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Service Code HCPCS 86357
Hospital Charge Code 3028635701
Hospital Revenue Code 302
Min. Negotiated Rate $214.89
Max. Negotiated Rate $390.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $382.20
Rate for Payer: Aetna of WY Medicare $257.40
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 $226.20
Rate for Payer: HealthUtah PPO $390.00
Rate for Payer: Idaho Integrated Healthcare Commercial $378.30
Rate for Payer: Multiplan Medicare/VA $214.89
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 $226.20
Rate for Payer: United Healthcare Commercial $339.30
Rate for Payer: United Healthcare Medicare $226.20
Rate for Payer: WINHealth Partners Commercial $382.20
Rate for Payer: Wise Provider Network Commercial $370.50
Service Code HCPCS A9500
Hospital Charge Code 343A950001
Hospital Revenue Code 343
Min. Negotiated Rate $944.96
Max. Negotiated Rate $1,715.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,680.70
Rate for Payer: Aetna of WY Medicare $1,131.90
Rate for Payer: Altius Auto/Workers Compensation $1,646.40
Rate for Payer: Altius Commercial $1,646.40
Rate for Payer: Beech Street Commercial $1,680.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,408.02
Rate for Payer: Cash Price $1,200.50
Rate for Payer: ChoiceCare Network Commercial $1,663.55
Rate for Payer: Cigna of WY Commercial $1,680.70
Rate for Payer: Entrust Commercial $1,629.25
Rate for Payer: First Choice Health Commercial $1,629.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,629.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $994.70
Rate for Payer: HealthUtah PPO $1,715.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,663.55
Rate for Payer: Multiplan Medicare/VA $944.96
Rate for Payer: One Health Plan of WY PPO $1,680.70
Rate for Payer: PacificSource Commercial $1,543.50
Rate for Payer: PHCS PPO $1,680.70
Rate for Payer: Three Rivers PPO $1,286.25
Rate for Payer: TriWest Veterans Administration $994.70
Rate for Payer: United Healthcare Commercial $1,492.05
Rate for Payer: United Healthcare Medicare $994.70
Rate for Payer: WINHealth Partners Commercial $1,680.70
Rate for Payer: Wise Provider Network Commercial $1,629.25
Service Code HCPCS A9500
Hospital Charge Code 343A950001
Hospital Revenue Code 343
Min. Negotiated Rate $1,075.30
Max. Negotiated Rate $1,715.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,680.70
Rate for Payer: Altius Auto/Workers Compensation $1,646.40
Rate for Payer: Altius Commercial $1,646.40
Rate for Payer: Beech Street Commercial $1,680.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,408.02
Rate for Payer: Cash Price $1,200.50
Rate for Payer: ChoiceCare Network Commercial $1,663.55
Rate for Payer: Cigna of WY Commercial $1,680.70
Rate for Payer: Entrust Commercial $1,629.25
Rate for Payer: First Choice Health Commercial $1,629.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,629.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,131.90
Rate for Payer: HealthUtah PPO $1,715.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,663.55
Rate for Payer: Multiplan Medicare/VA $1,075.30
Rate for Payer: One Health Plan of WY PPO $1,680.70
Rate for Payer: PacificSource Commercial $1,543.50
Rate for Payer: PHCS PPO $1,680.70
Rate for Payer: Three Rivers PPO $1,286.25
Rate for Payer: TriWest Veterans Administration $1,131.90
Rate for Payer: United Healthcare Commercial $1,492.05
Rate for Payer: United Healthcare Medicare $1,131.90
Rate for Payer: WINHealth Partners Commercial $1,629.25
Rate for Payer: Wise Provider Network Commercial $1,629.25
Service Code HCPCS A9500
Hospital Charge Code 343A950002
Hospital Revenue Code 343
Min. Negotiated Rate $771.40
Max. Negotiated Rate $1,400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,372.00
Rate for Payer: Aetna of WY Medicare $924.00
Rate for Payer: Altius Auto/Workers Compensation $1,344.00
Rate for Payer: Altius Commercial $1,344.00
Rate for Payer: Beech Street Commercial $1,372.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,149.40
Rate for Payer: Cash Price $980.00
Rate for Payer: ChoiceCare Network Commercial $1,358.00
Rate for Payer: Cigna of WY Commercial $1,372.00
Rate for Payer: Entrust Commercial $1,330.00
Rate for Payer: First Choice Health Commercial $1,330.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,330.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $812.00
Rate for Payer: HealthUtah PPO $1,400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,358.00
Rate for Payer: Multiplan Medicare/VA $771.40
Rate for Payer: One Health Plan of WY PPO $1,372.00
Rate for Payer: PacificSource Commercial $1,260.00
Rate for Payer: PHCS PPO $1,372.00
Rate for Payer: Three Rivers PPO $1,050.00
Rate for Payer: TriWest Veterans Administration $812.00
Rate for Payer: United Healthcare Commercial $1,218.00
Rate for Payer: United Healthcare Medicare $812.00
Rate for Payer: WINHealth Partners Commercial $1,372.00
Rate for Payer: Wise Provider Network Commercial $1,330.00
Service Code HCPCS A9500
Hospital Charge Code 343A950002
Hospital Revenue Code 343
Min. Negotiated Rate $877.80
Max. Negotiated Rate $1,400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,372.00
Rate for Payer: Altius Auto/Workers Compensation $1,344.00
Rate for Payer: Altius Commercial $1,344.00
Rate for Payer: Beech Street Commercial $1,372.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,149.40
Rate for Payer: Cash Price $980.00
Rate for Payer: ChoiceCare Network Commercial $1,358.00
Rate for Payer: Cigna of WY Commercial $1,372.00
Rate for Payer: Entrust Commercial $1,330.00
Rate for Payer: First Choice Health Commercial $1,330.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,330.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $924.00
Rate for Payer: HealthUtah PPO $1,400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,358.00
Rate for Payer: Multiplan Medicare/VA $877.80
Rate for Payer: One Health Plan of WY PPO $1,372.00
Rate for Payer: PacificSource Commercial $1,260.00
Rate for Payer: PHCS PPO $1,372.00
Rate for Payer: Three Rivers PPO $1,050.00
Rate for Payer: TriWest Veterans Administration $924.00
Rate for Payer: United Healthcare Commercial $1,218.00
Rate for Payer: United Healthcare Medicare $924.00
Rate for Payer: WINHealth Partners Commercial $1,330.00
Rate for Payer: Wise Provider Network Commercial $1,330.00
Service Code HCPCS 78806
Hospital Charge Code 3417880602
Hospital Revenue Code 341
Min. Negotiated Rate $2,653.06
Max. Negotiated Rate $4,815.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,718.70
Rate for Payer: Aetna of WY Medicare $3,177.90
Rate for Payer: Altius Auto/Workers Compensation $4,622.40
Rate for Payer: Altius Commercial $4,622.40
Rate for Payer: Beech Street Commercial $4,718.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,953.12
Rate for Payer: Cash Price $3,370.50
Rate for Payer: ChoiceCare Network Commercial $4,670.55
Rate for Payer: Cigna of WY Commercial $4,718.70
Rate for Payer: Entrust Commercial $4,574.25
Rate for Payer: First Choice Health Commercial $4,574.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,574.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,792.70
Rate for Payer: HealthUtah PPO $4,815.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,670.55
Rate for Payer: Multiplan Medicare/VA $2,653.06
Rate for Payer: One Health Plan of WY PPO $4,718.70
Rate for Payer: PacificSource Commercial $4,333.50
Rate for Payer: PHCS PPO $4,718.70
Rate for Payer: Three Rivers PPO $3,611.25
Rate for Payer: TriWest Veterans Administration $2,792.70
Rate for Payer: United Healthcare Commercial $4,189.05
Rate for Payer: United Healthcare Medicare $2,792.70
Rate for Payer: WINHealth Partners Commercial $4,718.70
Rate for Payer: Wise Provider Network Commercial $4,574.25
Service Code HCPCS 78806
Hospital Charge Code 3417880602
Hospital Revenue Code 341
Min. Negotiated Rate $3,019.00
Max. Negotiated Rate $4,815.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,718.70
Rate for Payer: Altius Auto/Workers Compensation $4,622.40
Rate for Payer: Altius Commercial $4,622.40
Rate for Payer: Beech Street Commercial $4,718.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,953.12
Rate for Payer: Cash Price $3,370.50
Rate for Payer: ChoiceCare Network Commercial $4,670.55
Rate for Payer: Cigna of WY Commercial $4,718.70
Rate for Payer: Entrust Commercial $4,574.25
Rate for Payer: First Choice Health Commercial $4,574.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,574.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,177.90
Rate for Payer: HealthUtah PPO $4,815.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,670.55
Rate for Payer: Multiplan Medicare/VA $3,019.00
Rate for Payer: One Health Plan of WY PPO $4,718.70
Rate for Payer: PacificSource Commercial $4,333.50
Rate for Payer: PHCS PPO $4,718.70
Rate for Payer: Three Rivers PPO $3,611.25
Rate for Payer: TriWest Veterans Administration $3,177.90
Rate for Payer: United Healthcare Commercial $4,189.05
Rate for Payer: United Healthcare Medicare $3,177.90
Rate for Payer: WINHealth Partners Commercial $4,574.25
Rate for Payer: Wise Provider Network Commercial $4,574.25
Service Code HCPCS Q9969
Hospital Charge Code 343Q996901
Hospital Revenue Code 343
Min. Negotiated Rate $60.61
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Aetna of WY Medicare $72.60
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $63.80
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $60.61
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $63.80
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $63.80
Rate for Payer: WINHealth Partners Commercial $107.80
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS Q9969
Hospital Charge Code 343Q996901
Hospital Revenue Code 343
Min. Negotiated Rate $68.97
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.60
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $68.97
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $72.60
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $72.60
Rate for Payer: WINHealth Partners Commercial $104.50
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS 94761
Hospital Charge Code 4609476101
Hospital Revenue Code 460
Min. Negotiated Rate $110.20
Max. Negotiated Rate $200.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.00
Rate for Payer: Aetna of WY Medicare $132.00
Rate for Payer: Altius Auto/Workers Compensation $192.00
Rate for Payer: Altius Commercial $192.00
Rate for Payer: Beech Street Commercial $196.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $164.20
Rate for Payer: Cash Price $140.00
Rate for Payer: ChoiceCare Network Commercial $194.00
Rate for Payer: Cigna of WY Commercial $196.00
Rate for Payer: Entrust Commercial $190.00
Rate for Payer: First Choice Health Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $116.00
Rate for Payer: HealthUtah PPO $200.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.00
Rate for Payer: Multiplan Medicare/VA $110.20
Rate for Payer: One Health Plan of WY PPO $196.00
Rate for Payer: PacificSource Commercial $180.00
Rate for Payer: PHCS PPO $196.00
Rate for Payer: Three Rivers PPO $150.00
Rate for Payer: TriWest Veterans Administration $116.00
Rate for Payer: United Healthcare Commercial $174.00
Rate for Payer: United Healthcare Medicare $116.00
Rate for Payer: WINHealth Partners Commercial $196.00
Rate for Payer: Wise Provider Network Commercial $190.00
Service Code HCPCS 94761
Hospital Charge Code 4609476101
Hospital Revenue Code 460
Min. Negotiated Rate $125.40
Max. Negotiated Rate $200.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $196.00
Rate for Payer: Altius Auto/Workers Compensation $192.00
Rate for Payer: Altius Commercial $192.00
Rate for Payer: Beech Street Commercial $196.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $164.20
Rate for Payer: Cash Price $140.00
Rate for Payer: ChoiceCare Network Commercial $194.00
Rate for Payer: Cigna of WY Commercial $196.00
Rate for Payer: Entrust Commercial $190.00
Rate for Payer: First Choice Health Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $190.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $132.00
Rate for Payer: HealthUtah PPO $200.00
Rate for Payer: Idaho Integrated Healthcare Commercial $194.00
Rate for Payer: Multiplan Medicare/VA $125.40
Rate for Payer: One Health Plan of WY PPO $196.00
Rate for Payer: PacificSource Commercial $180.00
Rate for Payer: PHCS PPO $196.00
Rate for Payer: Three Rivers PPO $150.00
Rate for Payer: TriWest Veterans Administration $132.00
Rate for Payer: United Healthcare Commercial $174.00
Rate for Payer: United Healthcare Medicare $132.00
Rate for Payer: WINHealth Partners Commercial $190.00
Rate for Payer: Wise Provider Network Commercial $190.00
Service Code HCPCS 94760
Hospital Charge Code 4609476001
Hospital Revenue Code 460
Min. Negotiated Rate $8.78
Max. Negotiated Rate $14.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $13.72
Rate for Payer: Altius Auto/Workers Compensation $13.44
Rate for Payer: Altius Commercial $13.44
Rate for Payer: Beech Street Commercial $13.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $11.49
Rate for Payer: Cash Price $9.80
Rate for Payer: ChoiceCare Network Commercial $13.58
Rate for Payer: Cigna of WY Commercial $13.72
Rate for Payer: Entrust Commercial $13.30
Rate for Payer: First Choice Health Commercial $13.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $13.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.24
Rate for Payer: HealthUtah PPO $14.00
Rate for Payer: Idaho Integrated Healthcare Commercial $13.58
Rate for Payer: Multiplan Medicare/VA $8.78
Rate for Payer: One Health Plan of WY PPO $13.72
Rate for Payer: PacificSource Commercial $12.60
Rate for Payer: PHCS PPO $13.72
Rate for Payer: Three Rivers PPO $10.50
Rate for Payer: TriWest Veterans Administration $9.24
Rate for Payer: United Healthcare Commercial $12.18
Rate for Payer: United Healthcare Medicare $9.24
Rate for Payer: WINHealth Partners Commercial $13.30
Rate for Payer: Wise Provider Network Commercial $13.30
Service Code HCPCS 94760
Hospital Charge Code 4609476001
Hospital Revenue Code 460
Min. Negotiated Rate $7.71
Max. Negotiated Rate $14.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $13.72
Rate for Payer: Aetna of WY Medicare $9.24
Rate for Payer: Altius Auto/Workers Compensation $13.44
Rate for Payer: Altius Commercial $13.44
Rate for Payer: Beech Street Commercial $13.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $11.49
Rate for Payer: Cash Price $9.80
Rate for Payer: ChoiceCare Network Commercial $13.58
Rate for Payer: Cigna of WY Commercial $13.72
Rate for Payer: Entrust Commercial $13.30
Rate for Payer: First Choice Health Commercial $13.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $13.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.12
Rate for Payer: HealthUtah PPO $14.00
Rate for Payer: Idaho Integrated Healthcare Commercial $13.58
Rate for Payer: Multiplan Medicare/VA $7.71
Rate for Payer: One Health Plan of WY PPO $13.72
Rate for Payer: PacificSource Commercial $12.60
Rate for Payer: PHCS PPO $13.72
Rate for Payer: Three Rivers PPO $10.50
Rate for Payer: TriWest Veterans Administration $8.12
Rate for Payer: United Healthcare Commercial $12.18
Rate for Payer: United Healthcare Medicare $8.12
Rate for Payer: WINHealth Partners Commercial $13.72
Rate for Payer: Wise Provider Network Commercial $13.30
Service Code HCPCS 94762
Hospital Charge Code 4609476201
Hospital Revenue Code 460
Min. Negotiated Rate $188.10
Max. Negotiated Rate $300.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.00
Rate for Payer: Altius Auto/Workers Compensation $288.00
Rate for Payer: Altius Commercial $288.00
Rate for Payer: Beech Street Commercial $294.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.30
Rate for Payer: Cash Price $210.00
Rate for Payer: ChoiceCare Network Commercial $291.00
Rate for Payer: Cigna of WY Commercial $294.00
Rate for Payer: Entrust Commercial $285.00
Rate for Payer: First Choice Health Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $198.00
Rate for Payer: HealthUtah PPO $300.00
Rate for Payer: Idaho Integrated Healthcare Commercial $291.00
Rate for Payer: Multiplan Medicare/VA $188.10
Rate for Payer: One Health Plan of WY PPO $294.00
Rate for Payer: PacificSource Commercial $270.00
Rate for Payer: PHCS PPO $294.00
Rate for Payer: Three Rivers PPO $225.00
Rate for Payer: TriWest Veterans Administration $198.00
Rate for Payer: United Healthcare Commercial $261.00
Rate for Payer: United Healthcare Medicare $198.00
Rate for Payer: WINHealth Partners Commercial $285.00
Rate for Payer: Wise Provider Network Commercial $285.00
Service Code HCPCS 94762
Hospital Charge Code 4609476201
Hospital Revenue Code 460
Min. Negotiated Rate $165.30
Max. Negotiated Rate $300.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.00
Rate for Payer: Aetna of WY Medicare $198.00
Rate for Payer: Altius Auto/Workers Compensation $288.00
Rate for Payer: Altius Commercial $288.00
Rate for Payer: Beech Street Commercial $294.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.30
Rate for Payer: Cash Price $210.00
Rate for Payer: ChoiceCare Network Commercial $291.00
Rate for Payer: Cigna of WY Commercial $294.00
Rate for Payer: Entrust Commercial $285.00
Rate for Payer: First Choice Health Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $174.00
Rate for Payer: HealthUtah PPO $300.00
Rate for Payer: Idaho Integrated Healthcare Commercial $291.00
Rate for Payer: Multiplan Medicare/VA $165.30
Rate for Payer: One Health Plan of WY PPO $294.00
Rate for Payer: PacificSource Commercial $270.00
Rate for Payer: PHCS PPO $294.00
Rate for Payer: Three Rivers PPO $225.00
Rate for Payer: TriWest Veterans Administration $174.00
Rate for Payer: United Healthcare Commercial $261.00
Rate for Payer: United Healthcare Medicare $174.00
Rate for Payer: WINHealth Partners Commercial $294.00
Rate for Payer: Wise Provider Network Commercial $285.00
Service Code HCPCS 75809
Hospital Charge Code 3207580901
Hospital Revenue Code 320
Min. Negotiated Rate $292.03
Max. Negotiated Rate $530.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $519.40
Rate for Payer: Aetna of WY Medicare $349.80
Rate for Payer: Altius Auto/Workers Compensation $508.80
Rate for Payer: Altius Commercial $508.80
Rate for Payer: Beech Street Commercial $519.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $435.13
Rate for Payer: Cash Price $371.00
Rate for Payer: ChoiceCare Network Commercial $514.10
Rate for Payer: Cigna of WY Commercial $519.40
Rate for Payer: Entrust Commercial $503.50
Rate for Payer: First Choice Health Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $307.40
Rate for Payer: HealthUtah PPO $530.00
Rate for Payer: Idaho Integrated Healthcare Commercial $514.10
Rate for Payer: Multiplan Medicare/VA $292.03
Rate for Payer: One Health Plan of WY PPO $519.40
Rate for Payer: PacificSource Commercial $477.00
Rate for Payer: PHCS PPO $519.40
Rate for Payer: Three Rivers PPO $397.50
Rate for Payer: TriWest Veterans Administration $307.40
Rate for Payer: United Healthcare Commercial $461.10
Rate for Payer: United Healthcare Medicare $307.40
Rate for Payer: WINHealth Partners Commercial $519.40
Rate for Payer: Wise Provider Network Commercial $503.50
Service Code HCPCS 75809
Hospital Charge Code 3207580901
Hospital Revenue Code 320
Min. Negotiated Rate $332.31
Max. Negotiated Rate $530.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $519.40
Rate for Payer: Altius Auto/Workers Compensation $508.80
Rate for Payer: Altius Commercial $508.80
Rate for Payer: Beech Street Commercial $519.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $435.13
Rate for Payer: Cash Price $371.00
Rate for Payer: ChoiceCare Network Commercial $514.10
Rate for Payer: Cigna of WY Commercial $519.40
Rate for Payer: Entrust Commercial $503.50
Rate for Payer: First Choice Health Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $349.80
Rate for Payer: HealthUtah PPO $530.00
Rate for Payer: Idaho Integrated Healthcare Commercial $514.10
Rate for Payer: Multiplan Medicare/VA $332.31
Rate for Payer: One Health Plan of WY PPO $519.40
Rate for Payer: PacificSource Commercial $477.00
Rate for Payer: PHCS PPO $519.40
Rate for Payer: Three Rivers PPO $397.50
Rate for Payer: TriWest Veterans Administration $349.80
Rate for Payer: United Healthcare Commercial $461.10
Rate for Payer: United Healthcare Medicare $349.80
Rate for Payer: WINHealth Partners Commercial $503.50
Rate for Payer: Wise Provider Network Commercial $503.50
Service Code HCPCS 76814
Hospital Charge Code 4027681401
Hospital Revenue Code 402
Min. Negotiated Rate $332.31
Max. Negotiated Rate $530.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $519.40
Rate for Payer: Altius Auto/Workers Compensation $508.80
Rate for Payer: Altius Commercial $508.80
Rate for Payer: Beech Street Commercial $519.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $435.13
Rate for Payer: Cash Price $371.00
Rate for Payer: ChoiceCare Network Commercial $514.10
Rate for Payer: Cigna of WY Commercial $519.40
Rate for Payer: Entrust Commercial $503.50
Rate for Payer: First Choice Health Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $349.80
Rate for Payer: HealthUtah PPO $530.00
Rate for Payer: Idaho Integrated Healthcare Commercial $514.10
Rate for Payer: Multiplan Medicare/VA $332.31
Rate for Payer: One Health Plan of WY PPO $519.40
Rate for Payer: PacificSource Commercial $477.00
Rate for Payer: PHCS PPO $519.40
Rate for Payer: Three Rivers PPO $397.50
Rate for Payer: TriWest Veterans Administration $349.80
Rate for Payer: United Healthcare Commercial $461.10
Rate for Payer: United Healthcare Medicare $349.80
Rate for Payer: WINHealth Partners Commercial $503.50
Rate for Payer: Wise Provider Network Commercial $503.50
Service Code HCPCS 76814
Hospital Charge Code 4027681401
Hospital Revenue Code 402
Min. Negotiated Rate $292.03
Max. Negotiated Rate $530.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $519.40
Rate for Payer: Aetna of WY Medicare $349.80
Rate for Payer: Altius Auto/Workers Compensation $508.80
Rate for Payer: Altius Commercial $508.80
Rate for Payer: Beech Street Commercial $519.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $435.13
Rate for Payer: Cash Price $371.00
Rate for Payer: ChoiceCare Network Commercial $514.10
Rate for Payer: Cigna of WY Commercial $519.40
Rate for Payer: Entrust Commercial $503.50
Rate for Payer: First Choice Health Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $503.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $307.40
Rate for Payer: HealthUtah PPO $530.00
Rate for Payer: Idaho Integrated Healthcare Commercial $514.10
Rate for Payer: Multiplan Medicare/VA $292.03
Rate for Payer: One Health Plan of WY PPO $519.40
Rate for Payer: PacificSource Commercial $477.00
Rate for Payer: PHCS PPO $519.40
Rate for Payer: Three Rivers PPO $397.50
Rate for Payer: TriWest Veterans Administration $307.40
Rate for Payer: United Healthcare Commercial $461.10
Rate for Payer: United Healthcare Medicare $307.40
Rate for Payer: WINHealth Partners Commercial $519.40
Rate for Payer: Wise Provider Network Commercial $503.50
Service Code HCPCS 86235
Hospital Charge Code 3028623503
Hospital Revenue Code 302
Min. Negotiated Rate $151.52
Max. Negotiated Rate $275.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $269.50
Rate for Payer: Aetna of WY Medicare $181.50
Rate for Payer: Altius Auto/Workers Compensation $264.00
Rate for Payer: Altius Commercial $264.00
Rate for Payer: Beech Street Commercial $269.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $225.78
Rate for Payer: Cash Price $192.50
Rate for Payer: ChoiceCare Network Commercial $266.75
Rate for Payer: Cigna of WY Commercial $269.50
Rate for Payer: Entrust Commercial $261.25
Rate for Payer: First Choice Health Commercial $261.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $261.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $159.50
Rate for Payer: HealthUtah PPO $275.00
Rate for Payer: Idaho Integrated Healthcare Commercial $266.75
Rate for Payer: Multiplan Medicare/VA $151.52
Rate for Payer: One Health Plan of WY PPO $269.50
Rate for Payer: PacificSource Commercial $247.50
Rate for Payer: PHCS PPO $269.50
Rate for Payer: Three Rivers PPO $206.25
Rate for Payer: TriWest Veterans Administration $159.50
Rate for Payer: United Healthcare Commercial $239.25
Rate for Payer: United Healthcare Medicare $159.50
Rate for Payer: WINHealth Partners Commercial $269.50
Rate for Payer: Wise Provider Network Commercial $261.25
Service Code HCPCS 86235
Hospital Charge Code 3028623503
Hospital Revenue Code 302
Min. Negotiated Rate $172.42
Max. Negotiated Rate $275.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $269.50
Rate for Payer: Altius Auto/Workers Compensation $264.00
Rate for Payer: Altius Commercial $264.00
Rate for Payer: Beech Street Commercial $269.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $225.78
Rate for Payer: Cash Price $192.50
Rate for Payer: ChoiceCare Network Commercial $266.75
Rate for Payer: Cigna of WY Commercial $269.50
Rate for Payer: Entrust Commercial $261.25
Rate for Payer: First Choice Health Commercial $261.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $261.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $181.50
Rate for Payer: HealthUtah PPO $275.00
Rate for Payer: Idaho Integrated Healthcare Commercial $266.75
Rate for Payer: Multiplan Medicare/VA $172.42
Rate for Payer: One Health Plan of WY PPO $269.50
Rate for Payer: PacificSource Commercial $247.50
Rate for Payer: PHCS PPO $269.50
Rate for Payer: Three Rivers PPO $206.25
Rate for Payer: TriWest Veterans Administration $181.50
Rate for Payer: United Healthcare Commercial $239.25
Rate for Payer: United Healthcare Medicare $181.50
Rate for Payer: WINHealth Partners Commercial $261.25
Rate for Payer: Wise Provider Network Commercial $261.25
Service Code HCPCS 86235
Hospital Charge Code 3028623506
Hospital Revenue Code 302
Min. Negotiated Rate $146.57
Max. Negotiated Rate $266.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $260.68
Rate for Payer: Aetna of WY Medicare $175.56
Rate for Payer: Altius Auto/Workers Compensation $255.36
Rate for Payer: Altius Commercial $255.36
Rate for Payer: Beech Street Commercial $260.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $218.39
Rate for Payer: Cash Price $186.20
Rate for Payer: ChoiceCare Network Commercial $258.02
Rate for Payer: Cigna of WY Commercial $260.68
Rate for Payer: Entrust Commercial $252.70
Rate for Payer: First Choice Health Commercial $252.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $252.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $154.28
Rate for Payer: HealthUtah PPO $266.00
Rate for Payer: Idaho Integrated Healthcare Commercial $258.02
Rate for Payer: Multiplan Medicare/VA $146.57
Rate for Payer: One Health Plan of WY PPO $260.68
Rate for Payer: PacificSource Commercial $239.40
Rate for Payer: PHCS PPO $260.68
Rate for Payer: Three Rivers PPO $199.50
Rate for Payer: TriWest Veterans Administration $154.28
Rate for Payer: United Healthcare Commercial $231.42
Rate for Payer: United Healthcare Medicare $154.28
Rate for Payer: WINHealth Partners Commercial $260.68
Rate for Payer: Wise Provider Network Commercial $252.70
Service Code HCPCS 86235
Hospital Charge Code 3028623506
Hospital Revenue Code 302
Min. Negotiated Rate $166.78
Max. Negotiated Rate $266.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $260.68
Rate for Payer: Altius Auto/Workers Compensation $255.36
Rate for Payer: Altius Commercial $255.36
Rate for Payer: Beech Street Commercial $260.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $218.39
Rate for Payer: Cash Price $186.20
Rate for Payer: ChoiceCare Network Commercial $258.02
Rate for Payer: Cigna of WY Commercial $260.68
Rate for Payer: Entrust Commercial $252.70
Rate for Payer: First Choice Health Commercial $252.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $252.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $175.56
Rate for Payer: HealthUtah PPO $266.00
Rate for Payer: Idaho Integrated Healthcare Commercial $258.02
Rate for Payer: Multiplan Medicare/VA $166.78
Rate for Payer: One Health Plan of WY PPO $260.68
Rate for Payer: PacificSource Commercial $239.40
Rate for Payer: PHCS PPO $260.68
Rate for Payer: Three Rivers PPO $199.50
Rate for Payer: TriWest Veterans Administration $175.56
Rate for Payer: United Healthcare Commercial $231.42
Rate for Payer: United Healthcare Medicare $175.56
Rate for Payer: WINHealth Partners Commercial $252.70
Rate for Payer: Wise Provider Network Commercial $252.70
Service Code HCPCS 86235
Hospital Charge Code 3028623504
Hospital Revenue Code 302
Min. Negotiated Rate $170.81
Max. Negotiated Rate $310.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $303.80
Rate for Payer: Aetna of WY Medicare $204.60
Rate for Payer: Altius Auto/Workers Compensation $297.60
Rate for Payer: Altius Commercial $297.60
Rate for Payer: Beech Street Commercial $303.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $254.51
Rate for Payer: Cash Price $217.00
Rate for Payer: ChoiceCare Network Commercial $300.70
Rate for Payer: Cigna of WY Commercial $303.80
Rate for Payer: Entrust Commercial $294.50
Rate for Payer: First Choice Health Commercial $294.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $294.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $179.80
Rate for Payer: HealthUtah PPO $310.00
Rate for Payer: Idaho Integrated Healthcare Commercial $300.70
Rate for Payer: Multiplan Medicare/VA $170.81
Rate for Payer: One Health Plan of WY PPO $303.80
Rate for Payer: PacificSource Commercial $279.00
Rate for Payer: PHCS PPO $303.80
Rate for Payer: Three Rivers PPO $232.50
Rate for Payer: TriWest Veterans Administration $179.80
Rate for Payer: United Healthcare Commercial $269.70
Rate for Payer: United Healthcare Medicare $179.80
Rate for Payer: WINHealth Partners Commercial $303.80
Rate for Payer: Wise Provider Network Commercial $294.50
Service Code HCPCS 86235
Hospital Charge Code 3028623504
Hospital Revenue Code 302
Min. Negotiated Rate $194.37
Max. Negotiated Rate $310.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $303.80
Rate for Payer: Altius Auto/Workers Compensation $297.60
Rate for Payer: Altius Commercial $297.60
Rate for Payer: Beech Street Commercial $303.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $254.51
Rate for Payer: Cash Price $217.00
Rate for Payer: ChoiceCare Network Commercial $300.70
Rate for Payer: Cigna of WY Commercial $303.80
Rate for Payer: Entrust Commercial $294.50
Rate for Payer: First Choice Health Commercial $294.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $294.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $204.60
Rate for Payer: HealthUtah PPO $310.00
Rate for Payer: Idaho Integrated Healthcare Commercial $300.70
Rate for Payer: Multiplan Medicare/VA $194.37
Rate for Payer: One Health Plan of WY PPO $303.80
Rate for Payer: PacificSource Commercial $279.00
Rate for Payer: PHCS PPO $303.80
Rate for Payer: Three Rivers PPO $232.50
Rate for Payer: TriWest Veterans Administration $204.60
Rate for Payer: United Healthcare Commercial $269.70
Rate for Payer: United Healthcare Medicare $204.60
Rate for Payer: WINHealth Partners Commercial $294.50
Rate for Payer: Wise Provider Network Commercial $294.50