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Service Code HCPCS 72157
Hospital Charge Code 6127215701
Hospital Revenue Code 612
Min. Negotiated Rate $2,204.00
Max. Negotiated Rate $4,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,920.00
Rate for Payer: Aetna of WY Medicare $2,640.00
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 $2,320.00
Rate for Payer: HealthUtah PPO $4,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,880.00
Rate for Payer: Multiplan Medicare/VA $2,204.00
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 $2,320.00
Rate for Payer: United Healthcare Commercial $3,480.00
Rate for Payer: United Healthcare Medicare $2,320.00
Rate for Payer: WINHealth Partners Commercial $3,920.00
Rate for Payer: Wise Provider Network Commercial $3,800.00
Service Code HCPCS 72147
Hospital Charge Code 6127214701
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 72147
Hospital Charge Code 6127214701
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 72146
Hospital Charge Code 6127214602
Hospital Revenue Code 612
Min. Negotiated Rate $1,743.06
Max. Negotiated Rate $2,780.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,724.40
Rate for Payer: Altius Auto/Workers Compensation $2,668.80
Rate for Payer: Altius Commercial $2,668.80
Rate for Payer: Beech Street Commercial $2,724.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,282.38
Rate for Payer: Cash Price $1,946.00
Rate for Payer: ChoiceCare Network Commercial $2,696.60
Rate for Payer: Cigna of WY Commercial $2,724.40
Rate for Payer: Entrust Commercial $2,641.00
Rate for Payer: First Choice Health Commercial $2,641.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,641.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,834.80
Rate for Payer: HealthUtah PPO $2,780.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,696.60
Rate for Payer: Multiplan Medicare/VA $1,743.06
Rate for Payer: One Health Plan of WY PPO $2,724.40
Rate for Payer: PacificSource Commercial $2,502.00
Rate for Payer: PHCS PPO $2,724.40
Rate for Payer: Three Rivers PPO $2,085.00
Rate for Payer: TriWest Veterans Administration $1,834.80
Rate for Payer: United Healthcare Commercial $2,418.60
Rate for Payer: United Healthcare Medicare $1,834.80
Rate for Payer: WINHealth Partners Commercial $2,641.00
Rate for Payer: Wise Provider Network Commercial $2,641.00
Service Code HCPCS 72146
Hospital Charge Code 6127214602
Hospital Revenue Code 612
Min. Negotiated Rate $1,531.78
Max. Negotiated Rate $2,780.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,724.40
Rate for Payer: Aetna of WY Medicare $1,834.80
Rate for Payer: Altius Auto/Workers Compensation $2,668.80
Rate for Payer: Altius Commercial $2,668.80
Rate for Payer: Beech Street Commercial $2,724.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,282.38
Rate for Payer: Cash Price $1,946.00
Rate for Payer: ChoiceCare Network Commercial $2,696.60
Rate for Payer: Cigna of WY Commercial $2,724.40
Rate for Payer: Entrust Commercial $2,641.00
Rate for Payer: First Choice Health Commercial $2,641.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,641.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,612.40
Rate for Payer: HealthUtah PPO $2,780.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,696.60
Rate for Payer: Multiplan Medicare/VA $1,531.78
Rate for Payer: One Health Plan of WY PPO $2,724.40
Rate for Payer: PacificSource Commercial $2,502.00
Rate for Payer: PHCS PPO $2,724.40
Rate for Payer: Three Rivers PPO $2,085.00
Rate for Payer: TriWest Veterans Administration $1,612.40
Rate for Payer: United Healthcare Commercial $2,418.60
Rate for Payer: United Healthcare Medicare $1,612.40
Rate for Payer: WINHealth Partners Commercial $2,724.40
Rate for Payer: Wise Provider Network Commercial $2,641.00
Service Code HCPCS 70543
Hospital Charge Code 6157054302
Hospital Revenue Code 615
Min. Negotiated Rate $2,286.65
Max. Negotiated Rate $4,150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,067.00
Rate for Payer: Aetna of WY Medicare $2,739.00
Rate for Payer: Altius Auto/Workers Compensation $3,984.00
Rate for Payer: Altius Commercial $3,984.00
Rate for Payer: Beech Street Commercial $4,067.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,407.15
Rate for Payer: Cash Price $2,905.00
Rate for Payer: ChoiceCare Network Commercial $4,025.50
Rate for Payer: Cigna of WY Commercial $4,067.00
Rate for Payer: Entrust Commercial $3,942.50
Rate for Payer: First Choice Health Commercial $3,942.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,942.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,407.00
Rate for Payer: HealthUtah PPO $4,150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,025.50
Rate for Payer: Multiplan Medicare/VA $2,286.65
Rate for Payer: One Health Plan of WY PPO $4,067.00
Rate for Payer: PacificSource Commercial $3,735.00
Rate for Payer: PHCS PPO $4,067.00
Rate for Payer: Three Rivers PPO $3,112.50
Rate for Payer: TriWest Veterans Administration $2,407.00
Rate for Payer: United Healthcare Commercial $3,610.50
Rate for Payer: United Healthcare Medicare $2,407.00
Rate for Payer: WINHealth Partners Commercial $4,067.00
Rate for Payer: Wise Provider Network Commercial $3,942.50
Service Code HCPCS 70543
Hospital Charge Code 6157054302
Hospital Revenue Code 615
Min. Negotiated Rate $2,602.05
Max. Negotiated Rate $4,150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,067.00
Rate for Payer: Altius Auto/Workers Compensation $3,984.00
Rate for Payer: Altius Commercial $3,984.00
Rate for Payer: Beech Street Commercial $4,067.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,407.15
Rate for Payer: Cash Price $2,905.00
Rate for Payer: ChoiceCare Network Commercial $4,025.50
Rate for Payer: Cigna of WY Commercial $4,067.00
Rate for Payer: Entrust Commercial $3,942.50
Rate for Payer: First Choice Health Commercial $3,942.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,942.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,739.00
Rate for Payer: HealthUtah PPO $4,150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,025.50
Rate for Payer: Multiplan Medicare/VA $2,602.05
Rate for Payer: One Health Plan of WY PPO $4,067.00
Rate for Payer: PacificSource Commercial $3,735.00
Rate for Payer: PHCS PPO $4,067.00
Rate for Payer: Three Rivers PPO $3,112.50
Rate for Payer: TriWest Veterans Administration $2,739.00
Rate for Payer: United Healthcare Commercial $3,610.50
Rate for Payer: United Healthcare Medicare $2,739.00
Rate for Payer: WINHealth Partners Commercial $3,942.50
Rate for Payer: Wise Provider Network Commercial $3,942.50
Service Code HCPCS 70540
Hospital Charge Code 6157054002
Hospital Revenue Code 615
Min. Negotiated Rate $796.29
Max. Negotiated Rate $1,270.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,244.60
Rate for Payer: Altius Auto/Workers Compensation $1,219.20
Rate for Payer: Altius Commercial $1,219.20
Rate for Payer: Beech Street Commercial $1,244.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,042.67
Rate for Payer: Cash Price $889.00
Rate for Payer: ChoiceCare Network Commercial $1,231.90
Rate for Payer: Cigna of WY Commercial $1,244.60
Rate for Payer: Entrust Commercial $1,206.50
Rate for Payer: First Choice Health Commercial $1,206.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,206.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $838.20
Rate for Payer: HealthUtah PPO $1,270.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,231.90
Rate for Payer: Multiplan Medicare/VA $796.29
Rate for Payer: One Health Plan of WY PPO $1,244.60
Rate for Payer: PacificSource Commercial $1,143.00
Rate for Payer: PHCS PPO $1,244.60
Rate for Payer: Three Rivers PPO $952.50
Rate for Payer: TriWest Veterans Administration $838.20
Rate for Payer: United Healthcare Commercial $1,104.90
Rate for Payer: United Healthcare Medicare $838.20
Rate for Payer: WINHealth Partners Commercial $1,206.50
Rate for Payer: Wise Provider Network Commercial $1,206.50
Service Code HCPCS 70540
Hospital Charge Code 6157054002
Hospital Revenue Code 615
Min. Negotiated Rate $699.77
Max. Negotiated Rate $1,270.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,244.60
Rate for Payer: Aetna of WY Medicare $838.20
Rate for Payer: Altius Auto/Workers Compensation $1,219.20
Rate for Payer: Altius Commercial $1,219.20
Rate for Payer: Beech Street Commercial $1,244.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,042.67
Rate for Payer: Cash Price $889.00
Rate for Payer: ChoiceCare Network Commercial $1,231.90
Rate for Payer: Cigna of WY Commercial $1,244.60
Rate for Payer: Entrust Commercial $1,206.50
Rate for Payer: First Choice Health Commercial $1,206.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,206.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $736.60
Rate for Payer: HealthUtah PPO $1,270.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,231.90
Rate for Payer: Multiplan Medicare/VA $699.77
Rate for Payer: One Health Plan of WY PPO $1,244.60
Rate for Payer: PacificSource Commercial $1,143.00
Rate for Payer: PHCS PPO $1,244.60
Rate for Payer: Three Rivers PPO $952.50
Rate for Payer: TriWest Veterans Administration $736.60
Rate for Payer: United Healthcare Commercial $1,104.90
Rate for Payer: United Healthcare Medicare $736.60
Rate for Payer: WINHealth Partners Commercial $1,244.60
Rate for Payer: Wise Provider Network Commercial $1,206.50
Service Code HCPCS 70542
Hospital Charge Code 6157054202
Hospital Revenue Code 615
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 70542
Hospital Charge Code 6157054202
Hospital Revenue Code 615
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 73721
Hospital Charge Code 6147372101
Hospital Revenue Code 614
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 73721
Hospital Charge Code 6147372101
Hospital Revenue Code 614
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 73721
Hospital Charge Code 6147372102
Hospital Revenue Code 614
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 73721
Hospital Charge Code 6147372102
Hospital Revenue Code 614
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 73721
Hospital Charge Code 6167372106
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372106
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372105
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372105
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372102
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372102
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372101
Hospital Revenue Code 616
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 73721
Hospital Charge Code 6167372101
Hospital Revenue Code 616
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 73723
Hospital Charge Code 6147372306
Hospital Revenue Code 614
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 6147372306
Hospital Revenue Code 614
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