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Service Code HCPCS 73723
Hospital Charge Code 6147372305
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 6147372305
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
Service Code HCPCS 73723
Hospital Charge Code 6147372302
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
Service Code HCPCS 73723
Hospital Charge Code 6147372302
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 6147372301
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 6147372301
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
Service Code HCPCS 73723
Hospital Charge Code 6147372304
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
Service Code HCPCS 73723
Hospital Charge Code 6147372304
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 6147372303
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 6147372303
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
Service Code HCPCS 73722
Hospital Charge Code 3527372204
Hospital Revenue Code 352
Min. Negotiated Rate $2,110.33
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Aetna of WY Medicare $2,527.80
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,221.40
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,110.33
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,221.40
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,221.40
Rate for Payer: WINHealth Partners Commercial $3,753.40
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 3527372204
Hospital Revenue Code 352
Min. Negotiated Rate $2,401.41
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,527.80
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,401.41
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,527.80
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,527.80
Rate for Payer: WINHealth Partners Commercial $3,638.50
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372207
Hospital Revenue Code 614
Min. Negotiated Rate $2,110.33
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Aetna of WY Medicare $2,527.80
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,221.40
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,110.33
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,221.40
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,221.40
Rate for Payer: WINHealth Partners Commercial $3,753.40
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372207
Hospital Revenue Code 614
Min. Negotiated Rate $2,401.41
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,527.80
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,401.41
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,527.80
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,527.80
Rate for Payer: WINHealth Partners Commercial $3,638.50
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372208
Hospital Revenue Code 614
Min. Negotiated Rate $2,401.41
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,527.80
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,401.41
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,527.80
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,527.80
Rate for Payer: WINHealth Partners Commercial $3,638.50
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372208
Hospital Revenue Code 614
Min. Negotiated Rate $2,110.33
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Aetna of WY Medicare $2,527.80
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,221.40
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,110.33
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,221.40
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,221.40
Rate for Payer: WINHealth Partners Commercial $3,753.40
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372202
Hospital Revenue Code 614
Min. Negotiated Rate $1,085.47
Max. Negotiated Rate $1,970.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,930.60
Rate for Payer: Aetna of WY Medicare $1,300.20
Rate for Payer: Altius Auto/Workers Compensation $1,891.20
Rate for Payer: Altius Commercial $1,891.20
Rate for Payer: Beech Street Commercial $1,930.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,617.37
Rate for Payer: Cash Price $1,379.00
Rate for Payer: ChoiceCare Network Commercial $1,910.90
Rate for Payer: Cigna of WY Commercial $1,930.60
Rate for Payer: Entrust Commercial $1,871.50
Rate for Payer: First Choice Health Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,142.60
Rate for Payer: HealthUtah PPO $1,970.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,910.90
Rate for Payer: Multiplan Medicare/VA $1,085.47
Rate for Payer: One Health Plan of WY PPO $1,930.60
Rate for Payer: PacificSource Commercial $1,773.00
Rate for Payer: PHCS PPO $1,930.60
Rate for Payer: Three Rivers PPO $1,477.50
Rate for Payer: TriWest Veterans Administration $1,142.60
Rate for Payer: United Healthcare Commercial $1,713.90
Rate for Payer: United Healthcare Medicare $1,142.60
Rate for Payer: WINHealth Partners Commercial $1,930.60
Rate for Payer: Wise Provider Network Commercial $1,871.50
Service Code HCPCS 73722
Hospital Charge Code 6147372202
Hospital Revenue Code 614
Min. Negotiated Rate $1,235.19
Max. Negotiated Rate $1,970.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,930.60
Rate for Payer: Altius Auto/Workers Compensation $1,891.20
Rate for Payer: Altius Commercial $1,891.20
Rate for Payer: Beech Street Commercial $1,930.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,617.37
Rate for Payer: Cash Price $1,379.00
Rate for Payer: ChoiceCare Network Commercial $1,910.90
Rate for Payer: Cigna of WY Commercial $1,930.60
Rate for Payer: Entrust Commercial $1,871.50
Rate for Payer: First Choice Health Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,300.20
Rate for Payer: HealthUtah PPO $1,970.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,910.90
Rate for Payer: Multiplan Medicare/VA $1,235.19
Rate for Payer: One Health Plan of WY PPO $1,930.60
Rate for Payer: PacificSource Commercial $1,773.00
Rate for Payer: PHCS PPO $1,930.60
Rate for Payer: Three Rivers PPO $1,477.50
Rate for Payer: TriWest Veterans Administration $1,300.20
Rate for Payer: United Healthcare Commercial $1,713.90
Rate for Payer: United Healthcare Medicare $1,300.20
Rate for Payer: WINHealth Partners Commercial $1,871.50
Rate for Payer: Wise Provider Network Commercial $1,871.50
Service Code HCPCS 73722
Hospital Charge Code 6147372204
Hospital Revenue Code 614
Min. Negotiated Rate $1,085.47
Max. Negotiated Rate $1,970.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,930.60
Rate for Payer: Aetna of WY Medicare $1,300.20
Rate for Payer: Altius Auto/Workers Compensation $1,891.20
Rate for Payer: Altius Commercial $1,891.20
Rate for Payer: Beech Street Commercial $1,930.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,617.37
Rate for Payer: Cash Price $1,379.00
Rate for Payer: ChoiceCare Network Commercial $1,910.90
Rate for Payer: Cigna of WY Commercial $1,930.60
Rate for Payer: Entrust Commercial $1,871.50
Rate for Payer: First Choice Health Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,142.60
Rate for Payer: HealthUtah PPO $1,970.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,910.90
Rate for Payer: Multiplan Medicare/VA $1,085.47
Rate for Payer: One Health Plan of WY PPO $1,930.60
Rate for Payer: PacificSource Commercial $1,773.00
Rate for Payer: PHCS PPO $1,930.60
Rate for Payer: Three Rivers PPO $1,477.50
Rate for Payer: TriWest Veterans Administration $1,142.60
Rate for Payer: United Healthcare Commercial $1,713.90
Rate for Payer: United Healthcare Medicare $1,142.60
Rate for Payer: WINHealth Partners Commercial $1,930.60
Rate for Payer: Wise Provider Network Commercial $1,871.50
Service Code HCPCS 73722
Hospital Charge Code 6147372204
Hospital Revenue Code 614
Min. Negotiated Rate $1,235.19
Max. Negotiated Rate $1,970.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,930.60
Rate for Payer: Altius Auto/Workers Compensation $1,891.20
Rate for Payer: Altius Commercial $1,891.20
Rate for Payer: Beech Street Commercial $1,930.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,617.37
Rate for Payer: Cash Price $1,379.00
Rate for Payer: ChoiceCare Network Commercial $1,910.90
Rate for Payer: Cigna of WY Commercial $1,930.60
Rate for Payer: Entrust Commercial $1,871.50
Rate for Payer: First Choice Health Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,871.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,300.20
Rate for Payer: HealthUtah PPO $1,970.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,910.90
Rate for Payer: Multiplan Medicare/VA $1,235.19
Rate for Payer: One Health Plan of WY PPO $1,930.60
Rate for Payer: PacificSource Commercial $1,773.00
Rate for Payer: PHCS PPO $1,930.60
Rate for Payer: Three Rivers PPO $1,477.50
Rate for Payer: TriWest Veterans Administration $1,300.20
Rate for Payer: United Healthcare Commercial $1,713.90
Rate for Payer: United Healthcare Medicare $1,300.20
Rate for Payer: WINHealth Partners Commercial $1,871.50
Rate for Payer: Wise Provider Network Commercial $1,871.50
Service Code HCPCS 73722
Hospital Charge Code 6147372203
Hospital Revenue Code 614
Min. Negotiated Rate $2,401.41
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,527.80
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,401.41
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,527.80
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,527.80
Rate for Payer: WINHealth Partners Commercial $3,638.50
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73722
Hospital Charge Code 6147372203
Hospital Revenue Code 614
Min. Negotiated Rate $2,110.33
Max. Negotiated Rate $3,830.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,753.40
Rate for Payer: Aetna of WY Medicare $2,527.80
Rate for Payer: Altius Auto/Workers Compensation $3,676.80
Rate for Payer: Altius Commercial $3,676.80
Rate for Payer: Beech Street Commercial $3,753.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,144.43
Rate for Payer: Cash Price $2,681.00
Rate for Payer: ChoiceCare Network Commercial $3,715.10
Rate for Payer: Cigna of WY Commercial $3,753.40
Rate for Payer: Entrust Commercial $3,638.50
Rate for Payer: First Choice Health Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,638.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,221.40
Rate for Payer: HealthUtah PPO $3,830.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,715.10
Rate for Payer: Multiplan Medicare/VA $2,110.33
Rate for Payer: One Health Plan of WY PPO $3,753.40
Rate for Payer: PacificSource Commercial $3,447.00
Rate for Payer: PHCS PPO $3,753.40
Rate for Payer: Three Rivers PPO $2,872.50
Rate for Payer: TriWest Veterans Administration $2,221.40
Rate for Payer: United Healthcare Commercial $3,332.10
Rate for Payer: United Healthcare Medicare $2,221.40
Rate for Payer: WINHealth Partners Commercial $3,753.40
Rate for Payer: Wise Provider Network Commercial $3,638.50
Service Code HCPCS 73221
Hospital Charge Code 6147322104
Hospital Revenue Code 614
Min. Negotiated Rate $1,495.40
Max. Negotiated Rate $2,385.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,337.30
Rate for Payer: Altius Auto/Workers Compensation $2,289.60
Rate for Payer: Altius Commercial $2,289.60
Rate for Payer: Beech Street Commercial $2,337.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,958.08
Rate for Payer: Cash Price $1,669.50
Rate for Payer: ChoiceCare Network Commercial $2,313.45
Rate for Payer: Cigna of WY Commercial $2,337.30
Rate for Payer: Entrust Commercial $2,265.75
Rate for Payer: First Choice Health Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,574.10
Rate for Payer: HealthUtah PPO $2,385.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,313.45
Rate for Payer: Multiplan Medicare/VA $1,495.40
Rate for Payer: One Health Plan of WY PPO $2,337.30
Rate for Payer: PacificSource Commercial $2,146.50
Rate for Payer: PHCS PPO $2,337.30
Rate for Payer: Three Rivers PPO $1,788.75
Rate for Payer: TriWest Veterans Administration $1,574.10
Rate for Payer: United Healthcare Commercial $2,074.95
Rate for Payer: United Healthcare Medicare $1,574.10
Rate for Payer: WINHealth Partners Commercial $2,265.75
Rate for Payer: Wise Provider Network Commercial $2,265.75
Service Code HCPCS 73221
Hospital Charge Code 6147322104
Hospital Revenue Code 614
Min. Negotiated Rate $1,314.14
Max. Negotiated Rate $2,385.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,337.30
Rate for Payer: Aetna of WY Medicare $1,574.10
Rate for Payer: Altius Auto/Workers Compensation $2,289.60
Rate for Payer: Altius Commercial $2,289.60
Rate for Payer: Beech Street Commercial $2,337.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,958.08
Rate for Payer: Cash Price $1,669.50
Rate for Payer: ChoiceCare Network Commercial $2,313.45
Rate for Payer: Cigna of WY Commercial $2,337.30
Rate for Payer: Entrust Commercial $2,265.75
Rate for Payer: First Choice Health Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,383.30
Rate for Payer: HealthUtah PPO $2,385.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,313.45
Rate for Payer: Multiplan Medicare/VA $1,314.14
Rate for Payer: One Health Plan of WY PPO $2,337.30
Rate for Payer: PacificSource Commercial $2,146.50
Rate for Payer: PHCS PPO $2,337.30
Rate for Payer: Three Rivers PPO $1,788.75
Rate for Payer: TriWest Veterans Administration $1,383.30
Rate for Payer: United Healthcare Commercial $2,074.95
Rate for Payer: United Healthcare Medicare $1,383.30
Rate for Payer: WINHealth Partners Commercial $2,337.30
Rate for Payer: Wise Provider Network Commercial $2,265.75
Service Code HCPCS 73221
Hospital Charge Code 6147322103
Hospital Revenue Code 614
Min. Negotiated Rate $1,314.14
Max. Negotiated Rate $2,385.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,337.30
Rate for Payer: Aetna of WY Medicare $1,574.10
Rate for Payer: Altius Auto/Workers Compensation $2,289.60
Rate for Payer: Altius Commercial $2,289.60
Rate for Payer: Beech Street Commercial $2,337.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,958.08
Rate for Payer: Cash Price $1,669.50
Rate for Payer: ChoiceCare Network Commercial $2,313.45
Rate for Payer: Cigna of WY Commercial $2,337.30
Rate for Payer: Entrust Commercial $2,265.75
Rate for Payer: First Choice Health Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,265.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,383.30
Rate for Payer: HealthUtah PPO $2,385.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,313.45
Rate for Payer: Multiplan Medicare/VA $1,314.14
Rate for Payer: One Health Plan of WY PPO $2,337.30
Rate for Payer: PacificSource Commercial $2,146.50
Rate for Payer: PHCS PPO $2,337.30
Rate for Payer: Three Rivers PPO $1,788.75
Rate for Payer: TriWest Veterans Administration $1,383.30
Rate for Payer: United Healthcare Commercial $2,074.95
Rate for Payer: United Healthcare Medicare $1,383.30
Rate for Payer: WINHealth Partners Commercial $2,337.30
Rate for Payer: Wise Provider Network Commercial $2,265.75