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Service Code HCPCS 82726
Hospital Charge Code 3018272601
Hospital Revenue Code 301
Min. Negotiated Rate $112.86
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
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 $118.80
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $112.86
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 $118.80
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $118.80
Rate for Payer: WINHealth Partners Commercial $171.00
Rate for Payer: Wise Provider Network Commercial $171.00
Service Code HCPCS 93242
Hospital Charge Code 7319324201
Hospital Revenue Code 731
Min. Negotiated Rate $282.15
Max. Negotiated Rate $450.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $441.00
Rate for Payer: Altius Auto/Workers Compensation $432.00
Rate for Payer: Altius Commercial $432.00
Rate for Payer: Beech Street Commercial $441.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $369.45
Rate for Payer: Cash Price $315.00
Rate for Payer: ChoiceCare Network Commercial $436.50
Rate for Payer: Cigna of WY Commercial $441.00
Rate for Payer: Entrust Commercial $427.50
Rate for Payer: First Choice Health Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $297.00
Rate for Payer: HealthUtah PPO $450.00
Rate for Payer: Idaho Integrated Healthcare Commercial $436.50
Rate for Payer: Multiplan Medicare/VA $282.15
Rate for Payer: One Health Plan of WY PPO $441.00
Rate for Payer: PacificSource Commercial $405.00
Rate for Payer: PHCS PPO $441.00
Rate for Payer: Three Rivers PPO $337.50
Rate for Payer: TriWest Veterans Administration $297.00
Rate for Payer: United Healthcare Commercial $391.50
Rate for Payer: United Healthcare Medicare $297.00
Rate for Payer: WINHealth Partners Commercial $427.50
Rate for Payer: Wise Provider Network Commercial $427.50
Service Code HCPCS 93242
Hospital Charge Code 7319324201
Hospital Revenue Code 731
Min. Negotiated Rate $247.95
Max. Negotiated Rate $450.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $441.00
Rate for Payer: Aetna of WY Medicare $297.00
Rate for Payer: Altius Auto/Workers Compensation $432.00
Rate for Payer: Altius Commercial $432.00
Rate for Payer: Beech Street Commercial $441.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $369.45
Rate for Payer: Cash Price $315.00
Rate for Payer: ChoiceCare Network Commercial $436.50
Rate for Payer: Cigna of WY Commercial $441.00
Rate for Payer: Entrust Commercial $427.50
Rate for Payer: First Choice Health Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $261.00
Rate for Payer: HealthUtah PPO $450.00
Rate for Payer: Idaho Integrated Healthcare Commercial $436.50
Rate for Payer: Multiplan Medicare/VA $247.95
Rate for Payer: One Health Plan of WY PPO $441.00
Rate for Payer: PacificSource Commercial $405.00
Rate for Payer: PHCS PPO $441.00
Rate for Payer: Three Rivers PPO $337.50
Rate for Payer: TriWest Veterans Administration $261.00
Rate for Payer: United Healthcare Commercial $391.50
Rate for Payer: United Healthcare Medicare $261.00
Rate for Payer: WINHealth Partners Commercial $441.00
Rate for Payer: Wise Provider Network Commercial $427.50
Service Code HCPCS 93246
Hospital Charge Code 7319324601
Hospital Revenue Code 731
Min. Negotiated Rate $21.32
Max. Negotiated Rate $34.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.32
Rate for Payer: Altius Auto/Workers Compensation $32.64
Rate for Payer: Altius Commercial $32.64
Rate for Payer: Beech Street Commercial $33.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.91
Rate for Payer: Cash Price $23.80
Rate for Payer: ChoiceCare Network Commercial $32.98
Rate for Payer: Cigna of WY Commercial $33.32
Rate for Payer: Entrust Commercial $32.30
Rate for Payer: First Choice Health Commercial $32.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.44
Rate for Payer: HealthUtah PPO $34.00
Rate for Payer: Idaho Integrated Healthcare Commercial $32.98
Rate for Payer: Multiplan Medicare/VA $21.32
Rate for Payer: One Health Plan of WY PPO $33.32
Rate for Payer: PacificSource Commercial $30.60
Rate for Payer: PHCS PPO $33.32
Rate for Payer: Three Rivers PPO $25.50
Rate for Payer: TriWest Veterans Administration $22.44
Rate for Payer: United Healthcare Commercial $29.58
Rate for Payer: United Healthcare Medicare $22.44
Rate for Payer: WINHealth Partners Commercial $32.30
Rate for Payer: Wise Provider Network Commercial $32.30
Service Code HCPCS 93246
Hospital Charge Code 7319324601
Hospital Revenue Code 731
Min. Negotiated Rate $18.73
Max. Negotiated Rate $34.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.32
Rate for Payer: Aetna of WY Medicare $22.44
Rate for Payer: Altius Auto/Workers Compensation $32.64
Rate for Payer: Altius Commercial $32.64
Rate for Payer: Beech Street Commercial $33.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.91
Rate for Payer: Cash Price $23.80
Rate for Payer: ChoiceCare Network Commercial $32.98
Rate for Payer: Cigna of WY Commercial $33.32
Rate for Payer: Entrust Commercial $32.30
Rate for Payer: First Choice Health Commercial $32.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.72
Rate for Payer: HealthUtah PPO $34.00
Rate for Payer: Idaho Integrated Healthcare Commercial $32.98
Rate for Payer: Multiplan Medicare/VA $18.73
Rate for Payer: One Health Plan of WY PPO $33.32
Rate for Payer: PacificSource Commercial $30.60
Rate for Payer: PHCS PPO $33.32
Rate for Payer: Three Rivers PPO $25.50
Rate for Payer: TriWest Veterans Administration $19.72
Rate for Payer: United Healthcare Commercial $29.58
Rate for Payer: United Healthcare Medicare $19.72
Rate for Payer: WINHealth Partners Commercial $33.32
Rate for Payer: Wise Provider Network Commercial $32.30
Service Code HCPCS 73723
Hospital Charge Code 4027372303
Hospital Revenue Code 402
Min. Negotiated Rate $2,116.12
Max. Negotiated Rate $3,375.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,307.50
Rate for Payer: Altius Auto/Workers Compensation $3,240.00
Rate for Payer: Altius Commercial $3,240.00
Rate for Payer: Beech Street Commercial $3,307.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,770.88
Rate for Payer: Cash Price $2,362.50
Rate for Payer: ChoiceCare Network Commercial $3,273.75
Rate for Payer: Cigna of WY Commercial $3,307.50
Rate for Payer: Entrust Commercial $3,206.25
Rate for Payer: First Choice Health Commercial $3,206.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,206.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,227.50
Rate for Payer: HealthUtah PPO $3,375.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,273.75
Rate for Payer: Multiplan Medicare/VA $2,116.12
Rate for Payer: One Health Plan of WY PPO $3,307.50
Rate for Payer: PacificSource Commercial $3,037.50
Rate for Payer: PHCS PPO $3,307.50
Rate for Payer: Three Rivers PPO $2,531.25
Rate for Payer: TriWest Veterans Administration $2,227.50
Rate for Payer: United Healthcare Commercial $2,936.25
Rate for Payer: United Healthcare Medicare $2,227.50
Rate for Payer: WINHealth Partners Commercial $3,206.25
Rate for Payer: Wise Provider Network Commercial $3,206.25
Service Code HCPCS 73723
Hospital Charge Code 4027372303
Hospital Revenue Code 402
Min. Negotiated Rate $1,859.62
Max. Negotiated Rate $3,375.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,307.50
Rate for Payer: Aetna of WY Medicare $2,227.50
Rate for Payer: Altius Auto/Workers Compensation $3,240.00
Rate for Payer: Altius Commercial $3,240.00
Rate for Payer: Beech Street Commercial $3,307.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,770.88
Rate for Payer: Cash Price $2,362.50
Rate for Payer: ChoiceCare Network Commercial $3,273.75
Rate for Payer: Cigna of WY Commercial $3,307.50
Rate for Payer: Entrust Commercial $3,206.25
Rate for Payer: First Choice Health Commercial $3,206.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,206.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,957.50
Rate for Payer: HealthUtah PPO $3,375.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,273.75
Rate for Payer: Multiplan Medicare/VA $1,859.62
Rate for Payer: One Health Plan of WY PPO $3,307.50
Rate for Payer: PacificSource Commercial $3,037.50
Rate for Payer: PHCS PPO $3,307.50
Rate for Payer: Three Rivers PPO $2,531.25
Rate for Payer: TriWest Veterans Administration $1,957.50
Rate for Payer: United Healthcare Commercial $2,936.25
Rate for Payer: United Healthcare Medicare $1,957.50
Rate for Payer: WINHealth Partners Commercial $3,307.50
Rate for Payer: Wise Provider Network Commercial $3,206.25
Service Code HCPCS 94200
Hospital Charge Code 4609420001
Hospital Revenue Code 460
Min. Negotiated Rate $110.20
Max. Negotiated Rate $200.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.00
Rate for Payer: Aetna of WY Medicare $132.00
Rate for Payer: Altius Auto/Workers Compensation $192.00
Rate for Payer: Altius Commercial $192.00
Rate for Payer: Beech Street Commercial $196.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $164.20
Rate for Payer: Cash Price $140.00
Rate for Payer: ChoiceCare Network Commercial $194.00
Rate for Payer: Cigna of WY Commercial $196.00
Rate for Payer: Entrust Commercial $190.00
Rate for Payer: First Choice Health Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $116.00
Rate for Payer: HealthUtah PPO $200.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.00
Rate for Payer: Multiplan Medicare/VA $110.20
Rate for Payer: One Health Plan of WY PPO $196.00
Rate for Payer: PacificSource Commercial $180.00
Rate for Payer: PHCS PPO $196.00
Rate for Payer: Three Rivers PPO $150.00
Rate for Payer: TriWest Veterans Administration $116.00
Rate for Payer: United Healthcare Commercial $174.00
Rate for Payer: United Healthcare Medicare $116.00
Rate for Payer: WINHealth Partners Commercial $196.00
Rate for Payer: Wise Provider Network Commercial $190.00
Service Code HCPCS 94200
Hospital Charge Code 4609420001
Hospital Revenue Code 460
Min. Negotiated Rate $125.40
Max. Negotiated Rate $200.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.00
Rate for Payer: Altius Auto/Workers Compensation $192.00
Rate for Payer: Altius Commercial $192.00
Rate for Payer: Beech Street Commercial $196.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $164.20
Rate for Payer: Cash Price $140.00
Rate for Payer: ChoiceCare Network Commercial $194.00
Rate for Payer: Cigna of WY Commercial $196.00
Rate for Payer: Entrust Commercial $190.00
Rate for Payer: First Choice Health Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $132.00
Rate for Payer: HealthUtah PPO $200.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.00
Rate for Payer: Multiplan Medicare/VA $125.40
Rate for Payer: One Health Plan of WY PPO $196.00
Rate for Payer: PacificSource Commercial $180.00
Rate for Payer: PHCS PPO $196.00
Rate for Payer: Three Rivers PPO $150.00
Rate for Payer: TriWest Veterans Administration $132.00
Rate for Payer: United Healthcare Commercial $174.00
Rate for Payer: United Healthcare Medicare $132.00
Rate for Payer: WINHealth Partners Commercial $190.00
Rate for Payer: Wise Provider Network Commercial $190.00
Service Code HCPCS 78580
Hospital Charge Code 3417858001
Hospital Revenue Code 341
Min. Negotiated Rate $964.25
Max. Negotiated Rate $1,750.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,715.00
Rate for Payer: Aetna of WY Medicare $1,155.00
Rate for Payer: Altius Auto/Workers Compensation $1,680.00
Rate for Payer: Altius Commercial $1,680.00
Rate for Payer: Beech Street Commercial $1,715.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,436.75
Rate for Payer: Cash Price $1,225.00
Rate for Payer: ChoiceCare Network Commercial $1,697.50
Rate for Payer: Cigna of WY Commercial $1,715.00
Rate for Payer: Entrust Commercial $1,662.50
Rate for Payer: First Choice Health Commercial $1,662.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,662.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,015.00
Rate for Payer: HealthUtah PPO $1,750.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,697.50
Rate for Payer: Multiplan Medicare/VA $964.25
Rate for Payer: One Health Plan of WY PPO $1,715.00
Rate for Payer: PacificSource Commercial $1,575.00
Rate for Payer: PHCS PPO $1,715.00
Rate for Payer: Three Rivers PPO $1,312.50
Rate for Payer: TriWest Veterans Administration $1,015.00
Rate for Payer: United Healthcare Commercial $1,522.50
Rate for Payer: United Healthcare Medicare $1,015.00
Rate for Payer: WINHealth Partners Commercial $1,715.00
Rate for Payer: Wise Provider Network Commercial $1,662.50
Service Code HCPCS 78580
Hospital Charge Code 3417858001
Hospital Revenue Code 341
Min. Negotiated Rate $1,097.25
Max. Negotiated Rate $1,750.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,715.00
Rate for Payer: Altius Auto/Workers Compensation $1,680.00
Rate for Payer: Altius Commercial $1,680.00
Rate for Payer: Beech Street Commercial $1,715.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,436.75
Rate for Payer: Cash Price $1,225.00
Rate for Payer: ChoiceCare Network Commercial $1,697.50
Rate for Payer: Cigna of WY Commercial $1,715.00
Rate for Payer: Entrust Commercial $1,662.50
Rate for Payer: First Choice Health Commercial $1,662.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,662.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,155.00
Rate for Payer: HealthUtah PPO $1,750.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,697.50
Rate for Payer: Multiplan Medicare/VA $1,097.25
Rate for Payer: One Health Plan of WY PPO $1,715.00
Rate for Payer: PacificSource Commercial $1,575.00
Rate for Payer: PHCS PPO $1,715.00
Rate for Payer: Three Rivers PPO $1,312.50
Rate for Payer: TriWest Veterans Administration $1,155.00
Rate for Payer: United Healthcare Commercial $1,522.50
Rate for Payer: United Healthcare Medicare $1,155.00
Rate for Payer: WINHealth Partners Commercial $1,662.50
Rate for Payer: Wise Provider Network Commercial $1,662.50
Service Code HCPCS 78579
Hospital Charge Code 3417857901
Hospital Revenue Code 341
Min. Negotiated Rate $617.12
Max. Negotiated Rate $1,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,097.60
Rate for Payer: Aetna of WY Medicare $739.20
Rate for Payer: Altius Auto/Workers Compensation $1,075.20
Rate for Payer: Altius Commercial $1,075.20
Rate for Payer: Beech Street Commercial $1,097.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $919.52
Rate for Payer: Cash Price $784.00
Rate for Payer: ChoiceCare Network Commercial $1,086.40
Rate for Payer: Cigna of WY Commercial $1,097.60
Rate for Payer: Entrust Commercial $1,064.00
Rate for Payer: First Choice Health Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $649.60
Rate for Payer: HealthUtah PPO $1,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,086.40
Rate for Payer: Multiplan Medicare/VA $617.12
Rate for Payer: One Health Plan of WY PPO $1,097.60
Rate for Payer: PacificSource Commercial $1,008.00
Rate for Payer: PHCS PPO $1,097.60
Rate for Payer: Three Rivers PPO $840.00
Rate for Payer: TriWest Veterans Administration $649.60
Rate for Payer: United Healthcare Commercial $974.40
Rate for Payer: United Healthcare Medicare $649.60
Rate for Payer: WINHealth Partners Commercial $1,097.60
Rate for Payer: Wise Provider Network Commercial $1,064.00
Service Code HCPCS 78579
Hospital Charge Code 3417857901
Hospital Revenue Code 341
Min. Negotiated Rate $702.24
Max. Negotiated Rate $1,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,097.60
Rate for Payer: Altius Auto/Workers Compensation $1,075.20
Rate for Payer: Altius Commercial $1,075.20
Rate for Payer: Beech Street Commercial $1,097.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $919.52
Rate for Payer: Cash Price $784.00
Rate for Payer: ChoiceCare Network Commercial $1,086.40
Rate for Payer: Cigna of WY Commercial $1,097.60
Rate for Payer: Entrust Commercial $1,064.00
Rate for Payer: First Choice Health Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $739.20
Rate for Payer: HealthUtah PPO $1,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,086.40
Rate for Payer: Multiplan Medicare/VA $702.24
Rate for Payer: One Health Plan of WY PPO $1,097.60
Rate for Payer: PacificSource Commercial $1,008.00
Rate for Payer: PHCS PPO $1,097.60
Rate for Payer: Three Rivers PPO $840.00
Rate for Payer: TriWest Veterans Administration $739.20
Rate for Payer: United Healthcare Commercial $974.40
Rate for Payer: United Healthcare Medicare $739.20
Rate for Payer: WINHealth Partners Commercial $1,064.00
Rate for Payer: Wise Provider Network Commercial $1,064.00
Service Code HCPCS 78582
Hospital Charge Code 3417858202
Hospital Revenue Code 341
Min. Negotiated Rate $2,382.60
Max. Negotiated Rate $3,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,724.00
Rate for Payer: Altius Auto/Workers Compensation $3,648.00
Rate for Payer: Altius Commercial $3,648.00
Rate for Payer: Beech Street Commercial $3,724.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,119.80
Rate for Payer: Cash Price $2,660.00
Rate for Payer: ChoiceCare Network Commercial $3,686.00
Rate for Payer: Cigna of WY Commercial $3,724.00
Rate for Payer: Entrust Commercial $3,610.00
Rate for Payer: First Choice Health Commercial $3,610.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,610.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,508.00
Rate for Payer: HealthUtah PPO $3,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,686.00
Rate for Payer: Multiplan Medicare/VA $2,382.60
Rate for Payer: One Health Plan of WY PPO $3,724.00
Rate for Payer: PacificSource Commercial $3,420.00
Rate for Payer: PHCS PPO $3,724.00
Rate for Payer: Three Rivers PPO $2,850.00
Rate for Payer: TriWest Veterans Administration $2,508.00
Rate for Payer: United Healthcare Commercial $3,306.00
Rate for Payer: United Healthcare Medicare $2,508.00
Rate for Payer: WINHealth Partners Commercial $3,610.00
Rate for Payer: Wise Provider Network Commercial $3,610.00
Service Code HCPCS 78582
Hospital Charge Code 3417858202
Hospital Revenue Code 341
Min. Negotiated Rate $2,093.80
Max. Negotiated Rate $3,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,724.00
Rate for Payer: Aetna of WY Medicare $2,508.00
Rate for Payer: Altius Auto/Workers Compensation $3,648.00
Rate for Payer: Altius Commercial $3,648.00
Rate for Payer: Beech Street Commercial $3,724.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,119.80
Rate for Payer: Cash Price $2,660.00
Rate for Payer: ChoiceCare Network Commercial $3,686.00
Rate for Payer: Cigna of WY Commercial $3,724.00
Rate for Payer: Entrust Commercial $3,610.00
Rate for Payer: First Choice Health Commercial $3,610.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,610.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,204.00
Rate for Payer: HealthUtah PPO $3,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,686.00
Rate for Payer: Multiplan Medicare/VA $2,093.80
Rate for Payer: One Health Plan of WY PPO $3,724.00
Rate for Payer: PacificSource Commercial $3,420.00
Rate for Payer: PHCS PPO $3,724.00
Rate for Payer: Three Rivers PPO $2,850.00
Rate for Payer: TriWest Veterans Administration $2,204.00
Rate for Payer: United Healthcare Commercial $3,306.00
Rate for Payer: United Healthcare Medicare $2,204.00
Rate for Payer: WINHealth Partners Commercial $3,724.00
Rate for Payer: Wise Provider Network Commercial $3,610.00
Service Code HCPCS 86618
Hospital Charge Code 3028661802
Hospital Revenue Code 302
Min. Negotiated Rate $107.44
Max. Negotiated Rate $195.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $191.10
Rate for Payer: Aetna of WY Medicare $128.70
Rate for Payer: Altius Auto/Workers Compensation $187.20
Rate for Payer: Altius Commercial $187.20
Rate for Payer: Beech Street Commercial $191.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $160.10
Rate for Payer: Cash Price $136.50
Rate for Payer: ChoiceCare Network Commercial $189.15
Rate for Payer: Cigna of WY Commercial $191.10
Rate for Payer: Entrust Commercial $185.25
Rate for Payer: First Choice Health Commercial $185.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $185.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $113.10
Rate for Payer: HealthUtah PPO $195.00
Rate for Payer: Idaho Integrated Healthcare Commercial $189.15
Rate for Payer: Multiplan Medicare/VA $107.44
Rate for Payer: One Health Plan of WY PPO $191.10
Rate for Payer: PacificSource Commercial $175.50
Rate for Payer: PHCS PPO $191.10
Rate for Payer: Three Rivers PPO $146.25
Rate for Payer: TriWest Veterans Administration $113.10
Rate for Payer: United Healthcare Commercial $169.65
Rate for Payer: United Healthcare Medicare $113.10
Rate for Payer: WINHealth Partners Commercial $191.10
Rate for Payer: Wise Provider Network Commercial $185.25
Service Code HCPCS 86618
Hospital Charge Code 3028661802
Hospital Revenue Code 302
Min. Negotiated Rate $122.26
Max. Negotiated Rate $195.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $191.10
Rate for Payer: Altius Auto/Workers Compensation $187.20
Rate for Payer: Altius Commercial $187.20
Rate for Payer: Beech Street Commercial $191.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $160.10
Rate for Payer: Cash Price $136.50
Rate for Payer: ChoiceCare Network Commercial $189.15
Rate for Payer: Cigna of WY Commercial $191.10
Rate for Payer: Entrust Commercial $185.25
Rate for Payer: First Choice Health Commercial $185.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $185.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $128.70
Rate for Payer: HealthUtah PPO $195.00
Rate for Payer: Idaho Integrated Healthcare Commercial $189.15
Rate for Payer: Multiplan Medicare/VA $122.26
Rate for Payer: One Health Plan of WY PPO $191.10
Rate for Payer: PacificSource Commercial $175.50
Rate for Payer: PHCS PPO $191.10
Rate for Payer: Three Rivers PPO $146.25
Rate for Payer: TriWest Veterans Administration $128.70
Rate for Payer: United Healthcare Commercial $169.65
Rate for Payer: United Healthcare Medicare $128.70
Rate for Payer: WINHealth Partners Commercial $185.25
Rate for Payer: Wise Provider Network Commercial $185.25
Service Code HCPCS 86617
Hospital Charge Code 3028661702
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86617
Hospital Charge Code 3028661702
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86617
Hospital Charge Code 3028661701
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86617
Hospital Charge Code 3028661701
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 78195
Hospital Charge Code 3417819501
Hospital Revenue Code 341
Min. Negotiated Rate $1,082.72
Max. Negotiated Rate $1,965.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,925.70
Rate for Payer: Aetna of WY Medicare $1,296.90
Rate for Payer: Altius Auto/Workers Compensation $1,886.40
Rate for Payer: Altius Commercial $1,886.40
Rate for Payer: Beech Street Commercial $1,925.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,613.26
Rate for Payer: Cash Price $1,375.50
Rate for Payer: ChoiceCare Network Commercial $1,906.05
Rate for Payer: Cigna of WY Commercial $1,925.70
Rate for Payer: Entrust Commercial $1,866.75
Rate for Payer: First Choice Health Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,139.70
Rate for Payer: HealthUtah PPO $1,965.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,906.05
Rate for Payer: Multiplan Medicare/VA $1,082.72
Rate for Payer: One Health Plan of WY PPO $1,925.70
Rate for Payer: PacificSource Commercial $1,768.50
Rate for Payer: PHCS PPO $1,925.70
Rate for Payer: Three Rivers PPO $1,473.75
Rate for Payer: TriWest Veterans Administration $1,139.70
Rate for Payer: United Healthcare Commercial $1,709.55
Rate for Payer: United Healthcare Medicare $1,139.70
Rate for Payer: WINHealth Partners Commercial $1,925.70
Rate for Payer: Wise Provider Network Commercial $1,866.75
Service Code HCPCS 78195
Hospital Charge Code 3417819501
Hospital Revenue Code 341
Min. Negotiated Rate $1,232.06
Max. Negotiated Rate $1,965.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,925.70
Rate for Payer: Altius Auto/Workers Compensation $1,886.40
Rate for Payer: Altius Commercial $1,886.40
Rate for Payer: Beech Street Commercial $1,925.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,613.26
Rate for Payer: Cash Price $1,375.50
Rate for Payer: ChoiceCare Network Commercial $1,906.05
Rate for Payer: Cigna of WY Commercial $1,925.70
Rate for Payer: Entrust Commercial $1,866.75
Rate for Payer: First Choice Health Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,296.90
Rate for Payer: HealthUtah PPO $1,965.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,906.05
Rate for Payer: Multiplan Medicare/VA $1,232.06
Rate for Payer: One Health Plan of WY PPO $1,925.70
Rate for Payer: PacificSource Commercial $1,768.50
Rate for Payer: PHCS PPO $1,925.70
Rate for Payer: Three Rivers PPO $1,473.75
Rate for Payer: TriWest Veterans Administration $1,296.90
Rate for Payer: United Healthcare Commercial $1,709.55
Rate for Payer: United Healthcare Medicare $1,296.90
Rate for Payer: WINHealth Partners Commercial $1,866.75
Rate for Payer: Wise Provider Network Commercial $1,866.75
Service Code HCPCS 78195
Hospital Charge Code 3417819502
Hospital Revenue Code 341
Min. Negotiated Rate $1,082.72
Max. Negotiated Rate $1,965.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,925.70
Rate for Payer: Aetna of WY Medicare $1,296.90
Rate for Payer: Altius Auto/Workers Compensation $1,886.40
Rate for Payer: Altius Commercial $1,886.40
Rate for Payer: Beech Street Commercial $1,925.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,613.26
Rate for Payer: Cash Price $1,375.50
Rate for Payer: ChoiceCare Network Commercial $1,906.05
Rate for Payer: Cigna of WY Commercial $1,925.70
Rate for Payer: Entrust Commercial $1,866.75
Rate for Payer: First Choice Health Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,139.70
Rate for Payer: HealthUtah PPO $1,965.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,906.05
Rate for Payer: Multiplan Medicare/VA $1,082.72
Rate for Payer: One Health Plan of WY PPO $1,925.70
Rate for Payer: PacificSource Commercial $1,768.50
Rate for Payer: PHCS PPO $1,925.70
Rate for Payer: Three Rivers PPO $1,473.75
Rate for Payer: TriWest Veterans Administration $1,139.70
Rate for Payer: United Healthcare Commercial $1,709.55
Rate for Payer: United Healthcare Medicare $1,139.70
Rate for Payer: WINHealth Partners Commercial $1,925.70
Rate for Payer: Wise Provider Network Commercial $1,866.75
Service Code HCPCS 78195
Hospital Charge Code 3417819502
Hospital Revenue Code 341
Min. Negotiated Rate $1,232.06
Max. Negotiated Rate $1,965.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,925.70
Rate for Payer: Altius Auto/Workers Compensation $1,886.40
Rate for Payer: Altius Commercial $1,886.40
Rate for Payer: Beech Street Commercial $1,925.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,613.26
Rate for Payer: Cash Price $1,375.50
Rate for Payer: ChoiceCare Network Commercial $1,906.05
Rate for Payer: Cigna of WY Commercial $1,925.70
Rate for Payer: Entrust Commercial $1,866.75
Rate for Payer: First Choice Health Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,866.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,296.90
Rate for Payer: HealthUtah PPO $1,965.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,906.05
Rate for Payer: Multiplan Medicare/VA $1,232.06
Rate for Payer: One Health Plan of WY PPO $1,925.70
Rate for Payer: PacificSource Commercial $1,768.50
Rate for Payer: PHCS PPO $1,925.70
Rate for Payer: Three Rivers PPO $1,473.75
Rate for Payer: TriWest Veterans Administration $1,296.90
Rate for Payer: United Healthcare Commercial $1,709.55
Rate for Payer: United Healthcare Medicare $1,296.90
Rate for Payer: WINHealth Partners Commercial $1,866.75
Rate for Payer: Wise Provider Network Commercial $1,866.75