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Hospital Charge Code 3600000011
Hospital Revenue Code 360
Min. Negotiated Rate $562.02
Max. Negotiated Rate $1,020.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $999.60
Rate for Payer: Aetna of WY Medicare $673.20
Rate for Payer: Altius Auto/Workers Compensation $979.20
Rate for Payer: Altius Commercial $979.20
Rate for Payer: Beech Street Commercial $999.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $837.42
Rate for Payer: Cash Price $714.00
Rate for Payer: ChoiceCare Network Commercial $989.40
Rate for Payer: Cigna of WY Commercial $999.60
Rate for Payer: Entrust Commercial $969.00
Rate for Payer: First Choice Health Commercial $969.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $969.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $591.60
Rate for Payer: HealthUtah PPO $1,020.00
Rate for Payer: Idaho Integrated Healthcare Commercial $989.40
Rate for Payer: Multiplan Medicare/VA $562.02
Rate for Payer: One Health Plan of WY PPO $999.60
Rate for Payer: PacificSource Commercial $918.00
Rate for Payer: PHCS PPO $999.60
Rate for Payer: Three Rivers PPO $765.00
Rate for Payer: TriWest Veterans Administration $591.60
Rate for Payer: United Healthcare Commercial $887.40
Rate for Payer: United Healthcare Medicare $591.60
Rate for Payer: WINHealth Partners Commercial $999.60
Rate for Payer: Wise Provider Network Commercial $969.00
Hospital Charge Code 3600000011
Hospital Revenue Code 360
Min. Negotiated Rate $639.54
Max. Negotiated Rate $1,020.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $999.60
Rate for Payer: Altius Auto/Workers Compensation $979.20
Rate for Payer: Altius Commercial $979.20
Rate for Payer: Beech Street Commercial $999.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $837.42
Rate for Payer: Cash Price $714.00
Rate for Payer: ChoiceCare Network Commercial $989.40
Rate for Payer: Cigna of WY Commercial $999.60
Rate for Payer: Entrust Commercial $969.00
Rate for Payer: First Choice Health Commercial $969.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $969.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $673.20
Rate for Payer: HealthUtah PPO $1,020.00
Rate for Payer: Idaho Integrated Healthcare Commercial $989.40
Rate for Payer: Multiplan Medicare/VA $639.54
Rate for Payer: One Health Plan of WY PPO $999.60
Rate for Payer: PacificSource Commercial $918.00
Rate for Payer: PHCS PPO $999.60
Rate for Payer: Three Rivers PPO $765.00
Rate for Payer: TriWest Veterans Administration $673.20
Rate for Payer: United Healthcare Commercial $887.40
Rate for Payer: United Healthcare Medicare $673.20
Rate for Payer: WINHealth Partners Commercial $969.00
Rate for Payer: Wise Provider Network Commercial $969.00
Service Code HCPCS S3620
Hospital Charge Code 300S362001
Hospital Revenue Code 300
Min. Negotiated Rate $49.59
Max. Negotiated Rate $90.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $88.20
Rate for Payer: Aetna of WY Medicare $59.40
Rate for Payer: Altius Auto/Workers Compensation $86.40
Rate for Payer: Altius Commercial $86.40
Rate for Payer: Beech Street Commercial $88.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $73.89
Rate for Payer: Cash Price $63.00
Rate for Payer: ChoiceCare Network Commercial $87.30
Rate for Payer: Cigna of WY Commercial $88.20
Rate for Payer: Entrust Commercial $85.50
Rate for Payer: First Choice Health Commercial $85.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $85.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $52.20
Rate for Payer: HealthUtah PPO $90.00
Rate for Payer: Idaho Integrated Healthcare Commercial $87.30
Rate for Payer: Multiplan Medicare/VA $49.59
Rate for Payer: One Health Plan of WY PPO $88.20
Rate for Payer: PacificSource Commercial $81.00
Rate for Payer: PHCS PPO $88.20
Rate for Payer: Three Rivers PPO $67.50
Rate for Payer: TriWest Veterans Administration $52.20
Rate for Payer: United Healthcare Commercial $78.30
Rate for Payer: United Healthcare Medicare $52.20
Rate for Payer: WINHealth Partners Commercial $88.20
Rate for Payer: Wise Provider Network Commercial $85.50
Service Code HCPCS S3620
Hospital Charge Code 300S362001
Hospital Revenue Code 300
Min. Negotiated Rate $56.43
Max. Negotiated Rate $90.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $88.20
Rate for Payer: Altius Auto/Workers Compensation $86.40
Rate for Payer: Altius Commercial $86.40
Rate for Payer: Beech Street Commercial $88.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $73.89
Rate for Payer: Cash Price $63.00
Rate for Payer: ChoiceCare Network Commercial $87.30
Rate for Payer: Cigna of WY Commercial $88.20
Rate for Payer: Entrust Commercial $85.50
Rate for Payer: First Choice Health Commercial $85.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $85.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $59.40
Rate for Payer: HealthUtah PPO $90.00
Rate for Payer: Idaho Integrated Healthcare Commercial $87.30
Rate for Payer: Multiplan Medicare/VA $56.43
Rate for Payer: One Health Plan of WY PPO $88.20
Rate for Payer: PacificSource Commercial $81.00
Rate for Payer: PHCS PPO $88.20
Rate for Payer: Three Rivers PPO $67.50
Rate for Payer: TriWest Veterans Administration $59.40
Rate for Payer: United Healthcare Commercial $78.30
Rate for Payer: United Healthcare Medicare $59.40
Rate for Payer: WINHealth Partners Commercial $85.50
Rate for Payer: Wise Provider Network Commercial $85.50
Service Code HCPCS 87591
Hospital Charge Code 3068759101
Hospital Revenue Code 306
Min. Negotiated Rate $82.65
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Aetna of WY Medicare $99.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $82.65
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $87.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $87.00
Rate for Payer: WINHealth Partners Commercial $147.00
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 87591
Hospital Charge Code 3068759101
Hospital Revenue Code 306
Min. Negotiated Rate $94.05
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $94.05
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $99.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $99.00
Rate for Payer: WINHealth Partners Commercial $142.50
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 47531
Hospital Charge Code 3204753101
Hospital Revenue Code 320
Min. Negotiated Rate $9,718.50
Max. Negotiated Rate $15,500.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $15,190.00
Rate for Payer: Altius Auto/Workers Compensation $14,880.00
Rate for Payer: Altius Commercial $14,880.00
Rate for Payer: Beech Street Commercial $15,190.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $12,725.50
Rate for Payer: Cash Price $10,850.00
Rate for Payer: ChoiceCare Network Commercial $15,035.00
Rate for Payer: Cigna of WY Commercial $15,190.00
Rate for Payer: Entrust Commercial $14,725.00
Rate for Payer: First Choice Health Commercial $14,725.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14,725.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10,230.00
Rate for Payer: HealthUtah PPO $15,500.00
Rate for Payer: Idaho Integrated Healthcare Commercial $15,035.00
Rate for Payer: Multiplan Medicare/VA $9,718.50
Rate for Payer: One Health Plan of WY PPO $15,190.00
Rate for Payer: PacificSource Commercial $13,950.00
Rate for Payer: PHCS PPO $15,190.00
Rate for Payer: Three Rivers PPO $11,625.00
Rate for Payer: TriWest Veterans Administration $10,230.00
Rate for Payer: United Healthcare Commercial $13,485.00
Rate for Payer: United Healthcare Medicare $10,230.00
Rate for Payer: WINHealth Partners Commercial $14,725.00
Rate for Payer: Wise Provider Network Commercial $14,725.00
Service Code HCPCS 47531
Hospital Charge Code 3204753101
Hospital Revenue Code 320
Min. Negotiated Rate $8,540.50
Max. Negotiated Rate $15,500.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $15,190.00
Rate for Payer: Aetna of WY Medicare $10,230.00
Rate for Payer: Altius Auto/Workers Compensation $14,880.00
Rate for Payer: Altius Commercial $14,880.00
Rate for Payer: Beech Street Commercial $15,190.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $12,725.50
Rate for Payer: Cash Price $10,850.00
Rate for Payer: ChoiceCare Network Commercial $15,035.00
Rate for Payer: Cigna of WY Commercial $15,190.00
Rate for Payer: Entrust Commercial $14,725.00
Rate for Payer: First Choice Health Commercial $14,725.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14,725.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8,990.00
Rate for Payer: HealthUtah PPO $15,500.00
Rate for Payer: Idaho Integrated Healthcare Commercial $15,035.00
Rate for Payer: Multiplan Medicare/VA $8,540.50
Rate for Payer: One Health Plan of WY PPO $15,190.00
Rate for Payer: PacificSource Commercial $13,950.00
Rate for Payer: PHCS PPO $15,190.00
Rate for Payer: Three Rivers PPO $11,625.00
Rate for Payer: TriWest Veterans Administration $8,990.00
Rate for Payer: United Healthcare Commercial $13,485.00
Rate for Payer: United Healthcare Medicare $8,990.00
Rate for Payer: WINHealth Partners Commercial $15,190.00
Rate for Payer: Wise Provider Network Commercial $14,725.00
Service Code HCPCS 62321
Hospital Charge Code 3206232101
Hospital Revenue Code 320
Min. Negotiated Rate $1,943.70
Max. Negotiated Rate $3,100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,038.00
Rate for Payer: Altius Auto/Workers Compensation $2,976.00
Rate for Payer: Altius Commercial $2,976.00
Rate for Payer: Beech Street Commercial $3,038.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,545.10
Rate for Payer: Cash Price $2,170.00
Rate for Payer: ChoiceCare Network Commercial $3,007.00
Rate for Payer: Cigna of WY Commercial $3,038.00
Rate for Payer: Entrust Commercial $2,945.00
Rate for Payer: First Choice Health Commercial $2,945.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,945.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,046.00
Rate for Payer: HealthUtah PPO $3,100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,007.00
Rate for Payer: Multiplan Medicare/VA $1,943.70
Rate for Payer: One Health Plan of WY PPO $3,038.00
Rate for Payer: PacificSource Commercial $2,790.00
Rate for Payer: PHCS PPO $3,038.00
Rate for Payer: Three Rivers PPO $2,325.00
Rate for Payer: TriWest Veterans Administration $2,046.00
Rate for Payer: United Healthcare Commercial $2,697.00
Rate for Payer: United Healthcare Medicare $2,046.00
Rate for Payer: WINHealth Partners Commercial $2,945.00
Rate for Payer: Wise Provider Network Commercial $2,945.00
Service Code HCPCS 62321
Hospital Charge Code 3206232101
Hospital Revenue Code 320
Min. Negotiated Rate $1,708.10
Max. Negotiated Rate $3,100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,038.00
Rate for Payer: Aetna of WY Medicare $2,046.00
Rate for Payer: Altius Auto/Workers Compensation $2,976.00
Rate for Payer: Altius Commercial $2,976.00
Rate for Payer: Beech Street Commercial $3,038.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,545.10
Rate for Payer: Cash Price $2,170.00
Rate for Payer: ChoiceCare Network Commercial $3,007.00
Rate for Payer: Cigna of WY Commercial $3,038.00
Rate for Payer: Entrust Commercial $2,945.00
Rate for Payer: First Choice Health Commercial $2,945.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,945.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,798.00
Rate for Payer: HealthUtah PPO $3,100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,007.00
Rate for Payer: Multiplan Medicare/VA $1,708.10
Rate for Payer: One Health Plan of WY PPO $3,038.00
Rate for Payer: PacificSource Commercial $2,790.00
Rate for Payer: PHCS PPO $3,038.00
Rate for Payer: Three Rivers PPO $2,325.00
Rate for Payer: TriWest Veterans Administration $1,798.00
Rate for Payer: United Healthcare Commercial $2,697.00
Rate for Payer: United Healthcare Medicare $1,798.00
Rate for Payer: WINHealth Partners Commercial $3,038.00
Rate for Payer: Wise Provider Network Commercial $2,945.00
Service Code HCPCS 62324
Hospital Charge Code 7616232401
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 62324
Hospital Charge Code 7616232401
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 62320
Hospital Charge Code 3206232001
Hospital Revenue Code 320
Min. Negotiated Rate $2,333.48
Max. Negotiated Rate $4,235.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,150.30
Rate for Payer: Aetna of WY Medicare $2,795.10
Rate for Payer: Altius Auto/Workers Compensation $4,065.60
Rate for Payer: Altius Commercial $4,065.60
Rate for Payer: Beech Street Commercial $4,150.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,476.94
Rate for Payer: Cash Price $2,964.50
Rate for Payer: ChoiceCare Network Commercial $4,107.95
Rate for Payer: Cigna of WY Commercial $4,150.30
Rate for Payer: Entrust Commercial $4,023.25
Rate for Payer: First Choice Health Commercial $4,023.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,023.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,456.30
Rate for Payer: HealthUtah PPO $4,235.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,107.95
Rate for Payer: Multiplan Medicare/VA $2,333.48
Rate for Payer: One Health Plan of WY PPO $4,150.30
Rate for Payer: PacificSource Commercial $3,811.50
Rate for Payer: PHCS PPO $4,150.30
Rate for Payer: Three Rivers PPO $3,176.25
Rate for Payer: TriWest Veterans Administration $2,456.30
Rate for Payer: United Healthcare Commercial $3,684.45
Rate for Payer: United Healthcare Medicare $2,456.30
Rate for Payer: WINHealth Partners Commercial $4,150.30
Rate for Payer: Wise Provider Network Commercial $4,023.25
Service Code HCPCS 62320
Hospital Charge Code 3206232001
Hospital Revenue Code 320
Min. Negotiated Rate $2,655.34
Max. Negotiated Rate $4,235.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,150.30
Rate for Payer: Altius Auto/Workers Compensation $4,065.60
Rate for Payer: Altius Commercial $4,065.60
Rate for Payer: Beech Street Commercial $4,150.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,476.94
Rate for Payer: Cash Price $2,964.50
Rate for Payer: ChoiceCare Network Commercial $4,107.95
Rate for Payer: Cigna of WY Commercial $4,150.30
Rate for Payer: Entrust Commercial $4,023.25
Rate for Payer: First Choice Health Commercial $4,023.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,023.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,795.10
Rate for Payer: HealthUtah PPO $4,235.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,107.95
Rate for Payer: Multiplan Medicare/VA $2,655.34
Rate for Payer: One Health Plan of WY PPO $4,150.30
Rate for Payer: PacificSource Commercial $3,811.50
Rate for Payer: PHCS PPO $4,150.30
Rate for Payer: Three Rivers PPO $3,176.25
Rate for Payer: TriWest Veterans Administration $2,795.10
Rate for Payer: United Healthcare Commercial $3,684.45
Rate for Payer: United Healthcare Medicare $2,795.10
Rate for Payer: WINHealth Partners Commercial $4,023.25
Rate for Payer: Wise Provider Network Commercial $4,023.25
Service Code HCPCS 62323
Hospital Charge Code 5106232301
Hospital Revenue Code 510
Min. Negotiated Rate $322.28
Max. Negotiated Rate $514.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $503.72
Rate for Payer: Altius Auto/Workers Compensation $493.44
Rate for Payer: Altius Commercial $493.44
Rate for Payer: Beech Street Commercial $503.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $421.99
Rate for Payer: Cash Price $359.80
Rate for Payer: ChoiceCare Network Commercial $498.58
Rate for Payer: Cigna of WY Commercial $503.72
Rate for Payer: Entrust Commercial $488.30
Rate for Payer: First Choice Health Commercial $488.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $488.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $339.24
Rate for Payer: HealthUtah PPO $514.00
Rate for Payer: Idaho Integrated Healthcare Commercial $498.58
Rate for Payer: Multiplan Medicare/VA $322.28
Rate for Payer: One Health Plan of WY PPO $503.72
Rate for Payer: PacificSource Commercial $462.60
Rate for Payer: PHCS PPO $503.72
Rate for Payer: Three Rivers PPO $385.50
Rate for Payer: TriWest Veterans Administration $339.24
Rate for Payer: United Healthcare Commercial $447.18
Rate for Payer: United Healthcare Medicare $339.24
Rate for Payer: WINHealth Partners Commercial $488.30
Rate for Payer: Wise Provider Network Commercial $488.30
Service Code HCPCS 62323 50
Hospital Charge Code 5106232301
Hospital Revenue Code 510
Min. Negotiated Rate $565.88
Max. Negotiated Rate $1,027.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,006.46
Rate for Payer: Aetna of WY Medicare $677.82
Rate for Payer: Altius Auto/Workers Compensation $985.92
Rate for Payer: Altius Commercial $985.92
Rate for Payer: Beech Street Commercial $1,006.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $843.17
Rate for Payer: Cash Price $718.90
Rate for Payer: ChoiceCare Network Commercial $996.19
Rate for Payer: Cigna of WY Commercial $1,006.46
Rate for Payer: Entrust Commercial $975.65
Rate for Payer: First Choice Health Commercial $975.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $975.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $595.66
Rate for Payer: HealthUtah PPO $1,027.00
Rate for Payer: Idaho Integrated Healthcare Commercial $996.19
Rate for Payer: Multiplan Medicare/VA $565.88
Rate for Payer: One Health Plan of WY PPO $1,006.46
Rate for Payer: PacificSource Commercial $924.30
Rate for Payer: PHCS PPO $1,006.46
Rate for Payer: Three Rivers PPO $770.25
Rate for Payer: TriWest Veterans Administration $595.66
Rate for Payer: United Healthcare Commercial $893.49
Rate for Payer: United Healthcare Medicare $595.66
Rate for Payer: WINHealth Partners Commercial $1,006.46
Rate for Payer: Wise Provider Network Commercial $975.65
Service Code HCPCS 62323 50
Hospital Charge Code 5106232301
Hospital Revenue Code 510
Min. Negotiated Rate $643.93
Max. Negotiated Rate $1,027.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,006.46
Rate for Payer: Altius Auto/Workers Compensation $985.92
Rate for Payer: Altius Commercial $985.92
Rate for Payer: Beech Street Commercial $1,006.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $843.17
Rate for Payer: Cash Price $718.90
Rate for Payer: ChoiceCare Network Commercial $996.19
Rate for Payer: Cigna of WY Commercial $1,006.46
Rate for Payer: Entrust Commercial $975.65
Rate for Payer: First Choice Health Commercial $975.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $975.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $677.82
Rate for Payer: HealthUtah PPO $1,027.00
Rate for Payer: Idaho Integrated Healthcare Commercial $996.19
Rate for Payer: Multiplan Medicare/VA $643.93
Rate for Payer: One Health Plan of WY PPO $1,006.46
Rate for Payer: PacificSource Commercial $924.30
Rate for Payer: PHCS PPO $1,006.46
Rate for Payer: Three Rivers PPO $770.25
Rate for Payer: TriWest Veterans Administration $677.82
Rate for Payer: United Healthcare Commercial $893.49
Rate for Payer: United Healthcare Medicare $677.82
Rate for Payer: WINHealth Partners Commercial $975.65
Rate for Payer: Wise Provider Network Commercial $975.65
Service Code HCPCS 62323
Hospital Charge Code 5106232301
Hospital Revenue Code 510
Min. Negotiated Rate $283.21
Max. Negotiated Rate $514.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $503.72
Rate for Payer: Aetna of WY Medicare $339.24
Rate for Payer: Altius Auto/Workers Compensation $493.44
Rate for Payer: Altius Commercial $493.44
Rate for Payer: Beech Street Commercial $503.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $421.99
Rate for Payer: Cash Price $359.80
Rate for Payer: ChoiceCare Network Commercial $498.58
Rate for Payer: Cigna of WY Commercial $503.72
Rate for Payer: Entrust Commercial $488.30
Rate for Payer: First Choice Health Commercial $488.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $488.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $298.12
Rate for Payer: HealthUtah PPO $514.00
Rate for Payer: Idaho Integrated Healthcare Commercial $498.58
Rate for Payer: Multiplan Medicare/VA $283.21
Rate for Payer: One Health Plan of WY PPO $503.72
Rate for Payer: PacificSource Commercial $462.60
Rate for Payer: PHCS PPO $503.72
Rate for Payer: Three Rivers PPO $385.50
Rate for Payer: TriWest Veterans Administration $298.12
Rate for Payer: United Healthcare Commercial $447.18
Rate for Payer: United Healthcare Medicare $298.12
Rate for Payer: WINHealth Partners Commercial $503.72
Rate for Payer: Wise Provider Network Commercial $488.30
Service Code HCPCS 62323
Hospital Charge Code 3206232301
Hospital Revenue Code 320
Min. Negotiated Rate $1,542.80
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Aetna of WY Medicare $1,848.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,624.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,542.80
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,624.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,624.00
Rate for Payer: WINHealth Partners Commercial $2,744.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Service Code HCPCS 62323
Hospital Charge Code 3206232301
Hospital Revenue Code 320
Min. Negotiated Rate $1,755.60
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,848.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,755.60
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,848.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,848.00
Rate for Payer: WINHealth Partners Commercial $2,660.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Service Code HCPCS 62323 50
Hospital Charge Code 3206232301
Hospital Revenue Code 320
Min. Negotiated Rate $1,542.80
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Aetna of WY Medicare $1,848.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,624.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,542.80
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,624.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,624.00
Rate for Payer: WINHealth Partners Commercial $2,744.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Service Code HCPCS 62323 50
Hospital Charge Code 3206232301
Hospital Revenue Code 320
Min. Negotiated Rate $1,755.60
Max. Negotiated Rate $2,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,744.00
Rate for Payer: Altius Auto/Workers Compensation $2,688.00
Rate for Payer: Altius Commercial $2,688.00
Rate for Payer: Beech Street Commercial $2,744.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,298.80
Rate for Payer: Cash Price $1,960.00
Rate for Payer: ChoiceCare Network Commercial $2,716.00
Rate for Payer: Cigna of WY Commercial $2,744.00
Rate for Payer: Entrust Commercial $2,660.00
Rate for Payer: First Choice Health Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,660.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,848.00
Rate for Payer: HealthUtah PPO $2,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,716.00
Rate for Payer: Multiplan Medicare/VA $1,755.60
Rate for Payer: One Health Plan of WY PPO $2,744.00
Rate for Payer: PacificSource Commercial $2,520.00
Rate for Payer: PHCS PPO $2,744.00
Rate for Payer: Three Rivers PPO $2,100.00
Rate for Payer: TriWest Veterans Administration $1,848.00
Rate for Payer: United Healthcare Commercial $2,436.00
Rate for Payer: United Healthcare Medicare $1,848.00
Rate for Payer: WINHealth Partners Commercial $2,660.00
Rate for Payer: Wise Provider Network Commercial $2,660.00
Service Code HCPCS 62323
Hospital Charge Code 3506232301
Hospital Revenue Code 350
Min. Negotiated Rate $1,140.57
Max. Negotiated Rate $2,070.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,028.60
Rate for Payer: Aetna of WY Medicare $1,366.20
Rate for Payer: Altius Auto/Workers Compensation $1,987.20
Rate for Payer: Altius Commercial $1,987.20
Rate for Payer: Beech Street Commercial $2,028.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,699.47
Rate for Payer: Cash Price $1,449.00
Rate for Payer: ChoiceCare Network Commercial $2,007.90
Rate for Payer: Cigna of WY Commercial $2,028.60
Rate for Payer: Entrust Commercial $1,966.50
Rate for Payer: First Choice Health Commercial $1,966.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,966.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,200.60
Rate for Payer: HealthUtah PPO $2,070.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,007.90
Rate for Payer: Multiplan Medicare/VA $1,140.57
Rate for Payer: One Health Plan of WY PPO $2,028.60
Rate for Payer: PacificSource Commercial $1,863.00
Rate for Payer: PHCS PPO $2,028.60
Rate for Payer: Three Rivers PPO $1,552.50
Rate for Payer: TriWest Veterans Administration $1,200.60
Rate for Payer: United Healthcare Commercial $1,800.90
Rate for Payer: United Healthcare Medicare $1,200.60
Rate for Payer: WINHealth Partners Commercial $2,028.60
Rate for Payer: Wise Provider Network Commercial $1,966.50
Service Code HCPCS 62323
Hospital Charge Code 3506232301
Hospital Revenue Code 350
Min. Negotiated Rate $1,297.89
Max. Negotiated Rate $2,070.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,028.60
Rate for Payer: Altius Auto/Workers Compensation $1,987.20
Rate for Payer: Altius Commercial $1,987.20
Rate for Payer: Beech Street Commercial $2,028.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,699.47
Rate for Payer: Cash Price $1,449.00
Rate for Payer: ChoiceCare Network Commercial $2,007.90
Rate for Payer: Cigna of WY Commercial $2,028.60
Rate for Payer: Entrust Commercial $1,966.50
Rate for Payer: First Choice Health Commercial $1,966.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,966.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,366.20
Rate for Payer: HealthUtah PPO $2,070.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,007.90
Rate for Payer: Multiplan Medicare/VA $1,297.89
Rate for Payer: One Health Plan of WY PPO $2,028.60
Rate for Payer: PacificSource Commercial $1,863.00
Rate for Payer: PHCS PPO $2,028.60
Rate for Payer: Three Rivers PPO $1,552.50
Rate for Payer: TriWest Veterans Administration $1,366.20
Rate for Payer: United Healthcare Commercial $1,800.90
Rate for Payer: United Healthcare Medicare $1,366.20
Rate for Payer: WINHealth Partners Commercial $1,966.50
Rate for Payer: Wise Provider Network Commercial $1,966.50
Service Code HCPCS 86357
Hospital Charge Code 3028635701
Hospital Revenue Code 302
Min. Negotiated Rate $244.53
Max. Negotiated Rate $390.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $382.20
Rate for Payer: Altius Auto/Workers Compensation $374.40
Rate for Payer: Altius Commercial $374.40
Rate for Payer: Beech Street Commercial $382.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $320.19
Rate for Payer: Cash Price $273.00
Rate for Payer: ChoiceCare Network Commercial $378.30
Rate for Payer: Cigna of WY Commercial $382.20
Rate for Payer: Entrust Commercial $370.50
Rate for Payer: First Choice Health Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $257.40
Rate for Payer: HealthUtah PPO $390.00
Rate for Payer: Idaho Integrated Healthcare Commercial $378.30
Rate for Payer: Multiplan Medicare/VA $244.53
Rate for Payer: One Health Plan of WY PPO $382.20
Rate for Payer: PacificSource Commercial $351.00
Rate for Payer: PHCS PPO $382.20
Rate for Payer: Three Rivers PPO $292.50
Rate for Payer: TriWest Veterans Administration $257.40
Rate for Payer: United Healthcare Commercial $339.30
Rate for Payer: United Healthcare Medicare $257.40
Rate for Payer: WINHealth Partners Commercial $370.50
Rate for Payer: Wise Provider Network Commercial $370.50