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Service Code HCPCS 76816
Hospital Charge Code 4027681601
Hospital Revenue Code 402
Min. Negotiated Rate $258.97
Max. Negotiated Rate $470.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $460.60
Rate for Payer: Aetna of WY Medicare $310.20
Rate for Payer: Altius Auto/Workers Compensation $451.20
Rate for Payer: Altius Commercial $451.20
Rate for Payer: Beech Street Commercial $460.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $385.87
Rate for Payer: Cash Price $329.00
Rate for Payer: ChoiceCare Network Commercial $455.90
Rate for Payer: Cigna of WY Commercial $460.60
Rate for Payer: Entrust Commercial $446.50
Rate for Payer: First Choice Health Commercial $446.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $446.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $272.60
Rate for Payer: HealthUtah PPO $470.00
Rate for Payer: Idaho Integrated Healthcare Commercial $455.90
Rate for Payer: Multiplan Medicare/VA $258.97
Rate for Payer: One Health Plan of WY PPO $460.60
Rate for Payer: PacificSource Commercial $423.00
Rate for Payer: PHCS PPO $460.60
Rate for Payer: Three Rivers PPO $352.50
Rate for Payer: TriWest Veterans Administration $272.60
Rate for Payer: United Healthcare Commercial $408.90
Rate for Payer: United Healthcare Medicare $272.60
Rate for Payer: WINHealth Partners Commercial $460.60
Rate for Payer: Wise Provider Network Commercial $446.50
Service Code HCPCS 76816
Hospital Charge Code 4027681601
Hospital Revenue Code 402
Min. Negotiated Rate $294.69
Max. Negotiated Rate $470.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $460.60
Rate for Payer: Altius Auto/Workers Compensation $451.20
Rate for Payer: Altius Commercial $451.20
Rate for Payer: Beech Street Commercial $460.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $385.87
Rate for Payer: Cash Price $329.00
Rate for Payer: ChoiceCare Network Commercial $455.90
Rate for Payer: Cigna of WY Commercial $460.60
Rate for Payer: Entrust Commercial $446.50
Rate for Payer: First Choice Health Commercial $446.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $446.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $310.20
Rate for Payer: HealthUtah PPO $470.00
Rate for Payer: Idaho Integrated Healthcare Commercial $455.90
Rate for Payer: Multiplan Medicare/VA $294.69
Rate for Payer: One Health Plan of WY PPO $460.60
Rate for Payer: PacificSource Commercial $423.00
Rate for Payer: PHCS PPO $460.60
Rate for Payer: Three Rivers PPO $352.50
Rate for Payer: TriWest Veterans Administration $310.20
Rate for Payer: United Healthcare Commercial $408.90
Rate for Payer: United Healthcare Medicare $310.20
Rate for Payer: WINHealth Partners Commercial $446.50
Rate for Payer: Wise Provider Network Commercial $446.50
Service Code HCPCS 76815
Hospital Charge Code 4027681501
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 76815
Hospital Charge Code 4027681501
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 99211 NONPBBPAYER
Hospital Charge Code 9839921101
Hospital Revenue Code 983
Min. Negotiated Rate $51.41
Max. Negotiated Rate $82.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $80.36
Rate for Payer: Altius Auto/Workers Compensation $78.72
Rate for Payer: Altius Commercial $78.72
Rate for Payer: Beech Street Commercial $80.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $67.32
Rate for Payer: Cash Price $57.40
Rate for Payer: ChoiceCare Network Commercial $79.54
Rate for Payer: Cigna of WY Commercial $80.36
Rate for Payer: Entrust Commercial $77.90
Rate for Payer: First Choice Health Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $54.12
Rate for Payer: HealthUtah PPO $82.00
Rate for Payer: Idaho Integrated Healthcare Commercial $79.54
Rate for Payer: Multiplan Medicare/VA $51.41
Rate for Payer: One Health Plan of WY PPO $80.36
Rate for Payer: PacificSource Commercial $73.80
Rate for Payer: PHCS PPO $80.36
Rate for Payer: Three Rivers PPO $61.50
Rate for Payer: TriWest Veterans Administration $54.12
Rate for Payer: United Healthcare Commercial $71.34
Rate for Payer: United Healthcare Medicare $54.12
Rate for Payer: WINHealth Partners Commercial $77.90
Rate for Payer: Wise Provider Network Commercial $77.90
Service Code HCPCS 99211 NONPBBPAYER
Hospital Charge Code 9839921101
Hospital Revenue Code 983
Min. Negotiated Rate $25.44
Max. Negotiated Rate $80.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $80.36
Rate for Payer: Aetna of WY Medicare $54.12
Rate for Payer: Altius Auto/Workers Compensation $78.72
Rate for Payer: Altius Commercial $78.72
Rate for Payer: Beech Street Commercial $80.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $67.32
Rate for Payer: Cash Price $57.40
Rate for Payer: Cash Price $57.40
Rate for Payer: ChoiceCare Network Commercial $79.54
Rate for Payer: Cigna of WY Commercial $80.36
Rate for Payer: Entrust Commercial $77.90
Rate for Payer: First Choice Health Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $47.56
Rate for Payer: HealthUtah PPO $25.44
Rate for Payer: Idaho Integrated Healthcare Commercial $79.54
Rate for Payer: Multiplan Medicare/VA $45.18
Rate for Payer: One Health Plan of WY PPO $80.36
Rate for Payer: PacificSource Commercial $73.80
Rate for Payer: PHCS PPO $80.36
Rate for Payer: Three Rivers PPO $61.50
Rate for Payer: TriWest Veterans Administration $47.56
Rate for Payer: United Healthcare Commercial $71.34
Rate for Payer: United Healthcare Medicare $47.56
Rate for Payer: WINHealth Partners Commercial $80.36
Rate for Payer: Wise Provider Network Commercial $77.90
Service Code HCPCS 99211
Hospital Charge Code 9839921101
Hospital Revenue Code 983
Min. Negotiated Rate $25.44
Max. Negotiated Rate $64.68
Rate for Payer: Aetna of WY Commercial/Medical Rental $64.68
Rate for Payer: Aetna of WY Medicare $43.56
Rate for Payer: Altius Auto/Workers Compensation $63.36
Rate for Payer: Altius Commercial $63.36
Rate for Payer: Beech Street Commercial $64.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $54.19
Rate for Payer: Cash Price $46.20
Rate for Payer: Cash Price $46.20
Rate for Payer: ChoiceCare Network Commercial $64.02
Rate for Payer: Cigna of WY Commercial $64.68
Rate for Payer: Entrust Commercial $62.70
Rate for Payer: First Choice Health Commercial $62.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $62.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $38.28
Rate for Payer: HealthUtah PPO $25.44
Rate for Payer: Idaho Integrated Healthcare Commercial $64.02
Rate for Payer: Multiplan Medicare/VA $36.37
Rate for Payer: One Health Plan of WY PPO $64.68
Rate for Payer: PacificSource Commercial $59.40
Rate for Payer: PHCS PPO $64.68
Rate for Payer: Three Rivers PPO $49.50
Rate for Payer: TriWest Veterans Administration $38.28
Rate for Payer: United Healthcare Commercial $57.42
Rate for Payer: United Healthcare Medicare $38.28
Rate for Payer: WINHealth Partners Commercial $64.68
Rate for Payer: Wise Provider Network Commercial $62.70
Service Code HCPCS 99211
Hospital Charge Code 4209921101
Hospital Revenue Code 420
Min. Negotiated Rate $25.44
Max. Negotiated Rate $156.80
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Aetna of WY Medicare $105.60
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $92.80
Rate for Payer: HealthUtah PPO $25.44
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $88.16
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $92.80
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $92.80
Rate for Payer: WINHealth Partners Commercial $156.80
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 99211
Hospital Charge Code 4209921101
Hospital Revenue Code 420
Min. Negotiated Rate $100.32
Max. Negotiated Rate $160.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $105.60
Rate for Payer: HealthUtah PPO $160.00
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $100.32
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $105.60
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $105.60
Rate for Payer: WINHealth Partners Commercial $152.00
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 99211
Hospital Charge Code 9839921101
Hospital Revenue Code 983
Min. Negotiated Rate $41.38
Max. Negotiated Rate $66.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $64.68
Rate for Payer: Altius Auto/Workers Compensation $63.36
Rate for Payer: Altius Commercial $63.36
Rate for Payer: Beech Street Commercial $64.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $54.19
Rate for Payer: Cash Price $46.20
Rate for Payer: ChoiceCare Network Commercial $64.02
Rate for Payer: Cigna of WY Commercial $64.68
Rate for Payer: Entrust Commercial $62.70
Rate for Payer: First Choice Health Commercial $62.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $62.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $43.56
Rate for Payer: HealthUtah PPO $66.00
Rate for Payer: Idaho Integrated Healthcare Commercial $64.02
Rate for Payer: Multiplan Medicare/VA $41.38
Rate for Payer: One Health Plan of WY PPO $64.68
Rate for Payer: PacificSource Commercial $59.40
Rate for Payer: PHCS PPO $64.68
Rate for Payer: Three Rivers PPO $49.50
Rate for Payer: TriWest Veterans Administration $43.56
Rate for Payer: United Healthcare Commercial $57.42
Rate for Payer: United Healthcare Medicare $43.56
Rate for Payer: WINHealth Partners Commercial $62.70
Rate for Payer: Wise Provider Network Commercial $62.70
Service Code HCPCS 99211
Hospital Charge Code 9409921101
Hospital Revenue Code 940
Min. Negotiated Rate $97.18
Max. Negotiated Rate $155.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $151.90
Rate for Payer: Altius Auto/Workers Compensation $148.80
Rate for Payer: Altius Commercial $148.80
Rate for Payer: Beech Street Commercial $151.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $127.26
Rate for Payer: Cash Price $108.50
Rate for Payer: ChoiceCare Network Commercial $150.35
Rate for Payer: Cigna of WY Commercial $151.90
Rate for Payer: Entrust Commercial $147.25
Rate for Payer: First Choice Health Commercial $147.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $147.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $102.30
Rate for Payer: HealthUtah PPO $155.00
Rate for Payer: Idaho Integrated Healthcare Commercial $150.35
Rate for Payer: Multiplan Medicare/VA $97.18
Rate for Payer: One Health Plan of WY PPO $151.90
Rate for Payer: PacificSource Commercial $139.50
Rate for Payer: PHCS PPO $151.90
Rate for Payer: Three Rivers PPO $116.25
Rate for Payer: TriWest Veterans Administration $102.30
Rate for Payer: United Healthcare Commercial $134.85
Rate for Payer: United Healthcare Medicare $102.30
Rate for Payer: WINHealth Partners Commercial $147.25
Rate for Payer: Wise Provider Network Commercial $147.25
Service Code HCPCS 99211
Hospital Charge Code 9409921101
Hospital Revenue Code 940
Min. Negotiated Rate $25.44
Max. Negotiated Rate $151.90
Rate for Payer: Aetna of WY Commercial/Medical Rental $151.90
Rate for Payer: Aetna of WY Medicare $102.30
Rate for Payer: Altius Auto/Workers Compensation $148.80
Rate for Payer: Altius Commercial $148.80
Rate for Payer: Beech Street Commercial $151.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $127.26
Rate for Payer: Cash Price $108.50
Rate for Payer: Cash Price $108.50
Rate for Payer: ChoiceCare Network Commercial $150.35
Rate for Payer: Cigna of WY Commercial $151.90
Rate for Payer: Entrust Commercial $147.25
Rate for Payer: First Choice Health Commercial $147.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $147.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.90
Rate for Payer: HealthUtah PPO $25.44
Rate for Payer: Idaho Integrated Healthcare Commercial $150.35
Rate for Payer: Multiplan Medicare/VA $85.40
Rate for Payer: One Health Plan of WY PPO $151.90
Rate for Payer: PacificSource Commercial $139.50
Rate for Payer: PHCS PPO $151.90
Rate for Payer: Three Rivers PPO $116.25
Rate for Payer: TriWest Veterans Administration $89.90
Rate for Payer: United Healthcare Commercial $134.85
Rate for Payer: United Healthcare Medicare $89.90
Rate for Payer: WINHealth Partners Commercial $151.90
Rate for Payer: Wise Provider Network Commercial $147.25
Service Code HCPCS 99201
Hospital Charge Code 9839920101
Hospital Revenue Code 983
Min. Negotiated Rate $42.93
Max. Negotiated Rate $115.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $115.64
Rate for Payer: Aetna of WY Medicare $77.88
Rate for Payer: Altius Auto/Workers Compensation $113.28
Rate for Payer: Altius Commercial $113.28
Rate for Payer: Beech Street Commercial $115.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $96.88
Rate for Payer: Cash Price $82.60
Rate for Payer: Cash Price $82.60
Rate for Payer: ChoiceCare Network Commercial $114.46
Rate for Payer: Cigna of WY Commercial $115.64
Rate for Payer: Entrust Commercial $112.10
Rate for Payer: First Choice Health Commercial $112.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $112.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $68.44
Rate for Payer: HealthUtah PPO $42.93
Rate for Payer: Idaho Integrated Healthcare Commercial $114.46
Rate for Payer: Multiplan Medicare/VA $65.02
Rate for Payer: One Health Plan of WY PPO $115.64
Rate for Payer: PacificSource Commercial $106.20
Rate for Payer: PHCS PPO $115.64
Rate for Payer: Three Rivers PPO $88.50
Rate for Payer: TriWest Veterans Administration $68.44
Rate for Payer: United Healthcare Commercial $102.66
Rate for Payer: United Healthcare Medicare $68.44
Rate for Payer: WINHealth Partners Commercial $115.64
Rate for Payer: Wise Provider Network Commercial $112.10
Service Code HCPCS 99201
Hospital Charge Code 9839920101
Hospital Revenue Code 983
Min. Negotiated Rate $73.99
Max. Negotiated Rate $118.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $115.64
Rate for Payer: Altius Auto/Workers Compensation $113.28
Rate for Payer: Altius Commercial $113.28
Rate for Payer: Beech Street Commercial $115.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $96.88
Rate for Payer: Cash Price $82.60
Rate for Payer: ChoiceCare Network Commercial $114.46
Rate for Payer: Cigna of WY Commercial $115.64
Rate for Payer: Entrust Commercial $112.10
Rate for Payer: First Choice Health Commercial $112.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $112.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $77.88
Rate for Payer: HealthUtah PPO $118.00
Rate for Payer: Idaho Integrated Healthcare Commercial $114.46
Rate for Payer: Multiplan Medicare/VA $73.99
Rate for Payer: One Health Plan of WY PPO $115.64
Rate for Payer: PacificSource Commercial $106.20
Rate for Payer: PHCS PPO $115.64
Rate for Payer: Three Rivers PPO $88.50
Rate for Payer: TriWest Veterans Administration $77.88
Rate for Payer: United Healthcare Commercial $102.66
Rate for Payer: United Healthcare Medicare $77.88
Rate for Payer: WINHealth Partners Commercial $112.10
Rate for Payer: Wise Provider Network Commercial $112.10
Service Code HCPCS 99212
Hospital Charge Code 4209921201
Hospital Revenue Code 420
Min. Negotiated Rate $150.48
Max. Negotiated Rate $240.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $235.20
Rate for Payer: Altius Auto/Workers Compensation $230.40
Rate for Payer: Altius Commercial $230.40
Rate for Payer: Beech Street Commercial $235.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $197.04
Rate for Payer: Cash Price $168.00
Rate for Payer: ChoiceCare Network Commercial $232.80
Rate for Payer: Cigna of WY Commercial $235.20
Rate for Payer: Entrust Commercial $228.00
Rate for Payer: First Choice Health Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $158.40
Rate for Payer: HealthUtah PPO $240.00
Rate for Payer: Idaho Integrated Healthcare Commercial $232.80
Rate for Payer: Multiplan Medicare/VA $150.48
Rate for Payer: One Health Plan of WY PPO $235.20
Rate for Payer: PacificSource Commercial $216.00
Rate for Payer: PHCS PPO $235.20
Rate for Payer: Three Rivers PPO $180.00
Rate for Payer: TriWest Veterans Administration $158.40
Rate for Payer: United Healthcare Commercial $208.80
Rate for Payer: United Healthcare Medicare $158.40
Rate for Payer: WINHealth Partners Commercial $228.00
Rate for Payer: Wise Provider Network Commercial $228.00
Service Code HCPCS 99212
Hospital Charge Code 4209921201
Hospital Revenue Code 420
Min. Negotiated Rate $45.64
Max. Negotiated Rate $235.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $235.20
Rate for Payer: Aetna of WY Medicare $158.40
Rate for Payer: Altius Auto/Workers Compensation $230.40
Rate for Payer: Altius Commercial $230.40
Rate for Payer: Beech Street Commercial $235.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $197.04
Rate for Payer: Cash Price $168.00
Rate for Payer: Cash Price $168.00
Rate for Payer: ChoiceCare Network Commercial $232.80
Rate for Payer: Cigna of WY Commercial $235.20
Rate for Payer: Entrust Commercial $228.00
Rate for Payer: First Choice Health Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $139.20
Rate for Payer: HealthUtah PPO $45.64
Rate for Payer: Idaho Integrated Healthcare Commercial $232.80
Rate for Payer: Multiplan Medicare/VA $132.24
Rate for Payer: One Health Plan of WY PPO $235.20
Rate for Payer: PacificSource Commercial $216.00
Rate for Payer: PHCS PPO $235.20
Rate for Payer: Three Rivers PPO $180.00
Rate for Payer: TriWest Veterans Administration $139.20
Rate for Payer: United Healthcare Commercial $208.80
Rate for Payer: United Healthcare Medicare $139.20
Rate for Payer: WINHealth Partners Commercial $235.20
Rate for Payer: Wise Provider Network Commercial $228.00
Service Code HCPCS 99215
Hospital Charge Code 9839921501
Hospital Revenue Code 983
Min. Negotiated Rate $146.51
Max. Negotiated Rate $316.54
Rate for Payer: Aetna of WY Commercial/Medical Rental $316.54
Rate for Payer: Aetna of WY Medicare $213.18
Rate for Payer: Altius Auto/Workers Compensation $310.08
Rate for Payer: Altius Commercial $310.08
Rate for Payer: Beech Street Commercial $316.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $265.18
Rate for Payer: Cash Price $226.10
Rate for Payer: Cash Price $226.10
Rate for Payer: ChoiceCare Network Commercial $313.31
Rate for Payer: Cigna of WY Commercial $316.54
Rate for Payer: Entrust Commercial $306.85
Rate for Payer: First Choice Health Commercial $306.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $306.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $187.34
Rate for Payer: HealthUtah PPO $146.51
Rate for Payer: Idaho Integrated Healthcare Commercial $313.31
Rate for Payer: Multiplan Medicare/VA $177.97
Rate for Payer: One Health Plan of WY PPO $316.54
Rate for Payer: PacificSource Commercial $290.70
Rate for Payer: PHCS PPO $316.54
Rate for Payer: Three Rivers PPO $242.25
Rate for Payer: TriWest Veterans Administration $187.34
Rate for Payer: United Healthcare Commercial $281.01
Rate for Payer: United Healthcare Medicare $187.34
Rate for Payer: WINHealth Partners Commercial $316.54
Rate for Payer: Wise Provider Network Commercial $306.85
Service Code HCPCS 99215 NONPBBPAYER
Hospital Charge Code 9839921501
Hospital Revenue Code 983
Min. Negotiated Rate $146.51
Max. Negotiated Rate $395.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $395.92
Rate for Payer: Aetna of WY Medicare $266.64
Rate for Payer: Altius Auto/Workers Compensation $387.84
Rate for Payer: Altius Commercial $387.84
Rate for Payer: Beech Street Commercial $395.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $331.68
Rate for Payer: Cash Price $282.80
Rate for Payer: Cash Price $282.80
Rate for Payer: ChoiceCare Network Commercial $391.88
Rate for Payer: Cigna of WY Commercial $395.92
Rate for Payer: Entrust Commercial $383.80
Rate for Payer: First Choice Health Commercial $383.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $383.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $234.32
Rate for Payer: HealthUtah PPO $146.51
Rate for Payer: Idaho Integrated Healthcare Commercial $391.88
Rate for Payer: Multiplan Medicare/VA $222.60
Rate for Payer: One Health Plan of WY PPO $395.92
Rate for Payer: PacificSource Commercial $363.60
Rate for Payer: PHCS PPO $395.92
Rate for Payer: Three Rivers PPO $303.00
Rate for Payer: TriWest Veterans Administration $234.32
Rate for Payer: United Healthcare Commercial $351.48
Rate for Payer: United Healthcare Medicare $234.32
Rate for Payer: WINHealth Partners Commercial $395.92
Rate for Payer: Wise Provider Network Commercial $383.80
Service Code HCPCS 99215
Hospital Charge Code 9839921501
Hospital Revenue Code 983
Min. Negotiated Rate $202.52
Max. Negotiated Rate $323.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $316.54
Rate for Payer: Altius Auto/Workers Compensation $310.08
Rate for Payer: Altius Commercial $310.08
Rate for Payer: Beech Street Commercial $316.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $265.18
Rate for Payer: Cash Price $226.10
Rate for Payer: ChoiceCare Network Commercial $313.31
Rate for Payer: Cigna of WY Commercial $316.54
Rate for Payer: Entrust Commercial $306.85
Rate for Payer: First Choice Health Commercial $306.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $306.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $213.18
Rate for Payer: HealthUtah PPO $323.00
Rate for Payer: Idaho Integrated Healthcare Commercial $313.31
Rate for Payer: Multiplan Medicare/VA $202.52
Rate for Payer: One Health Plan of WY PPO $316.54
Rate for Payer: PacificSource Commercial $290.70
Rate for Payer: PHCS PPO $316.54
Rate for Payer: Three Rivers PPO $242.25
Rate for Payer: TriWest Veterans Administration $213.18
Rate for Payer: United Healthcare Commercial $281.01
Rate for Payer: United Healthcare Medicare $213.18
Rate for Payer: WINHealth Partners Commercial $306.85
Rate for Payer: Wise Provider Network Commercial $306.85
Service Code HCPCS 99215 NONPBBPAYER
Hospital Charge Code 9839921501
Hospital Revenue Code 983
Min. Negotiated Rate $253.31
Max. Negotiated Rate $404.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $395.92
Rate for Payer: Altius Auto/Workers Compensation $387.84
Rate for Payer: Altius Commercial $387.84
Rate for Payer: Beech Street Commercial $395.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $331.68
Rate for Payer: Cash Price $282.80
Rate for Payer: ChoiceCare Network Commercial $391.88
Rate for Payer: Cigna of WY Commercial $395.92
Rate for Payer: Entrust Commercial $383.80
Rate for Payer: First Choice Health Commercial $383.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $383.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $266.64
Rate for Payer: HealthUtah PPO $404.00
Rate for Payer: Idaho Integrated Healthcare Commercial $391.88
Rate for Payer: Multiplan Medicare/VA $253.31
Rate for Payer: One Health Plan of WY PPO $395.92
Rate for Payer: PacificSource Commercial $363.60
Rate for Payer: PHCS PPO $395.92
Rate for Payer: Three Rivers PPO $303.00
Rate for Payer: TriWest Veterans Administration $266.64
Rate for Payer: United Healthcare Commercial $351.48
Rate for Payer: United Healthcare Medicare $266.64
Rate for Payer: WINHealth Partners Commercial $383.80
Rate for Payer: Wise Provider Network Commercial $383.80
Service Code HCPCS 83916
Hospital Charge Code 3018391601
Hospital Revenue Code 301
Min. Negotiated Rate $88.16
Max. Negotiated Rate $160.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Aetna of WY Medicare $105.60
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $92.80
Rate for Payer: HealthUtah PPO $160.00
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $88.16
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $92.80
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $92.80
Rate for Payer: WINHealth Partners Commercial $156.80
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 83916
Hospital Charge Code 3018391601
Hospital Revenue Code 301
Min. Negotiated Rate $100.32
Max. Negotiated Rate $160.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $105.60
Rate for Payer: HealthUtah PPO $160.00
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $100.32
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $105.60
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $105.60
Rate for Payer: WINHealth Partners Commercial $152.00
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 27814
Hospital Charge Code 5102781401
Hospital Revenue Code 510
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 27814
Hospital Charge Code 5102781401
Hospital Revenue Code 510
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 27784
Hospital Charge Code 5102778401
Hospital Revenue Code 510
Min. Negotiated Rate $377.45
Max. Negotiated Rate $602.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $589.96
Rate for Payer: Altius Auto/Workers Compensation $577.92
Rate for Payer: Altius Commercial $577.92
Rate for Payer: Beech Street Commercial $589.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $494.24
Rate for Payer: Cash Price $421.40
Rate for Payer: ChoiceCare Network Commercial $583.94
Rate for Payer: Cigna of WY Commercial $589.96
Rate for Payer: Entrust Commercial $571.90
Rate for Payer: First Choice Health Commercial $571.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $571.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $397.32
Rate for Payer: HealthUtah PPO $602.00
Rate for Payer: Idaho Integrated Healthcare Commercial $583.94
Rate for Payer: Multiplan Medicare/VA $377.45
Rate for Payer: One Health Plan of WY PPO $589.96
Rate for Payer: PacificSource Commercial $541.80
Rate for Payer: PHCS PPO $589.96
Rate for Payer: Three Rivers PPO $451.50
Rate for Payer: TriWest Veterans Administration $397.32
Rate for Payer: United Healthcare Commercial $523.74
Rate for Payer: United Healthcare Medicare $397.32
Rate for Payer: WINHealth Partners Commercial $571.90
Rate for Payer: Wise Provider Network Commercial $571.90