
Rate for Payer: HealthUtah PPO $4.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3.88
Rate for Payer: Multiplan Medicare/VA $2.20
Rate for Payer: One Health Plan of WY PPO $3.92
Rate for Payer: PacificSource Commercial $3.60
Rate for Payer: PHCS PPO $3.92
Rate for Payer: Three Rivers PPO $3.00
Rate for Payer: TriWest Veterans Administration $2.32
Rate for Payer: United Healthcare Commercial $3.48
Rate for Payer: United Healthcare Medicare $2.32
Rate for Payer: WINHealth Partners Commercial $3.92
Rate for Payer: Wise Provider Network Commercial $3.80
Service Code HCPCS Q9967
Hospital Charge Code 255Q996701
Hospital Revenue Code 255
Min. Negotiated Rate $2.51
Max. Negotiated Rate $4.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.92
Rate for Payer: Altius Auto/Workers Compensation $3.84
Rate for Payer: Altius Commercial $3.84
Rate for Payer: Beech Street Commercial $3.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3.28
Rate for Payer: Cash Price $2.80
Rate for Payer: ChoiceCare Network Commercial $3.88
Rate for Payer: Cigna of WY Commercial $3.92
Rate for Payer: Entrust Commercial $3.80
Rate for Payer: First Choice Health Commercial $3.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.64
Rate for Payer: HealthUtah PPO $4.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3.88
Rate for Payer: Multiplan Medicare/VA $2.51
Rate for Payer: One Health Plan of WY PPO $3.92
Rate for Payer: PacificSource Commercial $3.60
Rate for Payer: PHCS PPO $3.92
Rate for Payer: Three Rivers PPO $3.00
Rate for Payer: TriWest Veterans Administration $2.64
Rate for Payer: United Healthcare Commercial $3.48
Rate for Payer: United Healthcare Medicare $2.64
Rate for Payer: WINHealth Partners Commercial $3.80
Rate for Payer: Wise Provider Network Commercial $3.80
Service Code HCPCS 82726
Hospital Charge Code 3018272601
Hospital Revenue Code 301
Min. Negotiated Rate $99.18
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Aetna of WY Medicare $118.80
Rate for Payer: Altius Auto/Workers Compensation $172.80
Rate for Payer: Altius Commercial $172.80
Rate for Payer: Beech Street Commercial $176.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $147.78
Rate for Payer: Cash Price $126.00
Rate for Payer: ChoiceCare Network Commercial $174.60
Rate for Payer: Cigna of WY Commercial $176.40
Rate for Payer: Entrust Commercial $171.00
Rate for Payer: First Choice Health Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $104.40
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $99.18
Rate for Payer: One Health Plan of WY PPO $176.40
Rate for Payer: PacificSource Commercial $162.00
Rate for Payer: PHCS PPO $176.40
Rate for Payer: Three Rivers PPO $135.00
Rate for Payer: TriWest Veterans Administration $104.40
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $104.40
Rate for Payer: WINHealth Partners Commercial $176.40
Rate for Payer: Wise Provider Network Commercial $171.00