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Service Code HCPCS 74182
Hospital Charge Code 6147418202
Hospital Revenue Code 614
Min. Negotiated Rate $1,881.00
Max. Negotiated Rate $3,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,940.00
Rate for Payer: Altius Auto/Workers Compensation $2,880.00
Rate for Payer: Altius Commercial $2,880.00
Rate for Payer: Beech Street Commercial $2,940.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,463.00
Rate for Payer: Cash Price $2,100.00
Rate for Payer: ChoiceCare Network Commercial $2,910.00
Rate for Payer: Cigna of WY Commercial $2,940.00
Rate for Payer: Entrust Commercial $2,850.00
Rate for Payer: First Choice Health Commercial $2,850.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,850.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,980.00
Rate for Payer: HealthUtah PPO $3,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,910.00
Rate for Payer: Multiplan Medicare/VA $1,881.00
Rate for Payer: One Health Plan of WY PPO $2,940.00
Rate for Payer: PacificSource Commercial $2,700.00
Rate for Payer: PHCS PPO $2,940.00
Rate for Payer: Three Rivers PPO $2,250.00
Rate for Payer: TriWest Veterans Administration $1,980.00
Rate for Payer: United Healthcare Commercial $2,610.00
Rate for Payer: United Healthcare Medicare $1,980.00
Rate for Payer: WINHealth Partners Commercial $2,850.00
Rate for Payer: Wise Provider Network Commercial $2,850.00
Service Code HCPCS 74182
Hospital Charge Code 6147418202
Hospital Revenue Code 614
Min. Negotiated Rate $1,653.00
Max. Negotiated Rate $3,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,940.00
Rate for Payer: Aetna of WY Medicare $1,980.00
Rate for Payer: Altius Auto/Workers Compensation $2,880.00
Rate for Payer: Altius Commercial $2,880.00
Rate for Payer: Beech Street Commercial $2,940.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,463.00
Rate for Payer: Cash Price $2,100.00
Rate for Payer: ChoiceCare Network Commercial $2,910.00
Rate for Payer: Cigna of WY Commercial $2,940.00
Rate for Payer: Entrust Commercial $2,850.00
Rate for Payer: First Choice Health Commercial $2,850.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,850.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,740.00
Rate for Payer: HealthUtah PPO $3,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,910.00
Rate for Payer: Multiplan Medicare/VA $1,653.00
Rate for Payer: One Health Plan of WY PPO $2,940.00
Rate for Payer: PacificSource Commercial $2,700.00
Rate for Payer: PHCS PPO $2,940.00
Rate for Payer: Three Rivers PPO $2,250.00
Rate for Payer: TriWest Veterans Administration $1,740.00
Rate for Payer: United Healthcare Commercial $2,610.00
Rate for Payer: United Healthcare Medicare $1,740.00
Rate for Payer: WINHealth Partners Commercial $2,940.00
Rate for Payer: Wise Provider Network Commercial $2,850.00
Service Code HCPCS 70553
Hospital Charge Code 6117055302
Hospital Revenue Code 611
Min. Negotiated Rate $2,291.68
Max. Negotiated Rate $3,655.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,581.90
Rate for Payer: Altius Auto/Workers Compensation $3,508.80
Rate for Payer: Altius Commercial $3,508.80
Rate for Payer: Beech Street Commercial $3,581.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,000.76
Rate for Payer: Cash Price $2,558.50
Rate for Payer: ChoiceCare Network Commercial $3,545.35
Rate for Payer: Cigna of WY Commercial $3,581.90
Rate for Payer: Entrust Commercial $3,472.25
Rate for Payer: First Choice Health Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,412.30
Rate for Payer: HealthUtah PPO $3,655.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,545.35
Rate for Payer: Multiplan Medicare/VA $2,291.68
Rate for Payer: One Health Plan of WY PPO $3,581.90
Rate for Payer: PacificSource Commercial $3,289.50
Rate for Payer: PHCS PPO $3,581.90
Rate for Payer: Three Rivers PPO $2,741.25
Rate for Payer: TriWest Veterans Administration $2,412.30
Rate for Payer: United Healthcare Commercial $3,179.85
Rate for Payer: United Healthcare Medicare $2,412.30
Rate for Payer: WINHealth Partners Commercial $3,472.25
Rate for Payer: Wise Provider Network Commercial $3,472.25
Service Code HCPCS 70553
Hospital Charge Code 6117055302
Hospital Revenue Code 611
Min. Negotiated Rate $2,013.90
Max. Negotiated Rate $3,655.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,581.90
Rate for Payer: Aetna of WY Medicare $2,412.30
Rate for Payer: Altius Auto/Workers Compensation $3,508.80
Rate for Payer: Altius Commercial $3,508.80
Rate for Payer: Beech Street Commercial $3,581.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,000.76
Rate for Payer: Cash Price $2,558.50
Rate for Payer: ChoiceCare Network Commercial $3,545.35
Rate for Payer: Cigna of WY Commercial $3,581.90
Rate for Payer: Entrust Commercial $3,472.25
Rate for Payer: First Choice Health Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,119.90
Rate for Payer: HealthUtah PPO $3,655.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,545.35
Rate for Payer: Multiplan Medicare/VA $2,013.90
Rate for Payer: One Health Plan of WY PPO $3,581.90
Rate for Payer: PacificSource Commercial $3,289.50
Rate for Payer: PHCS PPO $3,581.90
Rate for Payer: Three Rivers PPO $2,741.25
Rate for Payer: TriWest Veterans Administration $2,119.90
Rate for Payer: United Healthcare Commercial $3,179.85
Rate for Payer: United Healthcare Medicare $2,119.90
Rate for Payer: WINHealth Partners Commercial $3,581.90
Rate for Payer: Wise Provider Network Commercial $3,472.25
Service Code HCPCS 70553
Hospital Charge Code 6117055301
Hospital Revenue Code 611
Min. Negotiated Rate $2,291.68
Max. Negotiated Rate $3,655.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,581.90
Rate for Payer: Altius Auto/Workers Compensation $3,508.80
Rate for Payer: Altius Commercial $3,508.80
Rate for Payer: Beech Street Commercial $3,581.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,000.76
Rate for Payer: Cash Price $2,558.50
Rate for Payer: ChoiceCare Network Commercial $3,545.35
Rate for Payer: Cigna of WY Commercial $3,581.90
Rate for Payer: Entrust Commercial $3,472.25
Rate for Payer: First Choice Health Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,412.30
Rate for Payer: HealthUtah PPO $3,655.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,545.35
Rate for Payer: Multiplan Medicare/VA $2,291.68
Rate for Payer: One Health Plan of WY PPO $3,581.90
Rate for Payer: PacificSource Commercial $3,289.50
Rate for Payer: PHCS PPO $3,581.90
Rate for Payer: Three Rivers PPO $2,741.25
Rate for Payer: TriWest Veterans Administration $2,412.30
Rate for Payer: United Healthcare Commercial $3,179.85
Rate for Payer: United Healthcare Medicare $2,412.30
Rate for Payer: WINHealth Partners Commercial $3,472.25
Rate for Payer: Wise Provider Network Commercial $3,472.25
Service Code HCPCS 70553
Hospital Charge Code 6117055301
Hospital Revenue Code 611
Min. Negotiated Rate $2,013.90
Max. Negotiated Rate $3,655.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,581.90
Rate for Payer: Aetna of WY Medicare $2,412.30
Rate for Payer: Altius Auto/Workers Compensation $3,508.80
Rate for Payer: Altius Commercial $3,508.80
Rate for Payer: Beech Street Commercial $3,581.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,000.76
Rate for Payer: Cash Price $2,558.50
Rate for Payer: ChoiceCare Network Commercial $3,545.35
Rate for Payer: Cigna of WY Commercial $3,581.90
Rate for Payer: Entrust Commercial $3,472.25
Rate for Payer: First Choice Health Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,472.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,119.90
Rate for Payer: HealthUtah PPO $3,655.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,545.35
Rate for Payer: Multiplan Medicare/VA $2,013.90
Rate for Payer: One Health Plan of WY PPO $3,581.90
Rate for Payer: PacificSource Commercial $3,289.50
Rate for Payer: PHCS PPO $3,581.90
Rate for Payer: Three Rivers PPO $2,741.25
Rate for Payer: TriWest Veterans Administration $2,119.90
Rate for Payer: United Healthcare Commercial $3,179.85
Rate for Payer: United Healthcare Medicare $2,119.90
Rate for Payer: WINHealth Partners Commercial $3,581.90
Rate for Payer: Wise Provider Network Commercial $3,472.25
Service Code HCPCS 70552
Hospital Charge Code 6117055202
Hospital Revenue Code 611
Min. Negotiated Rate $1,843.38
Max. Negotiated Rate $2,940.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,881.20
Rate for Payer: Altius Auto/Workers Compensation $2,822.40
Rate for Payer: Altius Commercial $2,822.40
Rate for Payer: Beech Street Commercial $2,881.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,413.74
Rate for Payer: Cash Price $2,058.00
Rate for Payer: ChoiceCare Network Commercial $2,851.80
Rate for Payer: Cigna of WY Commercial $2,881.20
Rate for Payer: Entrust Commercial $2,793.00
Rate for Payer: First Choice Health Commercial $2,793.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,793.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,940.40
Rate for Payer: HealthUtah PPO $2,940.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,851.80
Rate for Payer: Multiplan Medicare/VA $1,843.38
Rate for Payer: One Health Plan of WY PPO $2,881.20
Rate for Payer: PacificSource Commercial $2,646.00
Rate for Payer: PHCS PPO $2,881.20
Rate for Payer: Three Rivers PPO $2,205.00
Rate for Payer: TriWest Veterans Administration $1,940.40
Rate for Payer: United Healthcare Commercial $2,557.80
Rate for Payer: United Healthcare Medicare $1,940.40
Rate for Payer: WINHealth Partners Commercial $2,793.00
Rate for Payer: Wise Provider Network Commercial $2,793.00
Service Code HCPCS 70552
Hospital Charge Code 6117055202
Hospital Revenue Code 611
Min. Negotiated Rate $1,619.94
Max. Negotiated Rate $2,940.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,881.20
Rate for Payer: Aetna of WY Medicare $1,940.40
Rate for Payer: Altius Auto/Workers Compensation $2,822.40
Rate for Payer: Altius Commercial $2,822.40
Rate for Payer: Beech Street Commercial $2,881.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,413.74
Rate for Payer: Cash Price $2,058.00
Rate for Payer: ChoiceCare Network Commercial $2,851.80
Rate for Payer: Cigna of WY Commercial $2,881.20
Rate for Payer: Entrust Commercial $2,793.00
Rate for Payer: First Choice Health Commercial $2,793.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,793.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,705.20
Rate for Payer: HealthUtah PPO $2,940.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,851.80
Rate for Payer: Multiplan Medicare/VA $1,619.94
Rate for Payer: One Health Plan of WY PPO $2,881.20
Rate for Payer: PacificSource Commercial $2,646.00
Rate for Payer: PHCS PPO $2,881.20
Rate for Payer: Three Rivers PPO $2,205.00
Rate for Payer: TriWest Veterans Administration $1,705.20
Rate for Payer: United Healthcare Commercial $2,557.80
Rate for Payer: United Healthcare Medicare $1,705.20
Rate for Payer: WINHealth Partners Commercial $2,881.20
Rate for Payer: Wise Provider Network Commercial $2,793.00
Service Code HCPCS 70551
Hospital Charge Code 6117055102
Hospital Revenue Code 611
Min. Negotiated Rate $1,732.90
Max. Negotiated Rate $3,145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,082.10
Rate for Payer: Aetna of WY Medicare $2,075.70
Rate for Payer: Altius Auto/Workers Compensation $3,019.20
Rate for Payer: Altius Commercial $3,019.20
Rate for Payer: Beech Street Commercial $3,082.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,582.04
Rate for Payer: Cash Price $2,201.50
Rate for Payer: ChoiceCare Network Commercial $3,050.65
Rate for Payer: Cigna of WY Commercial $3,082.10
Rate for Payer: Entrust Commercial $2,987.75
Rate for Payer: First Choice Health Commercial $2,987.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,987.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,824.10
Rate for Payer: HealthUtah PPO $3,145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,050.65
Rate for Payer: Multiplan Medicare/VA $1,732.90
Rate for Payer: One Health Plan of WY PPO $3,082.10
Rate for Payer: PacificSource Commercial $2,830.50
Rate for Payer: PHCS PPO $3,082.10
Rate for Payer: Three Rivers PPO $2,358.75
Rate for Payer: TriWest Veterans Administration $1,824.10
Rate for Payer: United Healthcare Commercial $2,736.15
Rate for Payer: United Healthcare Medicare $1,824.10
Rate for Payer: WINHealth Partners Commercial $3,082.10
Rate for Payer: Wise Provider Network Commercial $2,987.75
Service Code HCPCS 70551
Hospital Charge Code 6117055102
Hospital Revenue Code 611
Min. Negotiated Rate $1,971.92
Max. Negotiated Rate $3,145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,082.10
Rate for Payer: Altius Auto/Workers Compensation $3,019.20
Rate for Payer: Altius Commercial $3,019.20
Rate for Payer: Beech Street Commercial $3,082.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,582.04
Rate for Payer: Cash Price $2,201.50
Rate for Payer: ChoiceCare Network Commercial $3,050.65
Rate for Payer: Cigna of WY Commercial $3,082.10
Rate for Payer: Entrust Commercial $2,987.75
Rate for Payer: First Choice Health Commercial $2,987.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,987.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,075.70
Rate for Payer: HealthUtah PPO $3,145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,050.65
Rate for Payer: Multiplan Medicare/VA $1,971.92
Rate for Payer: One Health Plan of WY PPO $3,082.10
Rate for Payer: PacificSource Commercial $2,830.50
Rate for Payer: PHCS PPO $3,082.10
Rate for Payer: Three Rivers PPO $2,358.75
Rate for Payer: TriWest Veterans Administration $2,075.70
Rate for Payer: United Healthcare Commercial $2,736.15
Rate for Payer: United Healthcare Medicare $2,075.70
Rate for Payer: WINHealth Partners Commercial $2,987.75
Rate for Payer: Wise Provider Network Commercial $2,987.75
Service Code HCPCS 77049
Hospital Charge Code 6147704901
Hospital Revenue Code 614
Min. Negotiated Rate $1,222.65
Max. Negotiated Rate $1,950.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,911.00
Rate for Payer: Altius Auto/Workers Compensation $1,872.00
Rate for Payer: Altius Commercial $1,872.00
Rate for Payer: Beech Street Commercial $1,911.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,600.95
Rate for Payer: Cash Price $1,365.00
Rate for Payer: ChoiceCare Network Commercial $1,891.50
Rate for Payer: Cigna of WY Commercial $1,911.00
Rate for Payer: Entrust Commercial $1,852.50
Rate for Payer: First Choice Health Commercial $1,852.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,852.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,287.00
Rate for Payer: HealthUtah PPO $1,950.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,891.50
Rate for Payer: Multiplan Medicare/VA $1,222.65
Rate for Payer: One Health Plan of WY PPO $1,911.00
Rate for Payer: PacificSource Commercial $1,755.00
Rate for Payer: PHCS PPO $1,911.00
Rate for Payer: Three Rivers PPO $1,462.50
Rate for Payer: TriWest Veterans Administration $1,287.00
Rate for Payer: United Healthcare Commercial $1,696.50
Rate for Payer: United Healthcare Medicare $1,287.00
Rate for Payer: WINHealth Partners Commercial $1,852.50
Rate for Payer: Wise Provider Network Commercial $1,852.50
Service Code HCPCS 77049
Hospital Charge Code 6147704901
Hospital Revenue Code 614
Min. Negotiated Rate $1,074.45
Max. Negotiated Rate $1,950.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,911.00
Rate for Payer: Aetna of WY Medicare $1,287.00
Rate for Payer: Altius Auto/Workers Compensation $1,872.00
Rate for Payer: Altius Commercial $1,872.00
Rate for Payer: Beech Street Commercial $1,911.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,600.95
Rate for Payer: Cash Price $1,365.00
Rate for Payer: ChoiceCare Network Commercial $1,891.50
Rate for Payer: Cigna of WY Commercial $1,911.00
Rate for Payer: Entrust Commercial $1,852.50
Rate for Payer: First Choice Health Commercial $1,852.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,852.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,131.00
Rate for Payer: HealthUtah PPO $1,950.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,891.50
Rate for Payer: Multiplan Medicare/VA $1,074.45
Rate for Payer: One Health Plan of WY PPO $1,911.00
Rate for Payer: PacificSource Commercial $1,755.00
Rate for Payer: PHCS PPO $1,911.00
Rate for Payer: Three Rivers PPO $1,462.50
Rate for Payer: TriWest Veterans Administration $1,131.00
Rate for Payer: United Healthcare Commercial $1,696.50
Rate for Payer: United Healthcare Medicare $1,131.00
Rate for Payer: WINHealth Partners Commercial $1,911.00
Rate for Payer: Wise Provider Network Commercial $1,852.50
Service Code HCPCS 72156
Hospital Charge Code 6127215601
Hospital Revenue Code 612
Min. Negotiated Rate $2,297.67
Max. Negotiated Rate $4,170.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,086.60
Rate for Payer: Aetna of WY Medicare $2,752.20
Rate for Payer: Altius Auto/Workers Compensation $4,003.20
Rate for Payer: Altius Commercial $4,003.20
Rate for Payer: Beech Street Commercial $4,086.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,423.57
Rate for Payer: Cash Price $2,919.00
Rate for Payer: ChoiceCare Network Commercial $4,044.90
Rate for Payer: Cigna of WY Commercial $4,086.60
Rate for Payer: Entrust Commercial $3,961.50
Rate for Payer: First Choice Health Commercial $3,961.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,961.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,418.60
Rate for Payer: HealthUtah PPO $4,170.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,044.90
Rate for Payer: Multiplan Medicare/VA $2,297.67
Rate for Payer: One Health Plan of WY PPO $4,086.60
Rate for Payer: PacificSource Commercial $3,753.00
Rate for Payer: PHCS PPO $4,086.60
Rate for Payer: Three Rivers PPO $3,127.50
Rate for Payer: TriWest Veterans Administration $2,418.60
Rate for Payer: United Healthcare Commercial $3,627.90
Rate for Payer: United Healthcare Medicare $2,418.60
Rate for Payer: WINHealth Partners Commercial $4,086.60
Rate for Payer: Wise Provider Network Commercial $3,961.50
Service Code HCPCS 72156
Hospital Charge Code 6127215601
Hospital Revenue Code 612
Min. Negotiated Rate $2,614.59
Max. Negotiated Rate $4,170.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,086.60
Rate for Payer: Altius Auto/Workers Compensation $4,003.20
Rate for Payer: Altius Commercial $4,003.20
Rate for Payer: Beech Street Commercial $4,086.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,423.57
Rate for Payer: Cash Price $2,919.00
Rate for Payer: ChoiceCare Network Commercial $4,044.90
Rate for Payer: Cigna of WY Commercial $4,086.60
Rate for Payer: Entrust Commercial $3,961.50
Rate for Payer: First Choice Health Commercial $3,961.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,961.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,752.20
Rate for Payer: HealthUtah PPO $4,170.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,044.90
Rate for Payer: Multiplan Medicare/VA $2,614.59
Rate for Payer: One Health Plan of WY PPO $4,086.60
Rate for Payer: PacificSource Commercial $3,753.00
Rate for Payer: PHCS PPO $4,086.60
Rate for Payer: Three Rivers PPO $3,127.50
Rate for Payer: TriWest Veterans Administration $2,752.20
Rate for Payer: United Healthcare Commercial $3,627.90
Rate for Payer: United Healthcare Medicare $2,752.20
Rate for Payer: WINHealth Partners Commercial $3,961.50
Rate for Payer: Wise Provider Network Commercial $3,961.50
Service Code HCPCS 72142
Hospital Charge Code 6127214201
Hospital Revenue Code 612
Min. Negotiated Rate $1,245.26
Max. Negotiated Rate $2,260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,214.80
Rate for Payer: Aetna of WY Medicare $1,491.60
Rate for Payer: Altius Auto/Workers Compensation $2,169.60
Rate for Payer: Altius Commercial $2,169.60
Rate for Payer: Beech Street Commercial $2,214.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,855.46
Rate for Payer: Cash Price $1,582.00
Rate for Payer: ChoiceCare Network Commercial $2,192.20
Rate for Payer: Cigna of WY Commercial $2,214.80
Rate for Payer: Entrust Commercial $2,147.00
Rate for Payer: First Choice Health Commercial $2,147.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,147.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,310.80
Rate for Payer: HealthUtah PPO $2,260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,192.20
Rate for Payer: Multiplan Medicare/VA $1,245.26
Rate for Payer: One Health Plan of WY PPO $2,214.80
Rate for Payer: PacificSource Commercial $2,034.00
Rate for Payer: PHCS PPO $2,214.80
Rate for Payer: Three Rivers PPO $1,695.00
Rate for Payer: TriWest Veterans Administration $1,310.80
Rate for Payer: United Healthcare Commercial $1,966.20
Rate for Payer: United Healthcare Medicare $1,310.80
Rate for Payer: WINHealth Partners Commercial $2,214.80
Rate for Payer: Wise Provider Network Commercial $2,147.00
Service Code HCPCS 72142
Hospital Charge Code 6127214201
Hospital Revenue Code 612
Min. Negotiated Rate $1,417.02
Max. Negotiated Rate $2,260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,214.80
Rate for Payer: Altius Auto/Workers Compensation $2,169.60
Rate for Payer: Altius Commercial $2,169.60
Rate for Payer: Beech Street Commercial $2,214.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,855.46
Rate for Payer: Cash Price $1,582.00
Rate for Payer: ChoiceCare Network Commercial $2,192.20
Rate for Payer: Cigna of WY Commercial $2,214.80
Rate for Payer: Entrust Commercial $2,147.00
Rate for Payer: First Choice Health Commercial $2,147.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,147.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,491.60
Rate for Payer: HealthUtah PPO $2,260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,192.20
Rate for Payer: Multiplan Medicare/VA $1,417.02
Rate for Payer: One Health Plan of WY PPO $2,214.80
Rate for Payer: PacificSource Commercial $2,034.00
Rate for Payer: PHCS PPO $2,214.80
Rate for Payer: Three Rivers PPO $1,695.00
Rate for Payer: TriWest Veterans Administration $1,491.60
Rate for Payer: United Healthcare Commercial $1,966.20
Rate for Payer: United Healthcare Medicare $1,491.60
Rate for Payer: WINHealth Partners Commercial $2,147.00
Rate for Payer: Wise Provider Network Commercial $2,147.00
Service Code HCPCS 72141
Hospital Charge Code 6127214102
Hospital Revenue Code 612
Min. Negotiated Rate $1,661.26
Max. Negotiated Rate $3,015.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,954.70
Rate for Payer: Aetna of WY Medicare $1,989.90
Rate for Payer: Altius Auto/Workers Compensation $2,894.40
Rate for Payer: Altius Commercial $2,894.40
Rate for Payer: Beech Street Commercial $2,954.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,475.32
Rate for Payer: Cash Price $2,110.50
Rate for Payer: ChoiceCare Network Commercial $2,924.55
Rate for Payer: Cigna of WY Commercial $2,954.70
Rate for Payer: Entrust Commercial $2,864.25
Rate for Payer: First Choice Health Commercial $2,864.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,864.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,748.70
Rate for Payer: HealthUtah PPO $3,015.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,924.55
Rate for Payer: Multiplan Medicare/VA $1,661.26
Rate for Payer: One Health Plan of WY PPO $2,954.70
Rate for Payer: PacificSource Commercial $2,713.50
Rate for Payer: PHCS PPO $2,954.70
Rate for Payer: Three Rivers PPO $2,261.25
Rate for Payer: TriWest Veterans Administration $1,748.70
Rate for Payer: United Healthcare Commercial $2,623.05
Rate for Payer: United Healthcare Medicare $1,748.70
Rate for Payer: WINHealth Partners Commercial $2,954.70
Rate for Payer: Wise Provider Network Commercial $2,864.25
Service Code HCPCS 72141
Hospital Charge Code 6127214102
Hospital Revenue Code 612
Min. Negotiated Rate $1,890.40
Max. Negotiated Rate $3,015.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,954.70
Rate for Payer: Altius Auto/Workers Compensation $2,894.40
Rate for Payer: Altius Commercial $2,894.40
Rate for Payer: Beech Street Commercial $2,954.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,475.32
Rate for Payer: Cash Price $2,110.50
Rate for Payer: ChoiceCare Network Commercial $2,924.55
Rate for Payer: Cigna of WY Commercial $2,954.70
Rate for Payer: Entrust Commercial $2,864.25
Rate for Payer: First Choice Health Commercial $2,864.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,864.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,989.90
Rate for Payer: HealthUtah PPO $3,015.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,924.55
Rate for Payer: Multiplan Medicare/VA $1,890.40
Rate for Payer: One Health Plan of WY PPO $2,954.70
Rate for Payer: PacificSource Commercial $2,713.50
Rate for Payer: PHCS PPO $2,954.70
Rate for Payer: Three Rivers PPO $2,261.25
Rate for Payer: TriWest Veterans Administration $1,989.90
Rate for Payer: United Healthcare Commercial $2,623.05
Rate for Payer: United Healthcare Medicare $1,989.90
Rate for Payer: WINHealth Partners Commercial $2,864.25
Rate for Payer: Wise Provider Network Commercial $2,864.25
Service Code HCPCS 71552
Hospital Charge Code 6107155202
Hospital Revenue Code 610
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 71552
Hospital Charge Code 6107155202
Hospital Revenue Code 610
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 71550
Hospital Charge Code 6107155001
Hospital Revenue Code 610
Min. Negotiated Rate $974.98
Max. Negotiated Rate $1,555.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,523.90
Rate for Payer: Altius Auto/Workers Compensation $1,492.80
Rate for Payer: Altius Commercial $1,492.80
Rate for Payer: Beech Street Commercial $1,523.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,276.66
Rate for Payer: Cash Price $1,088.50
Rate for Payer: ChoiceCare Network Commercial $1,508.35
Rate for Payer: Cigna of WY Commercial $1,523.90
Rate for Payer: Entrust Commercial $1,477.25
Rate for Payer: First Choice Health Commercial $1,477.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,477.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,026.30
Rate for Payer: HealthUtah PPO $1,555.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,508.35
Rate for Payer: Multiplan Medicare/VA $974.98
Rate for Payer: One Health Plan of WY PPO $1,523.90
Rate for Payer: PacificSource Commercial $1,399.50
Rate for Payer: PHCS PPO $1,523.90
Rate for Payer: Three Rivers PPO $1,166.25
Rate for Payer: TriWest Veterans Administration $1,026.30
Rate for Payer: United Healthcare Commercial $1,352.85
Rate for Payer: United Healthcare Medicare $1,026.30
Rate for Payer: WINHealth Partners Commercial $1,477.25
Rate for Payer: Wise Provider Network Commercial $1,477.25
Service Code HCPCS 71550
Hospital Charge Code 6107155001
Hospital Revenue Code 610
Min. Negotiated Rate $856.80
Max. Negotiated Rate $1,555.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,523.90
Rate for Payer: Aetna of WY Medicare $1,026.30
Rate for Payer: Altius Auto/Workers Compensation $1,492.80
Rate for Payer: Altius Commercial $1,492.80
Rate for Payer: Beech Street Commercial $1,523.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,276.66
Rate for Payer: Cash Price $1,088.50
Rate for Payer: ChoiceCare Network Commercial $1,508.35
Rate for Payer: Cigna of WY Commercial $1,523.90
Rate for Payer: Entrust Commercial $1,477.25
Rate for Payer: First Choice Health Commercial $1,477.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,477.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $901.90
Rate for Payer: HealthUtah PPO $1,555.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,508.35
Rate for Payer: Multiplan Medicare/VA $856.80
Rate for Payer: One Health Plan of WY PPO $1,523.90
Rate for Payer: PacificSource Commercial $1,399.50
Rate for Payer: PHCS PPO $1,523.90
Rate for Payer: Three Rivers PPO $1,166.25
Rate for Payer: TriWest Veterans Administration $901.90
Rate for Payer: United Healthcare Commercial $1,352.85
Rate for Payer: United Healthcare Medicare $901.90
Rate for Payer: WINHealth Partners Commercial $1,523.90
Rate for Payer: Wise Provider Network Commercial $1,477.25
Service Code HCPCS 71551
Hospital Charge Code 6107155101
Hospital Revenue Code 610
Min. Negotiated Rate $2,749.40
Max. Negotiated Rate $4,385.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,297.30
Rate for Payer: Altius Auto/Workers Compensation $4,209.60
Rate for Payer: Altius Commercial $4,209.60
Rate for Payer: Beech Street Commercial $4,297.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,600.08
Rate for Payer: Cash Price $3,069.50
Rate for Payer: ChoiceCare Network Commercial $4,253.45
Rate for Payer: Cigna of WY Commercial $4,297.30
Rate for Payer: Entrust Commercial $4,165.75
Rate for Payer: First Choice Health Commercial $4,165.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,165.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,894.10
Rate for Payer: HealthUtah PPO $4,385.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,253.45
Rate for Payer: Multiplan Medicare/VA $2,749.40
Rate for Payer: One Health Plan of WY PPO $4,297.30
Rate for Payer: PacificSource Commercial $3,946.50
Rate for Payer: PHCS PPO $4,297.30
Rate for Payer: Three Rivers PPO $3,288.75
Rate for Payer: TriWest Veterans Administration $2,894.10
Rate for Payer: United Healthcare Commercial $3,814.95
Rate for Payer: United Healthcare Medicare $2,894.10
Rate for Payer: WINHealth Partners Commercial $4,165.75
Rate for Payer: Wise Provider Network Commercial $4,165.75
Service Code HCPCS 71551
Hospital Charge Code 6107155101
Hospital Revenue Code 610
Min. Negotiated Rate $2,416.14
Max. Negotiated Rate $4,385.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,297.30
Rate for Payer: Aetna of WY Medicare $2,894.10
Rate for Payer: Altius Auto/Workers Compensation $4,209.60
Rate for Payer: Altius Commercial $4,209.60
Rate for Payer: Beech Street Commercial $4,297.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,600.08
Rate for Payer: Cash Price $3,069.50
Rate for Payer: ChoiceCare Network Commercial $4,253.45
Rate for Payer: Cigna of WY Commercial $4,297.30
Rate for Payer: Entrust Commercial $4,165.75
Rate for Payer: First Choice Health Commercial $4,165.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,165.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,543.30
Rate for Payer: HealthUtah PPO $4,385.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,253.45
Rate for Payer: Multiplan Medicare/VA $2,416.14
Rate for Payer: One Health Plan of WY PPO $4,297.30
Rate for Payer: PacificSource Commercial $3,946.50
Rate for Payer: PHCS PPO $4,297.30
Rate for Payer: Three Rivers PPO $3,288.75
Rate for Payer: TriWest Veterans Administration $2,543.30
Rate for Payer: United Healthcare Commercial $3,814.95
Rate for Payer: United Healthcare Medicare $2,543.30
Rate for Payer: WINHealth Partners Commercial $4,297.30
Rate for Payer: Wise Provider Network Commercial $4,165.75
Service Code HCPCS 72157
Hospital Charge Code 6127215701
Hospital Revenue Code 612
Min. Negotiated Rate $2,508.00
Max. Negotiated Rate $4,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,920.00
Rate for Payer: Altius Auto/Workers Compensation $3,840.00
Rate for Payer: Altius Commercial $3,840.00
Rate for Payer: Beech Street Commercial $3,920.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,284.00
Rate for Payer: Cash Price $2,800.00
Rate for Payer: ChoiceCare Network Commercial $3,880.00
Rate for Payer: Cigna of WY Commercial $3,920.00
Rate for Payer: Entrust Commercial $3,800.00
Rate for Payer: First Choice Health Commercial $3,800.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,800.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,640.00
Rate for Payer: HealthUtah PPO $4,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,880.00
Rate for Payer: Multiplan Medicare/VA $2,508.00
Rate for Payer: One Health Plan of WY PPO $3,920.00
Rate for Payer: PacificSource Commercial $3,600.00
Rate for Payer: PHCS PPO $3,920.00
Rate for Payer: Three Rivers PPO $3,000.00
Rate for Payer: TriWest Veterans Administration $2,640.00
Rate for Payer: United Healthcare Commercial $3,480.00
Rate for Payer: United Healthcare Medicare $2,640.00
Rate for Payer: WINHealth Partners Commercial $3,800.00
Rate for Payer: Wise Provider Network Commercial $3,800.00