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Service Code HCPCS 86727
Hospital Charge Code 3028672701
Hospital Revenue Code 302
Min. Negotiated Rate $72.10
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.90
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $72.10
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $75.90
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $75.90
Rate for Payer: WINHealth Partners Commercial $109.25
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 86727
Hospital Charge Code 3028672701
Hospital Revenue Code 302
Min. Negotiated Rate $63.36
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Aetna of WY Medicare $75.90
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.70
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $63.36
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $66.70
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $66.70
Rate for Payer: WINHealth Partners Commercial $112.70
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 86353
Hospital Charge Code 3028635301
Hospital Revenue Code 302
Min. Negotiated Rate $374.68
Max. Negotiated Rate $680.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $666.40
Rate for Payer: Aetna of WY Medicare $448.80
Rate for Payer: Altius Auto/Workers Compensation $652.80
Rate for Payer: Altius Commercial $652.80
Rate for Payer: Beech Street Commercial $666.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $558.28
Rate for Payer: Cash Price $476.00
Rate for Payer: ChoiceCare Network Commercial $659.60
Rate for Payer: Cigna of WY Commercial $666.40
Rate for Payer: Entrust Commercial $646.00
Rate for Payer: First Choice Health Commercial $646.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $646.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $394.40
Rate for Payer: HealthUtah PPO $680.00
Rate for Payer: Idaho Integrated Healthcare Commercial $659.60
Rate for Payer: Multiplan Medicare/VA $374.68
Rate for Payer: One Health Plan of WY PPO $666.40
Rate for Payer: PacificSource Commercial $612.00
Rate for Payer: PHCS PPO $666.40
Rate for Payer: Three Rivers PPO $510.00
Rate for Payer: TriWest Veterans Administration $394.40
Rate for Payer: United Healthcare Commercial $591.60
Rate for Payer: United Healthcare Medicare $394.40
Rate for Payer: WINHealth Partners Commercial $666.40
Rate for Payer: Wise Provider Network Commercial $646.00
Service Code HCPCS 86353
Hospital Charge Code 3028635301
Hospital Revenue Code 302
Min. Negotiated Rate $426.36
Max. Negotiated Rate $680.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $666.40
Rate for Payer: Altius Auto/Workers Compensation $652.80
Rate for Payer: Altius Commercial $652.80
Rate for Payer: Beech Street Commercial $666.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $558.28
Rate for Payer: Cash Price $476.00
Rate for Payer: ChoiceCare Network Commercial $659.60
Rate for Payer: Cigna of WY Commercial $666.40
Rate for Payer: Entrust Commercial $646.00
Rate for Payer: First Choice Health Commercial $646.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $646.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $448.80
Rate for Payer: HealthUtah PPO $680.00
Rate for Payer: Idaho Integrated Healthcare Commercial $659.60
Rate for Payer: Multiplan Medicare/VA $426.36
Rate for Payer: One Health Plan of WY PPO $666.40
Rate for Payer: PacificSource Commercial $612.00
Rate for Payer: PHCS PPO $666.40
Rate for Payer: Three Rivers PPO $510.00
Rate for Payer: TriWest Veterans Administration $448.80
Rate for Payer: United Healthcare Commercial $591.60
Rate for Payer: United Healthcare Medicare $448.80
Rate for Payer: WINHealth Partners Commercial $646.00
Rate for Payer: Wise Provider Network Commercial $646.00
Service Code HCPCS 54162
Hospital Charge Code 5105416201
Hospital Revenue Code 510
Min. Negotiated Rate $110.75
Max. Negotiated Rate $201.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.98
Rate for Payer: Aetna of WY Medicare $132.66
Rate for Payer: Altius Auto/Workers Compensation $192.96
Rate for Payer: Altius Commercial $192.96
Rate for Payer: Beech Street Commercial $196.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $165.02
Rate for Payer: Cash Price $140.70
Rate for Payer: ChoiceCare Network Commercial $194.97
Rate for Payer: Cigna of WY Commercial $196.98
Rate for Payer: Entrust Commercial $190.95
Rate for Payer: First Choice Health Commercial $190.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $116.58
Rate for Payer: HealthUtah PPO $201.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.97
Rate for Payer: Multiplan Medicare/VA $110.75
Rate for Payer: One Health Plan of WY PPO $196.98
Rate for Payer: PacificSource Commercial $180.90
Rate for Payer: PHCS PPO $196.98
Rate for Payer: Three Rivers PPO $150.75
Rate for Payer: TriWest Veterans Administration $116.58
Rate for Payer: United Healthcare Commercial $174.87
Rate for Payer: United Healthcare Medicare $116.58
Rate for Payer: WINHealth Partners Commercial $196.98
Rate for Payer: Wise Provider Network Commercial $190.95
Service Code HCPCS 54162
Hospital Charge Code 5105416201
Hospital Revenue Code 510
Min. Negotiated Rate $126.03
Max. Negotiated Rate $201.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.98
Rate for Payer: Altius Auto/Workers Compensation $192.96
Rate for Payer: Altius Commercial $192.96
Rate for Payer: Beech Street Commercial $196.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $165.02
Rate for Payer: Cash Price $140.70
Rate for Payer: ChoiceCare Network Commercial $194.97
Rate for Payer: Cigna of WY Commercial $196.98
Rate for Payer: Entrust Commercial $190.95
Rate for Payer: First Choice Health Commercial $190.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $132.66
Rate for Payer: HealthUtah PPO $201.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.97
Rate for Payer: Multiplan Medicare/VA $126.03
Rate for Payer: One Health Plan of WY PPO $196.98
Rate for Payer: PacificSource Commercial $180.90
Rate for Payer: PHCS PPO $196.98
Rate for Payer: Three Rivers PPO $150.75
Rate for Payer: TriWest Veterans Administration $132.66
Rate for Payer: United Healthcare Commercial $174.87
Rate for Payer: United Healthcare Medicare $132.66
Rate for Payer: WINHealth Partners Commercial $190.95
Rate for Payer: Wise Provider Network Commercial $190.95
Service Code HCPCS 87207
Hospital Charge Code 3068720702
Hospital Revenue Code 306
Min. Negotiated Rate $46.84
Max. Negotiated Rate $85.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $83.30
Rate for Payer: Aetna of WY Medicare $56.10
Rate for Payer: Altius Auto/Workers Compensation $81.60
Rate for Payer: Altius Commercial $81.60
Rate for Payer: Beech Street Commercial $83.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $69.78
Rate for Payer: Cash Price $59.50
Rate for Payer: ChoiceCare Network Commercial $82.45
Rate for Payer: Cigna of WY Commercial $83.30
Rate for Payer: Entrust Commercial $80.75
Rate for Payer: First Choice Health Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $49.30
Rate for Payer: HealthUtah PPO $85.00
Rate for Payer: Idaho Integrated Healthcare Commercial $82.45
Rate for Payer: Multiplan Medicare/VA $46.84
Rate for Payer: One Health Plan of WY PPO $83.30
Rate for Payer: PacificSource Commercial $76.50
Rate for Payer: PHCS PPO $83.30
Rate for Payer: Three Rivers PPO $63.75
Rate for Payer: TriWest Veterans Administration $49.30
Rate for Payer: United Healthcare Commercial $73.95
Rate for Payer: United Healthcare Medicare $49.30
Rate for Payer: WINHealth Partners Commercial $83.30
Rate for Payer: Wise Provider Network Commercial $80.75
Service Code HCPCS 87207
Hospital Charge Code 3068720702
Hospital Revenue Code 306
Min. Negotiated Rate $53.30
Max. Negotiated Rate $85.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $83.30
Rate for Payer: Altius Auto/Workers Compensation $81.60
Rate for Payer: Altius Commercial $81.60
Rate for Payer: Beech Street Commercial $83.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $69.78
Rate for Payer: Cash Price $59.50
Rate for Payer: ChoiceCare Network Commercial $82.45
Rate for Payer: Cigna of WY Commercial $83.30
Rate for Payer: Entrust Commercial $80.75
Rate for Payer: First Choice Health Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $56.10
Rate for Payer: HealthUtah PPO $85.00
Rate for Payer: Idaho Integrated Healthcare Commercial $82.45
Rate for Payer: Multiplan Medicare/VA $53.30
Rate for Payer: One Health Plan of WY PPO $83.30
Rate for Payer: PacificSource Commercial $76.50
Rate for Payer: PHCS PPO $83.30
Rate for Payer: Three Rivers PPO $63.75
Rate for Payer: TriWest Veterans Administration $56.10
Rate for Payer: United Healthcare Commercial $73.95
Rate for Payer: United Healthcare Medicare $56.10
Rate for Payer: WINHealth Partners Commercial $80.75
Rate for Payer: Wise Provider Network Commercial $80.75
Service Code HCPCS 77067
Hospital Charge Code 4037706709
Hospital Revenue Code 403
Min. Negotiated Rate $401.28
Max. Negotiated Rate $640.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $627.20
Rate for Payer: Altius Auto/Workers Compensation $614.40
Rate for Payer: Altius Commercial $614.40
Rate for Payer: Beech Street Commercial $627.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $525.44
Rate for Payer: Cash Price $448.00
Rate for Payer: ChoiceCare Network Commercial $620.80
Rate for Payer: Cigna of WY Commercial $627.20
Rate for Payer: Entrust Commercial $608.00
Rate for Payer: First Choice Health Commercial $608.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $608.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $422.40
Rate for Payer: HealthUtah PPO $640.00
Rate for Payer: Idaho Integrated Healthcare Commercial $620.80
Rate for Payer: Multiplan Medicare/VA $401.28
Rate for Payer: One Health Plan of WY PPO $627.20
Rate for Payer: PacificSource Commercial $576.00
Rate for Payer: PHCS PPO $627.20
Rate for Payer: Three Rivers PPO $480.00
Rate for Payer: TriWest Veterans Administration $422.40
Rate for Payer: United Healthcare Commercial $556.80
Rate for Payer: United Healthcare Medicare $422.40
Rate for Payer: WINHealth Partners Commercial $608.00
Rate for Payer: Wise Provider Network Commercial $608.00
Service Code HCPCS 77067
Hospital Charge Code 4037706709
Hospital Revenue Code 403
Min. Negotiated Rate $125.31
Max. Negotiated Rate $640.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $627.20
Rate for Payer: Aetna of WY Medicare $422.40
Rate for Payer: Altius Auto/Workers Compensation $614.40
Rate for Payer: Altius Commercial $614.40
Rate for Payer: Beech Street Commercial $627.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $525.44
Rate for Payer: Cash Price $448.00
Rate for Payer: Cash Price $448.00
Rate for Payer: ChoiceCare Network Commercial $620.80
Rate for Payer: Cigna of WY Commercial $627.20
Rate for Payer: Entrust Commercial $608.00
Rate for Payer: First Choice Health Commercial $608.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $608.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $371.20
Rate for Payer: HealthUtah PPO $640.00
Rate for Payer: Idaho Integrated Healthcare Commercial $620.80
Rate for Payer: Multiplan Medicare/VA $352.64
Rate for Payer: One Health Plan of WY PPO $627.20
Rate for Payer: PacificSource Commercial $576.00
Rate for Payer: PHCS PPO $627.20
Rate for Payer: Three Rivers PPO $480.00
Rate for Payer: TriWest Veterans Administration $371.20
Rate for Payer: United Healthcare Commercial $556.80
Rate for Payer: United Healthcare Medicare $125.31
Rate for Payer: WINHealth Partners Commercial $627.20
Rate for Payer: Wise Provider Network Commercial $608.00
Service Code HCPCS 26341
Hospital Charge Code 5102634101
Hospital Revenue Code 510
Min. Negotiated Rate $246.41
Max. Negotiated Rate $393.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $385.14
Rate for Payer: Altius Auto/Workers Compensation $377.28
Rate for Payer: Altius Commercial $377.28
Rate for Payer: Beech Street Commercial $385.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $322.65
Rate for Payer: Cash Price $275.10
Rate for Payer: ChoiceCare Network Commercial $381.21
Rate for Payer: Cigna of WY Commercial $385.14
Rate for Payer: Entrust Commercial $373.35
Rate for Payer: First Choice Health Commercial $373.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $373.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $259.38
Rate for Payer: HealthUtah PPO $393.00
Rate for Payer: Idaho Integrated Healthcare Commercial $381.21
Rate for Payer: Multiplan Medicare/VA $246.41
Rate for Payer: One Health Plan of WY PPO $385.14
Rate for Payer: PacificSource Commercial $353.70
Rate for Payer: PHCS PPO $385.14
Rate for Payer: Three Rivers PPO $294.75
Rate for Payer: TriWest Veterans Administration $259.38
Rate for Payer: United Healthcare Commercial $341.91
Rate for Payer: United Healthcare Medicare $259.38
Rate for Payer: WINHealth Partners Commercial $373.35
Rate for Payer: Wise Provider Network Commercial $373.35
Service Code HCPCS 26341
Hospital Charge Code 5102634101
Hospital Revenue Code 510
Min. Negotiated Rate $216.54
Max. Negotiated Rate $393.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $385.14
Rate for Payer: Aetna of WY Medicare $259.38
Rate for Payer: Altius Auto/Workers Compensation $377.28
Rate for Payer: Altius Commercial $377.28
Rate for Payer: Beech Street Commercial $385.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $322.65
Rate for Payer: Cash Price $275.10
Rate for Payer: ChoiceCare Network Commercial $381.21
Rate for Payer: Cigna of WY Commercial $385.14
Rate for Payer: Entrust Commercial $373.35
Rate for Payer: First Choice Health Commercial $373.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $373.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $227.94
Rate for Payer: HealthUtah PPO $393.00
Rate for Payer: Idaho Integrated Healthcare Commercial $381.21
Rate for Payer: Multiplan Medicare/VA $216.54
Rate for Payer: One Health Plan of WY PPO $385.14
Rate for Payer: PacificSource Commercial $353.70
Rate for Payer: PHCS PPO $385.14
Rate for Payer: Three Rivers PPO $294.75
Rate for Payer: TriWest Veterans Administration $227.94
Rate for Payer: United Healthcare Commercial $341.91
Rate for Payer: United Healthcare Medicare $227.94
Rate for Payer: WINHealth Partners Commercial $385.14
Rate for Payer: Wise Provider Network Commercial $373.35
Service Code HCPCS 56440
Hospital Charge Code 5105644001
Hospital Revenue Code 510
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 56440
Hospital Charge Code 5105644001
Hospital Revenue Code 510
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 83789
Hospital Charge Code 3018378907
Hospital Revenue Code 301
Min. Negotiated Rate $96.42
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $115.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $96.42
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $101.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $101.50
Rate for Payer: WINHealth Partners Commercial $171.50
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378907
Hospital Revenue Code 301
Min. Negotiated Rate $109.72
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $115.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $109.72
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $115.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $115.50
Rate for Payer: WINHealth Partners Commercial $166.25
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378904
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 83789
Hospital Charge Code 3018378904
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
Service Code HCPCS 83789
Hospital Charge Code 3018378902
Hospital Revenue Code 301
Min. Negotiated Rate $96.42
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $115.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $96.42
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $101.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $101.50
Rate for Payer: WINHealth Partners Commercial $171.50
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378902
Hospital Revenue Code 301
Min. Negotiated Rate $109.72
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $115.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $109.72
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $115.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $115.50
Rate for Payer: WINHealth Partners Commercial $166.25
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378906
Hospital Revenue Code 301
Min. Negotiated Rate $96.42
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $115.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $96.42
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $101.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $101.50
Rate for Payer: WINHealth Partners Commercial $171.50
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378906
Hospital Revenue Code 301
Min. Negotiated Rate $109.72
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $115.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $109.72
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $115.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $115.50
Rate for Payer: WINHealth Partners Commercial $166.25
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378903
Hospital Revenue Code 301
Min. Negotiated Rate $96.42
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $115.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $96.42
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $101.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $101.50
Rate for Payer: WINHealth Partners Commercial $171.50
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378903
Hospital Revenue Code 301
Min. Negotiated Rate $109.72
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Altius Auto/Workers Compensation $168.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.68
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $115.50
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $109.72
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $115.50
Rate for Payer: United Healthcare Commercial $152.25
Rate for Payer: United Healthcare Medicare $115.50
Rate for Payer: WINHealth Partners Commercial $166.25
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 83789
Hospital Charge Code 3018378905
Hospital Revenue Code 301
Min. Negotiated Rate $154.28
Max. Negotiated Rate $280.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $274.40
Rate for Payer: Aetna of WY Medicare $184.80
Rate for Payer: Altius Auto/Workers Compensation $268.80
Rate for Payer: Altius Commercial $268.80
Rate for Payer: Beech Street Commercial $274.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $229.88
Rate for Payer: Cash Price $196.00
Rate for Payer: ChoiceCare Network Commercial $271.60
Rate for Payer: Cigna of WY Commercial $274.40
Rate for Payer: Entrust Commercial $266.00
Rate for Payer: First Choice Health Commercial $266.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $266.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $162.40
Rate for Payer: HealthUtah PPO $280.00
Rate for Payer: Idaho Integrated Healthcare Commercial $271.60
Rate for Payer: Multiplan Medicare/VA $154.28
Rate for Payer: One Health Plan of WY PPO $274.40
Rate for Payer: PacificSource Commercial $252.00
Rate for Payer: PHCS PPO $274.40
Rate for Payer: Three Rivers PPO $210.00
Rate for Payer: TriWest Veterans Administration $162.40
Rate for Payer: United Healthcare Commercial $243.60
Rate for Payer: United Healthcare Medicare $162.40
Rate for Payer: WINHealth Partners Commercial $274.40
Rate for Payer: Wise Provider Network Commercial $266.00