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Service Code HCPCS 86235
Hospital Charge Code 3028623501
Hospital Revenue Code 302
Min. Negotiated Rate $187.34
Max. Negotiated Rate $340.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $333.20
Rate for Payer: Aetna of WY Medicare $224.40
Rate for Payer: Altius Auto/Workers Compensation $326.40
Rate for Payer: Altius Commercial $326.40
Rate for Payer: Beech Street Commercial $333.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $279.14
Rate for Payer: Cash Price $238.00
Rate for Payer: ChoiceCare Network Commercial $329.80
Rate for Payer: Cigna of WY Commercial $333.20
Rate for Payer: Entrust Commercial $323.00
Rate for Payer: First Choice Health Commercial $323.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $323.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $197.20
Rate for Payer: HealthUtah PPO $340.00
Rate for Payer: Idaho Integrated Healthcare Commercial $329.80
Rate for Payer: Multiplan Medicare/VA $187.34
Rate for Payer: One Health Plan of WY PPO $333.20
Rate for Payer: PacificSource Commercial $306.00
Rate for Payer: PHCS PPO $333.20
Rate for Payer: Three Rivers PPO $255.00
Rate for Payer: TriWest Veterans Administration $197.20
Rate for Payer: United Healthcare Commercial $295.80
Rate for Payer: United Healthcare Medicare $197.20
Rate for Payer: WINHealth Partners Commercial $333.20
Rate for Payer: Wise Provider Network Commercial $323.00
Service Code HCPCS 86235
Hospital Charge Code 3028623501
Hospital Revenue Code 302
Min. Negotiated Rate $213.18
Max. Negotiated Rate $340.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $333.20
Rate for Payer: Altius Auto/Workers Compensation $326.40
Rate for Payer: Altius Commercial $326.40
Rate for Payer: Beech Street Commercial $333.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $279.14
Rate for Payer: Cash Price $238.00
Rate for Payer: ChoiceCare Network Commercial $329.80
Rate for Payer: Cigna of WY Commercial $333.20
Rate for Payer: Entrust Commercial $323.00
Rate for Payer: First Choice Health Commercial $323.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $323.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $224.40
Rate for Payer: HealthUtah PPO $340.00
Rate for Payer: Idaho Integrated Healthcare Commercial $329.80
Rate for Payer: Multiplan Medicare/VA $213.18
Rate for Payer: One Health Plan of WY PPO $333.20
Rate for Payer: PacificSource Commercial $306.00
Rate for Payer: PHCS PPO $333.20
Rate for Payer: Three Rivers PPO $255.00
Rate for Payer: TriWest Veterans Administration $224.40
Rate for Payer: United Healthcare Commercial $295.80
Rate for Payer: United Healthcare Medicare $224.40
Rate for Payer: WINHealth Partners Commercial $323.00
Rate for Payer: Wise Provider Network Commercial $323.00
Service Code HCPCS 86235
Hospital Charge Code 3028623502
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 3028623502
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
Hospital Charge Code 1710000001
Hospital Revenue Code 171
Min. Negotiated Rate $946.77
Max. Negotiated Rate $1,510.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,479.80
Rate for Payer: Aetna of WY Medicare $966.40
Rate for Payer: Altius Auto/Workers Compensation $1,449.60
Rate for Payer: Altius Commercial $1,449.60
Rate for Payer: Beech Street Commercial $1,479.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,239.71
Rate for Payer: Cash Price $1,057.00
Rate for Payer: ChoiceCare Network Commercial $1,464.70
Rate for Payer: Cigna of WY Commercial $1,479.80
Rate for Payer: Entrust Commercial $1,434.50
Rate for Payer: First Choice Health Commercial $1,434.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,434.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $996.60
Rate for Payer: HealthUtah PPO $1,510.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,464.70
Rate for Payer: Multiplan Medicare/VA $946.77
Rate for Payer: One Health Plan of WY PPO $1,479.80
Rate for Payer: PacificSource Commercial $1,359.00
Rate for Payer: PHCS PPO $1,479.80
Rate for Payer: Three Rivers PPO $1,132.50
Rate for Payer: TriWest Veterans Administration $996.60
Rate for Payer: United Healthcare Commercial $1,313.70
Rate for Payer: United Healthcare Medicare $996.60
Rate for Payer: WINHealth Partners Commercial $1,434.50
Rate for Payer: Wise Provider Network Commercial $1,434.50
Hospital Charge Code 1720000001
Hospital Revenue Code 172
Min. Negotiated Rate $1,426.42
Max. Negotiated Rate $2,275.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,229.50
Rate for Payer: Aetna of WY Medicare $1,456.00
Rate for Payer: Altius Auto/Workers Compensation $2,184.00
Rate for Payer: Altius Commercial $2,184.00
Rate for Payer: Beech Street Commercial $2,229.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,867.78
Rate for Payer: Cash Price $1,592.50
Rate for Payer: ChoiceCare Network Commercial $2,206.75
Rate for Payer: Cigna of WY Commercial $2,229.50
Rate for Payer: Entrust Commercial $2,161.25
Rate for Payer: First Choice Health Commercial $2,161.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,161.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,501.50
Rate for Payer: HealthUtah PPO $2,275.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,206.75
Rate for Payer: Multiplan Medicare/VA $1,426.42
Rate for Payer: One Health Plan of WY PPO $2,229.50
Rate for Payer: PacificSource Commercial $2,047.50
Rate for Payer: PHCS PPO $2,229.50
Rate for Payer: Three Rivers PPO $1,706.25
Rate for Payer: TriWest Veterans Administration $1,501.50
Rate for Payer: United Healthcare Commercial $1,979.25
Rate for Payer: United Healthcare Medicare $1,501.50
Rate for Payer: WINHealth Partners Commercial $2,161.25
Rate for Payer: Wise Provider Network Commercial $2,161.25
Hospital Charge Code 1730000001
Hospital Revenue Code 173
Min. Negotiated Rate $1,630.20
Max. Negotiated Rate $2,600.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,548.00
Rate for Payer: Aetna of WY Medicare $1,664.00
Rate for Payer: Altius Auto/Workers Compensation $2,496.00
Rate for Payer: Altius Commercial $2,496.00
Rate for Payer: Beech Street Commercial $2,548.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,134.60
Rate for Payer: Cash Price $1,820.00
Rate for Payer: ChoiceCare Network Commercial $2,522.00
Rate for Payer: Cigna of WY Commercial $2,548.00
Rate for Payer: Entrust Commercial $2,470.00
Rate for Payer: First Choice Health Commercial $2,470.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,470.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,716.00
Rate for Payer: HealthUtah PPO $2,600.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,522.00
Rate for Payer: Multiplan Medicare/VA $1,630.20
Rate for Payer: One Health Plan of WY PPO $2,548.00
Rate for Payer: PacificSource Commercial $2,340.00
Rate for Payer: PHCS PPO $2,548.00
Rate for Payer: Three Rivers PPO $1,950.00
Rate for Payer: TriWest Veterans Administration $1,716.00
Rate for Payer: United Healthcare Commercial $2,262.00
Rate for Payer: United Healthcare Medicare $1,716.00
Rate for Payer: WINHealth Partners Commercial $2,470.00
Rate for Payer: Wise Provider Network Commercial $2,470.00
Hospital Charge Code 7210000005
Hospital Revenue Code 721
Min. Negotiated Rate $776.91
Max. Negotiated Rate $1,410.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,381.80
Rate for Payer: Aetna of WY Medicare $930.60
Rate for Payer: Altius Auto/Workers Compensation $1,353.60
Rate for Payer: Altius Commercial $1,353.60
Rate for Payer: Beech Street Commercial $1,381.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,157.61
Rate for Payer: Cash Price $987.00
Rate for Payer: ChoiceCare Network Commercial $1,367.70
Rate for Payer: Cigna of WY Commercial $1,381.80
Rate for Payer: Entrust Commercial $1,339.50
Rate for Payer: First Choice Health Commercial $1,339.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,339.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $817.80
Rate for Payer: HealthUtah PPO $1,410.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,367.70
Rate for Payer: Multiplan Medicare/VA $776.91
Rate for Payer: One Health Plan of WY PPO $1,381.80
Rate for Payer: PacificSource Commercial $1,269.00
Rate for Payer: PHCS PPO $1,381.80
Rate for Payer: Three Rivers PPO $1,057.50
Rate for Payer: TriWest Veterans Administration $817.80
Rate for Payer: United Healthcare Commercial $1,226.70
Rate for Payer: United Healthcare Medicare $817.80
Rate for Payer: WINHealth Partners Commercial $1,381.80
Rate for Payer: Wise Provider Network Commercial $1,339.50
Hospital Charge Code 7210000005
Hospital Revenue Code 721
Min. Negotiated Rate $884.07
Max. Negotiated Rate $1,410.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,381.80
Rate for Payer: Altius Auto/Workers Compensation $1,353.60
Rate for Payer: Altius Commercial $1,353.60
Rate for Payer: Beech Street Commercial $1,381.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,157.61
Rate for Payer: Cash Price $987.00
Rate for Payer: ChoiceCare Network Commercial $1,367.70
Rate for Payer: Cigna of WY Commercial $1,381.80
Rate for Payer: Entrust Commercial $1,339.50
Rate for Payer: First Choice Health Commercial $1,339.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,339.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $930.60
Rate for Payer: HealthUtah PPO $1,410.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,367.70
Rate for Payer: Multiplan Medicare/VA $884.07
Rate for Payer: One Health Plan of WY PPO $1,381.80
Rate for Payer: PacificSource Commercial $1,269.00
Rate for Payer: PHCS PPO $1,381.80
Rate for Payer: Three Rivers PPO $1,057.50
Rate for Payer: TriWest Veterans Administration $930.60
Rate for Payer: United Healthcare Commercial $1,226.70
Rate for Payer: United Healthcare Medicare $930.60
Rate for Payer: WINHealth Partners Commercial $1,339.50
Rate for Payer: Wise Provider Network Commercial $1,339.50
Hospital Charge Code 7200000001
Hospital Revenue Code 720
Min. Negotiated Rate $517.28
Max. Negotiated Rate $825.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $808.50
Rate for Payer: Altius Auto/Workers Compensation $792.00
Rate for Payer: Altius Commercial $792.00
Rate for Payer: Beech Street Commercial $808.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $677.32
Rate for Payer: Cash Price $577.50
Rate for Payer: ChoiceCare Network Commercial $800.25
Rate for Payer: Cigna of WY Commercial $808.50
Rate for Payer: Entrust Commercial $783.75
Rate for Payer: First Choice Health Commercial $783.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $783.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $544.50
Rate for Payer: HealthUtah PPO $825.00
Rate for Payer: Idaho Integrated Healthcare Commercial $800.25
Rate for Payer: Multiplan Medicare/VA $517.28
Rate for Payer: One Health Plan of WY PPO $808.50
Rate for Payer: PacificSource Commercial $742.50
Rate for Payer: PHCS PPO $808.50
Rate for Payer: Three Rivers PPO $618.75
Rate for Payer: TriWest Veterans Administration $544.50
Rate for Payer: United Healthcare Commercial $717.75
Rate for Payer: United Healthcare Medicare $544.50
Rate for Payer: WINHealth Partners Commercial $783.75
Rate for Payer: Wise Provider Network Commercial $783.75
Hospital Charge Code 7200000001
Hospital Revenue Code 720
Min. Negotiated Rate $454.58
Max. Negotiated Rate $825.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $808.50
Rate for Payer: Aetna of WY Medicare $544.50
Rate for Payer: Altius Auto/Workers Compensation $792.00
Rate for Payer: Altius Commercial $792.00
Rate for Payer: Beech Street Commercial $808.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $677.32
Rate for Payer: Cash Price $577.50
Rate for Payer: ChoiceCare Network Commercial $800.25
Rate for Payer: Cigna of WY Commercial $808.50
Rate for Payer: Entrust Commercial $783.75
Rate for Payer: First Choice Health Commercial $783.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $783.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $478.50
Rate for Payer: HealthUtah PPO $825.00
Rate for Payer: Idaho Integrated Healthcare Commercial $800.25
Rate for Payer: Multiplan Medicare/VA $454.58
Rate for Payer: One Health Plan of WY PPO $808.50
Rate for Payer: PacificSource Commercial $742.50
Rate for Payer: PHCS PPO $808.50
Rate for Payer: Three Rivers PPO $618.75
Rate for Payer: TriWest Veterans Administration $478.50
Rate for Payer: United Healthcare Commercial $717.75
Rate for Payer: United Healthcare Medicare $478.50
Rate for Payer: WINHealth Partners Commercial $808.50
Rate for Payer: Wise Provider Network Commercial $783.75
Service Code HCPCS 80055
Hospital Charge Code 3018005501
Hospital Revenue Code 301
Min. Negotiated Rate $206.62
Max. Negotiated Rate $375.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $367.50
Rate for Payer: Aetna of WY Medicare $247.50
Rate for Payer: Altius Auto/Workers Compensation $360.00
Rate for Payer: Altius Commercial $360.00
Rate for Payer: Beech Street Commercial $367.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $307.88
Rate for Payer: Cash Price $262.50
Rate for Payer: ChoiceCare Network Commercial $363.75
Rate for Payer: Cigna of WY Commercial $367.50
Rate for Payer: Entrust Commercial $356.25
Rate for Payer: First Choice Health Commercial $356.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $356.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $217.50
Rate for Payer: HealthUtah PPO $375.00
Rate for Payer: Idaho Integrated Healthcare Commercial $363.75
Rate for Payer: Multiplan Medicare/VA $206.62
Rate for Payer: One Health Plan of WY PPO $367.50
Rate for Payer: PacificSource Commercial $337.50
Rate for Payer: PHCS PPO $367.50
Rate for Payer: Three Rivers PPO $281.25
Rate for Payer: TriWest Veterans Administration $217.50
Rate for Payer: United Healthcare Commercial $326.25
Rate for Payer: United Healthcare Medicare $217.50
Rate for Payer: WINHealth Partners Commercial $367.50
Rate for Payer: Wise Provider Network Commercial $356.25
Service Code HCPCS 80055
Hospital Charge Code 3018005501
Hospital Revenue Code 301
Min. Negotiated Rate $235.12
Max. Negotiated Rate $375.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $367.50
Rate for Payer: Altius Auto/Workers Compensation $360.00
Rate for Payer: Altius Commercial $360.00
Rate for Payer: Beech Street Commercial $367.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $307.88
Rate for Payer: Cash Price $262.50
Rate for Payer: ChoiceCare Network Commercial $363.75
Rate for Payer: Cigna of WY Commercial $367.50
Rate for Payer: Entrust Commercial $356.25
Rate for Payer: First Choice Health Commercial $356.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $356.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $247.50
Rate for Payer: HealthUtah PPO $375.00
Rate for Payer: Idaho Integrated Healthcare Commercial $363.75
Rate for Payer: Multiplan Medicare/VA $235.12
Rate for Payer: One Health Plan of WY PPO $367.50
Rate for Payer: PacificSource Commercial $337.50
Rate for Payer: PHCS PPO $367.50
Rate for Payer: Three Rivers PPO $281.25
Rate for Payer: TriWest Veterans Administration $247.50
Rate for Payer: United Healthcare Commercial $326.25
Rate for Payer: United Healthcare Medicare $247.50
Rate for Payer: WINHealth Partners Commercial $356.25
Rate for Payer: Wise Provider Network Commercial $356.25
Service Code HCPCS 76802
Hospital Charge Code 4027680201
Hospital Revenue Code 402
Min. Negotiated Rate $266.48
Max. Negotiated Rate $425.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $416.50
Rate for Payer: Altius Auto/Workers Compensation $408.00
Rate for Payer: Altius Commercial $408.00
Rate for Payer: Beech Street Commercial $416.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $348.92
Rate for Payer: Cash Price $297.50
Rate for Payer: ChoiceCare Network Commercial $412.25
Rate for Payer: Cigna of WY Commercial $416.50
Rate for Payer: Entrust Commercial $403.75
Rate for Payer: First Choice Health Commercial $403.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $403.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $280.50
Rate for Payer: HealthUtah PPO $425.00
Rate for Payer: Idaho Integrated Healthcare Commercial $412.25
Rate for Payer: Multiplan Medicare/VA $266.48
Rate for Payer: One Health Plan of WY PPO $416.50
Rate for Payer: PacificSource Commercial $382.50
Rate for Payer: PHCS PPO $416.50
Rate for Payer: Three Rivers PPO $318.75
Rate for Payer: TriWest Veterans Administration $280.50
Rate for Payer: United Healthcare Commercial $369.75
Rate for Payer: United Healthcare Medicare $280.50
Rate for Payer: WINHealth Partners Commercial $403.75
Rate for Payer: Wise Provider Network Commercial $403.75
Service Code HCPCS 76802
Hospital Charge Code 4027680201
Hospital Revenue Code 402
Min. Negotiated Rate $234.18
Max. Negotiated Rate $425.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $416.50
Rate for Payer: Aetna of WY Medicare $280.50
Rate for Payer: Altius Auto/Workers Compensation $408.00
Rate for Payer: Altius Commercial $408.00
Rate for Payer: Beech Street Commercial $416.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $348.92
Rate for Payer: Cash Price $297.50
Rate for Payer: ChoiceCare Network Commercial $412.25
Rate for Payer: Cigna of WY Commercial $416.50
Rate for Payer: Entrust Commercial $403.75
Rate for Payer: First Choice Health Commercial $403.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $403.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $246.50
Rate for Payer: HealthUtah PPO $425.00
Rate for Payer: Idaho Integrated Healthcare Commercial $412.25
Rate for Payer: Multiplan Medicare/VA $234.18
Rate for Payer: One Health Plan of WY PPO $416.50
Rate for Payer: PacificSource Commercial $382.50
Rate for Payer: PHCS PPO $416.50
Rate for Payer: Three Rivers PPO $318.75
Rate for Payer: TriWest Veterans Administration $246.50
Rate for Payer: United Healthcare Commercial $369.75
Rate for Payer: United Healthcare Medicare $246.50
Rate for Payer: WINHealth Partners Commercial $416.50
Rate for Payer: Wise Provider Network Commercial $403.75
Service Code HCPCS 76810
Hospital Charge Code 4027681001
Hospital Revenue Code 402
Min. Negotiated Rate $341.62
Max. Negotiated Rate $620.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $607.60
Rate for Payer: Aetna of WY Medicare $409.20
Rate for Payer: Altius Auto/Workers Compensation $595.20
Rate for Payer: Altius Commercial $595.20
Rate for Payer: Beech Street Commercial $607.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $509.02
Rate for Payer: Cash Price $434.00
Rate for Payer: ChoiceCare Network Commercial $601.40
Rate for Payer: Cigna of WY Commercial $607.60
Rate for Payer: Entrust Commercial $589.00
Rate for Payer: First Choice Health Commercial $589.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $589.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $359.60
Rate for Payer: HealthUtah PPO $620.00
Rate for Payer: Idaho Integrated Healthcare Commercial $601.40
Rate for Payer: Multiplan Medicare/VA $341.62
Rate for Payer: One Health Plan of WY PPO $607.60
Rate for Payer: PacificSource Commercial $558.00
Rate for Payer: PHCS PPO $607.60
Rate for Payer: Three Rivers PPO $465.00
Rate for Payer: TriWest Veterans Administration $359.60
Rate for Payer: United Healthcare Commercial $539.40
Rate for Payer: United Healthcare Medicare $359.60
Rate for Payer: WINHealth Partners Commercial $607.60
Rate for Payer: Wise Provider Network Commercial $589.00
Service Code HCPCS 76810
Hospital Charge Code 4027681001
Hospital Revenue Code 402
Min. Negotiated Rate $388.74
Max. Negotiated Rate $620.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $607.60
Rate for Payer: Altius Auto/Workers Compensation $595.20
Rate for Payer: Altius Commercial $595.20
Rate for Payer: Beech Street Commercial $607.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $509.02
Rate for Payer: Cash Price $434.00
Rate for Payer: ChoiceCare Network Commercial $601.40
Rate for Payer: Cigna of WY Commercial $607.60
Rate for Payer: Entrust Commercial $589.00
Rate for Payer: First Choice Health Commercial $589.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $589.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $409.20
Rate for Payer: HealthUtah PPO $620.00
Rate for Payer: Idaho Integrated Healthcare Commercial $601.40
Rate for Payer: Multiplan Medicare/VA $388.74
Rate for Payer: One Health Plan of WY PPO $607.60
Rate for Payer: PacificSource Commercial $558.00
Rate for Payer: PHCS PPO $607.60
Rate for Payer: Three Rivers PPO $465.00
Rate for Payer: TriWest Veterans Administration $409.20
Rate for Payer: United Healthcare Commercial $539.40
Rate for Payer: United Healthcare Medicare $409.20
Rate for Payer: WINHealth Partners Commercial $589.00
Rate for Payer: Wise Provider Network Commercial $589.00
Service Code HCPCS 76801
Hospital Charge Code 4027680101
Hospital Revenue Code 402
Min. Negotiated Rate $326.04
Max. Negotiated Rate $520.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $509.60
Rate for Payer: Altius Auto/Workers Compensation $499.20
Rate for Payer: Altius Commercial $499.20
Rate for Payer: Beech Street Commercial $509.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $426.92
Rate for Payer: Cash Price $364.00
Rate for Payer: ChoiceCare Network Commercial $504.40
Rate for Payer: Cigna of WY Commercial $509.60
Rate for Payer: Entrust Commercial $494.00
Rate for Payer: First Choice Health Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $343.20
Rate for Payer: HealthUtah PPO $520.00
Rate for Payer: Idaho Integrated Healthcare Commercial $504.40
Rate for Payer: Multiplan Medicare/VA $326.04
Rate for Payer: One Health Plan of WY PPO $509.60
Rate for Payer: PacificSource Commercial $468.00
Rate for Payer: PHCS PPO $509.60
Rate for Payer: Three Rivers PPO $390.00
Rate for Payer: TriWest Veterans Administration $343.20
Rate for Payer: United Healthcare Commercial $452.40
Rate for Payer: United Healthcare Medicare $343.20
Rate for Payer: WINHealth Partners Commercial $494.00
Rate for Payer: Wise Provider Network Commercial $494.00
Service Code HCPCS 76801
Hospital Charge Code 4027680101
Hospital Revenue Code 402
Min. Negotiated Rate $286.52
Max. Negotiated Rate $520.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $509.60
Rate for Payer: Aetna of WY Medicare $343.20
Rate for Payer: Altius Auto/Workers Compensation $499.20
Rate for Payer: Altius Commercial $499.20
Rate for Payer: Beech Street Commercial $509.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $426.92
Rate for Payer: Cash Price $364.00
Rate for Payer: ChoiceCare Network Commercial $504.40
Rate for Payer: Cigna of WY Commercial $509.60
Rate for Payer: Entrust Commercial $494.00
Rate for Payer: First Choice Health Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $301.60
Rate for Payer: HealthUtah PPO $520.00
Rate for Payer: Idaho Integrated Healthcare Commercial $504.40
Rate for Payer: Multiplan Medicare/VA $286.52
Rate for Payer: One Health Plan of WY PPO $509.60
Rate for Payer: PacificSource Commercial $468.00
Rate for Payer: PHCS PPO $509.60
Rate for Payer: Three Rivers PPO $390.00
Rate for Payer: TriWest Veterans Administration $301.60
Rate for Payer: United Healthcare Commercial $452.40
Rate for Payer: United Healthcare Medicare $301.60
Rate for Payer: WINHealth Partners Commercial $509.60
Rate for Payer: Wise Provider Network Commercial $494.00
Service Code HCPCS 76805
Hospital Charge Code 4027680501
Hospital Revenue Code 402
Min. Negotiated Rate $322.34
Max. Negotiated Rate $585.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $573.30
Rate for Payer: Aetna of WY Medicare $386.10
Rate for Payer: Altius Auto/Workers Compensation $561.60
Rate for Payer: Altius Commercial $561.60
Rate for Payer: Beech Street Commercial $573.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $480.28
Rate for Payer: Cash Price $409.50
Rate for Payer: ChoiceCare Network Commercial $567.45
Rate for Payer: Cigna of WY Commercial $573.30
Rate for Payer: Entrust Commercial $555.75
Rate for Payer: First Choice Health Commercial $555.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $555.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $339.30
Rate for Payer: HealthUtah PPO $585.00
Rate for Payer: Idaho Integrated Healthcare Commercial $567.45
Rate for Payer: Multiplan Medicare/VA $322.34
Rate for Payer: One Health Plan of WY PPO $573.30
Rate for Payer: PacificSource Commercial $526.50
Rate for Payer: PHCS PPO $573.30
Rate for Payer: Three Rivers PPO $438.75
Rate for Payer: TriWest Veterans Administration $339.30
Rate for Payer: United Healthcare Commercial $508.95
Rate for Payer: United Healthcare Medicare $339.30
Rate for Payer: WINHealth Partners Commercial $573.30
Rate for Payer: Wise Provider Network Commercial $555.75
Service Code HCPCS 76805
Hospital Charge Code 4027680501
Hospital Revenue Code 402
Min. Negotiated Rate $366.80
Max. Negotiated Rate $585.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $573.30
Rate for Payer: Altius Auto/Workers Compensation $561.60
Rate for Payer: Altius Commercial $561.60
Rate for Payer: Beech Street Commercial $573.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $480.28
Rate for Payer: Cash Price $409.50
Rate for Payer: ChoiceCare Network Commercial $567.45
Rate for Payer: Cigna of WY Commercial $573.30
Rate for Payer: Entrust Commercial $555.75
Rate for Payer: First Choice Health Commercial $555.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $555.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $386.10
Rate for Payer: HealthUtah PPO $585.00
Rate for Payer: Idaho Integrated Healthcare Commercial $567.45
Rate for Payer: Multiplan Medicare/VA $366.80
Rate for Payer: One Health Plan of WY PPO $573.30
Rate for Payer: PacificSource Commercial $526.50
Rate for Payer: PHCS PPO $573.30
Rate for Payer: Three Rivers PPO $438.75
Rate for Payer: TriWest Veterans Administration $386.10
Rate for Payer: United Healthcare Commercial $508.95
Rate for Payer: United Healthcare Medicare $386.10
Rate for Payer: WINHealth Partners Commercial $555.75
Rate for Payer: Wise Provider Network Commercial $555.75
Service Code HCPCS 76812
Hospital Charge Code 4027681201
Hospital Revenue Code 402
Min. Negotiated Rate $849.58
Max. Negotiated Rate $1,355.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,327.90
Rate for Payer: Altius Auto/Workers Compensation $1,300.80
Rate for Payer: Altius Commercial $1,300.80
Rate for Payer: Beech Street Commercial $1,327.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,112.46
Rate for Payer: Cash Price $948.50
Rate for Payer: ChoiceCare Network Commercial $1,314.35
Rate for Payer: Cigna of WY Commercial $1,327.90
Rate for Payer: Entrust Commercial $1,287.25
Rate for Payer: First Choice Health Commercial $1,287.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,287.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $894.30
Rate for Payer: HealthUtah PPO $1,355.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,314.35
Rate for Payer: Multiplan Medicare/VA $849.58
Rate for Payer: One Health Plan of WY PPO $1,327.90
Rate for Payer: PacificSource Commercial $1,219.50
Rate for Payer: PHCS PPO $1,327.90
Rate for Payer: Three Rivers PPO $1,016.25
Rate for Payer: TriWest Veterans Administration $894.30
Rate for Payer: United Healthcare Commercial $1,178.85
Rate for Payer: United Healthcare Medicare $894.30
Rate for Payer: WINHealth Partners Commercial $1,287.25
Rate for Payer: Wise Provider Network Commercial $1,287.25
Service Code HCPCS 76812
Hospital Charge Code 4027681201
Hospital Revenue Code 402
Min. Negotiated Rate $746.60
Max. Negotiated Rate $1,355.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,327.90
Rate for Payer: Aetna of WY Medicare $894.30
Rate for Payer: Altius Auto/Workers Compensation $1,300.80
Rate for Payer: Altius Commercial $1,300.80
Rate for Payer: Beech Street Commercial $1,327.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,112.46
Rate for Payer: Cash Price $948.50
Rate for Payer: ChoiceCare Network Commercial $1,314.35
Rate for Payer: Cigna of WY Commercial $1,327.90
Rate for Payer: Entrust Commercial $1,287.25
Rate for Payer: First Choice Health Commercial $1,287.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,287.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $785.90
Rate for Payer: HealthUtah PPO $1,355.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,314.35
Rate for Payer: Multiplan Medicare/VA $746.60
Rate for Payer: One Health Plan of WY PPO $1,327.90
Rate for Payer: PacificSource Commercial $1,219.50
Rate for Payer: PHCS PPO $1,327.90
Rate for Payer: Three Rivers PPO $1,016.25
Rate for Payer: TriWest Veterans Administration $785.90
Rate for Payer: United Healthcare Commercial $1,178.85
Rate for Payer: United Healthcare Medicare $785.90
Rate for Payer: WINHealth Partners Commercial $1,327.90
Rate for Payer: Wise Provider Network Commercial $1,287.25
Service Code HCPCS 76811
Hospital Charge Code 4027681101
Hospital Revenue Code 402
Min. Negotiated Rate $617.12
Max. Negotiated Rate $1,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,097.60
Rate for Payer: Aetna of WY Medicare $739.20
Rate for Payer: Altius Auto/Workers Compensation $1,075.20
Rate for Payer: Altius Commercial $1,075.20
Rate for Payer: Beech Street Commercial $1,097.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $919.52
Rate for Payer: Cash Price $784.00
Rate for Payer: ChoiceCare Network Commercial $1,086.40
Rate for Payer: Cigna of WY Commercial $1,097.60
Rate for Payer: Entrust Commercial $1,064.00
Rate for Payer: First Choice Health Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $649.60
Rate for Payer: HealthUtah PPO $1,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,086.40
Rate for Payer: Multiplan Medicare/VA $617.12
Rate for Payer: One Health Plan of WY PPO $1,097.60
Rate for Payer: PacificSource Commercial $1,008.00
Rate for Payer: PHCS PPO $1,097.60
Rate for Payer: Three Rivers PPO $840.00
Rate for Payer: TriWest Veterans Administration $649.60
Rate for Payer: United Healthcare Commercial $974.40
Rate for Payer: United Healthcare Medicare $649.60
Rate for Payer: WINHealth Partners Commercial $1,097.60
Rate for Payer: Wise Provider Network Commercial $1,064.00
Service Code HCPCS 76811
Hospital Charge Code 4027681101
Hospital Revenue Code 402
Min. Negotiated Rate $702.24
Max. Negotiated Rate $1,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,097.60
Rate for Payer: Altius Auto/Workers Compensation $1,075.20
Rate for Payer: Altius Commercial $1,075.20
Rate for Payer: Beech Street Commercial $1,097.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $919.52
Rate for Payer: Cash Price $784.00
Rate for Payer: ChoiceCare Network Commercial $1,086.40
Rate for Payer: Cigna of WY Commercial $1,097.60
Rate for Payer: Entrust Commercial $1,064.00
Rate for Payer: First Choice Health Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,064.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $739.20
Rate for Payer: HealthUtah PPO $1,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,086.40
Rate for Payer: Multiplan Medicare/VA $702.24
Rate for Payer: One Health Plan of WY PPO $1,097.60
Rate for Payer: PacificSource Commercial $1,008.00
Rate for Payer: PHCS PPO $1,097.60
Rate for Payer: Three Rivers PPO $840.00
Rate for Payer: TriWest Veterans Administration $739.20
Rate for Payer: United Healthcare Commercial $974.40
Rate for Payer: United Healthcare Medicare $739.20
Rate for Payer: WINHealth Partners Commercial $1,064.00
Rate for Payer: Wise Provider Network Commercial $1,064.00